It's surprising to most people that there are physical therapists that specialize in pediatrics, more specifically in the NICU (Neonatal Intensive Care Unit). It's extremely common for PT's to work with babies within the first few hours after delivery to check reflexes and help ensure range of motion after delivery. Listed below are some physical conditions that are especially common during the first couple of weeks after birth.
Most babies’ bellies normally stick out, especially after a large feeding. Between feedings, however, they should feel quite soft. If your child’s abdomen feels swollen and hard, and if he has not had a bowel movement for more than one or two days or is vomiting, call your pediatrician. Most likely the problem is due to gas or constipation, but it also could signal a more serious intestinal problem.
It is possible for babies to be injured during birth, especially if labor is particularly long or difficult, or when babies are very large. While newborns recover quickly from some of these injuries, others persist longer term. Quite often the injury is a broken collarbone, which will heal quickly if the arm on that side is kept relatively motionless. Incidentally, after a few weeks a small lump may form at the site of the fracture, but don’t be alarmed; this is a positive sign that new bone is forming to mend the injury.
Muscle weakness is another common birth injury, caused during labor by pressure or stretching of the nerves attached to the muscles. These muscles, usually weakened on one side of the face or one shoulder or arm, generally return to normal after several weeks. In the meantime, ask your pediatrician to show you how to nurse and hold the baby to promote healing.
Babies may have mildly blue hands and feet, but this may not be a cause for concern. If their hands and feet turn a bit blue from cold, they should return to pink as soon as they are warm. Occasionally, the face, tongue, and lips may turn a little blue when the newborn is crying hard, but once he becomes calm, his color in these parts of the body should quickly return to normal. However, persistently blue skin coloring, especially with breathing difficulties and feeding difficulties, is a sign that the heart or lungs are not operating properly, and the baby is not getting enough oxygen in the blood. Immediate medical attention is essential.
If the baby drinks very fast or tries to drink water for the first time, he may cough and sputter a bit; but this type of coughing should stop as soon as he adjusts to a familiar feeding routine. This may also be related to how strong or fast a breastfeeding mom’s milk comes down. If he coughs persistently or routinely gags during feedings, consult the pediatrician. These symptoms could indicate an underlying problem in the lungs or digestive tract.
All newborns cry, often for no apparent reason. If you’ve made sure that your baby is fed, burped, warm, and dressed in a clean diaper, the best tactic is probably to hold him and talk or sing to him until he stops. You cannot “spoil” a baby this age by giving him too much attention. If this doesn’t work, wrap him snugly in a blanket.
You’ll become accustomed to your baby’s normal pattern of crying. If it ever sounds peculiar—for example, like shrieks of pain—or if it persists for an unusual length of time, it could mean a medical problem. Call the pediatrician and ask for advice.
When forceps are used to help during a delivery, they can leave red marks or even superficial scrapes on a newborn’s face and head where the metal pressed against the skin. These generally disappear within a few days. Sometimes a firm, flat lump develops in one of these areas because of minor damage to the tissue under the skin, but this, too, usually will go away within two months.
Many normal, healthy newborns have a yellowish tinge to their skin, which is known as jaundice. It is caused by a buildup of a chemical called bilirubin in the child’s blood. This occurs most often when the immature liver has not yet begun to efficiently do its job of removing bilirubin from the bloodstream (bilirubin is formed from the body’s normal breakdown of red blood cells). While babies often have a mild case of jaundice, which is harmless, it can become a serious condition when bilirubin reaches what the pediatrician considers to be a very high level. Although jaundice is quite treatable, if the bilirubin level is very high and is not treated effectively, it can even lead to nervous system or brain damage in some cases, which is why the condition must be checked for and appropriately treated. Jaundice tends to be more common in newborns who are breastfeeding, most often in those who are not nursing well; breastfeeding mothers should nurse at least eight to twelve times per day, which will help produce enough milk and help keep bilirubin levels low.
Jaundice appears first on the face, then on the chest and abdomen, and finally on the arms and legs in some instances. The whites of the eyes may also be yellow. The pediatrician will examine the baby for jaundice, and if she suspects that it may be present—based not only on the amount of yellow in the skin, but also on the baby’s age and other factors—she may order a skin or blood test to definitively diagnose the condition. If jaundice develops before the baby is twenty-four hours old, a bilirubin test is always needed to make an accurate diagnosis. At three to five days old, newborns should be checked by a doctor or nurse, since this is the time when the bilirubin level is highest; for that reason, if an infant is discharged before he is seventy-two hours old, he should be seen by the pediatrician within two days of that discharge. Some newborns need to be seen even sooner, including:
- Those with a high bilirubin level before leaving the hospital
- Those born early (more than two weeks before the due date)
- Those whose jaundice is present in the first twenty-four hours after birth
- Those who are not breastfeeding well
- Those with considerable bruising and bleeding under the scalp, associated with labor and delivery
- Those who have a parent or sibling who had high bilirubin levels and underwent treatment for it
When the doctor determines that jaundice is present and needs to be treated, the bilirubin level can be reduced by placing the infant under special lights when he is undressed—either in the hospital or at home. His eyes will be covered to protect them during the light therapy. This kind of treatment can prevent the harmful effects of jaundice. In infants who are breastfed, jaundice may last for more than two to three weeks; in those who are formula-fed, most cases of jaundice go away by two weeks of age.
Lethargy and Sleepiness
Every newborn spends most of his time sleeping. As long as he wakes up every few hours, eats well, seems content, and is alert part of the day, it’s perfectly normal for him to sleep the rest of the time. But if he’s rarely alert, does not wake up on his own for feedings, or seems too tired or uninterested to eat, you should consult your pediatrician. This lethargy—especially if it’s a sudden change in his usual pattern—may be a symptom of a serious illness.
It may take your baby a few hours after birth to form a normal pattern of breathing, but then he should have no further difficulties. If he seems to be breathing in an unusual manner, it is most often from blockage of the nasal passages. The use of saline nasal drops, followed by the use of a bulb syringe, are what may be needed to fix the problem; both are available over the counter at all pharmacies.
However, if your newborn shows any of the following warning signs, notify your pediatrician immediately:
- Fast breathing (more than sixty breaths in one minute), although keep in mind that babies normally breathe more rapidly than adults.
- Retractions (sucking in the muscles between the ribs with each breath, so that her ribs stick out)
- Flaring of her nose
- Grunting while breathing
- Persistent blue skin coloring