Mothers of Newborns

It is strange to see the contrast of different mothers and how they act with their newborn baby. Fortunatly, my patients have all had loving adoring mothers. Even when their baby (or babies in the case of one family) go through the "feeding frenzy" (when baby's gut finally starts moving and mom's milk comes in and the baby wants to eat ALL the time) on days two and three of life, they look exhaustedly patient and happy.

But today I went into a room with my co-intern's patient--a cocaine-addicted mom with a tox screen positive at pregnancy, no prenatal care, etc. She had the baby in bed with her when we woke her up. As we were taking the baby to examine her, she kept calling her, "Hey Fatty. Hey," and not in much of a warm loving way. We told her the baby had a few problems, like a heart murmer that may or may not be serious, and the mother's response was, "Yeah, I thought she'd be alright, for as much as I ate." We all try not to look shocked or judging, and think to ourselves, "What about all the crack you 'ate'"? Plus, when the social worker asked her if she had diapers ("no"), carseat, ("no"), crib ("no"), etc., she finally said, "Why don't you tell me what you do have. Turns out she had nothing to prepare for her new baby. Maybe because she knew there was no way we'd let the baby go home with her. Which we, along with Child Protective Services, won't.

It was a relief to visit my other mothers, even the HIV infected mother who thought and thought about having her baby and finally decided to have her and love her and take the very small risk of transmission. (No baby seroconverted here or in Cincinnati in the last 10 years when mom has good prenatal care, AZT during delivery, and doesn't breast feed.) But we won't know for completely certain until the baby is 18 months old. Their baby (dad there, too, always nice) cried all night but when I woke them up to ask how she was this morning (mean, I know, hospitals are not good places for rest) she groggily arose and again looked adoringly at her baby and waited anxiously for me to finish my exam to make sure everything was still okay. She had a very common newborn rash called erythema toxicum that looks sort of like migrating bug bites with a little white dot in the middle. It occurs in about 70-80% of newborns and is completely harmless and goes away in a week or two. "Your baby is perfect." The parents who love their babies completely love to hear that and hang on your every word. "Your baby is perfect." It is full of promise and relief and joy. "Your baby is perfect."

I'm learning a ton in these first few days of the rotation:

1. Erythema toxicum: The rash mentioned above. New theory is that it is the result of mom's developing white blood cells that cross the placenta and get into the baby's skin and the redness reaction is the baby's body trying to get rid of them by a collection of eosinophils (the body's cells that usually respond in allergic conditions).

2. Meth/Cocaine v. Narcatic IUDE (intrauterine drug exposure): Amphetamine babies do better in the newborn period because withdrawal from heroin is awful (the babies are fussy and agitated and uncomfortable, the best treatment is actually mother's milk which will have some of the narcotic in it if she is in a tapering treatment program--the baby gets tapered with her through the milk). Anyway, the methadone babies have this awful pained cry until the drug is weaned from their system. The cocaine or crystal meth babies are jittery for a little while at first, but then do okay in the short term. In the long-term, they have many more developmental delays and problems with learning and behavior, even microcephaly (small head) or other physical deformities.

3. Soy-based formulas: If you must feed your baby formula, no babies should have soy-based formula. There was concern that the milk-based formula's caused more allergies but if that is a problem it is better to just go straight to the elemental formulas like Progestemil. Soy doesn't have the right protiens for a baby's optimal growth.

4. Crib next to bed: For the first six months of life, it is good to keep the baby's bassinet right next to the parents' bed. This prevents the risk of rolling over on them with co-bedding, but it reduces the risk of SIDS (sudden infant death syndrome), probably because of the hightened awareness and stimulation from the close proximity.

5. Circumcision: About 80% of parents choose to circumsize their newborn boys. Circumcision actually started thousands of years ago in Jewish cultures (I think) as a way to desensitize the penis and prevent boys from masterbating and succombing to sexual pleasures as readily (not sure that works). Circumsicions are not at all fun to watch or assist. If more parents could see it, I don't think they'd choose it so carelessly. And insurance companies don't pay for it so they cost around $250.

6. Head shaping: In 1992, when pediatricians began recommending the "Back to Sleep" position, the incidence of SIDS in this country dropped dramatically. But there has been one problem that has developed. When babies sleep on their back all the time, it is usually the back of their head that is flat on the mattress. Because baby's skull bones are still fusing and growing, their heads can become misshapen. To prevent this, we're now encouraging parents to adjust their baby's head when they put them to sleep. Alternate sides of the head that they rest on. Left, right, back of head alternating.

7. Neck stiffness: Since babies are all crunched up inutero, about 20% will be born with some tight muscles on one side of his or her neck. This is best tested by gently stretching their ear to their shoulder (instead of the more standard chin to shoulder twist which can miss a lot). If it's mild, like most is, it can be treated simply by putting the baby to sleep preferentially so that they look to the opposite direction and stretch out that side of their neck. If more severe, you can get some neck stretching exercises from your pediatrician.

8. Lacrimal duct cyst: I guess about 20% of lacrimal ducts (the duct that drains your tears into your mouth) are stenotic (small). We had one baby yesterday who had a pretty small duct and got infected with E. Coli in his eye because of it. The opthamolgists came to treat him and it was much more brutal than any of us expected. They were good at it and it looked pretty straight-forward, but it was a pretty forceful POP and forcing open of the duct with this thing that looked like a fancy stretched out paper clip. Our attending had never seen one and she almost had to sit down afterwards.

9. Ear tag: Little nubbin of extra skin off the ear. Very common and runs in families. One of my patients has one. We treated it by just tying it off really tightly with a string to block off the blood flow and let it die a natural death and fall off by itself in four or five days. The ENT docs don't always like this because it leaves a very small bump behind, but the alternative is a bigger surgery with general anesthesia with them. Most parents choose the string. Strangely, this is also how my brother castrates his baby goats--except with a rubberband instead of a string.


I took a ridiculously long nap this afternoon after being emotionally exhausted for reasons entirely unrelated to work, so now I'm wide awake. Great. I'll read for a little while.

I love holding the babies. It makes me want my own. Guess I'm about that age anyway.