LITTLE THINGS M MMY - Pfizer Pro · 2019-09-10 · Pregnancy is a time of great happiness for any couple. Every parent wishes to do everything possible to ensure a smooth pregnancy

M MMYSHOULD KNOW

LITTLE THINGS

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Pregnancy is a time of great happiness for any couple. Every parent wishes to do everything possible to ensure a smooth pregnancy and a healthy baby and mother. However, it is also a time when you are full of questions. It is important to follow your judgement along with the doctor's advice to keep an eye out for any problems occurring during pregnancy.

CONTENTSNew Mom

Your New-born

How to Breastfeed

Breastfeeding - Are You Finding It Di�cult?

Growth Chart and Baby Development

Shield Your Baby

04

09

14

21

23

32

M MMYSHOULD KNOW

LITTLE THINGS

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NEW MOM

Things One Must Know Before Leaving the Hospital

Becoming a mother is an emotional and

life altering experience. For many

mothers, the excitement and joy of

holding the new baby far outweighs the

challenges that taking care of a newborn

brings.

However, as a new mom, there are a few

essential aspects that one must know to

enter smoothly this new phase of life.

a. Care of stitches

• In case the stitches are sore and uncomfortable, contact your doctor.

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b. Using the washroom

• In case of di�culty in passing urine, contact your doctor.

• Eat a balanced diet and drink plenty of water to prevent constipation.

c. Bleeding

• Initially, bleeding continues for the next few days after childbirth. This is normal and termed as lochia.

• The lochia changes from red to white in color in 2-3 weeks, reduces in quantity and eventually stops.

• Do not use tampons for this as they can cause infections.

• Losing blood in the form of large clots needs medical attention.

• If the bleeding starts to increase again, then report this to your doctor.

• On noticing any of these signs or symptoms, immediately contact the nearest doctor or gynaecologist.

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Pain in the lower abdomen Shortness of breath

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CHANGES IN LIFESTYLEThe introduction of a new baby demands a drastic change in a new mom's lifestyle especially in the initial weeks as the baby will need most of the mother's attention.

Excess vaginal bleeding Fainting

Blurry vision

07

a. Diet

Eat a varied, healthy and balanced diet.

• Have lots of water before and after feeding

c. Foods to avoid

• Avoid too much ca�eine i.e. strong tea

• or co�ee, energy drinks, etc.

References:1. The pregnancy book. London, UK: Department of Health, NHS;2009. [Internet] Available at: https://www.stgeorges.nhs.uk/wp-content/uploads/2013/11/ Pregnancy_Book_comp.pdf. Accessed on: 22.03.19.

2. My safe motherhood- booklet for expecting mothers. National Health Mission. India; Ministry of Health and Family Welfare. [Internet] Available at: http://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/my_safe_motherhood_booklet_english.pdf. Accessed on: 22.03.19.

3. Dietary guidelines For Indians- A manual. National Institute of Nutrition; Hyderabad, India. 2nd Ed.2011.[Internet] Available at: http://ninindia.org/DietaryGuidelinesforNINwebsite.pdf. Accessed on: 22.03.19.

Do you know aboutPneumococcal disease?

Choose Wisely

Pfizer Limited. The Capital, 1802/1901, Plot No. C-70, G Block, Bandra-Kurla Complex, Bandra (East),Mumbai 400 051.

Yes No

Ask your pediatrician about Pneumococcal disease and

which Pneumococcal vaccine is right for your child.

Do you know aboutPneumococcal disease?

Choose Wisely

Yes No

Ask your pediatrician about Pneumococcal disease and

which Pneumococcal vaccine is right for your child.

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09

YOUR NEW BORN• Immediately after birth, the baby is transferred onto the

mother's breast, to develop skin-to-skin contact & bond with the mother. Newborns rapidly learn to co-ordinate sucking and breathing in the first few days of life. This also helps in early milk secretion.

• The baby is dried and wrapped at birth and covered, especially the head and feet.2

• The baby must pass first stools within the first 24 hours and first urine within the first 48 hours itself.

• Interact with the baby as every moment the baby is learning from the mother.

• Never place the child on the side, always place it on the back so that it doesn't choke.

• Nothing should be applied on the umbilical cord stump.

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a. Urine

2-3 wet nappies are seen in the first 48 hours. After day 5, there will be at least 6 wet nappies every 24 hours.

b. Weight

Initially, most babies lose weight up to day 3 to 5. Babies start gaining weight after that, and the birth weight is regained in the first 2 weeks naturally.

c. Stools

Initially, black tar-like stool (poop) is passed by the baby called meconium. Around day 3, stools change to lighter, greenish, and runnier stools, which are easy to clean. The baby should pass at least two yellow stools from the 4th day till the first few weeks.

CHANGES OCCURRING IN YOUR BABY'SBODY AFTER BIRTH

Brown Green Yellow

Black Grey or white Red or Blood stained

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d. Baby cry

Check for these reasons - hunger, temperature not tolerable, tired and not able to sleep, lonely wanting company, bored and wants to play, wet diaper, gas, colic or fright.

please consult your doctor if you notice any of these problems.

COMMON PROBLEMS IN A NEWBORN

COLICExcessive crying,

but otherwise thriving baby,

may be having a colic.

The baby has nofeeding issues

and gains weightnormally.

Upsetting for parents.

It can last forsome weeks.

JAUNDICEIs common at

three days age.

Causes discoloration of skin and eyes to

yellow color.

It might take 10 ormore days to

resolve.

Severe cases(continues for

over two weeks), need light therapy.

BLEEDINGLook out for anybleeding either from the stump of the umbilical

cord or from the nose.

DIARRHEA/VOMITINGSubstantial part

of feeds are thrown up or

there is watery diarrhea for over

2 weeks, it indicates that the baby is losing too much fluid.

Needs prompttreatment.

References:1. The pregnancy book. London, UK: Department of Health, NHS; 2009. [Internet] Available at: https://www.stgeorges.nhs.uk/wp-content/uploads/2013/11/Pregnancy_Book_comp.pdf. Accessed on: 22.03.19.

2. My safe motherhood- booklet for expecting mothers. National health Mission. India; Ministry of Health and Family Welfare. [Internet] Available at: ttp://nhm.gov.in/images/pdf/ programmes/maternal-health/guidelines/my_safe_motherhood_booklet_english.pdf. Accessed on: 22.03.19.

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On seeing any of these signs in your baby, immediately contact a pediatrician.

• Baby crying for hours continuously,1 or in an unusual manner

• Baby turning blue or very pale,1,2 or yellow

• Breathing is quick, di�cult or grunting or unusual periods of breathing

• Baby is unusually drowsy or doesn't seem to recognize you

• A rash which does not fade and1 blanch when pressed

• Loose motions

PROBLEMS REQUIRING IMMEDIATE MEDICAL ATTENTION


Do you know aboutPneumococcal vaccines?

Choose Wisely

Yes No

Spend some time with your

pediatrician discussing vaccines againstPneumococcal disease.

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14

Before milk flows from a new mom's breasts, the thick and yellowish breast 2 milk, which is secreted in the first 2-3 days is called colostrum. This 'first milk' protects the new born from infections as it contains high concentration of protective immunoglobulins and white blood cells. Do not discard the colostrum.

One must feed immediately after birth, within the 1st hour, in the delivery room itself by the breast crawl method.

COLOSTRUM

HOW TO BREASTFEED

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COLOSTRUM

ontainsBenefits tothe baby

• Complete food, species specific

• Easily digested and well absorbed

• Protects againstinfection

• Promotes emotionalboanding

• Better brain growth

Benefits toMother

• Helps in involutionof uterus

• Delays pregnancy

• Lowers risk of breast and ovarian cancer

• Decreases mother's work load

• Saves money

• Promotes family planning

• Decreases need for hospitalization

• Contributes to child survival

Benefits to family and

society

Helping a Mother to Breastfeed

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16

The World Health Organization (WHO) recommends exclusive breastfeeds for the first 6 months of life.

a. infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.

b. During the 2nd year of life, one must breastfeed at least 4-6 times in 24 hours, including night feeds.

c. One may start complementary feeding after 6 months age along with breastfeeding.

HOW LONG SHOULD ONE BREASTFEED,AND WHEN TO INTRODUCE OTHER FOODS?

a. Feed in a sitting or lying position.

b. Clean the hands and breasts before each feed.

c. The baby's head should always be supported by the mother's forearm and hands; the baby's head and body should be straight.

d. Using the first finger, support the breast with the thumb above the areola (pigmented area around the nipple). Do not keep the fingers near the nipple as this may su�ocate the baby.

POSITIONS DURING BREASTFEEDING

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a. Express a little milk on the nipples and touch the baby's lips to it.

b. Wait for the baby's mouth to open wide, with the tongue placed down and forward.

c. Quickly move the baby onto the breast, with the nipple towards the baby's palate and the lower lip well below the nipple.

d. The baby should take many slow deep sucks before swallowing, and then pause.

e. Feed the baby on one breast, then switch to the other, after he/she leaves the nipple on his own.

LATCHING TECHNIQUES AND SIGNS OFGOOD ATTACHMENT

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One must breastfeed only whenever the baby is hungry and gives cues. This is called on-demand breast feeding. One may feed the baby at least 8-10 times in 24 hours. More breast milk is produced if the baby is frequently breastfed.

Keep a time interval of 2 to 3 hours between each feed. Ensure that night feeds are not vomited.

FREQUENCY OF FEEDING

Good Attachment Poor Attachment

EARLY CUES:

• Rapid eye movement

• Sucking movements and sounds

• Lip smacking

• Restlessness

• Licking the hand

LATE CUES:

• Cooing

• Sighing

• Crying

BREASTFEEDING

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The baby is receiving adequate milk supply if it does the following:

• Passes urine 6-8 times in 24 hours

• Sleeps for 2-3 hours after a feed

• Gains adequate weight

CHECKING THAT THE BABY IS RECEIVINGADEQUATE MILK

References:1. My safe motherhood- booklet for expecting mothers. National Health Mission. India; Ministry of Health and Family Welfare. [Internet] Available at: http://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/my_safe_motherhood_booklet_english.pdf. Accessed on: 22.03.19.

2. Resource document on newborn and neonatal care of children: A report. New Delhi, India; 2016. National Institute of Public Cooperation and Child Development. [Internet] Available at: http://nipccd.nic.in/reports/neo.pdf. Accessed on: 22.03.19.

3. World Health Organization. Nutrition. Breastfeeding. Available at: https://www.who.int/ nutrition/topics/exclusive_breastfeeding/en/ Accessed on: 22.03.19.

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Is your child vaccinatedagainst Pneumococcal

diseases?

Choose Wisely


Yes No

Ask your pediatrician

which Pneumococcal vaccine is rightfor your child

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21

The new born has an inborn sucking reflex that helps it suck. Here are some common di�culties a new mom might face and tips to overcome them.

BREASTFEEDING - ARE YOU FINDING IT DIFFICULT?

Common causes include feeding bottles, lack of experience and skilled support. This results in painful, damaged or sore nipple, swollen breast, insu�cient breast milk production leaving the infant unsatisfied. Inverted or flat nipples, sore nipples, engorged breast and breast abscess are common conditions that a new mom might experience. An obstetrician can help you treat these and continue feeding the baby.

Common causes of lack of milk production include too short, infrequent or hurried breastfeeding practice; poor position; breast engorgement or mastitis.Other common problems include too much or too little milk, mastitis (breast inflammation), and blocked milk duct for which you must visit an obstetrician.2

LATCHING DIFFICULTIES

References:1. Resource document on newborn and neonatal care of children: A report. New Delhi, India; 2016. National Institute of Public Cooperation and Child Development. [Internet] Available at: http://nipccd.nic.in/reports/neo.pdf. Accessed on: 22.03.19.

2. Breastfeeding problems. Your pregnancy and baby guide. London, UK: Department of Health, NHS; 2016. [Internet] Available at: https://www.nhs.uk/conditions/ pregnancy-and-baby/problemsbreastfeeding/? Accessed on: 22.03.19.

Do you know which Pneumococcalconjugate vaccine provides broad

coverage against Pneumococcal disease?

Choose Wisely


Yes No

Spend some time with your

pediatrician discussing vaccines againstpneumococcal disease.

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WHAT IS A GROWTH CHART?The growth chart records weight up to 5 years and is based on World Health Organization (WHO) Child Growth Standards. Pink and blue colored growth charts are used for girls and boys, respectively. The printed growth curves on each growth chart act as reference lines, to compare and understand the growth pattern. A point is marked on the chart at the appropriate age each time the child is weighed, indicating the weight at that time. Joining many points gives a growth curve. This signifies the growth pattern of the child over a period of time. The table below shows the types of growth patterns.

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GROWTH CHART AND BABYDEVELOPMENTGrowth monitoring of a child should be carried out once every month, up to the age of 3 years using a growth chart. Thereafter, it should be done at least once in 3 months.

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Table contd...

Direction of Growth Curves

Growth Pattern

Upward Growth Curve GoodIndicates adequate weight gain for theage of the child. The child is growing welland is healthy.

Flat Growth Curve DangerousIndicates that the child has not gainedweight and is not growing adequately.This is called stagration. The child needsattention by the mother. This needs to be investigated

Table: 1 Types of growth curves and their significance

Birth weight should double by 5 months and be triple by the 1st

year. By the 2nd year, weight should be 4 times the birth weight

with an increase in 1 height by 7-8 cm.

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NORMAL WEIGHT GAIN BETWEEN 0 TO 3 YEARS OF AGE

Table: 1 Types of growth curves and their significance

Direction of Growth Curves

Growth Pattern

Downward Growth Curve

Very dangerousIndicates loss of weight. The childrequires immediate referral andhealth care.

Average Age Weight Gain Per Month

Birth to 2 months

3 to 4 months

5 to 6 months

7 to 3 years

800 gm

600 gm

400 gm

200 gm

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DEVELOPMENTAL MILESTONES IN A CHILD

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0 month 1 2 3 4 5 6

6 month 7 8 9 10 11 12

Developmental milestones are classified based on age groups as illustrated in the table below.

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Age Social/emotional

Communication Cognitive development(learning, Physical thinking, problem-solving)

Physicaldevelopment

2 Months • Makes gurgling sounds/coos

• urns head

• Observes faces

• Starts following things with eyes

• Head holding

• Movements turn smoother with arms legs

Communicationpeople, looks at parents

4 Months • Babbles with expression and copies sounds

• Learns di�erent ways of crying to show hunger, pain, or being tired

• Likes playing with people

• Starts copying movements & facial expressions, like smiling or frowning

• Responds to a�ection and starts watching faces closely

• Eye movements from side to side

• Recognizes familiar people and things at a distance

• Holds head steady unsupported

• Rolls over from tummy to back

• Brings hands to mouth

6 Months • Makes sounds

• Strings vowels and begins to say consonants

• Makes sounds to express emotions

• Recognizes a stranger

• Responds to emotions

• Looks in a mirror

• Looks around at things nearby

• Brings things to mouth

• Shows curiosity

• Passes things from one hand to the other

• Rolls over in both directions, sits without support and crawls backward

• Supports weight on legs while standing

• Rocks back and forth

Table contd...

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Physicaldevelopment

9 Months • Understands “no”

• Makes and copies di�erent sounds like “mama” and baba

• Starts finger pointing

• Plays peek-a-boo

• Puts things in her mouth

• Smoothly passes things from one hand to the other

• Thumb and index finger movements

• Pulls to stand by

• Sits without support

• Crawls

• Stranger anxiety

• Clingy with familiar adults

• Has favorite toys

12 Months • Responds to simple spoken

• Simple gestures used, shaking head, waving

• Tone modulation

• Says “mama” and “dada” and “uh-oh!”

• Tries to say words you say

• Shows di�erent emotions

• Parent attachment

• Helps with dressing

• Repeats sounds or actions to get attention

• Exploring things by shaking, banging, throwing

• Finds hidden things easily, puts things in container

• Pointing at right things

• Copies gestures Learns proper use of things

• Gets to a sitting position without help

• Pulls up to stand, walks holding on to furniture (“cruising”)

• May take a few steps without holding on

• May stand alone

Table contd...

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Physicaldevelopment

18 Months • Says many single words

• Says and shakes head “no”

• Points to show someone what he wants

• Understand things like telephone, brush, spoon, etc.

• Points to get the attention of others

• Scribbles on his own

• Can follow 1-step verbal commands

• Walks alone, can words walk up steps and run

• Pulls toys while walking

• Can help undress herself

• Drinks from a cup

• Eats with a spoon

•Hands over things

• Shows temper tantrums

• Afraid of strangers Shows a�ection to familiar people

• Plays simple pretend, such as feeding a doll

2 Years • Says sentences with 2 to 4 words

• Follows simple instructions

• Repeats overheard words

• Points to things in a book

Copies others

• Gets excited with other children

• Shows increasing independence

• Shows defiance

• Finds things even when deeply hidden

• Shapes and colors orientation

• Completes sentences and rhymes

• Follows two-step instructions

• Stands on tiptoe

• Walks up and down stairs holding onto it

• Kicks, throws a ball and runs

• Climbs without help on furniture

• Makes or copies straight lines and circles

Table contd...

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Physicaldevelopment

3 Years • Follows instructions

• Converses in 2 to 3 sentences

• Says first name, age, and sex

• Names a friend, familiar things

• Talks well enough for strangers to understand

• Can work toys etc.

• Understands what “two” means

• Turns book pages one at a time

• Can open and close bottles

• Climbs well

• Runs easily

• Pedals a tricycle(3-wheel bike)

• Walks up and down stairs, one foot on each step

• Makes friends

• Takes ownership

• Shows many emotions

• Can stay without mom and dad

• Self dressing

References:1. Resource document on newborn and neonatal care of children: A report. New Delhi, India; 2016. National Institute of Public Cooperation and Child Development. [Internet] Available at: http://nipccd.nic.in/reports/neo.pdf. Accessed on: 22.03.19.

2. Milestone checklists. USA; Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. 2018. [Internet]. Available at: https://www.cdc.gov/ncbddd/actearly/pdf/checklists/all_checklists.pdf. Accessed on: 22.03.19.


Did you know that the best way toprevent Pneumococcal disease is to

get the vaccine(s)?

Choose Wisely

Yes No

Ask your Pediatrician

which Pneumococcal vaccine is rightfor your child

31

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SHIELD YOUR BABYVACCINES – WHAT THEY ARE, HOW THEY WORK, HOWLONG THEY HELP

Vaccines are made from the infection-producing microbe itself by certain chemical processes. They make the body produce antibodies against the germ. In the future, if the baby comes in contact with the disease, his immune system will quickly recognize it and produce antibodies to fight it o�.

32

VACCINATION SCHEDULEHere is the list of recommended vaccines by the Indian Academy of Pediatrics for children up to 18 years.

Indian Academy of Pediatrics immunization schedule for children aged 0-18 years, 2018

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Sr. No Age Vaccines

1. Birth BCG, HB 1, OPV 0

2. 6 weeks HB 2, HiB 1, IPV** 1, PCV 1, DTP 1Rota 1

3. 10 weeks HB 3, HiB 2, IPV** 2, PCV 2, DTP 2, Rota 2

4. 14 weeks HB* 4, HiB 3, IPV** 3, PCV 3, DTP 3, Rota 3****

5. 6 months TCV#, Influenza (Yearly)******

6.

7.

8.

9 months MMR1, MCV^ 1

12. 9-14 years PCV^, Tdap, HPV 1&2

13. 15-18 years Td, HPV 1,2,3

9-12 months Hep –A1, JE^ 1, MCV^ 1,Cholera^ 1&2

13 months JE^ 2

15 months PCV B1, Varicella 1, MMR 2

9.

10.

11.

9.

16-18 months IPV*** B1, Hep A2 *****, DTP B1, HiB B1

2-3 years MCV^ 1

4-6 years DTP B2, Varicella 2, MMR 3/MMRV

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References:1. How vaccines work. UK;NHS Choices. 2016. [Internet] Available at: https://www.nhs.uk/conditions/vaccinations/how-vaccines-work/. Accessed on: 22.03.19.

2. Balasubramanian, S., et al. "Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018-19) and Update on Immunization for Children Aged 0 Through 18 Years." Indian Pediatrics 55.12 (2018): 1066-1074.

BCG: Bacille Calmette Guerin HB 1: Hepatitis A OPV: Oral Polio Vaccine. IPV: Inactivated Polio Vaccine. DTwP: Diphtheria Tetanus whole cell Pertussis. DTaP: Diphtheria-Tetanus acellular. Pertussis Hib: Hemophilus influenzae type B. PCV: Pneumococcal Conjugate Vaccine.

Rota 1: Rotavirus. TCV: Typhoid Conjugate Vaccine. MMR: Measles Mumps Rubella.

MCV: Meningococcal Vaccine. Hep A1: Hepatitis A. JE: Japanese. Encephalitis. Tdap/Td: Tetanus and diphtheria toxoids with cellular pertussis.

HPV: Human Papilloma Virus vaccine.

^Range of recommended age for high-risk children/area. *Fourth dose of Hepatitis B permissible for combination vaccines only. **In case IPV is not available or feasible, the child should be o�ered b-OPV (3 doses). In such cases, give two fractional doses of IPV at 6 and 14 wks.

***b-OPV, if IPV booster (standalone or combination) not feasible. ****Third dose not required for RV1. Catch-up up to 1 year of age in UIP schedule.

*****Live attenuated Hepatitis A vaccine: single dose only. ******Begin influenza vaccination after 6 months of age, about 2-4 weeks before the season. Give 2 doses at the interval of 4 weeks during the first week and then single dose yearly till 5 years of age.

#TCV= Typhoid Conjugate Vaccine, ##HPV= Human Papilloma Virus. Meningococcal Vaccine (MCV): 9 months through 23 months; 2 doses, at least 3 months apart; 2 years through 55 years; single dose only. Japanese Encephalitis (JE): For individuals living in endemic areas & for travellers to JE endemic areas provided their expected stay is for a minimum period of 4 weeks.

HPV: 2 doses at 6 months interval 9-14 years age; 3 doses (at 0, 1-2 & 6 months) 15 years or older and immunocompromised. Cholera Vaccine: Two doses 2 weeks apart for >1-year-old; for individuals living in high endemic areas and travelling to areas where the risk of transmission is very high.


Choose to protect your child with a broad coverage vaccine

Choose Wisely

Pneumococcal disease can infect the lungs,

the middle ear and the bloodstream.

However, this can be prevented with appropriate

† vaccination. Speak to your paediatrician about

vaccination that provides broad coverage.

Issued in the public interest.

Pfizer Limited. The Capital, 1802/1901, Plot No. C-70 G Block, Bandra-Kurla Complex Bandra (East), Mumbai 400 051.

Disclaimers: 1. This booklet content is issued by Pfizer in public interest. 2. The content of this booklet is meant for informational and awareness purpose only and should not be construed as a substitute for medical advice. 3. Consult your pediatrician for guidance on the information stated herein or further information on the subject. 4. While due care and caution has been taken to ensure that the content here is free from mistakes or omissions, Pfizer makes no representations or warranties of any kind, expressed or implied; as to the accuracy, completeness or adequacy of its contents and will not be liable for any damages, adverse events, and personal liability arising therefrom. PP-P

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LITTLE THINGS M MMY - Pfizer Pro · 2019-09-10 · Pregnancy is a time of great happiness for any couple. Every parent wishes to do everything possible to ensure a smooth pregnancy