Should my baby sleep in my bed? Should I give him a pacifier or not? Here’s what you need to know to make some key choices regarding your newborn.
WORDS RACHEL KWEK
Decisions, decisions, decisions! With the arrival of your newborn, you suddenly find yourself faced with a whole lot of decisions to make. No one said motherhood is a breeze but you can definitely make your new mum journey a smooth one with the right decisions. Get reliable advice from the experts to help you make these important decisions with peace of mind.
The Pacifier Debate
Dr Wendy Sinnathamby, specialist in paediatrics and consultant at Raffles Children’s Centre says that babies tend to have a strong sucking reflex which serves to soothe them. Some babies have such a strong sucking reflex that they suck their fingers even before they are born and will continue to do so if not given a pacifier. She advises parents to consider the pros and cons of pacifier use and consider their own baby’s needs when deciding on using a pacifier.
Pros of pacifiers:
• Effective in soothing a fussy or agitated baby
• Helps baby to fall asleep easily
• Useful as a distraction during procedures such as vaccinations
• Useful during flights as sucking on a pacifier during take-off and landing may help ease discomfort in the ears due to air pressure changes
• Research suggests that using a pacifier during sleep can help reduce the incidence of sudden infant death syndrome
• Pacifiers are disposable and it is easier to wean a child off pacifiers than to wean a child off thumb sucking
Cons of pacifiers:
• Early pacifier use may interfere with establishment of effective breastfeeding
• Child may become dependent on pacifiers
• Pacifiers may increase the incidence of middle ear infections
• Prolonged pacifier use may lead to poor dentition and even delayed speech
Associate Professor Lee Jiun, head and senior consultant, Department of Neonatology, National University Hospital advises against pacifier use during the first month because it may interfere with successful breastfeeding.
Both doctors say toddlers should be weaned off pacifiers by one year of age as prolonged use is associated with problems with dentition (such as teeth misalignment) and speech development. The longer parents wait to wean off pacifier use, the harder it becomes.
To Circumcise or Not?
Whether or not and when to circumcise depends on medical indications. A/Prof Lee says there is no medical need for newborns to be circumcised because there is no health benefit. “In older children, circumcision may sometimes be needed for certain medical reasons, although alternative non-surgical treatment is preferred,” he says.
Dr Joyce Chua, specialist in paediatric surgery and consultant at Raffles Children’s Centre says early circumcision may reduce the risks of recurrent urinary tract infections in children with known congenital urological anomalies or who are predisposed to recurrent urinary tract infections. In such cases, circumcision should be performed as early in life as possible. Recurrent balano-posthitis (infections of the prepuce and the glans penis) may also necessitate circumcision as it is believed that the tight prepuce covering the glans penis results in urinary stasis and accumulation of smegma. Religious reasons aside, for boys who are totally asymptomatic, the benefits of circumcision do not justify the risks involved. For asymptomatic boys whose parents desire to have them circumcised, Dr Chua suggests doing it after they are off diapers to ease post-operative care and reduce the risk of meatal stenosis significantly.
Citing a tragic encounter of a father who rushed his lifeless infant to the A&E department where she worked in, Dr Veronica Toh, specialist in paediatrics & neonatology and consultant at Raffles Children’s Centre, says she discourages parents to bed share with their babies; the father had woken up to find his baby pinned under him.
Dr Toh shares that a recently published paper in 2012 by Dr M. M. Vennemann, from the University of Munster, mentioned that more than 10 studies in the last 20 years confirmed that bed sharing is a risk for sudden infant death syndrome (SIDS) and the risk increases exponentially when the mother was obese, smoked or co-sleeping with the infant on a sofa. The main reason for these deaths is suffocation due to blankets or the mother’s sleeping position. “Bed-sharing infants experienced more oxygen desaturation (a condition whereby the concentration of oxygen levels in the body drops),” Dr Toh adds. Furthermore, the tendency for mothers and babies to wake up more often when they bed share may diminish the quality of sleep for both and jeopardise their health. It may also make it harder for the child to adjust to sleeping by himself as he grows up Dr Toh says. The UK Department of Health recommends that a baby sleeps in a cot in the parents’ room for the first six months. This increases the success of breastfeeding and improved bonding.
Increased sensory contact and proximity between mother and infant also increases beneficial behavioural and physiological changes in babies.
Sticking to a Sleep Schedule
Dr Sinnathamby says sleep schedules are advisable as they will not only allow the caregiver to plan the day better but also allow the baby to learn what to expect every day. This will help to set your baby’s internal clock and might encourage him to sleep through the night at an earlier age.
Parents need not worry that their babies get too much sleep as newborns tend to sleep for 15 to 18 hours a day, usually in short periods of two to three hours, according to Dr Sinnathamby. She adds that newborns should generally not be left to sleep for more than three to four hours without feeding. However, she says it is alright for babies to sleep longer than usual as long as they are fed appropriately and have adequate stimulation during periods of being awake. To encourage your baby to follow a sleep schedule, she recommends setting a rhythm to the day so that your baby learns to distinguish between night and day. Besides using cues like reducing noise and activity at night, establishing bedtime routines may involve soothing songs and cuddles. It is also good to encourage your baby to fall asleep on his own so he will not become reliant on being rocked to sleep.
To Breastfeed or Bottle Feed?
“Breastfeeding is the recommended way of providing optimal nutrition for baby’s growth and development. Mums are encouraged to exclusively breastfeed up to six months of life. From six months, babies should start on baby foods but still receive mother’s milk,” Helen Cruz, senior lactation consultant at Raffles Hospital says.
A/Prof Yong Tze Tein, senior consultant, Department of Obstetrics & Gynaecology at SGH adds that the skin-to-skin contact not only aids brain development but also bonding, which makes babies feel calm and secure. She also says breast milk should ideally be direct from the breast; this eliminates the need to wash and sterilise and makes it convenient to travel with your baby. Breastfeeding mothers save a lot of time especially during the first weeks post-delivery and parents can get more rest. Dr Sinnathamby advises mums to stick to a feeding schedule as babies generally do well with routines and tend to develop better eating habits in the long run if there is a routine.
Cruz encourages mothers to start breastfeeding during the first month so they have time to master it. Bottle-feeding, however, may be necessary in instances whereby you have to return to work post-maternity leave or have to travel without your baby. In this case, introducing bottled breast milk gradually will ease the transition.
Giving the Gift of the Jab
Children should be immunised early in life to prevent them from being infected by diseases that can potentially kill or cause serious health problems. The Health Promotion Board (HPB) provides vaccines for children in Singapore under the National Childhood Immunisation Programme which is based on the recommendations of the Expert Committee on Immunisation that comprises senior officials from the Ministry of Health, consultant paediatricians and experts in communicable disease control. Dr Toh says, “All babies born in Singapore hold a health booklet where the immunisation schedule is detailed and adherence is mandatory.” At birth, babies should receive tuberculosis and hepatitis B vaccines whereas other vaccines are scheduled for a later age.
Dr Chu Hui Ping, specialist in paediatrics and consultant at Raffles Children’s Centre strongly recommends all children receive the vaccines listed unless medical reasons forbid. While diphtheria and measles vaccines are compulsory by law, some like those against chickenpox and rotavirus are optional. Dr Toh strongly encourages children with asthma or congenital heart conditions to be vaccinated against influenza. Additional doses of vaccines for certain diseases, called boosters, are administered at later stages of the child’s life to maintain immunity against them.
Refer to https://www.hpb.gov.sg/HOPPortal/health-article/630 for a list of vaccines recommended by the HPB.