• Height & weight chart
• Immunisation
• Safety at home
• Toys
• Bath time
• Kitchen
• First aid
• Trimming nails

• Colic
• High temperature
• Coughs & colds
• Vomiting & reflux
• Diarrhoea & constipation

Percentile or reference charts are utilised to monitor growth of babies and children. The nutritional status of babies determines their growth rates. Even though the charts are based on U.S. data they are deemed suitable for Australia.

Breastfed babies tend to grow rapidly in the first 4 months then tend to slow down and this needs to be taken into account when looking at the charts.

Bottle fed babies will tend to follow the upward curve of the graph more closely.

The length of babies does not seem to fluctuate.

10th, 50th, 90th percentiles are the common reference terms used.

Percentile charts are a guide only. If you’re concerned about baby’s weight due to any of the following situations, then you should seek advice from a health professional or G.P:

• weight remains static for 2 weeks
• loses weight over a week
• crosses the 10th or 90th percentiles

The younger the baby, the bigger the weight lost and if the baby is already on the lower or higher margins of percentiles the more reason for concern.

Baby’s Personal Health Record book will have height and weight charts within that you can plot baby’s growth. Take them with you when you attend your Early Childhood Centre and for Doctor’s visits.

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Babies at birth have passive immunity from their mother, lasting from 3 – 6 months.

Immunisation aims to protect your baby/child from viral and bacterial organisms and the poisons (toxin) they produce. By giving a vaccine, tiny dose of the killed, altered or inactivated toxin, makes the body produce an antibody to fight the organism. This builds a defence system overwhelming the organism when it enters the body and as a result gets destroyed.

There is a vast body of research and evidence that shows that immunisation works. It is easy to obtain, effective and carries few risks.

Outbreaks of the diseases being vaccinated against, usually occur in communities where levels of immunity are low. If there is an outbreak of a particular disease approximately 1:10 children who are immunised will contract the disease but all children not immunised will get the disease. These diseases are serious illness and can be life threatening.

Concern over the side-effects of the vaccines is the cause for low immunity levels in communities. Side effects include; progressing from a small local reaction to occasionally a rare shock reaction with brain swelling. Usually:

• a red welt or swelling at the injection site
• a mild fever
• be a bit whingey
• may have a loss of appetite
• occasionally the baby will become floppy and it seems that they are unconscious

If you are at all concerned seek medical advice.

Don’t vaccinate again if the baby had:

• convulsions
• swelling of the brain
• persistent screaming > 3 hours
• a fever > 40C

Don’t vaccinate for the measles, mumps & rubella vaccine at 12months if your baby has had any of the following:

• severe infective illness
• allergy to eggs or some antibiotics
• previous severe allergic reaction
• impaired immunity
• blood transfusion

Consult your GP or Health Professional.

Also alert your doctor before the administration of the oral polio vaccine if there is an issue with the baby’s immune system or if anyone living with the family is receiving radiation, taking corticosteroids or has leukaemia or tumours.

It is strongly recommended by health professionals to immunise your baby for their safety as well as the community. Keep a record of immunisation as it is important when they start school or day care.

There is no scientific evidence that homeopathic immunisation is effective.

A guide to the immunisation schedule

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This is a huge topic and may be a little daunting but the ideal is to plan ahead and childproof your home and your outside environment before baby is mobile. By staying 1 step ahead of their development and knowing the danger areas in any place your baby will be in, will help reduce the possibility of accidents. A good idea is to be prepared for accidents.

• Learn first-aid,
• if you have a pool know resuscitation techniques,
• have emergency telephone numbers easily accessible,
• and know where your baby/child is at all times.

NSW Health has a booklet – Safety tips for young children - This outlines safety in and around the home through the various ages from birth to 5 year olds.

Go to the relevant sections on our website for a simple list of what to look out for when buying toys, bathing baby and being in the kitchen. Other areas for you to scrutinise include; dinning and living areas; bedroom; nursery; laundry; clothing baby wears; garage; water safety; gardening; outdoor play equipment; sunburn; in the car; animals.

• Age appropriate for their development
• Non-flammable & non-toxic
• Easy to wash
• Sharp objects, brittle plastic toys are to be avoided
• Check wooden toys for splinters
• Avoid heavy toys
• Seams on stuffed toys need to be checked regularly
• Walking trolleys need to be well-balanced

• Children should not be left alone in the bathroom at any age
• Babies should not be left on any surface unattended
• Bathmats, non-slip mats or strips in the bath will help prevent slipping
• Medicines should be placed high in a cupboard, preferably childproofed
• Run the cold water first then after filling the bath to cool the tap
• Test the water temperature before you put baby into the bath
• Electrical appliances, hairdryer, and razors need to be stored in childproof cupboards out of reach of children

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• Always put baby down away from the stove when cooking
• Turn saucepan handles towards the back of the stove
• Use curly cords on electrical equipment or cordless appliances
• Never leave a baby unattended when feeding them
• Don’t use tablecloths for baby to pull anything onto floor or them
• If using microwave stir and test food before giving to baby
• Feeding equipment should be unbreakable with no sharp edges
• Childproof locks and catches are available for cupboards & drawers
• Knives & scissors should be placed out of reach of children
• Close dishwasher properly to prevent access to powder in dispenser
• Prevent burns or scalds by being vigilant with hot surfaces and hot water
• Wipe up spills on floor to prevent slipping
• Have a fire blanket or extinguisher handy
  

It is recommended by most health professionals that parents should have basic first-aid and resuscitation skills. This allows you to deal with minor accidents and know what to do in emergency situations.

Organisations that run first-aid courses:

• St John Ambulance
• Red Cross
• The Royal Life Saving Society of Australia

Also have a copy of emergency numbers in a prominent place by the telephone:

• 000 – Ambulance/fire/police
• Local hospital
• Doctor
• Poisons information

Common causes of childhood emergencies include:

• Falls, crushes or violent impact
• Poisoning
• Near drowning
• Burns from hot liquids
• Severe allergies from food, bites or stings
• Choking
• Cuts from glass, knives or other sharp objects
• Electric shocks
• Very loose or knocked-out teeth
• Mouth or facial injuries
• Increasing or severe persistent pain
• Trouble with breathing
• Bleeding that does not stop
• Lips that look blue or purple
• Fitting or seizures
• Difficulty in waking a child
• Any loss of consciousness
• Bad headache
• Vomiting several times after a head injury
• Very unusual behaviour or confusion
• High temperature

If you require help:

• If it is an emergency Call 000 and ask for an ambulance
• Take them to your local hospital
• See your G.P.

First-aid kit

• First-aid book
• Adhesive tape
• Bandaids, sterile gauze pads of various sizes
• Wide gauze bandages
• Crepe bandages
• Triangular bandages
• Absorbent cotton
• Plastic bag
• Disposable gloves
• Antiseptic liquid or soap
• Liquid paracetamol
• Insect repellent
• Calamine lotion
• SPF 30+ sunscreen
• Emergency blanket
• Normal saline
• Thermometer
• Blunt ended tweezers
• Blunt/sharp scissors
• Safety pins or clips
• Hot/cold packs

Source: First-Aid Directory NSW Health

First-aid kits can be bought from:

• A Chemist
• St John Ambulance
• Australian Red Cross Society

For information on doing a First-Aid course:

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Colic
A term used by everyone for the prolonged periods of a baby crying, drawing up of their knees, screwing up of their face and looking as if they have a huge tummy ache. Yet the debate rages as to whether colic really exists and the probable cause.

It is normal for babies to have periods of unsettled behaviour in the first few weeks. The timing of colic seems to start around 5 - 6 weeks of age and disappear around 3 months. It tends to be a problem in the evenings.

Theories put forward include:

• Wind, reflux, lactose intolerance
• Parents’ emotional problems
• Poor feeding techniques
• Allergy or food intolerances
• Baby’s temperament
• Bored baby
• Over stimulated baby

Health professionals across most disciplines agree that colic has nothing to do with abdominal pain. Changes in diet and restrictions on individual foods do not seem to be of any benefit.

The first thing to check is that they are not just hungry, going through a growth spurt and require more frequent feeds. What is their weight doing?

In the first few weeks it is normal for babies to have periods of unsettled behaviour. They are reacting to a change in environment and their own bodily functions. Their discomfort usually resolved by feeding, warmth, mother’s contact and lots of cuddles.

At 5 – 6 weeks, developmentally, babies start to look around, visually absorb their environment and interact with any adult that meets their gaze. Once excited or over stimulated they become uncomfortable and haven’t the ability to calm themselves or self-soothe. This manifests as crying, wanting to suck and muscle tension – strain, push, and groan - reflexive movements. Their discomfort is relieved by parents helping babies regain their equilibrium.

At around 3 – 4 months babies can switch off and self-soothe when the stimulation and excitement become too much. If this is the case, then the cause of colic may actually be a growth and development issue, which is manageable.

The above so called theories of colic then become the symptoms not the cause. Usually baby’s intense crying provokes the response to:

• Pick them up, look at them, hand them around, bounce and jiggle them anything to stop them crying but it actually winds them up making matters worse.
• The crying baby swallows air, burps when picked up, then the crying is blamed as being a wind problem and baby needs to be burped more thoroughly. In fact babies do not need to be burped but can do this themselves quite effectively.
• Then they can’t sleep as they are over stimulated, irritable and become overtired and then may not feed effectively - hungry.
• As sucking is a comfort for babies they may want the breast more often as they are hungry but also want to use it as a dummy. Two possibilities arise from this;
  
  1. Baby may be drinking large quantities of milk with the stomach becoming very full leading to more straining, pushing, vomiting – diagnosed as reflux.
  
  2. If baby is not feeding effectively as the feeds are short and frequent an overload of lactose is possible leading to more bowel actions that are explosive (gas), farts a lot with an excoriated bottom – diagnosed as lactose intolerance.

Calming baby down:

• Take a deep breath yourself and relax – I know not easy
• Remove baby from a crowded area
• Put on some quiet restful music for both of you
• Keep lights off or low
• Feed baby so you know they are not hungry
• Wrap baby firmly in a light wrap
• Either hold baby firmly against your chest and curve them around your body
• Or place baby in their cot back rounded on their side facing the wall – you will turn baby onto their back once asleep before you leave the room
• Do not give baby any eye contact
• Whether you are holding baby or have placed baby into their cot pat baby quickly
• A dummy may help if they still want to suck
• It may take some time but keep patting with no eye contact or stimulation
• Slow the patting as baby calms down
• Slow your breathing to help you relax and if holding baby they will hook into the rhythm
• If holding baby as they calm or fall asleep then place in cot and continue patting until baby is asleep
• Perseverance and repetition is the key, it will improve
• For a couple of days have a routine that is calming so baby can sleep and the symptoms will disappear.

All babies are different so cope with different levels of stimulation. Remember that around times of increased activity for you, Christmas, Easter, birthdays, may be triggers for over excited, stimulated babies and there maybe consequences.

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Babies react differently, some become flushed, fretful and unsettled, while others are pale and lethargic.
Thermometers are inexpensive and useful to have in the house.

To help reduce baby’s temperature:

• Give baby a lukewarm bath or sponge – don’t let them get cold.
• Have baby in a cotton singlet and nappy with a cotton wrap which will be more comfortable.
• Place baby in a cool room out of breezes or draughts.
• Check baby regularly as babies chill easily.
• Give baby panadol elixir. Always give correct dosage and do not exceed the correct time between administrations.

If the temperature does not come down below 37.5C and stay down, consult a doctor.

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Coughs & colds

Most families will experience the common cold at least once a year. Babies have an immature immune system so can be susceptible to viruses. Due to the anti-viral substances in breast milk it is unusual for breastfed babies to get coughs & colds & ear infections. However, if someone in the family has a cold, the viruses are usually airborne, it is possible to infect babies. Respiratory viral infections generally are over within a few days.

Contact your doctor if concerned or if baby has any of the following symptoms:

• has a wheeze, a seal-like bark, or a chesty cough then see your doctor immediately.
• breathing is rapid – 60 or more breaths per minute
• temperature is > 38.3 or < 36 C
• is having fits or convulsions
• has fewer than 2 wet nappies a day
• jaundice is increasing after 1 week of age
• has blood in either their urine or bowel actions
• looks pale
• is drowsy & lethargic or floppy
• is refusing feeds or not taking what they normally do
• is vomiting & having diarrhoea
• is crying excessively
• just doesn’t look right.

Relieving the symptoms will make baby more comfortable.

• Lower the temperature with an infant panadol elixir. Always give correct dosage and do not exceed the correct time between administrations.
• Give baby a lukewarm bath or sponge – don’t let them get cold.
• Dress baby and wrap in a lightweight cotton clothes and wrap
• Place baby in a room out of breezes or draughts.
• If baby’s nose is blocked & interfering with feeding a drop of saline solution will help
• If baby’s eyes are watery, wipe with cooled boiled water – wipe inside to out, 1 clean cotton ball for each time or eye you do
• Small frequent feeds is sometimes easier for baby to tolerate – watch their urine output
• Humidifiers help to moisten the air – use to manufacturers instructions

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Vomiting

Vomiting is normal for a lot of babies. It can be either a small amount or large in volume. Usually, the cause is due to the normal weakness of the valve between the oesophagus and the stomach and fluid moving up and down the oesophagus. As they grow this valve strengthens. If baby is gaining weight, is happy and alert there is no cause for alarm.

See a doctor if the vomit is bright green (bile), baby’s behaviour is uncharacteristic or you are concerned. All treatment should be instigated by a doctor.

Management that might help:

• Sit baby up after feeds
• Prop the head of their bed up by placing pillows or rolled towel under the mattress
• If breastfeeding, express prior to baby feeding to remove the first letdown, the fast milk, slowing the flow
• If bottle feeding use a slow teat – always use the correct strength of formula
• Offer small frequent feeds

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Reflux

The cause of reflux is the same as vomiting which babies usually grow out of in 4 months. It needs to be treated by a doctor as problems arise when:

• The vomiting becomes more than a nuisance
• The baby’s weight is being affected
• When you feel baby’s crying is related to pain or discomfort.

Some doctors recommend:

• Baby lying on their right side with the head elevated at 30 degrees – speak with them about SIDS recommendations
• Using an antacid to reduce the irritation
• Thickening of feeds in a bottle-fed baby
• Only rarely is an operation necessary

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Diarrhoea

Diarrhoea is described as loose, watery stools/bowel motions. Seek medical advice as it might indicate a gastro virus and the danger is dehydration. Other causes include:

• Intolerance to food or drink
• Taking of medicines e.g. antibiotics
• Do not give baby any medications to stop the diarrhoea – speak with your doctor
• Where possible take a stool sample with you to the doctors.

Simple precautions can help protect your baby:

• Wash your hands after going to the toilet
• Wash your hands before handling food or bottles
• Sterilise all feeding equipment & comforters
• Careful storage of all baby’s food and bottles
• Continue to breastfeed for the protective factors in breastmilk

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Constipation

Constipation is described as hard dry stools/bowel motions (not infrequent stools).

Breastfed babies do not get constipated and it is not unusual for them to go days without a bowel motion. When they do go if it is not like rabbit pellets all is normal.

Solid foods will change the consistency of the motions.

Bottle fed babies if constipated need their formula checked to make sure the correct amount of powder to water is being used. Usually their stools are firmer than breastfed babies, going 4 times a day to once every couple of days. A small amount of cooled boiled water can be given to increase their fluid intake. If this is not working speak with your Early Childhood Nurse or G.P.

With the introduction of solids babies may become constipated. Look at the variety of solids baby is having.

• Try to increase the fruit and vegetables in their diet.
• A small amount of prune pulp or prune juice can be effective.
• Relaxation techniques, baby massages, bathing and gentle exercises may help.
• Laxatives and suppositories are not to be used unless ordered by your doctor.

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Baby’s nails are soft and sharp. The safest way to deal with them is to use a nail clipper or emery board. Many babies need their fingernails trimmed once a week.

• Hold the individual finger/toe and push the skin down and away from the nail.
• If as in newborns the skin is adhered to the nail use a soft emery board and file the nail.
• Use the clippers following the natural shape of the nail and round off the edges.
• Check each nail for rough edges and file with a soft emery board.
• Trim nails after a bath when they are soft
• Trim when baby is asleep
• Have another person help if needed
• Just do 1 hand or foot at a time if baby won’t sit still
  

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