More than half of all deaths under five happen in the first month, and most of them in the first week. Almost everything protective in that month is simple: warmth, the breast, a clean cord, and going quickly when something is wrong.
The first hour
- Skin to skin on the mother’s chest, dried and covered, including the head.
- The first breastfeed within the first hour. The thick yellow first milk is the baby’s first immunisation, not something to throw away.
- Delay the first bath for at least 24 hours. Washing a newborn immediately cools them dangerously.
- Vitamin K, eye care and the birth vaccines at the facility.
Keeping the baby warm
A newborn cannot hold its own temperature. Cover the head, keep the room free of draughts, and keep the baby against the mother’s skin. For a small or premature baby, kangaroo mother care, the baby held upright, skin to skin, as many hours as possible, saves lives and works better than most equipment.
The cord
- Keep it clean and dry. Fold the nappy below it.
- Use chlorhexidine gel if it was given to you at the facility. Otherwise nothing.
- Never put herbs, ash, oil, cow dung or powder on it. This is how newborn tetanus happens, and newborn tetanus is usually fatal.
Go to a facility immediately if
- Not feeding, or feeding much less than before.
- Fast or difficult breathing, grunting, or the chest pulling in.
- Fever, or cold to the touch that does not correct with warming.
- A fit or convulsion.
- Floppy, or hard to wake.
- Yellow skin or eyes, especially in the first 24 hours, or yellow reaching the palms and soles.
- Redness, swelling or pus around the cord, or a bad smell.
- Constant crying that cannot be settled.
Feeding
Breast milk only for the first six months: no water, no herbal teas, no glucose water, even in hot weather. Feed on demand, at least eight to twelve times in 24 hours, and wake the baby to feed if more than three hours pass in the early weeks. Wet nappies, about six a day after the first week, are the simplest sign that enough is going in.
The mother matters too
Heavy bleeding, fever, severe headache, a fit, or severe pain in the mother are emergencies in this month as much as anything happening to the baby. So is a mother who cannot sleep, cannot eat, or feels unable to care for her baby; that is common, it is treatable, and it should be said out loud at the postnatal visit.
