Dr Byaruhanga on caring for children(Part 2)
Sunhealth continues conversation with Dr Charles Byaruhanga at Seyanyana Children’s Clinic on best practices when taking care of a new born.
Culture dictates that for the first few months, a new born should be shielded in the house and not be seen (except by immediate family and medical professionals at monthly check-ups). Your thoughts? When would you say is the right time to take baby outside the house to interact with their environment? As a paediatrician, I am not opposed to this practice because it protects the baby from getting infections that they could pick from exposure to the public. However, infants can be taken outside the house within their compound or veranda right away as long as parents follow some basic safety precautions.
There's no need to wait until 6 weeks or 2 months of age. Getting out, and in particular, getting outside for fresh air and exposure to sunlight is good for parents and babies. Early morning Sunlight provides health benefits like Vitamin D plus mood and energy boosts. Vitamin D is vital for the infant’s intestinal absorption of calcium which is needed to make bones strong and prevent Rickets.
The only natural source of Vitamin D is the sun. However, babies are also more susceptible to sunburn. Direct exposure to the sun should be limited to around 15 minutes.
Let’s talk about the umbilicrd cord. Our grandparents used to tend to it using things like ash for example. At hospitals, new mothers are advised to use surgical spirit to clean around the cord until it falls. But now, recent studies are advising against the use of spirit, claiming the alcohol in the spirit might not be good for the baby after all.
What is the best way to care for baby's umbilical cord stump until it dries out and eventually falls off? It’s true that some studies have shown that applied to wounds or raw surfaces, alcohol not only increase the injury but also form a coagulum under which bacteria may subsequently thrive. More still, it lucks prolonged action and it’s not sporicidal. Alcohol has also been shown to delay cord separation.
Therefore, most countries have shifted away from using alcohol as a standard of care for the umbilical cord stump. Like you mentioned, our parents have used a number of substances in the care for umbilical cord stumps. However, use of ash/cow dung/soil/breastmilk or any other local substance on the umbilical cord stump could cause infection to the stump which can lead to newborn illness or even death. I generally encourage mothers to use clean water during the care of the umbilical cord stump.
Except where cord stump infection is suspected, then chlorhexidine as 4% detergent water can be used and this will be recommended to you by your healthcare worker. How parents should care for the cord at home. - Use clean water. - Inspect the cord stump regularly to ensure it’s healing, remains clean and dry. - Always wash hands before and after touching the cord to reduce the risk of introducing an infection. - Clean from the base of the stump in a circumferential manner. Swab once and discard the used swab. Repeat using a new swab until the stump is clean.
Leave the stump to dry. Twice a day is enough with thorough cleaning. - Ensure that nappies do not rub on the cord stump by folding them down at the front. - Never attempt to pull or detach the stump; allow it to fall off spontaneously. - The cord stump should fall off between 4-15 days. Seek for medical help if it delays for more than 3 weeks. - Be alert for signs of infections like redness, swelling, pus discharge, bleeding, fever and poor feeding. Please seek early healthcare review in case of infection signs.
I have noted a lot of mothers being apprehensive about getting the COVID-19 Vaccine fearing the effects on it on their babies. Can the vaccine be excreted in breast milk? If yes, what effect can it have on the baby? There is no evidence suggesting that a vaccine against SARSCoV-2, the virus that causes COVID-19, is harmful to either the mother or the breastfed baby. The COVID-19 vaccine is not excreted in breast milk. The immunoglobulins produced by the mother’s immune system after vaccination are secreted in the breast milk. These antibodies are said to be protective to the infant against SARSCoV-2. Professional organisations (like WHO and CDC) recommend that COVID-19 vaccines be offered to those who are breastfeeding because the potential benefits of maternal vaccination outweigh the theoretical risks.
Can I give birth, care for and breastfeed my baby if I have Coronavirus? Or there is need to separate the baby until I recovery? Yes, you can. Current evidence suggests that the chance of a baby getting COVID-19 from their mother is low. Breastfeeding is the best choice for feeding your infant even when you are COVID-19 positive, as long you follow the standard operation precautions of proper hand hygiene and wearing of the mask. Emphasis to COVID-19 positive mother: Please wear a mask whenever you are within reach of your newborn. If the mother decides not to directly care for her baby (say mother in isolation at home), she can express the breast milk after appropriate hand hygiene (using soap and water or hand sanitizer with at least 60% alcohol), and milk may be fed to the infant by another uninfected caregiver. The caretaker must also practice hand hygiene.