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Handbook for Women with Visual Impairment - 8.

INFANT AND CHILD CARE
   

By
Anubha Rajesh and Meera Mittal

   

Preparing for the arrival of a child is an experience that is filled with hopes and dreams that may have extended far beyond the nine months of a typical pregnancy. Where do you begin, then? What do you need to do first and have right now, and what will you learn over time? Will you be able to understand the needs of your child? How will you react when your child starts crying? The initial phase will be full of questions like this.
  

GETTING TO KNOW YOUR BABY
  

Knowing what to expect from a newborn can be a challenge due to the unique personality that comes with every child. It can be comforting to new parents to have an idea of what is average. Newborns typically sleep 16 - 18 hours a day, will take milk every two to three hours, have six to eight wet diapers, at least two to four bowel movements per day and cry for reasons that range from hunger to fatigue to boredom. Most babies can be soothed by being held close, rocking rhythmic motion, a walk or ride, something to suck on in between feedings or a warm bath. You will quickly learn which works for different situations. As you learn about your baby and study his patterns of behavior you will quickly be able to differentiate a cry for hunger from a cry that indicates that it is time for a nap. Responding to your baby's cry is your first means of communication. He learns to trust you while you learn to trust your instinctive response and to follow natural intuition. Your first physical contact with your baby is when immediately after delivery the baby is placed on your chest or abdomen, skin to skin.
  

HOLDING YOUR BABY
  

Holding the new born may be a stimulating moment for you yet it may be full of fear and apprehension. You may be extremely anxious or nervous while you hold your little one. Nevertheless, it is important that you overcome this anxiety and enjoy the pleasure of holding your new born. The first thing to ensure while holding the infant is to provide support to the neck and the hips. This ensures that the baby is free from danger of accidentally getting hurt till he achieves neck control. The more comfortable and confident you feel the more reassured the infant is. Once you start feeling relaxed about holding the child it is obvious that you may naturally start conversing with the child.
  

The child can be carried on one arm by making a cradle of the arm. This should only be done when you are certain that the neck is firmly supported. This is helpful when the infant is small enough to be carried on one arm or while feeding. Otherwise it is preferable to carry the child with both the hands. Another way of carrying the baby can be on the shoulder. The baby’s head can rest on your shoulder and with one hand you could provide firm support to the neck. This is a good position for burping, rocking, or trying to get baby to go to sleep. This can be one of the most comfortable positions for your baby.
  

Once your baby is able to keep his head and neck under control, you can carry him on your hip. This leaves one of your arms free to do other things. Be careful when bending down and make sure you have a firm grip on the baby.
  

FEEDING THE INFANT
  

a) BREASTFEEDING: The first feeding (breastfeeding) can take place within 30 minutes to an hour after delivery. Breastfeeding not only provides nutrients that give immunity against certain diseases but also a sense of security and warmth to the child. Breastfed children are less likely to have ear infection, allergies, vomiting, diahorrea, wheezing etc. When close physical contact is maintained babies tend to sleep better and cry less.
   

The first milk is called ‘colostrum’ and is packed with nutrients that your baby needs. During the first two weeks, the newborns should not be given water, honey, sugar etc.
  

If you had a normal delivery you can nurse the baby in bed by either holding the baby in the cradle position or lying down but making sure that baby’s entire body is facing your body, not the ceiling. If you had a Caesarean-section delivery you can nurse your baby by sitting up and using extra pillows to support your baby and protect your incision or lie down on a side with your baby facing you. The baby should be breastfed from both the breasts alternatively. Breasts should be wiped with a moist cloth before feeding and care must be taken not to feed the baby under emotional stress or in critical illness.
   

To feed your baby you need to touch your nipple to the centre of the baby’s lips. It stimulates him to open his mouth wide. As this occurs, pull your baby straight forward onto the nipple and areola (area surrounding the nipple). Baby’s lips and gums should be around the areola and not on the nipple otherwise it would cause soreness. Hold the breast with your free hand and place your fingers under the breast and rest your thumb lightly on top. When the baby first nurses there will be a tugging sensation. If the feeding position is not correct you can experience pain and pinching sensation. Try to readjust the position till you can find the right one. From the 3rd day onwards the quantity of milk in the mother increases. The baby should be put up to breast 5-6 times a day depending on his hunger and should also be fed at night when he is hungry.
   

You can use nursing bras which have flaps that come down while nursing and can be refastened back. Or, you can wear clothes that are easy to undo. For privacy while feeding, you can cover your baby with dupatta, saree palloo or shawl.
  

If you face the problem of breast engorgement, remove milk by pressing the areola with thumb and index finger. Never squeeze the nipples. Gently massaging the breasts from under the arm and down toward the nipple would reduce soreness and ease flow of milk. If your nipples are sore or cracked do not wear plastic bra shields or plastic-lined nursing pads that hold in the moisture. Wash your breasts only with water. If problem persists consult your doctor.
  

Incidentally, it is sometimes believed that breastfeeding is a reliable means of family planning; it is not so.
   

b) BOTTLE-FEEDING: While breastfeeding is the best, yet there could be some compelling reasons for discontinuing it. e.g. Illness in mother or baby, job of the mother, mother thinks her milk is not sufficient, low birth weight of the baby or lack of confidence in breastfeeding. The formula milk advertisements or erroneous sense of superiority may also motivate some mothers to use it.
  

You should know all about bottle-feeding, if it is absolutely unavoidable for you to use it. You can use the straight bottle of glass or food-grade plastic one which is easier to clean and can withstand repeated boiling for sterilization. The teat must have a proper size of hole, neither too small to frustrate the baby nor too large that milk keeps on oozing out and trickles down the side of baby’s mouth and enters the ear or chokes him.
   

While preparing milk hands should be properly washed and utensils carefully cleaned and sterilized. Animal milk commonly used for feeding the baby is that of cow, goat or buffalo. The buffalo milk is high in fat so cream should be removed first and then filled in the bottle. The boiled undiluted milk added with sugar can be given to the baby 5 or 6 times a day. The quantity will vary with each baby but an approximate guide can be:
  

Birth to 1 month: 2-3 ounces (oz.), six to seven times a day;
  

1 month to 2 month: 3-4 oz, 6 to 7 times a day;
  

2 month to 4 month: 4 to 5 oz, 5 to 6 times a day;
  

4 month to 6 month: 6 to 7 oz, 5 times a day;
  

Beyond 6 months: 7 to 8 oz., 4 to 5 times a day.
  

c) FORMULA MILK: Another alternative to breastfeeding is the use of formula milk. Cleanliness should be strictly ensured while preparing it. The formula which is started should not be changed frequently. The proportion of formula to be added to the quantity of water is written on the box.
  

BURPING
  

After feeding the baby, he needs to burp. This is important in order to expel air swallowed during feeding. There are several positions used for burping - hold the baby upright with head cradled on your shoulder and her bottom resting on your forearm. Pat your baby's back gently for a few seconds while you steady her with other hand. Another way is by making the baby sit on your lap, facing either side. This is feasible once the infant is a little older.
 

DAILY CARE OF THE INFANT
  

a) Umbilical Cord Care: Apply spirit to the cord with a cotton ball 3 to 4 times a day. Take care not to wet it otherwise it could cause infection. You can slightly lift it to clean the place underneath. The cord should drop off on its own within one to two weeks of birth.
  

b) Massage: A sponge-bath or bath in warm water in a warm room is appropriate in the first month. Generally mother lays her infant on his back on her outstretched legs and applies some herbal or almond oil or baby oil on his body. Then the mother gently massages from shoulders to fingers and from groin to feet as also the face, chest and stomach. She then turns him over and massages the back portion. A good oil massage increases blood circulation in the body thereby helping baby to relax and sleep better and makes him more alert during his waking hours. It stimulates digestion and helps the baby pass gas. Talking, singing and smiling to the child while massaging keeps the child happy making the baby more secure and robust.
  

c) Bathing: Bathing is an important activity but just like feeding, bathing is not an easy task to undertake for a new mother. Here, you need to be careful about the temperature of the water (not too hot, not too cold) and also make sure you have a firm hold on your baby. Make the bath area safe for bathing. Bathing areas can be slippery, so protect yourself and your baby with a secure seating. Alternatively, you may like to stand and bathe the baby. In such a case, a shallow tub filled with some water can be placed on a higher platform. Baby may be placed in the tub while his head is being supported with one hand. Keeping all necessary things together in advance--mild soap, small bucket of water, soft towel-might be helpful. You can use tearless shampoo to clean his hair while taking care not to rub or try to scratch the soft and slightly hollow part in his head.
   

Do not leave your child unsupervised, even for just a minute. If you must leave in between, do not leave the child behind instead wrap the baby in a towel and take him with you.
   

d) Toilet Needs: Learn to look out for the baby’s body signals before he urinates or passes stool. The baby may squirm, shudder, make sounds, or change his breathing patterns. It is good to keep an absorbent cloth under the baby’s bottom to make cleaning easier. But parents may also keep their baby in diapers while they learn to identify the signals. Either way, you’ll need to invest time in close observation. Many times this comes easily because parents carry their babies most of the time. Teach the baby to associate certain cues with elimination. In many parts of the world, parents make a characteristic sound or gesture while the baby voids. Babies learn to associate the sound with the action and, eventually, you can use the signal as an invitation to void. As the child grows up teach the child to let you know that he needs to relieve himself.
   

e) Dressing Your Baby : Choosing the appropriate clothing for dressing the baby for the first time is very crucial. Parents should make sure that the clothes they provide for their child are large enough for easy dressing and have enough room for his movements. Dresses made from old clothes are soft and friendly for the child’s tender and delicate skin. While purchasing dresses for the baby they should be larger than the baby’s age in months. The dress should not have hooks or buttons at the back which could hurt him. Make sure to wash the new clothes to avoid rashes or irritation to the baby. Baby should be dressed according to the season and temperature outside. Cotton clothes are the best for him. Harsh detergents should not be used for washing his clothes.
   

f) Diapering Your Baby: Maintaining cleanliness and hygiene is crucial for the child to grow up in an infection free and healthy environment. Washing the child with water after removing the soiled diapers helps in maintaining hygienic environment. Do not be harsh while cleaning the child. Softly sponge the soiled area with lukewarm water and pat dry it. Chemicals should be avoided as they may be harmful for the child’s skin.
  

Diapering the baby requires lot of thought. There are diapers that are made of cloth, while there are others that are disposable. Well, each of these types has its own advantages and problems. We have many types of cloth diapers available in India - triangular shaped, square shaped. The square shaped diapers need to be folded according to the gender of the child. Usually for the boys the folds are thicker on the top and for the girls the layer of folds is thicker at the bottom. This ensures complete soaking. It is also important to protect the skin of your child when diapering. Use pins or fasteners carefully as these materials may harm your child’s skin. Ready made stitched cloth diapers with loops are also available in the market according to the age and weight of the baby. The cloth diapers can be washed and reused. When using a cloth diaper for your baby, make sure that it is well-soaked, washed, and dried. After the diapers get soiled they should be stored in a container with lid.
  

While selecting disposable diapers it is important to keep in mind that they are of good quality. Avoid the ones with elastic around the legs. Look for those with tape that can be refastened or the ones that glue at the top. A cream to prevent rashes would be handy. Discarding the stool in the toilet whenever possible is the best way to protect and maintain a healthy environment. Foul odors from bins cause discomfort to all. To maintain the cleanliness of your environment, never throw away disposable diapers in wastebasket. Instead, discard them in separate trash bags and dispose them of properly.
  

WEANING
  

Breastfeeding should be continued as long as possible but gradually along with it the process of weaning can be initiated. After four months liquid foods like dal water are introduced into the child’s diet.
  

Porridge made of suji or atta or ragi or rice can also be given. Mix a little ghee or oil and give 1 to 2 spoons in the beginning and gradually increase over the next 3-4 weeks. Gradually foods like mashed boiled potatoes, mashed banana, papaya, and steamed apples are introduced. It is important that you introduce only one kind of food in a week. This will help in figuring out which food did not suit the child.
  

At 5-6 months the baby can be given boiled or steamed seasonal vegetables like carrots, beans, peas etc. in a semi-solid state after adding a little oil or ghee. At 7 to 8 months a variety of food cooked for the family can be given 4 to 5 times a day. A combination of khichari, curds, kheer, dalia, bread can be given. Boiled, scrambled or poached egg can also be given. The child is teething now and is sitting up too. A piece of roti, toasted bread, carrot or biscuit can be given to him to nibble. Gradually as the child grows older many of the food items cooked for the family without much masala can be introduced to him.
  

When he is 9 months old you can help him to learn to drink from a cup to gradually wean him off from breastfeeding completely. Start with substituting one breastfeed during the midday with a cup feed. The trainer cup has two handles and a snap-on lid with a spout.
  

IMMUNIZATION
   

Small Pox and BCG vaccine have to be given as soon after birth as possible. The following schedule is normally suggested:
  

3rd month - DPT (Polio 1st dose);
  

4th month - DPT 2nd dose and Polio 2nd dose;
  

5th month - DPT 3rd dose and Polio 3rd dose;
  

9th month - Measles Vaccine;
  

10-12 months - Typhoid Vaccine;
  

One and half year - DPT first booster and Polio 4th dose;
  

3 years - secondary Small Pox Vaccine.
  

PLAY MATERIAL
  

There are a variety of toys available in the market catering to the needs of children of the different age groups. Children get attracted to sound-making, moving or bright-coloured toys and gadgets. Their desire to touch and explore to know things can be satisfied by giving them safe toys which they can touch, smell, lick or hold in their hands. Therefore, you have to choose the toys wisely. While metal toys or toys with sharp edges can hurt the child, the painted toys containing toxic chemicals can be equally dangerous. Most plastic toys may be cheap to buy but the toxins can enter a child when he puts it in his mouth. For the safety of the child it is advisable to buy well-crafted wooden toys or those made of food-grade plastic. These can be used later for learning purposes too.
  

BASIC KNOWLEDGE OF MILESTONES AND DEVELOPMENT
 

Watching a baby grow is a fascinating and unique experience for the parents. A child's growth is a complex and continuous process. He should be able to do certain things at certain ages. These are called developmental milestones. Each child is unique and no two children develop at the same rate.
  

You can use the table below to discern the growth and development of your child. Any marked deviation in this is a cause of concern and the pediatrician must be consulted.
  

Birth to 6 weeks - lies on the back with head turned to one side, has grasp reflex, fists are clenched,
  

2 months - social smile,
  

3 months - hand and leg movements are coordinated, makes gurgling sounds besides crying, recognizes mother and responds to her voice,
  

4 months - holding neck,
  

6 months - plays with his hands, turns his head towards sound, sits briefly with support, can lie on abdomen,
  

8 months - sitting without support,
  

9 months - can crawl or creep on his hands and knees,
 

12 months - standing, can say a few words like ‘mama’, is able to walk holding the furniture or may be on his own.- can spot small moving objects on the floor (vision test)- can hear distant sounds (hearing test).
  

18 Months - The child can hold a glass without help and drink from it without spilling, can walk all the way without support across a large room without falling or wobbling, can say a couple of words, is able to feed himself.
  

2 Years - can take off some clothes such as pajamas, is able to run without falling., takes interest in pictures in a picture book., is able to say what he wants, begins to repeat words others say., is able to point to some parts of his body.
  

3 Years - is able to throw a ball overhand, can answer simple questions like "Are you a boy or a girl?" helps put things away, can name at least one colour.
  

To conclude, caring for an infant and see him grow as a healthy baby is one of the most fascinating, exciting and rewarding experiences. As a mother, your responsibilities and challenges are manifold; so are the joys and thrills which accompany it. Good luck!

 

  

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