On the day of discharge, I often observe the mixed emotions that flash across new parent’s faces when they realize they are leaving the nursing home and the tiny bundle is all theirs to care for. Having spent some time in hospital surrounded by professionals and other parents makes the first couple of days fairly secure, so the announcement that I will see them again at six weeks of age seems daunting. Once home please ensure that you book your appointment for the six week check-up as soon as possible. If you delay this then it may be difficult for the healthcare professional to accommodate you on the day or time that best suites you.
Well believe it or not the day finally arrives when proud parents arrive in my practice for the first developmental check-up post discharge. (Please don’t suffer through the six weeks. You are welcome to contact your healthcare professional any time before this if you have questions or concerns.) The first consultation is always a proud moment. In most instances, the family has settled into a routine and things are becoming a little easier. Baby has also probably begun smiling. What a heart-warming response to all the love, care and sleepless nights. It is so precious that somehow the hard work and exhaustion all becomes worth-it.
What to expect
There are very specific things that a paediatrician is concerned with at the six-week check-up. For this reason, I encourage parents to make a list of questions that they would like discussed as well. Very often the parents become overwhelmed by all that is going on and the questions asked by the paediatrician that they forget to get feedback on their concerns.
General discussion:
The consultation generally begins with an informal discussion around how everyone has coped since arriving home. The paediatrician will ask about feeding, sleep, urine output, bowel action and safety with particular reference to car chairs. Other important areas for discussion will be immunisations and relevant screening for sight and hearing.
The examination:
Next comes the physical examination of your baby. Top of the list will be your baby’s growth so the weight, length and head circumference will be measured and plotted on the growth chart. Between birth and six weeks of age, your newborn has to adjust to the transition from foetal life and life in the external world. The paediatrician checks all the systems of the body in order to make sure that this transition has occurred.
The other areas of importance are:
Developmental milestones:
- Smiles/ some babies may laugh
- Turns head and eyes to sound
- Regards face
- Looks at own hands
- Hands meet in midline
- Follows past the midline
- While lying on tummy is able to lift head to 45°
- Equal movement on both sides of the body
- Cooing
There are general topics that are raised by parents at the six-week to eight week check-up.
Increased feeding
Around the time of the check-up a lot of mothers’ notice that the baby has begun feeding a lot more frequently and may be less easily satisfied. This is of particular concern to mothers who are breast feeding. In my experience babies go through a tremendous growth spurt at the age of six weeks and again closer to 12 weeks of age. Mothers often feel that they are losing their milk or that they don’t have enough milk. This is most often not the case. The mom just needs a few days for her body to respond to the increased demand for milk. Remember it is not the length of time that the baby spends on the breast that increases the milk production but the frequency that the baby is brought to the breast. I advise mother’s to rather feed more regularly during this time than to hurt their nipples with long, drawn out feeds that leaves both mom and baby exhausted. Your body is amazing and will respond as long as you are drinking lots of fluids and taking time to rest as well.
Encouraging good sleep patterns
The other big question relates to sleep. It is vital that babies get used to being put down to go to sleep. This will establish better sleep patterns as baby gets older. Obviously, there are things that disturb babies once they are down. You may need to lift baby to bring up a wind or simply pop baby on the other side if he or she has been lying in one position for a period of time. They simply want to be made comfortable and don’t necessarily need to be held. You may notice as well that your baby begins having times at night when he or she sleeps for longer periods. This often begins with them dropping the 10pm feed meaning that they can sleep from around 7pm to about 1am. This we call core sleep. If you do notice this pattern for a few nights in a row allow baby to sleep through these times. If baby has had good weight gain, is feeding regularly during the day and has had a good feed before going down to bed then this is an indication of baby establishing a core period of sleep. Going forward you may leave your baby to settle alone if he or she wakes during the core sleep period. That means that if baby awakes at this time don’t rush in immediately. Give some time for baby to try and settle without interference. Only if baby doesn’t settle should you offer a dummy, a little pat or a sip of water. It shouldn’t be necessary to feed unless you suspect baby is having a growth spurt and has been demanding additional feeds during the day as well.
Vaccinations
Baby will also be due for the six-week vaccinations. The World Bank has stated that “after clean water, immunisation is the most cost effective public health measure”. Your paediatrician or clinic sister is equipped to answer all your questions related to the vaccines, the diseases they protect against and the possible side effects. Parents must ensure that they are well educated on this topic as immunisations prevent the most devastating diseases but also are a cause for concern for some parents. There is a lot of information available but please ensure you receive it from credible, educated sources.
Development and stimulation
Finally parents often want to know how they can best help baby develop. At this age babies do still sleep for long periods but you will begin to experience longer periods of wakefulness. These are lovely times for bonding and interacting. I would encourage parents to spend time talking to their babies, showing them the world around them and encourage a lot of tummy time. A baby develops neck control, learns to reach for items and this will be the best position for your baby to be in for crawling. Babies do often complain in this position but if you stimulate them with a rattle or showing them themselves in a mirror or allowing a sibling to chat to them then this will become an enjoyable time. There is so much that one can do from now on. Many books and articles have been written on the subject. There are also a number of resource materials on the market. One that I have found to be particularly good is a DVD series called “Baby’s sensory world”. The DVD has been produced by Clamber Club and features Kate Baily, a very experienced occupational therapist. The 0-3-month DVD would be particularly helpful here as Kate explains the various areas of development relevant to this age group and gives practical ideas on how to encourage such development.
What about us?
Most importantly take time to enjoy your baby. So much will change between now and your next visit at 12 weeks. In between looking after baby, mothers and fathers must remember to look after one another as well. A happy baby is always found in a happy home. You are allowed to take time out for each other. In fact, I would highly recommend date night, if not once a week them at least every two weeks.
