Childhood Development

A home with small children is an exciting place to live. The activities of growing youngsters bring a never-ending series of delights. Yet life for these offspring is fraught with many perils.

Although many of the infectious diseases that took the lives of babies and young children a generation ago have come under control with better public health and hygienic measures, certain infectious diseases and risks of accidents, are always threatening. The newborn period is especially a time when vigilance is needed.

From the time a new baby takes his first breath through the first few weeks of life, great care is needed to provide a protected environment of health. Assuming that anatomic development has taken place normally, that first vital breath is encouraged as mucus gets cleared from the nose, mouth, and throat.

The rubber suction bulb is an indispensable device in the delivery suite, as well as the newborn nursery. Every parent should also have one of these suction devices in the home. It can be used to clear mucus, and is of considerable help during colds to maintain an unobstructed airway.

The newborn baby should usually sleep on his or her abdomen or be propped on one side, since for several weeks your baby is unable to turn him or herself. Aspiration of regurgitated milk or other stomach contents can occur when he or she is on his or her back.

Temperature stability is also important. A newborn entering the world is damp, and will immediately begin to lose heat. Therefore he or she must be dried, wrapped in a warm blanket, and either held close to the mother or in a special warming device.

In modern hospitals most nurses put a stocking cap over the baby’ s head to prevent rapid heat loss that otherwise occurs through a moist scalp, particularly those who have lots of hair. Avoid giving the newborn baby a bath too early, for this washes away the valuable cheese-like vernix caseosa that acts as a cosmetic cream to prevent drying and cracking of the baby’s skin.

Moreover, the greater necessity of warmth than cleanliness makes it advisable to delay the bath for several hours. As one looks at the newborn baby, several features become apparent. In contrast to adults, whose head is about one-eighth the size of the body, a newborn baby is divided more equally with a larger proportionate head size.

Charts are available to tell whether the circumference of the head is within normal limits. The height (about 20 inches) and the weight, which is usually 5.5 to 8 pounds (2500 to 4000 grams) also give a good estimate of the baby’s maturity.

The newborn’s skin is usually ruddy in complexion, particularly if the child has been left attached to the umbilical cord until pulsations cease. This extra blood that is “transfused” from the placenta can keep the baby’ s hemoglobin higher for several months, in spite of low iron intake.

After his or her initial cry the infant may either continue with the same loud sounds or sleep quietly for an hour. A low level of excitement in the birth room and the absence of trauma during delivery will influence this reaction considerably.

Usually the eyes are closed, but if they are open a light can be shined in to determine the presence of pupils with their “red reflex” off the retina. The ears are normally formed with well-developed cartilage, except in the premature, and the ear canals should be open (patent).

The nose must be unobstructed to permit adequate breathing, as a newborn baby cannot breathe solely through its mouth. Obstruction in this area should call for urgent medical evaluation to save the child from asphyxia. The sucking reflex is usually present from birth, as is the rooting reflex.

To demonstrate the latter, the child turns his or her mouth and face toward the side of the cheek that is gently stroked. This sort of nuzzling prepares the way for breast feeding. Small white dots on the nose (milia) and white “pearls” on the roof of the mouth (hard palate) are normal in a newborn.

The neck turns from side to side, and the collarbone can be felt. Unusual lumps or masses in the head, neck, or large discolorations of the skin should be evaluated for associated birth defects. The heart rate is still rapid in the newborn period, usually over 120 per minute. Gradually it slows to the childhood level within several days.

Listening to the heart with a stethoscope, the examiner should detect normal first and second heart sounds with no unusual murmurs or rhythm irregularities. The lungs should expand equally without retractions between the ribs or any crowing, labored respiration. The abdomen is usually protuberant.

Although sometimes the edge of the liver or spleen can be felt on careful palpation, there should be no masses or hard tumors in the abdomen. The umbilical cord has three blood vessels—two arteries and a vein. These are best seen when the cord is clamped and cut before drying has occurred.

Careful examination of the genitalia to determine sex and, in case of males the presence of descended testes, is important. Usually there is no difficulty in urination.

This spontaneously occurs within minutes to hours after birth. The need for circumcision in male babies remains a subject of controversy among pediatricians. However some decided benefits have been recently demonstrated, especially the lowered risk of urinary infection.

Many parents still prefer this minor surgical procedure for hygienic reasons or for continuity of appearance among the male offspring. If so, this should be deferred for several days to allow the newborn to equilibrate from his birth experience and establish the pattern of breast feeding.

The Biblical recommendation of circumcising a baby on the eighth day has value from a medical standpoint, in that the clotting ability of blood is usually restored to normal by that day, with the synthesis of Vitamin K in the intestinal tract. Most newborns by the eighth day will have little difficulty with hemorrhage.

Aseptic surgical precautions are needed if a circumcision is performed, to prevent infection, The examination of the extremities includes more than counting the fingers and toes. Creases in the thighs should be symmetrical, and leg length should be equal.

The hips should be able to rotate outward and inward equally, without a “clicking” sound or obvious asymmetry. Some inward turning of the ankles may be seen, because of the intrauterine position. But any unusual clubfoot deformity should be brought to the attention of a physician.

When the infant is dropped or jostled suddenly a Moro‘s reflex occurs. This involves a trembling of the hands with an outward grasping fashion. It is normal in newborns. The Babinski reflex is triggered by stroking the sole from the heel to the toe.

It also is normal up to one year of age. It is positive when the great toe extends itself and the little toes flair. Unusual lethargy, a jittery appearance, the presence of seizures, or any failure to take liquids and suck normally should call for medical attention promptly.