Question and Answers on Jaundice and Your Newborn

Hi,
For all the 'new' parents, the american academy of pediatrics has come up with some new guidelines for jaundice in the newborns, and given below is the common frequently asked questions for the same.
The following Frequently Asked Questions" (FAQs) are from the American Academy of Pediatrics (AAP).
Published on 25th June 2004
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Congratulations on the birth of your new baby!
To make sure your baby’s first week is safe and healthy, it is important that:

Your baby is checked for jaundice in the hospital.
If you are breastfeeding, you get the help you need to make sure it is going well.
Your baby is seen by a doctor or nurse at 3 to 5 days of age.
Here is some information about jaundice. (Please note: A Spanish version will be available late July 2004.)

Q: What is jaundice?
A: Jaundice is the yellow color seen in the skin of many newborns. It happens when a chemical called bilirubin builds up in the baby’s blood. Jaundice can occur in babies of any race or color.


Q: Why is jaundice common in newborns?
A: Everyone’s blood contains bilirubin, which is removed by the liver. Before birth, the mother’s liver does this for the baby. Most babies develop jaundice in the first few days after birth because it takes a few days for the baby’s liver to get better at removing bilirubin.


Q: How can I tell if my baby is jaundiced?
A: The skin of a baby with jaundice usually appears yellow. The best way to see jaundice is in good light, such as daylight or under fluorescent lights. Jaundice usually appears first in the face and then moves to the chest, abdomen, arms, and legs as the bilirubin level increases. The whites of the eyes may also be yellow. Jaundice may be harder to see in babies with darker skin color.


Q: Can jaundice hurt my baby?
A: Most infants have mild jaundice that is harmless, but in unusual situations the bilirubin level can get very high and might cause brain damage. This is why newborns should be checked carefully for jaundice and treated to prevent a high bilirubin level.


Q: How should my baby be checked for jaundice?
A: If your baby looks jaundiced in the first few days after birth, your baby’s doctor or nurse may use a skin test or blood test to check your baby’s bilirubin level. A bilirubin level is always needed if jaundice develops before the baby is 24 hours old. Whether a test is needed after that depends on the baby’s age, the amount of jaundice, and whether the baby has other factors that make jaundice more likely or harder to see.


Q: Does breastfeeding affect jaundice?
A: Jaundice is more common in babies who are breastfed than babies who are formula-fed, but this occurs mainly in infants who are not nursing well. If you are breastfeeding, you should nurse your baby at least 8 to 12 times a day for the first few days. This will help you produce enough milk and will help to keep the baby’s bilirubin level down. If you are having trouble breastfeeding, ask your baby’s doctor or nurse or a lactation specialist for help. Breast milk is the ideal food for your baby.


Q: When should my newborn get checked after leaving the hospital?
A: It is important for your baby to be seen by a nurse or doctor when the baby is between 3 and 5 days old, because this is usually when a baby’s bilirubin level is highest. The timing of this visit may vary depending on your baby’s age when released from the hospital and other factors.


Q: Which babies require more attention for jaundice?
A: Some babies have a greater risk for high levels of bilirubin and may need to be seen sooner after discharge from the hospital. Ask your doctor about an early follow-up visit if your baby has any of the following:

A high bilirubin level before leaving the hospital
Early birth (more than 2 weeks before the due date)
Jaundice in the first 24 hours after birth
Breastfeeding that is not going well
A lot of bruising or bleeding under the scalp related to labor and delivery
A parent or brother or sister who had high bilirubin and received light therapy

Q: When should I call my baby’s doctor?
A: Call your baby’s doctor if:

Your baby’s skin turns more yellow.
Your baby’s abdomen, arms, or legs are yellow.
The whites of your baby’s eyes are yellow.
Your baby is jaundiced and is hard to wake, fussy, or not nursing or taking formula well.

Q: How is harmful jaundice prevented?>
A: Most jaundice requires no treatment. When treatment is necessary, placing your baby under special lights while he or she is undressed will lower the bilirubin level. Depending on your baby’s bilirubin level, this can be done in the hospital or at home. Jaundice is treated at levels that are much lower than those at which brain damage is a concern. Treatment can prevent the harmful effects of jaundice.

Putting your baby in sunlight is not recommended as a safe way of treating jaundice. Exposing your baby to sunlight might help lower the bilirubin level, but this will only work if the baby is completely undressed. This cannot be done safely inside your home because your baby will get cold, and newborns should never be put in direct sunlight outside because they might get sunburned.


Q: When does jaundice go away?
A: In breastfed infants, jaundice often lasts for more than 2 to 3 weeks. In formula-fed infants, most jaundice goes away by 2 weeks. If your baby is jaundiced for more than 3 weeks, see your baby’s doctor.

Find more information on neonatal jaundice from Charak Clinics

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Does your child R.A.P. ?

Hi,
This article does NOT refer to the musical preferences of today's kids. Rather it deals with another common problem that almost 10-20% of school-going children have.. RAP or Recurrent Abdominal Pain.
Does my child have it?
Almost all kids have abdominal pain at some point of time, however RAP is defined as 3 episodes of abdominal pain over 3 months or more, interfering with daily activities like going to school etc.
What causes RAP?
Only around 10 % of RAP are caused by organic (physical) causes, the rest 90% are functional. This means that once the physical examination & basic lab tests are normal, you can be pretty confident that there is nothing wrong in the child's abdomen.
It is interesting to note that an Indian study has shown that children with functional RAP are likely to belong to a nuclear family, have history of marital fights between parents, irritable bowel syndrome and chronic painful disorders and maternal dysmneorrhoea in the family. School tantrums (before going to school) , absenteeism and punishments in shchool were more common among these children too. Generally sleep was not afffected in these kids. There was however no difference in school performance from their peers. All this indicates that family and school stressors may play a significant role in causing RAP.
What tests are needed to confirm the diagnosis?
In most cases only complete blood count, Stool & urine examination (three times each), and maybe an X ray/ Ultrasound abdomen will suffice to confirm the diagnosis. More expensive & invasive tests are not indicated routinely.
What is the treatment?

Reassurance is the KEY for the parents (and the child). Telling them that there is nothing wrong physically with the child is very important. Of course this does not mean that the child is lying, the pain is real, but the cause is not in the abdomen. Sometimes, simple distraction by telling the child that the parent has been 'taught' how to take care of the problem (like blowing on the abdomen) can bring about wonderful results. A psychological evaluation for stressors maybe useful. Medicine use should be avoided as far as possible.

Welcome to India, traveler: Vaccination & health tips

Are you an NRI visiting India after a long time?
Or are you a tourist wanting to see the some of the most beautiful history in the world?
Please come to see the Taj Mahal, Forts of Rajasthan, Ajanta & Ellora caves, beaches of Goa & Kerala & so much more!
But before you reach here please remember to check with your pediatrician as to the status of the following vaccines for your kids.
Hepatitis A vaccination (Avaxim, Havrix, Travel shot) is recommended for both adults as well as kids traveling to India. The first dose of hepatitis A vaccine should be administered at least 2 (and preferably 4) weeks prior to departure. The first dose of the hepatitis A vaccine series provides rapid protection against hepatitis A. Travelers should complete the vaccine series as recommended to ensure long-term protection, using an accelerated schedule if necessary. 
Typhoid vaccination is also a good idea since it is transmitted by contaminated food & water.
Both typhoid & hepatitis A vaccines are NOT routinely given in the US and other developed countries but these diseases are very common in India and other developing countries.
It is assumed here that your child is already on a regular vaccination schedule featuring DPT, Hib, Hepatitis B, MMR vaccines and may even have received optional vaccines like Chicken Pox etc. 
Yellow fever vaccine is NOT required unless you are coming from a yellow fever endemic countrylike the Sub-sahara africa or Central America. India does not have yellow fever.
Cholera vaccine may be needed if there is an ongoing cholera epidemic in the area you wish to travel (generally cholera occurs in the monsoons months of June to September in epidemic form, transmitted by unclean water). Japanese Encephalitis maybe indicated only in special situations like epidemics, while Rabies vaccine maybe taken if likely exposure to animals. 

Remember that all vaccines should be ideally taken at least 4-6 weeks before travelling for maximum effect

Malaria prophylaxis should be started before arriving in India and continued after reaching back. Use personal mosquito repellants creams (containing DEET), mosquito nets, insect sprays and electronic repellants in malaria endemic region. Not only will these protect you from Malaria but also Dengue, Filaria and Japanese encephalitis as well.
 
Common tips for the visitor:

• Drink bottled water of reputed brands like Bisleri, Aquafina, etc.
• Packaged fruit juices & cold drinks maybe consumed.
• Avoid cut fruits, tap water, spicy food, roadside vendors, ice cubes, fountain drinks even with all the temptation to just ‘taste’ the local delicacy.
• In case bottled water is unavailable carry 1 micron filter, and iodine tablets for purifying the water.
• Carry vomiting medications like Metaclopramide (Perinorm)/ Ondansetron (Emeset); ORS solutions; Abdominal pain medications like Meftal spas, and antibiotics for traveller’s diarrhea ‘delhi belly’ like Ciprofloxacin while traveling to remote tourist spots. In bigger towns almost all these medicinces are easily available over the counter.
• While in hot tropical areas consume lot of fluids to avoid heat stroke, stay in the shade, use sunscreens and hats and sunglasses.
• Wear long sleeved shirts, long pants to prevent insect bites
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Carry all your prescription medicines, and the prescription too

Once again all travelers coming to our beautiful India Namaste, Dhanyavad plus have a safe and enjoyable trip!  

See latest CDC information on travel to india