Baby’s oral health
Brushing
- Start brushing your baby’s teeth as soon as they come through the gum – usually at around 6 months old.
- Use a baby toothbrush and a tiny smear of family or baby toothpaste, containing at least 1000ppm fluoride.
- Don’t rinse your baby’s mouth after brushing.
- Brush your baby’s teeth twice a day – once at night and once during the day, usually in the morning.
NHS Oral health guidance for babies
Brushing for 0 to 3 year olds with Dr Ranj
Sugar
- Too much sugar can harm your baby’s new teeth.
- Only give water or milk to your baby to drink. Fresh fruit and vegetables provide your baby with all the sugar they need.
- Try not to give any food containing extra sugar – if you do, makde sure it is with a meal and not as a snack.
- Fresh fruit and vegetables are tooth-friendly snacks just like cheese, rice cakes, breadsticks and plain yogurt.
Dentist
National guidance advises that all babies should visit the dentist for the first time by their first birthday.Commonly used medicines after birth
Commonly used medicines after birth
1. Analgesics (pain killers)
a) Paracetamol (500mg tablets)
What is it used for? Paracetamol works by relieving pain and lowering high temperature. It can provide effective reliefnfrom mild to moderate pain, including headache, toothache, sore throat, symptomatic relief of rheumatic aches and pains, influenza symptoms and fever. How do I take it? Paracetamol can be taken regularly or when required for pain. Dosage: Adults and young persons aged 12 and over: take 2 tablets up to 4 times per day, as required. The tablets should be taken with water. Take only as much as you need to relieve symptom and leave at least 4 hours between each dose. Do not take more than 8 tablets in 23 hours. What are the side effects? Paracetamol is generally well-tolerated in most people. Is it safe to use while breastfeeding? Paracetamol is commonly used during breastfeeding.b) Co-dydramol
What is it used for? Co-dydramol (10/500 10mg dihydrocodeine and 500mg paracetamol) is a combination of paracetamol and dihydrocodeine. Dihydrocodeine is stronger than paracetamol and is used for the relief of mild to moderate pain. If you have had a caesarean section or moderate pain post-delivery, then you may be give a box of 30 tablets of co-dydramol on discharge from hospital. How do I take it? Dosage: Co-dydramol 1 to 2 tablets every 6 hours when required up to a maximum of 4 times per day. Do not take more than 8 tablets in 24 hours. We recommend that you step down pain relief and substitute these tablets for paracetamol as soon as possible which is usually after 3-4 days. Since these tablets contain paracetamol you should not take any other paracetamol tablets at the same time. Do not drink alcohol whilst taking co-dydramol. What are the side effects? The most common side effects of dihydrocodeine are drowsiness, constipation, feeling sick or dry mouth. You may be advised to take a gentle laxative if you experience constipation whilst taking co-dydramol. Is it safe to use during while breastfeeding? Dihydrocodeine can be used during breastfeeding as a pain killer where paracetamol has not been effective. Use the minimum effective does for the least amount of time. IMPORTANT: Although there is a small dose of dihydrocodeine in these co-dydramol tablets, if you are breastfeeding whilst taking it, inform your midwife immediately if your baby is showing signs of increased drowsiness, difficulty feeding, breathing problems or anything else unusual. Research has shown that some babies may be more susceptible than others to these side effects. If you would like any further information regarding the use of dihydrocodeine while breastfeeding, please discuss it with your midwife/doctor.c) Ibuprofen
What is it used for? Ibuprofen is anti-inflammatory drug used to treat inflammation in a variety of conditions. It is commonly used after birth to help ease pain and inflammation. How do I take it? Swallow tablets whole, with a glass of water. Take the tablets with, or after, food. Dosage: Adults: 400mg three times a day, 8 hours apart, is often prescribed after a procedure. If you have been given a diclofenac suppository after birth or a procedure, you cannot start ibuprofen until 18 hours later. The dose can be reduced to 200mg three times a day when the pain improves. Who should not use ibuprofen? Women with any of the following conditions should consult a doctor, midwife, or pharmacist before taking ibuprofen if there is history of:- asthma or breathing problems
- previous stomach ulcer
- previous reaction to aspirin, diclofenac and other non-steroidal anti-inflammatory drugs (NSAIDs)
- other medical conditions, e.g. kidney disease, heart disease, blood clotting disorders, liver disease.
- pass blood in your faeces (stools/motions)
- pass black tarry stools
- vomit blood or dark particles that look like coffee grounds
- suffer any allergic reaction such as itching, drowsiness, swelling of the face, lips, tongue, mouth or throat, which may in turn cause shortness of breath or difficult swallowing.
2. Ferrous Sulphate (Iron supplements)
What is it used for? Iron supplements are used to treat iron deficiency anaemia. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. It is common for women who are pregnant or who have just given birth to have this condition. These medicines work by replacing body iron. Iron is a mineral that the body needs to produce red blood cells. How should I take it? Swallow the tablets who with water. Although iron preparations are best absorbed on an empty stomach, they may be taken after food to reduce the effects on the stomach. Iron supplements should not be taken within one hour before or two hours after eating or drinking the following products: tea, coffee, milk, eggs and wholegrains. These products can reduce the absorption of iron. Dosage: Ferrous sulphate 200 mg tablets Treatment of iron deficiency anaemia: 1 tablet 2-3 times a day Prevention of iron deficiency anaemia: 1 tablet per day What are the side effects? Like all medicines, ferrous sulphate tablets may cause side effects, the most common of which are constipation, diarrhoea, stomach pain, feeling sick and blackened stools (faeces). Is it safe to use during breastfeeding? Ferrous sulphate tablets are commonly used safely while breastfeeding. Ensure that you do not take more than the recommended dose. If you cannot tolerate ferrous sulphate tablets, an alternative is available called ferrous fumarate. This is available as a liquid or tablets. The same side effect and safety information applies as above for ferrous sulphate.3. Laxatives
What are they used for? Laxatives are used to treat constipation. What else can I do to prevent becoming constipated? The following hints are helpful in maintaining regular bowel habits:- Eat fibre-containing foods, e.g. wholegrain bread, fruit and vegetables.
- Drink sufficient liquid, preferably water.
- Take regular exercise.
a) Lactulose
Lactulose is a liquid laxative used to treat and prevent constipation. Lactulose can take 2-3 days to have an effect; it is generally considered to be a gentle laxative. Dosage: Usually 10 mls twice daily. It must be taken regularly to have an effect.b) Fybogel (Ispaghula husk)
Fybogel is a high fibre drink that works to increase the fibre in your diet. Increased fibre in the diet helps to gently relieve constipation. Fybogel is considered to be a gentle laxative. It is important to maintain an adequate intake of fluid whilst using Fybogel. Dosage: The usual dose is one sachet mixed with a glass of water, up to twice daily. Is it safe to use Lactulose or Fybogel after birth? Lactulose and Fybogel are not absorbed into the blood and only have a local effect on the gut. Both drugs are generally considered safe to use while breastfeeding, under the advice of a midwife or doctor.4. Blood clot prevention
Enoxaparin (also known as Clexane) is used to prevent blood clots. Blood clots usually present as deep vein thrombosis (DVT) usually in a leg vein, or pulmonary embolism (PE), a blood clot in the lung. Blood clots are more common during pregnancy and some women will be more at risk of blood clots than others. As well as prevention, enoxaparin is also used at higher doses for treatment of DVT and PE. Is it safe to use during breastfeeding? Enoxaparin is given as an injection just beneath the skin (subcutaneous). It is usually injected into a skin fold in your abdomen (stomach) or the upper part of your thigh. If this is not suitable, you may be advised to inject into an alternative site. It should not be injected into your muscles. It may be given either once or twice daily. You should adminster the dose at the time recommended by your doctor. How is exonaparin used after birth/caesarean section? If you have, or develop risk factors at the time of the birth, you may be started on enoxaparin. Examples of possible risk factors would be having a caesarean section or infection. If you were on enoxaparin during pregnancy, your doctor will want you to stay on the same treatment after the birth. They will inform you how long to continue this treatment. How to inject Enoxaparin (Clexane) You will be able to inject enoxaparin once you have been shown how to do so by your doctor or midwife, or by following the instruction leaflet that will be given to you upon discharge. It is a simple process and one that you can do at home. Follow these steps:- Wash and dry your hands.
- Clean the injection site. If someone else is doing it for you it is advisable that they wear gloves.
- Choose the injection site either on the outer aspect of your left or right thigh or your stomach if advised to do so. It is important that you change the site each time. If there is any oozing of blood at the injection site, apply gentle pressure. Do not rub as this may cause bruising.
- Dispose of the syringe in the yellow sharps box provided. This box should be kept out of the reach of other people.
Baby car seats and slings
Baby car seats and slings
When travelling by car it is essential to place your baby in a suitable baby car seat. You will need the car seat to take your newborn baby home from hospital, so it is worth taking the time to find a suitable car seat during pregnancy.
Many parents also choose to carry their baby in a sling. The guidance in the link below shows how to do this safely.
Heart health after giving birth
Heart health after giving birth
Chest pain in pregnancy and/or after your baby’s birth should never be ignored. Some chest pain can be serious and can head to a heart attack, heart failure, cardiac arrest or even death. Most women do not suffer from these conditions during or after pregnancy but it is important to recognise the symptoms and, if you have any of them, to seek treatment quickly.
Pre-exisiting heart conditions
If you have a known heart condition, were born with a congenial heart defect or have been diagnosed with heart disease, your midwife/GP/cardilogist will monitor your heart health before, during and after pregnancy.Symptoms of a heart attack can include:
- central chest pain
- arm pain or numbness
- pain in the jaw, back or shoulders
- nausea
- sweating/clamminess
- breathing difficulties
When should I contact the midwife or doctor?
If you feel unwell, contact your midwife or GP for guidance. If you experience some/all of the above symptoms, dial 999 and ask for an ambulance as yoru heart health needs to be investigated quickly. An ECG monitor and a troponin blood test should be carried out to find out if you have had a heart attack.When am I more likely to have a heart attack?
You are more likely to have a heart attack if you:- have a family history of heart problems
- have high blood pressure
- have high cholesterol
- smoke
- drink excessively
- are obese
Keeping your baby warm after birth
Keeping your baby warm after birth
Why is this important?
If a baby becomes cold after the birth, the baby can be at risk of developing hypothermia.
Hypothermia is a condition where the body temperature drops to a dangerously low level. In a newborn, this occurs when the baby’s temperature drops below 36.5°C.
A baby with hypothermia may have problems breathing regularly and maintaining their blood sugar and may result in admission to the Neonatal Intensive Care Unit (NICU) for treatment.
Leaving the warmt of the womb at birth, the wet newborn baby comes into a much colder environment and immediately starts to lose heat. Most of this heat loss occurs within the first few minutes after birth and if not kept warm in the first 10-20 minutes, the baby may lose enough heat for their body temperature to fall to a very low level.
Some babies are more at risk of geting cold, these include:
- Preterm babies born at less than 37 weeks’ gestation
- Babies with low birth weight
- Babies of mothers who are diabetic
- Babies who need to be resuscitated at birth
- Babies where the mother has an infection in labour
What will my materniy team do to ensure that my baby is keep warm?
- Ensure the temperature of the birth room is at least 24°C
- Check the air conditioning and fans in the birth room are turned off or facing away from the baby
- Keep windows closed
- Turn on heaters if appropriate
- After the birth, your baby will be dried immediately and a hat will be put on your baby’s head.
- Tell a midwife or support worker if the birth room is not warm enough. This is very important just before and in the horus after the birth.
- This may mean reminding a midwife or support worker to close windows and turn off the air conditioning/fans, or turn up the heaters.
- Ensure that during skin-to-skin contact your baby is covered with blankets.
- Ensure tht your baby keeps the hat on for the first 12 horus; as much as 25% of heat loss will be from the baby’s head if it is not covered.
- If a red hat has been put on your baby’s head then please keep this in place for 12 hours. You can usually then remove the hat and replace it with one of your own baby hats.
- When dressing your baby for the time, warm the clothes and blankets beforehand. You can do this by placing the baby clothes against your skin or under your clothes.
- When in the cot, ensure that your baby is adequately covered. Babies usually need one or two more layers of clothing or bedding than adults.
- Tell a midwife or support worker if you think your baby’s breathing is no normal.
- If you notice that your baby is breathing very fast for a continuous period (more than 60 breaths per minute), or seems to be struggling to breathe, with nostrils flaring or making noises wih each breath, then please tell a member of your maternity team.
- Babies use up energy to keep themselves warm, there you will be encouraged to feed your baby regularly and will lbe supported in doing so. Some babies may need more frequent feeds. However, a well baby will need to have feeds at least every three hours for the first few days of life.
How can you help your baby?
As parents, you can help the maternity team in ensuring that your baby is kept warm. There are many things you can do to help:How long should I take these measures for?
If kept warm, once the baby is around six hours old, then will then usually be able to maintain their temperature at a normal level. The observation of your baby’s temperature will continue for at least 12 hours. Some babies that are unwell or vulnerable at the time of birth (for example, a baby with a low birth weight) may need support to keep warm for a longer period of time. If you have any questions, please ask one of the midwives or support workers.Handling your newborn baby
Handling your newborn baby
Babies like being held securely and gently. They need to have their heads and necks carefully supported as their neck muscles are not strong enough to hold their head up yet
Babies find touch soothing; an upset baby can be comforted by a gentle cuddle or rhythmic rocking in a parent’s arms. It may often help to wrap your baby up securely in a blanket, although it’s very important not to allow your baby to become overheated.
Very occasionally babies are accidentally dropped, particularly when a parent falls asleep holding a baby; or when holding the baby they slip, trip or fall.
Here are some things you can do to stop your baby being injured:
- Return your baby to its cot when settled
- Change your baby’s nappy on a changing mat on the floor
- Do not leave your baby unattended on a bed, sofa or changing table, even for a second, as they could roll off
- Always keep bouncing cradles or baby car seats on the floor, rather than on a table or kitchen worktop, as your baby’s wriggling could tip it over the edge
- Hold on to the handrail when carrying your baby up and down stairs, in case you trip. Make sure the stairs are free of toys and other trip hazards.
- Watch where you’re putting your feet while carrying your baby. It’s easy to trip over something like a toy.
Spontaneous Coronary Artery Dissection (SCAD) after birth
Spontaneous Coronary Artery Dissection (SCAD) after birth
SCAD is a rare but serious heart condition that causes a tear or bruise to develop in a coronary (heart) artery resulting in a blockage that prevents normal blood flow. It can cause heart attack, heart failure or cardiac arrest and can be fatal.
SCAD can happen during pregnancy and during the weeks and months after you have given birth. Symptoms can include:
- central chest pain
- arm pain or numbness
- pain in the jaw, back or shoulders
- nausea
- sweating/clamminess
- breathing difficulties
Coronavirus breastfeeding local information
Coronavirus breastfeeding local information
Amid the current pandemic of widespread infection and difficulties in purchasing formula milks, breastfeeding has never been more important for the health and wellbeing of our babies and their mothers. Current understanding is that COVID-19 cannot be passed to your baby via breastmilk. Infection could be spread to the baby in the same way as to anyone in close contact with you. However, the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk or by being in close contact with your child. Therefore guidance is that breastfeeding babies should stay with their mothers and continue to be breastfed. Practise excellent hand hygiene: washing thoroughly with soap for a minimum of 20 seconds after touching face or surfaces and before handling your baby. If you are symptomatic, then you can consider wearing a mask when handling and feeding baby. We know that breastmilk is likely to be part of baby’s best defence against the virus if they do contract it; and we know that there are currently shortages of alternative milks for baby, so we hope that this information sheet on breastfeeding support will be useful.Lancashire and South Cumbria local support with breastfeeding during COVID-19
If you are considering beginning breastfeeding for the first time, aiming to increase breastmilk supply because of formula shortages, or having breastfeeding complications that you’d like some support with, then we’ve put together some information about how to access support. Face to face breastfeeding peer support groups have been suspended to protect all. Visits from your midwifery and health visiting service will continue to some degree, but may be not be undertaken face to face or be reduced going forward. However, there are many ways to access support and information from a trained peer supporter or lactation consultants within our area and nationwide, during classic ‘working hours’ and also round the clock, which may be of use. These services are available by telephone, via social media groups and in some cases via WhatsApp video call or similar. NB. THESE ARRANGEMENTS COULD CHANGE DAILY ACCORDING TO STAFF AVAILABILITY but we will update the information regularly. We have agreed care pathways across Lancashire and South Cumbria so that if you require more specialist support, those delivering the below services can refer you onto it.Families and Babies Lancashire (covering North, Central, East and West Lancashire)
Staffed by peer supporters. Tel: 01254 722929 (9.30am – 2.30pm, 7 days a week) FAB Lancs Breastfeeding SupportBlackpool and Fylde Coast Breastfeeding Support
Staffed by peer supporters and lactation consultants. Fylde Coast Breastfeeding SupportSouth Cumbria Breastfeeding Support
Staffed by peer supporter/lactation consultant. ann@cumbriabreastfeeding.org.uk South Cumbria Breastfeeding Support SCBS In it Together (new group)Barnoldswick, Burnley and Colne BFFs
Staffed by peer supporters. Barnoldswick Group Burnley Group Colne GroupBlackburn with Darwen
Staffed by infant feeding support workers and volunteer peers supporters. Tel: 01282 803266 (Voicemail facility – please leave name, contact number and support question and we will respond with two working days.)Blackburn with Darwen’s Breast Intentions
Staffed by volunteer peer supporters. Breast intentions (BwD infant feeding support)East Lancs NCT Feeding Support
Staffed by peer supporters. branch.eastlancashire@NCT.org.uk Burnley Bumps and BabiesNational support
National Breastfeeding Helpline
Tel: 0300 100 0212 (9.30am – 9.30pm, 7 days a week) National Breastfeeding HelplineThe Breastfeeding Network Drugs in Breastmilk
A service for information on medications or medical conditions and breastfeeding – factsheets written by pharmacist Dr Wendy Jones (MBE). Breastfeeding network drugs fact sheetsLa Leche League Helpline
Tel: 0345 120 2918 La Leche League HelplineNCT Helpline
Tel: 0300 330 0700Lactation Consultants of Great Britain
An interactive map enables you to find expert and experienced International Board Certified Lactation Consultant (IBCLC) support. Many of our colleagues are using videocalls, email and phone support as a priority during the present COVID-19 situation. (NB Private IBCLC support may incur a fee.) Find an IBCLCOnline support
Breastfeeding Twins and Triplets UK
Breastfeeding Twins and Triplets UKBreastfeeding With CMPA and Other Food Allergies
Breastfeeding With CMPA and Other Food Allergies Support Group UKBreastfeeding Yummy Mummies
Evidence based information and support, administration by a team of qualified breastfeeding peer supporters, health visitors, midwives and IBCLC. Breastfeeding Yummy MummiesSupport in other languages
Breastfeeding support in other languagesInformation sources for health professionals
UK Drugs in Lactation Advisory Service (UKDILAS)
Information around medications whilst breastfeedingSmoking in the home
Smoking in the home
It may be tempting to start smoking again after the birth of your baby. However, second-hand smoke can still cause great harm to you, your family, and especially your new-born baby. Studies show that smoking during and after pregnancy can put your baby at risk of Sudden Infant Death Syndrome (SIDS). Here are some benefits of keeping your home smoke-free:
- babies and children from smoke-free homes are less likely to get illnesses such as asthma and meningitis.
- children that grow up in smoke-free homes are less likely to become smokers themselves.
- you are less likely to experience accidents caused by smoking, such as fire and injuries.
Support
You are much more likely to quit for good with the help of a trained stop smoking advisor. Your midwife or GP can refer you to local smoking cessation services or you can self-refer via the NHS Smoking Helpline on 0300 123 1044. The type of stop smoking support you receive will depend on where you live and your personal preferences. Stop smoking services usually offer:- Weekly support either face-to-face, over the phone or online
- Free medication or medication on prescription to help you stop smoking
E-cigarettes
Although not risk free, e-cigarettes carry a small fraction of the risk of smoking. If using an e-cigarette or ‘vaping’ helps you stay smoke free, it is far safer for you and your baby than continuing to smoke. If you want to use an e-cigarette, you can still get free expert help from a specialist stop smoking advisor.Portal: Smoking in the home after your baby is born
Pressure sores
Pressure sores
Pressure ulcers, also known as bed sores or pressure sores, are areas of damage to the skin and deeper layers of tissue.
Pressure ulcers may cause pain or become infected leading to a longer hospital stay.
Pressure ulcers are caused by a combination of:
Pressure: body weight and some medical equipment can squash the skin and damage the blood supply to the area. Lying or sitting in one position for a long period of time can cause this.
Shearing: sliding down the bed or chair can damage the skin and deeper layers of tissue. The skin may split or break.
Pressure ulcers can develop anywhere in the body but are more commonly found over boney areas such as bottom, heels, elbows, hips, ankles, spine, back of the head and shoulder blades. Usually people can relieve the effects of pressure and shearing by turning in bed and getting out of bed. You may be at risk of developing pressure ulcers if you stay in the same position for too long. Ask your healthcare professional or partner to help you move around safely. Ensure your clothing or bedding is not too tight so that you can move freely.
Early signs of pressure ulcers will appear as: a change in skin colour (redder or darker), change in skin temperature (hotter or colder) discomfort or pain, blistering and skin damage. You can check your own skin for signs of pressure ulcers, if you notice anything different on your skin, please contact your healthcare professional.
Whilst in hospital, your healthcare professional team will perform a risk and skin assessment to see if you are at risk of developing a pressure ulcer. After the birth, you can ask your healthcare professional to look at your skin if you feel any discomfort.
Protect your skin
- Keep your skin clean and dry. Wash your skin every day using mild soap and warm water. Do not use heavily perfumed soap or talcum powder, as these can soak up the skin’s natural oils leading to vulnerable dry areas.
- If you suffer from incontinence please inform your healthcare team as they can assess the best way to support you. Rubbing and massaging skin is bad for it.
- If you are given compression stockings (TEDS) to wear, do not allow them to roll down as this can cause pressure and skin damage. Remove the stockings once a day to wash, moisturise and inspect your skin.