The health of a newborn

Monitoring the Health of a Newborn

For the sake of children’s good health and development, they undergo regular health check-ups both in infancy and beyond. For this purpose, paediatricians, family doctors, family nurses, midwives, speciality doctors and the family cooperate. The child’s development, growth, weight, hearing, vision and speech are monitored. Vaccinations are given to prevent infectious diseases. Regular check-ups help shape the child’s healthy eating and exercise habits and support the family in caring for the child. Great emphasis is placed on both physical and mental well-being.

 

Baby’s health check - the first appointment after the birth of the child

During the first days of a baby’s life in the hospital, a paediatrician will examine him/her to check his/her health, and the paediatrician will issue a document describing the development and health of the newborn to the family doctor. On the 3rd to the 5th day of life, a blood test is taken to examine the newborn for 23 different treatable diseases. For example, the child will be tested for metabolic diseases which cause permanent damage to the nervous system and internal organ systems, in the case of a late diagnosis. The most common of these are hypothyroidism and phenylketonuria.

 

• Hypothyroidism is a condition in which the thyroid gland does not produce enough hormones.
• Phenylketonuria is a more common congenital metabolic disorder that can cause mental retardation.

The results of the first test are usually revealed by the end of the 2nd or 3rd week of the child’s life. When the results are normal, neither the family doctor nor the family is informed, but in cases of abnormalities, both are contacted immediately.

Another important screening test is a newborn hearing test. Newborn hearing screening is usually done before leaving the maternity ward, but it can also be done at home, at the family doctor’s office, or another clinic or health centre. The hearing test is completely safe, painless and only takes a few minutes. Parents can be with the child during the screening. If the test result is negative, the parents are informed about this, and recommendations are given to monitor the child’s development, as hearing problems can occur at any age and for many reasons. If the test result is positive, it does not necessarily mean that the child has hearing loss. Parents are asked to bring the child back for a repeat test after some time, and if the tests (both OAE and ABR) are positive, the child will be referred to the audiology department for further testing.

A healthy infant is monitored regularly during the first year of life to monitor the child’s growth and development and to support the parents. For this purpose, a family doctor and a family nurse are visited every month.

In the 1st, 3rd, 6th, 9th, and 12th months of life, a health check-up is performed by a family doctor, who thoroughly checks the child by organs and evaluates the development. The family nurse performs health checks on the child in the 2nd, 4th, 5th, 7th and 18th months of life.

At all visits related to monitoring the child, the child is weighed and measured, and his/her health status and age-appropriate motor development are assessed. Parents are also asked various questions and advised on more important issues related to feeding, hygiene, care and safety. A visit to the paediatrician is not intended for a healthy baby. If necessary, the family doctor will refer the child to a specialist, such as a neurologist or an orthopaedist.

 

How is a family doctor assigned to a child?

The newborn is automatically assigned to the list of the mother’s family doctor, but if you wish, you can also choose another family doctor for the child. To do this, you should apply to the desired family doctor.

 

When is it necessary to take your baby to the family doctor for the first time?

If the family doctor, family nurse or midwife has not made a postpartum home visit, the first family doctor visit must be made 14 days after the birth of the child.

 

When and how does the postpartum home visit take place?

Pregnancy and the postpartum period is a transitional time for women and families to adapt to physical, psychological and social changes and a new situation in life. At this point, early recognition of the needs of the woman and the family is of great importance to support adaptation and prevent the manifestation and complications of potential health problems for the woman and the child.

Postnatal care is carried out in cooperation with the woman and the family and is based on the individual needs of each family. Its purpose is to support the adjustment of the woman and the family after childbirth and to encourage the mother to take care of the newborn and herself to ensure long-term physical and mental well-being.

During postpartum home visits, recommendations for starting and continuing breastfeeding, advice and information on hygiene requirements, child care, health education and parenting skills are provided. A postpartum home visit enables early recognition of the woman’s and family’s need for support. This creates the conditions for early detection of mental health issues and psychosocial risks to intervene if necessary and create an effective support network.

The midwife monitors the family after the birth, depending on the individual needs of the woman and the newborn, this includes the mental and physical health of the mother, breastfeeding, problems in coping with the newborn, social problems, adaptation and health disorders of the newborn. An individual monitoring and support plan is drawn up for women and newborns belonging to the risk group.

The frequency of visits is planned according to the needs of the family, but every family could receive at least one universal home visit after leaving the hospital. If there are indications, the midwife can make repeated home visits until the child is 12 months old. Unfortunately, postnatal home visits by midwives are not yet available in all regions, be sure to ask your midwife, maternity ward or family doctor about this.

The midwife’s postpartum home visit takes place after discharge from the hospital, generally 5-7 days after delivery.

The following information is collected during the home visit:
 

• the most important complaints and observations of parents;
• the woman’s feedback on the course of pregnancy and childbirth, including the childbirth experience;
• the health condition (including emotional state) of the newborn and the mother
• newborn screenings and vaccinations and prophylactic dosing of vitamin K;
• in addition, feedback is requested regarding adapting to home conditions and coping with the new situation.

The mother and newborn are then examined to assess their condition and how they are coping. The newborn examination assesses:
 

• general condition and activity of the child;
• weight gain from the lowest weight (if the baby’s weight loss is 10% or more, the reasons why the child is not gaining weight should be investigated);
• skin and mucous membranes;
• condition of the navel;
• response to environmental sounds.

During the home visit, the adaptation of the newborn is also evaluated and nutrition advice is given (feeding and/or breastfeeding positions, duration of breastfeeding, frequency of feedings, and guidance on formula feeding if necessary).

The mother and parent are also taught:

 

• newborn care, including navel and eye care, and general care techniques;
• the course of newborn and infant development;
• relationship with the newborn and creating a secure attachment with the newborn;
• how to reduce uncertainty in using parenting skills;
• understanding of the danger signs of the newborn’s health condition;
• assessment and mitigation of risks arising from the home environment.

Based on the results of the examination, the need for a repeated home visit is decided and a further monitoring and support plan is drawn up, which is documented and of which the family doctor is informed. For example, if the child’s weight gain is insufficient, the midwife recommends repeated home visits and may offer the involvement of a lactation consultant. If the parents feel uncertain, the midwife can offer repeated home visits to support parenting skills and, if necessary, also involve other specialists.

The midwife makes the plan together with the family, and the time of the repeat home visit, and the purpose and the activities of the parents are agreed upon.

Based on the identified risks, a family doctor, a paediatrician at a children’s hospital, a gynaecologist, a mental health specialist, a social worker, a child protection worker, a support person or the police are involved if necessary.

 

Differences in the case of children with special needs and disabilities

Some babies, such as premature babies, can be born with a congenital condition that makes their lives a little different than normal, at least for a while. Children with special needs or disabilities receive special care in the hospital, and their care and treatment are organised by a family doctor. If the hospital of your place of residence does not have a department specialising in newborns, the child will be transferred to another hospital. In general, the mother or her partner can accompany the child.

Some parents know in advance that their unborn baby will have a health problem, but regardless of whether the news is known before or after the birth, there can be feelings that are difficult to cope with. Grief, anger, anxiety and resentment are natural at this point. Many parents, especially mothers, worry that they are somehow to blame for the problem – but that is highly unlikely.

Babies with health problems usually need to stay in the hospital for observation and necessary treatment after the mother is discharged from the hospital. In this case, it is especially important for you and your child to be together and to get to know each other. Dealing with your child may seem scary and difficult at first, but the hospital staff understand your feelings and will try to support and encourage you every step of the way.

You need as much support and information as possible. Talking to a midwife, doctor, hospital staff, social worker or counsellor can help. What also helps is talking to parents with similar experiences.


 

Vaccination - recommended vaccines

Based on the Estonian national immunisation plan, children are vaccinated from infancy against 11 infectious diseases, which can have serious consequences if they are caught or spread. These diseases include tuberculosis, hepatitis B, rotavirus, diphtheria, tetanus, whooping cough, polio, haemophilia, measles, mumps and rubella.

Vaccination is not mandatory, the decision whether to vaccinate the child or not is made by the parent. An informed decision is important when refusing vaccination, information sources must be adequate and evidence-based.

Until they go to school, children are vaccinated by the family nurse or the nurse at the immunisation office. Schoolchildren are vaccinated by a school health worker. You can ask your family doctor and family nurse, specialist doctor and midwife for more detailed information about vaccination.

Side effects caused by vaccines are mostly mild and transient. After the vaccine injection, the child may develop a fever and the injection site may be painful, red or swollen. There may be a yellowish discharge from the injection site of the tuberculosis vaccine - in this case, the injection site must be cleaned with boiled water. After the measles, mumps and rubella vaccine, a short-term rash may occur, which is not contagious and will pass. If the child is restless and crying, he/she can be given paracetamol. If the child does not have a fever, he/she can be bathed on the day of immunisation.

You can find comprehensive information about infectious diseases and vaccinations at www.vaktsineeri.ee .

 

Calendar of the Estonian National Immunisation Plan

Related institutions

• Tartu University Hospital