Category Archives: Health and Hygiene

Newborn hearing screening

The newborn hearing screening will be done within the first few days of birth. It has been available to all babies since 2006 and over 6 million babies have been screened since then. It was the National deaf childrens society that pushed for the tests on all children, here is what is involved:

What is involved?

There are two simple and basic tests that can quickly highlight if there is any need for any further investigation, these are usually done on the maternity ward by trained hearing screeners but, on some occasions may be offered at home or at a clinic. The two tests are called the Otoacoustic Emissions test (OAE) and the Automated Auditory Brainstem Response test (AABR). These are both painless for baby.

What is the Otoacoustic Emissions test (OAE) and how does it work?

The OAE test is the first hearing screening your newborn will be subject to. A small ear piece consisting of a microphone and speaker are placed in baby’s ear and a clicking sound played. If the ear is functioning properly the microphone will pick up the faint echo produced by the cochlea (inner ear). The results are immediate and recorded on a computer for the screener to analyse. On some occasions it is necessary to refer for a second test, this doesn’t necessarily mean your child has a hearing problem, it may have been inconclusive or the test failed for a number of different reasons such as a noisy room or fluid in the ear. If the results of this test are fine there will be no need for further investigation. The second test is the Automated Auditory Brainstem Response test (AABR). approximately 15% of babies are referred for this test.

What is the Automated Auditory Brainstem Response test (AABR)?

The AABR test records your baby’s brain activity in response to sounds. This is done by attaching 3 sensors on to your child’s head and playing clicking sounds through headphones. The sensors record if there is a strong response in brain activity as would be expected. The reason a strong response of brain activity is expected is because of the way ears work; sounds travel as vibrations through the outer ear to the cochlea where they are then converted in to an electrical signal. The electrical signal is sent to the brain via the hearing nerve, thus producing an increase in brain activity in response to sounds. If no activity is detected, your baby will be referred for a full diagnostic of hearing. Around 3 out of every 100 children are referred for this.

A full diagnostic

if your child hasn’t shown strong responses to the two tests as detailed above, she will be referred for a full diagnostic assessment of her hearing. This will usually take place at your local audiology department.
The diagnostic assessment will include tympanomenty and Auditory Brainstem Response (ABR) testing. Tympanometry tests how the eardrum and middle ear are working. This test is important because fluid or other problems in the middle ear can affect hearing. During a tympanogram test, a small earphone is placed in the ear canal and air pressure is gently changed. This test is helpful in showing if there is an ear infection or fluid in the ear.

If at any point you become concerned about your child’s hearing, you should contact your GP immediately. If your child is bring investigated, be sure to attend the appointments, the quicker a diagnosis is made, the quicker remedial actions can be put in place. It your child has hearing problems, it is unlikely you can change that, however, through quick diagnosis you will be able to support your child to live with the hearing loss (however severe) and ensure the impact of this is as minimal as possible (such as speech and language delays).

Helping your newborn with a cold

Is your newborn blocked up and suffering with the symptoms of a cold? Here are our 5 best tips for helping to alleviate the symptoms and guidance on when to seek medical advice.

Why and when is my newborn most susceptible?

For the first 4-6 weeks of life, your newborn is classed as high risk for colds and other viral infections. This is because your little ones immune system hasn’t yet matured, breastfeeding adds to the immunity protection already received through the placenta and is recommended but unfortunately it does not offer 100% immunity. As well as breastfeeding, ensure you and anyone else in contact with your baby washes their hands and if bottle feeding always follow the guidelines on sterilising and preparing the bottle properly. You may also want to avoid public transport or anywhere where there are large groups of people in a confined space. If despite your best efforts your newborn does get a cold. Here is what you can do:

First things first: See a doctor

Even if you are absolutely certain it is ‘just a cold’ you should make an appointment to see your doctor. As a new parent you need that piece of mind and you need to rule out anything more serious (however unlikely). Your doctor will be able to advise you on how best to help your newborn and may also recommend or prescribe some medication.

Medication

If you are prescribed medication or you buy something over the counter, always make sure the person giving you dosage instructions is aware of how old your newborn is and what the problem is. You must always follow these instructions carefully. Giving too low a dosage will probably result in the medication not working and giving too much could cause serious harm or even death.

Plenty of nourishment

As the saying goes, “Feed a cold”. This is true for adults, children and newborns. Give your child plenty of nourishment, if you are breastfeeding, feed on demand, if you are bottle feeding you may need to feed little and often. Ensure you look after yourself too. The stress, worry and lack of sleep caused by an unwell child can take its toll – have plenty of early nights and wherever possible, sleep when your baby sleeps. Never be tempted to sleep with your baby on the sofa and ensure you continue to follow the advice on SIDS.

Keep warm

Just as important as keeping nourished is the importance of keeping warm. There is nothing worse than feeling cold when you have got a cold and this is the case for babies too. Be sure you don’t wrap your baby up too much and always stick to the advice on tog rating and room temperatures.

Keep clean

Keep your hands clean, keep the environment clean and do all you can to avoid the spreading of germs. Your baby’s nose and face will need wiping frequently to avoid reinfection and to protect your little ones sensitive skin.

Monitor the symptoms

If you feel it is lasting an usually long time for your child to get over the cold, if he isn’t feeding well or if he has a raised temperature always go back to see your GP. As a new parent you will worry more as you don’t know what is ‘normal’ or what to expect. Never take a chance, it us always better to have an opinion of a medical professional.

Resources:
webmd, Babymed

What checks will they do on my newborn?

Your newborn will be checked soon after birth and again within 72 hours of birth. This is to check for any signs of an underlying health problem. Your little ones heart, hips, eyes and testes (boys) will be examined as part of a top to toe physical examination. Here is what to expect and how:

Who will carry out the examination?

The examination is normally carried out by one of the healthcare professionals in the maternity unit such as the midwife, junior doctor or paediatrician.

When will it be done?

Your newborn will initially be checked immediately after birth for any obvious physical problems and then when baby is calm and settled, a more thorough examination will take place.

What is involved?

The top to toe physical assessment is to check for any obvious signs of any physical problems as well as specific screenings and examinations to identify if there are any underlying conditions that may need to be followed up, monitored or treated. The specific screenings will always check the following:

  • Eyes – An ophthalmoscope (special torch) is used to check your newborns eyes for cataracts and other conditions, these conditions are identified by checking the movements and appearance of the eyes. Approximately 0.03% of babies have problems with their eyes that require treatment.
  • Heart – Your little one will be observed feeding as heart problems can cause poor feeding. Her pulse will be checked and her heart listened to in order to identify any problems. It is estimated around 0.5% of babies have a heart problem that requires follow up/treatment.
  • Hips – Each hip will be thoroughly examined as any problem left untreated could result in a limp or further joint problems. If further investigation is needed, an ultrasound may be arranged. Around 0.2% of babies have hip problems identified that require treatment.
  • Testes – Your little boy will be checked to ensure his testes are in the right place. Most boys testes will have dropped (into the scrotum) by around 12 months of age. If they haven’t dropped by 2 years of age an operation may be required. Approximately 1% of boys have problems identified that require an operation.
  • Ears – Usually carried out separately from the above tests, the newborn hearing screening will be conducted within a few days of birth. This is usually conducted on the maternity ward but in some areas this is offered at home. The test involves placing a small earpiece with a microphone and earphone attached into your child’s ear. A clicking sound is then played and the microphone picks up on whether the cochlea is functioning properly by monitoring the echo within the ear. This test is called the Octoacoustic emissions test. If the results of the OAE test are unsuccessful it could be due to a noisy atmosphere, fluid in the ear from birth or an unsettled baby. A second attempt is usually scheduled if this is the case. If the 2nd attempt is unsuccessful your child will be referred for further tests which involve monitoring the brain activity in response to sounds. This test is called the Automated Auditory Brainstem Response (AABR) test. Around 15% of newborns are referred to have the AABR test and approximately 3% of those children are then referred for a full diagnostic of their hearing at an audiology clinic. 0.2% of babies have some form of hearing loss in one or both ears.
  • What happens next?

    The results of the examination and the reason for any follow up will be explained to you and the details recorded in your maternity notes and in your child’s ‘red book’ (which you will be given soon after birth). The physical examination will be carried out again when your baby is around 8 weeks old.

    0.03% of babies have problems with their eyes, 0.5% of babies have a heart problem, 0.2% of babies have hip problems, 1% of boys have problems identified with their testes and 0.2% of babies have some form of hearing loss in one or both ears. These figures are not high but as a parent you can not help but worry. In some cases these problems will be minor, some can be corrected with surgery/treatment and in some cases it will be something you and your child have to live with. Identifying any sort of physical or underlying problem early helps with identifying and offering you and your child the support you will need (both medical and emotional).

    Resources: Newbornphysical.nhs, ncds

    Is it safe to swaddle?

    Does swaddling damage babies hips? Does it increase the risk of SIDS? Are there any 21st century benefits to swaddling? Swaddling is an ancient, traditional method of wrapping babies. The blankets or cloths used are tightly wound around the body thus restricting movement, particularly to the limbs. It dates back to around 4000 years ago until becoming unpopular in the 17th century, it appears it is becoming popular again in western civilisations but, some studies have cast doubt on whether it is safe to swaddle or not. Here is the low down:

    Does swaddling damage hips?

    Professor Nicholas Clarke, an orthopaedic surgeon from Southampton University Hospital, argues that swaddling may damage the development of babies hips. His theory was published in the peer reviewed journal ‘Archives of Disease and Childhood’. His opinion is that swaddling (tightly wrapping a baby) forces the hips into a straightened position where the legs are pressed together, and this he says, may lead to a condition called hip dysplasia.
    Dysplasia is not always painful, but can cause joint abnormalities and long-term complications such as osteoarthritis. Severe cases can eventually require hip replacement.

    Does it increase the risk of SIDS?

    As there are only risk factors for SIDS and not causes, it is difficult for any study to pinpoint one action as reducing the risk. You should create a safe sleeping environment which includes not allowing your baby to overheat, putting him on his back and don’t allow anything to cover his face. Swaddling is a risk factor – it can result in baby overheating, the blanket coming loose and covering her face and may also stop baby’s natural survival reflexes from waking her during the night. If after reading this you still decide you would like to swaddle, you should follow these recommendations:

  • Be aware of the risks, particularly of the use of heavy materials and the risk of the blanket coming loose.
  • NEVER be placed your baby on her stomach when swaddled.
  • If you are going to swaddle, research suggests it is safest to swaddle from birth and not to change bed time practices at 3 months of age, this is when SIDS risk is
    greatest.
  • Always make sure Secondary caregivers (childminders/nannies/nurseries/family members) are aware of your child’s usual sleeping environment and
    practices and they stick to this ie they don’t decide to start swaddling or allowing baby to sleep on her tummy.
  • There has been a lot of research in to the cause of SIDS and as a new parent it is the thing we worry most about. I always like to play on the safe side. I used a fitted sheet, had nothing else in her bed, my baby had a sleeping bag (that fits) and I also had a sensor pad with an alarm. We also co-slept – I always made sure this was made safe and we never slept on the sofa. It can seem like a bit if a minefield but the safest advice is to follow the advice. No one is telling you how to parent, just helping you to make sensible, informed decisions. The more we know about the risks, the better decisions we can make about our babies sleeping environment. The most important new information for me in this post is the advice not to change your little ones sleeping habits at around 3 months of age. This is where the risk of SIDS is at its highest – this may be due to secondary caregivers not being properly informed. I hope you found this post useful.

    Do you swaddle? Were you swaddled as a child? Did you inform your child’s carer of his sleeping habits/environment?

    Resources: NHS

    The pros and cons of introducing a dummy

    Should I introduce a dummy? What are the pros and cons? The dummy debate will continue for as long as there are both babies and dummies (and that isn’t going to stop anyone soon). This info will help you to make an informed decision on whether or not to introduce one.

    The pros

  • Giving your baby a dummy when she sleeps may reduce the risk of SIDS. You should put it in her mouth when you put her to sleep but there is no need to give it back to her should it fall out.
  • It also allows your baby to comfort and soothe herself.
  • It satisfies the sucking reflex. Some babies like to suck more than just when feeding and a dummy allows them to do this.
  • When the time comes that you don’t want your baby to have it anymore, it is easier to wean off a dummy than it is off sucking a thumb.
  • The cons

  • If you introduce a dummy before breastfeeding has been established, it may cause nipple confusion. This could result in your newborn being unable to breastfeed. It is best to wait until your baby is at least one month old.
  • Recent research suggests there may be a link between dummy use and ear infections. It is thought this is due to a change of pressure between the middle ear and upper throat. Bear in mind, there is not enough evidence to confirm if this link is accurate (it may be that mothers in the test group had babies who were already more prone to ear infections and gave a dummy to soothe them).
  • Overuse of a dummy can delay speech, it is recommended you limit the amount of time your child has it, using it for sleep time only is a good way of preventing this.
  • It may cause problems with teeth development if your child regularly uses it for prolonged periods.
  • You may offer a dummy when your little one really wants to be fed, it is an easy mistake and one you will have to be aware of.
  • Dummy safety

  • Always sterilise the dummy before use if your child is under 6 months. After this you can wash with warm soapy water.
  • Never clean a dummy by sucking it – you have lots of bacteria in your mouth that you will transfer.
  • Replace it regularly to ensure there are no cracks, this is where germs/bacteria can survive.
  • Never dip it in anything, particularly not sweet things like honey or juices.
  • Choose an orthodontic dummy with a large shield and air holes, look for the British Dental Association logo.
  • Avoid using a cord attached to the dummy as there is a strangulation risk.
  • Resources:
    WebMd, Product safety