The next interview in our Baby Health Series – about general baby health – comes from a good friend of mine, Chris. Chris is currently working as the Paediatrics Resident Medical Officer at a rural hospital, and he has a wealth of experience working with children (both in the medical profession and beyond). I was eager to chat with Chris about his experience of working with babies and families in the hospital setting, as well as find out when new mums should contact their GP or Paediatrician (because if you’re like me, you’ll likely do it at the drop of a hat!). Time to grab your next cuppa, and I hope you enjoy my chat with Chris! x
Hi Chris! Thank you for joining us this week as a part of our Baby Health Series. Tonight we’ll be looking at general baby health and concerns that new mums might have. Before we start, can you tell us a bit about yourself and your background?
Thanks for having me, Fi! Originally from Sydney, I’ve moved out to Central West NSW to escape the traffic. I’m currently the paediatrics resident medical officer (that’s a mouthful!) at a rural referral hospital. In more useful terms, I’m one of the junior doctors working on the kids team at the local hospital.
You do a lot of Newborn Baby checks in your role. What do these checks involve?
You’re right – newborn baby checks are a big part of my job.
If you’ve had kids before, you might remember that pesky doctor coming in and making bub cry to fill out a page in baby’s Personal Health Record (go easy on them – it’s just their job!)
These checks vary slightly between states in Australia, but the principles are the same. It’s a part of baby’s Personal Health Record (see below for information about your state) and is usually done around 24 – 48 hours of life. Ongoing checks are usually done with your General Practitioner (GP).
We start off by reviewing the details of mum’s health, pregnancy and delivery. Before the check, we’ll have a chat with you about how you think baby is going. You may have only known your baby for a few hours – but you still know them better than anyone else! You can expect to be asked questions about baby’s feeding, pooing and peeing (welcome to parenthood!) It’s really important that you bring up any concerns or questions you have with your doctor – there are no silly questions! After that, we do a head-to-toe check. Some of the things we look at:
- Head – assessing for birth trauma and making sure the skull is forming correctly. A little bit of swelling can be normal, especially if instruments were used.
- Face – assessing the position and shape of the eyes, ears, nose and mouth.
- Eyes – looking at the back of the eye with an ophthalmoscope for the ‘red reflex’. It’s the same principle as when you can see ‘red eye’ in a photo. It’s absence in babies can indicate eye problems which need further investigating. Your doctor might ask you to close the blinds or hold baby to encourage them to open their eyes for this.
- Heart & lungs – a lot of change happens to the lungs, heart and circulation when baby is born (YouTube it if you’re interested). Listening with a stethoscope, feeling pulses and checking oxygen levels on different limbs helps reassure us that the transition is going to plan. Feel free to ask your midwife or doctor to help you listen to baby’s heartbeat. Baby’s circulation continues to change through it’s early life which is why you will be asked to get a repeat check with a doctor, especially if you leave hospital early.
- Hips – this is checking for dislocating hips (Developmental Dysplasia of the Hips or ‘DDH’). Risk factors for DDH are being female, first child, breech during pregnancy, family history or being a large baby. Be sure to let your doctor know if there’s a family history of hip problems at birth. To play it safe, we have a low threshold of getting an ultrasound of the hips 6 weeks from the time baby was due to be born.
- Skin – babies have a lot of harmless spots/ rashes when they are born. There are a few that can be more sinister. Point out any new rashes to your doctor or midwife.
- Umbilical cord – making sure the umbilical cord is clean, not red, smelly, discharging or otherwise abnormal is really important. Infected umbilical stumps are very dangerous. Your doctor will check this during the baby check, but it’s really important you let you doctor or midwife know if you have concerns as it can change. The stump needs to be kept clean and dry. It will become black and hard and fall off within about a week.
- Reflexes – these are automatic reflexes babies grow out of over time. The main four checked are
o sucking reflex (baby’s hand or doctors finger in the mouth, checking the suck)
o rooting reflex (touching baby’s cheek, looking for a head turn in that direction)
o grip reflex (touching baby’s palm should get them to hold on)
o moro (startle) reflex (lowering baby quickly looking for them to throw their head back and arms out and back in – we won’t drop your baby!)
When should new parents see a doctor?
You should be checking in with your doctor or family nurse regularly to keep an eye on baby’s growth and development.
Seeking early medical attention when you’re worried about your baby is really important. Identifying sick babies is difficult, even with training. Unlike adults, babies have a poor reserve and can deteriorate very quickly.
Signs of serious concern are when baby is unusually drowsy or irritable, abnormal skin colour/ markings/ rashes, seizures, trouble breathing, floppy, unresponsive, not making many wet nappies, not feeding or otherwise looking unwell. A fever in a child 3 months or younger is also medical emergency. If your baby has any of these, call for an ambulance (000 in Australia) or present urgently to your local emergency department. You should have a low threshold for taking your baby to the emergency department to be seen by a doctor, particularly if your baby has any other health conditions (such as heart or lung problems). No health professional will ever judge you or dismiss you for bringing a baby to the emergency department, regardless of the concern or of the time of day.
If your baby is otherwise a bit sick, such as with a snotty nose, a cough or an older child with a fever (who is well otherwise), you should see your general practitioner early. Most GPs will have spots reserved for children for same day reviews.
If you can’t get in to see your doctor, or you’re not sure where to go, Health Direct is a free 24/7 phone advice service in Australia run by the government. A registered nurse will take your call at anytime and provide you with further advice. Call 1800 022 222 or visit www.healthdirect.gov.au
You’ve done some work in the ED (Emergency Department). What has been the most common reason a baby or child has been brought to the ED?
Being a reasonably small town with only one hospital, we tend to see kids with the same bugs coming into ED in waves! Given we’re now well into winter (so cold!), we’ve been seeing a lot of respiratory infections, particularly bronchiolitis. Earlier in the year, we had an influx of gastroenteritis.
All through the year our ED doctors will help kids who have hurt themselves in accidents (particularly sporting, biking and quad bike accidents).
What are some of the most common reasons why parents bring their children to paediatricians?
You need a referral from another doctor, usually your GP, to see a paediatrician in a clinic. Paediatricians see a wide variety of conditions relating to babies, children and young teenagers.
Paediatricians are particularly skilled at reviewing growth and development concerns, paediatric mental health and neurodevelopmental conditions (such as ODD, ADHD and autism spectrum disorders). Your paediatrician may prescribe medications for these conditions that most other doctors can’t
Your GP might also refer your child for a review of possible reflux, colic or other subacute issues.
What advice can you offer new parents in regards to looking after their baby’s general health and wellbeing?
It takes a village to raise a child, but it isn’t a competition. Parents can become anxious comparing their baby to others, particularly in terms of their development. Remember that Developmental Milestone Lists are averages not deadlines, which means that lots of healthy kids won’t meet all of them! Your baby is an individual and you know them best. If you’ve got concerns about your baby, whether it be their development or something else, get in touch with your doctor or family nurse. Our job is to help you be the best parent you can be!
Thank you so much for sharing your knowledge and insights about general baby health with us tonight Chris! Chris has also helpfully provided the links for the Personal Health Record for babies in each State of Australia (see below). He’s also outlined where you can find the Newborn check page (if available).
NSW – Personal Health Record (‘Blue Book’) (newborn check page 6.3)
Victoria – My Health Learning and Development Record (‘Green Book’) – not available online
Queensland – Personal Health Record (‘Red Book’) (newborn check page 12)
Tasmania – Personal Health Record (‘Blue Book’) – not available online
South Australia – My Health and Developmental Record (‘Blue Book’) – (newborn check page 6)
ACT – My ACT Personal Health Record (‘Blue Book’) (newborn check page 6.3)
Western Australia – The Personal Health Record (‘Purple Book’)
Northern Territory – not available