Babies under one year have different behaviour patterns.
Disturbances in some of these behaviours are important pointers towards certain problems.
Persistent inconsolable crying and marked disturbance in feeding need to be medically evaluated.
The passing of urine and opening of bowels could vary widely among different infants.
Certain norms have to be followed in growth and development during the first year of life and any gross deviations need to be medically evaluated.
Safety at home should be assured when they sit up, crawl and stand.
Dr. B.J.C.Perera MBBS(Ceylon), DCH(Ceylon), DCH(England), MD(Paediatrics), FRCP(Edinburgh), FRCP(London), FRCPCH(United Kingdom), FSLCPaed, FCCP, FCGP(Sri Lanka) Consultant Paediatrician
The newborn baby goes through a very rapid period of development in the first few years of life. Out of this, infancy is of utmost importance. During this vital period of a baby’s life, he or she is not able to vocalise the needs of the body. The baby grows quite markedly and there is an orderly achievement of certain functions and milestones during the first year of life. It is also a period when the baby is vulnerable to develop certain illnesses. In both these respects, the patterns of behaviour are of tremendous importance in assessing the need for further action.
Crying is a significant feature that is of some importance in assessing an infant. There are very many reasons for a baby to get into bouts of crying. There are some trivial causes such as wet diapers, feeling too cold or too warm etc. These of course need attention, are easily dealt with and the baby is happy when they are dealt with. Some babies cry because they need the warmth of being held, the attention of the mother or just the comfort of being close to the mother. In such situations, it is a mistake to allow the baby to cry it out and the baby should be cuddled and comforted.
Colic, also known as infant colic, three month colic and infantile colic, is a condition in which an otherwise healthy baby cries or screams frequently and for extended periods of time, without any discernible reason. The condition typically appears within the first month of life and generally disappears, often very suddenly, before the baby is three to four months old. However, in rare cases it may but can last up to 12 months of life. There is evidence that this particular problem is much less common in breastfed babies. The crying often increases during a specific period of the day, particularly the early evenings. Symptoms may worsen soon after feeding, especially in babies that do not burp easily. The strict medical definition of colic is a condition of a healthy baby in which it shows periods of intense, unexplained fussing or crying lasting more than 3 hours a day, more than 3 days a week for more than 3 weeks. However, many doctors consider that definition to be overly narrow and would consider babies with sudden, severe, unexplained crying lasting less than 3 hours a day as having "colic". In reality, this extreme version of colic is more likely to be the final stage of a condition that has worsened for a few weeks. There are many theories on the causation of this problem but none of them have been conclusively proven. There is a broad body of evidence showing that soothing measures, such as cuddling, allowing the baby to suck at the breast, and jiggly rocking are effective in calming babies during crying bouts. These techniques form the core of the so called "5 S’s" approach. These consist of swaddling, side on positioning, making a Shhhhhhh sound near the baby’s ear, swinging the baby with tiny jiggly movements of no more than a couple of inches back and forth with supporting the head and neck and suckling at the breast. Some reports have associated colic to changes in the bacterial balance in a baby’s intestine. They suggest treating the crying with daily doses of probiotics, or "good bacteria" such as Lactobacillus acidophilus or Lactobacillus reuteri. In some research studies these have been shown to be remarkably effective.
However, incessant crying where the baby does not calm down at all with simple measures should be taken note of rather more seriously. Sinister illnesses can and do present in this way. Such episodes mandatorily need medical attention to exclude the possibilities of serious problems such as meningitis, abdominal catastrophes and respiratory infections. Such a complaint in an infant and especially in a baby less than six months of age is always taken up as a potentially grave problem by all medical personnel and adequate steps would be taken to observe, investigate and treat such conditions. Under such circumstances, it is often necessary to admit the baby to a medical facility to assist further evaluation and appropriate management.
Many parents worry about the amount of sleep that a very young infant is engaged in. It must be emphasised that the amount of sleep and the depth of sleep in infants is a very variable thing. It is a constitutional feature of each individual baby. Some of them tend to sleep up to 16 hours a day while others are quite comfortable with lesser durations of sleep. AS long as the baby is healthy and is thriving well, there should not be any concerns regarding the amount or depth of sleep a baby is likely to indulge in. In fact, even some little babies sleep right through the night while others do not sleep that long at night. In the latter case, the mother and even perhaps the father is likely to have disturbed nights very frequently.
The feeding patterns of the baby are another important feature that gets disturbed with certain problems. It is generally true to say that unless the infant has a major problem, he or she will continue feeding, often quite normally. This is particularly true of breast feeding. If a baby of that age refuses to feed at the breast, one has to take serious note of this feature. Some severe and sinister illnesses are associated with the baby going off feeds to a very significant degree. In that sense, a baby who does not suck at the breast needs medical evaluation.
There are some parents who worry about the passing of urine and opening of the bowels of an infant. Quite unlike the situation in adult life, one cannot describe certain regular patterns for these biological phenomena. Some babies pass water quite frequently while others do so at not so frequent intervals. This is related to feeding and the degree of hydration of the infant’s body. As for bowel movements too there is no hard and fast rule. Some infants have several motions a day while others may open the bowels only once in a few days. As long as the baby remains healthy and is not distressed, one need not worry. However, a baby who cries in pain during urination or defecation may need to be medically evaluated. This of course does not refer to the occasional occurrence of such features but repeated occurrence of them even over a few hours. Crying during urination, particularly if associated with fever, needs to be tested for a urinary tract infection.
During infancy, weight gain too can vary quite a bit. There may not be uniform gains in weight every month. However, some gain in weight has to be present with age. Generally it tends to follow a reasonably uniform pattern which is quite obvious when plotted on a growth chart. What is important is that there should be exponential gain in weight following a certain growth line in the chart. Marked depressions or stagnations in weight gain need to be medically evaluated.
Infants achieve certain milestones of growth and development during the first year of life. Ability to hold the head upright, sitting up, crawling, babbling speech, standing with support and such like are some of these which have well known ranges of age during which they have to be achieved. Gross deviations of these, particularly when more than one feature is disturbed, invariably mean that there is a problem. Such situations need expert medical evaluation. However, isolated delay in one milestone over a rather short period of time may not be medically significant. It is particularly important to note whether there is any defect in hearing or vision as these need urgent attention.
Babies during the first year of life need only a few things to be sorted out for them. They need adequate nutrition for growth and development, plenty of love and attention to the very basic needs. During the first six months of life, breast milk is more than sufficient for all nutritional needs. Thereafter most normal food articles can be gradually introduced so that by one year the baby is able to eat most articles that comprises an adult diet. Clothing has to be very light and comfortable. In our sort of tropical climates, heavy clothing is not necessary at all. Once they start to sit up, crawl and stand, constant attention is needed to ensure that they do not injure themselves. Safety in the home should be of paramount importance during this important period of the life of a baby.
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