COMMON PROBLEMS
By Dr. Harry Zehnwirth
MB BS (Hons) FRACP. Paediatrician.

Introduction
The following information is provided as basic and general advice. It is based on the usual manifestations and outcomes of common and relatively minor conditions that may present as a problem in a newborn baby. It must be acknowledged however, that any concerns you have about the well-being of your baby should be discussed with your family doctor or other health care professional.

The general information provided should not be used as a substitute for the advice of your doctor or other health care professional. Individual differences characterise all conditions and while this information can be a guide, professional assessment of your baby's condition, which presents as a concern to you, cannot be underestimated for reassurance.

The issues discussed here are probably just a fraction of the information you want to know or understand as a new parent. Experience and getting to know your baby can be characterised by times of uncertainty. Further information, exploring the strategies for settling a fussy or irritable baby, is the focus of a book which accompanies our 'Sounds for Silence' CD. Links to helpful websites are also provided for your information on our homepage.

Some of the common minor problems that may affect newborn babies and may be of concern to you may include:

Reflux (or Posseting)
All babies regurgitate their milk feeds from time to time. The important distinguishing factor here is that regurgitation, or reflux is effortless vomiting, rather than forceful vomiting. Forceful vomiting does require family doctor's attention, whereas reflux is more of a nuisance in most instances.

Reflux is due to the immaturity of a valve at the top of the stomach, and this valve in babies allows the escape of milk back up the gullet (oesophagus) and into the mouth. The valve usually matures by itself in the first few months of life.

Significant reflux should be assessed by your doctor. If your baby is diagnosed as having reflux there are options available to help manage the problem.

Two simple measures can be carried out to minimize the degree of reflux, but perhaps without achieving a cure, include:
• Placing your baby in his or her cot following a feed with slight elevation of the top half of the body by putting
some form of padding under the cot mattress.
• If your baby is being bottle-fed, adding 1-4 teaspoons of rice cereal to a bottle of milk (150-250 ml.), and thereby
thickening the feed, you encourage the force of gravity to keep the feed in the stomach.
• You could try infant Gaviscon powder added to bottle feeds, or alternatively Gaviscon liquid prior to breast-feeds.
Gaviscon is a milk thickener, but it also protects the gullet from heartburn.
• Cow's milk protein intolerance may contribute to the problem of reflux, and a switch in formula for bottle-fed babies
to soy or protein hydrolysate may be helpful. If breast feeding, consider removing all dairy products from your diet
for a week.

Reflux is only a concern if it is complicated by inflammation of the gullet, manifested by irritability and pain, or failure to gain adequate weight. Even if your baby refluxes with each feed, and even though it may seem to be a fairly significant amount, almost all babies with reflux gain weight adequately, and have no complications whatsoever of the condition. As mentioned earlier, reflux resolves spontaneously usually over the first few months of life.

Occasionally babies will reflux and choke and this can be a particularly frightening experience for all.

Reflux With Choke
This is one of those scary things that can happen to babies. Your baby may vomit or regurgitate, and then choke. At such times, babies may stop breathing, go blue, perhaps become stiff, look frightened or even then become pale and floppy. These episodes are scary to anyone that witnesses them. However, they are not dangerous. Infants will always be able to work themselves around this sort of episode on their own, even if they are in the bassinet or cot by themselves.

If you witness an episode, simply pick your baby up, and cuddle him or her against your chest. Your baby will spontaneously be able to revert back to normal breathing and good colour. You do not need to tap the back, put your finger in the mouth, or intervene in any other way.

Concluding Remars
What has become abundantly clear to me over many years as a Paediatrician is that parenthood is not always the easy, happy, rewarding, relaxing, fulfilling and exhilarating activity that many media sources and contemporary drama may portray. Parenting certainly can be all these wonderful things from time to time, but I also see many exhausted, despondent and frustrated parents, and I hasten to say that they are generally very, very, good parents. I guess one of the greatest difficulties for mothers and fathers, particularly with their first child, is that uncertainty of what is going on. It can be exasperating not to know exactly what your baby is trying to tell you. And all this is complicated by all the conflicting advice you are constantly hearing from well meaning family, friends and counselors.

There is one bit of advice that I very rarely hear, but which I think is so important that it is worth stating in the last paragraph.

Assuming that you are confident your infant does not have a significant physical problem at the time, and has something like minor irritability or fussiness, you may still feel unsure of what to do about your unsettled baby. I urge you, rather than being confused by all the conflicting advice, to which you are bound to be exposed, listen to your own feelings. Trust your own maternal and paternal instincts, and do what you feel is best for both your baby and yourself. Trust your intuition.

Good Luck

Copyright 2007
Harry Zehnwirth