Well Baby Clinic
One of the places you’ll visit regularly after your baby’s born is a well-baby clinic – either a government one or a private clinic like Stork’s Nest, which is part of the Netcare group. Some paediatricians even offer well-baby clinic services. And that’s where you’ll go regularly to have your baby measured, weighed and vaccinated.
Letty Johnston, co-ordinator at the Park Lane Stork’s Nest in Johannesburg, says she advises parents to pop in for their first visit fairly soon after birth. “Most babies lose weight in hospital – that’s normal. We like to see the babies again 10 to 14 days later, so that we can weigh them and see that they are back to their birth weight,” she notes.
Those first few weeks with a new baby are hectic and parents often have questions. Johnston says it’s vital to jot them down, as it’s so easy to forget them when you’re tired and overwhelmed.
“That visit is also a good time to check that the mother is managing with feeding,” she adds. “For example, babies who are breastfed feed more often. Mothers worry they don’t have enough milk, when in fact the baby’s putting on weight. Breastfed babies also have frequent, runny stools, as opposed to the formed stools of a formula-fed baby. They may panic, thinking that their baby has diarrhoea, which is not the case. If anything, it’s a good sign in the first weeks that their baby is getting enough to eat.
“We measure the baby’s height, head circumference and weight and plot them on a growth chart. We weigh them with nothing on (not even a nappy) so that we get an accurate weight. And sometimes there are feeding issues, so if the baby has been weighed and is not back to her birth weight, we advise parents to come back after a week. That way we can also weigh the baby on the same scale, as different scales may be slightly differently calibrated,” she explains.
When it comes to vaccines, Johnston says they explain everything to parents at every visit – what to do afterwards, and any reaction the baby might have. “We advise them to give paracetamol if the baby has a slight fever – the dose is determined by the baby’s weight. Arnica oil or Zambuc also work wonders if the baby’s legs seem sore from the injections.
“And we always advise parents to buy a thermometer, so that they can see whether or not the baby has a fever before they give the paracetamol. Sometimes the baby is just hot – a slight fever of 38°C is very different from a fever of 40°C. It’s important to know that number,” says Johnston.
If the baby has a fever, don’t overdress her or cover her head, Johnston advises. “If the temperature doesn’t come down despite giving paracetamol, seek medical assistance immediately,” she stresses.
Your baby’s height weight and head circumference will be plotted on a graph at every visit. It’s not so much about what the numbers are, as it is about the trend. “The important thing about the growth chart is that your baby should be following the curves – not steeply climbing or dropping. It’s an indication that she’s growing and thriving the way she should,” Johnston explains.
When your baby’s six weeks old, you will have your first routine visit to the paediatrician. He will do a thorough check-up to ensure that she’s as healthy as possible, and that there are no issues that need attention.
Dr Paul Sinclair, who works at the Vincent Pallotti and Red Cross hospitals in Cape Town, says he first checks the baby’s growth by measuring weight, length and head circumference. To make things easier, dress your baby in clothes that are easy to remove and put back on.
“We also review the baby’s heart health, as the pressures change from those we see in utero,” he says. “We check her eyes for a red reflex. Red is good because it means a clear cornea and lens, and a healthy retina,” he explains.
“Next is the skin – we check for acne, seborrhoeic dermatitis (cradle cap) and the baby’s BCG (TB vaccine). We also check their mouth and nappy area for thrush and other rashes.”
By six weeks, your baby should also be starting to hold her head up by herself. The paediatrician will check your baby’s head control, as well as her general muscle tone. He will also test your baby’s reflexes, which should be symmetrical.
The paediatrician will then move onto the baby’s general wellbeing and ask parents about feeding, pooing, vomiting, sleep and any excessive crying.
“We also check the maternal status; their breasts, sleep and their psychological wellbeing. It’s important to look for signs of post-natal depression and act on those if necessary,” says Dr Sinclair.
In his view, the six-week check-up is the most important routine visit – for the baby and parents. “It is really helpful if both parents can attend,” he notes. “Also, some parents feel they have to wait for six weeks. But if you’re having problems before that, phone or visit earlier. It is a medical review, but also a supportive review of the whole family.
“I also recommend doing the six-week review before starting the vaccine programme – I like to have a final discussion about vaccines with parents at that visit,” says Dr Sinclair.
He advises parents to bring the baby’s Road to Health Card and a list of questions, so that nothing is forgotten. Also bring some knowledge of vaccines and any questions around inoculation at the same time.
There’s no need to go to the dentist as soon as the first tooth breaks through the gums. “I advise that kids come for their first visit around two or three,” says Dr Steven Lew, a Jo’burg-based dentist. “Start them as early as possible, as it makes things far less traumatic. If they are likely to be co-operative at two, start seeing the dentist then.”
But if you notice a problem before then, take your child for a check-up earlier. But the first visits are actually about getting the child used to the idea. “If I’m able to brief the parents beforehand, I tell them to tell the child that they need to have their teeth counted. It’s less intimidating language”
Don’t tell your kids to be brave, as that sets them up for a fearful experience. “I’m honest with kids if I have to do something uncomfortable. That’s better than saying it’s going to be painless and then it isn’t,” he says.
Davor Jadrijevic, a Jo’burg-based optometrist from Vision Optometrists, says in most instances, your child needs to have their first routine visit to the optometrist at about four or five years. “If there’s a hereditary ocular condition in the family or a complication at birth, you need to advise your paediatrician,” he recommends. “They will assess the baby and refer to an ophthalmologist if required,” he adds
The first appointment lasts about 30 minutes, he says. “The optometrist will check specific eye movements, see how well the eyes work together, check for a ‘squint’ eye, assess how well the child sees in the distance (like the board at school) and near (like reading), and advise if spectacles and/or eye exercises are needed.
“We also screen for internal and external eye diseases. The process is completely pain free and can be fun for the child,” he explains
To prepare your child, reassure them that it’s not painful. “The optometrist will ask the child a few questions during the examination. So the child should be advised that there are no right or wrong answers: she should just tell the optometrist what she is seeing. You can’t ‘fail’ – it’s simply an assessment of your visual system.
If your child ‘s squint eyed, rubbing her eyes a lot, or you’re worried about her vision, take her to a paediatric ophthalmologist,” says Jadrijevic.
*Originally published in July 2014
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