Bases of personal hygiene of children

Care for the newborn.

Asepsis and breastfeeding are the basis of all service infant.
This provision, deeply fair infants in General, is of very great importance for maintenance of children of the neonatal period.
The main issues, which should fix your attention a pediatrician from the moment of birth of the child, this dressing umbilical cord, initial and subsequent processing of the umbilical cord, prevention of infections of the eye, first and subsequent baths, clothes, equipment bed and hygiene rooms newborn.
Ligation of the umbilical cord is made on termination of her pulsations, which is enough to wait for 5-8 minutes from the moment of birth of the child.
Beforehand on the umbilical cord impose two sterile clip - one at the distance of 15 cm from the umbilical ring, another 2-3 cm outwards from the first. Between the umbilical cord clamps well wiped 95 degrees with alcohol and pererezali sterile scissors; the cut surface is smeared with iodine. Baby end of the umbilical cord zavertyayev in sterile gauze.
From this moment the child is permanently separated from their mothers and undergoes further initial procedures on the changing table, covered with rubber Mat, warm water (or child is lined heaters). To prevent cooling, it is also advisable to use an electric reflector.
First of all, the prevention of infections (gonorrheal conjunctivitis) Cred-Matveyev: in kongungualny bag each eye immediately after birth enter 1 drop of fresh 2% solution or 3 drops of 1 % solution of silver nitrate. We must pay attention to the drops fell really on the conjunctiva, not on the skin of the century and to the solution of silver nitrate was fresh and stored in a dark bottle. This method prevent infections cause mild conjunctivitis, usually through 2-4 days without any treatment. According to official statements, this procedure must make immediately after birth to the separation from his mother, but technically less convenient.
Now instead of a solution of silver nitrate is widely used instillation solution of penicillin (10,000 units in 1 ml); drops enter immediately at birth and 2 more times during the second day of life. Penicillin does not cause conjunctivitis.
Then the child should be carefully cleaned from received during childbirth pollution mucus and blood kin ways mother and rich clusters original grease (vernix caseosa) in skin folds, in young, armpits, neck, and so on, it is Best to clean the child sterile vegetable or mineral oil with a very soft sterile napkins from rags. Instead of butter can be consumed 30% aqueous solution of soap alcohol. To strive for thorough removal of all lubrication unnecessary or even inappropriate, but we must remember that the lubricant, leave in large numbers in the folds, often cause significant local skin irritation.
The first bath is not mandatory, and it is better to do without it, limited to careful washing the skin with warm water (37-38 degrees) or specified by the solution of soap alcohol (to warm up!) using a cotton swab.
It is impossible to suppose with all these manipulations cooling of the child, and if working conditions are not fertile, it is better to abandon first bath and thorough washing of the newborn, but in any case not to expose it to even a slight cooling.
After that you need to finish toilet remainder of the umbilical cord. Under the latter put a sterile gauze napkin, and approximately 2 cm from the umbilical ring on the cord impose teamcity the ligature or umbilical clamp. Over the ligature the rest of the umbilical cord should be wiped wool taken with tweezers and soaked 95 degrees alcohol, after which he cut sterile scissors, some distance from the ligatures 2-3 cm; remains stump length 4-5 see the Surface of the cut cuticles 10% iodine alcohol solution and impose final dry sterile dressing (see below).
After these initial manipulation of the child weigh, measure the length of his body, the circumference of the head and chest, clothes, and laid in a warm cot; next put a heating pad. The child's cot and a piece of its development necessarily numbers on one or another system that excludes the possibility of confusing children.
Child's clothing consists of shirts (vests) and blouses, have a soft ribbons, but without any buttons and buckles.
The lower body is wrapped in a diaper, which is the usual thin rectangular diaper, folded diagonally in the triangle. The wide part of him wrap his stomach, and the ends lay between her legs.
To this add one plain and one bomasang diaper between which lay a small piece of oilcloth, protects the outer parts of the service and changing from possible contamination during urination and defecation of the child.
In the first 2-3 days baby swaddled with handles, and his head covered with a warm edge diaper; prematurity and slabovrajenna children swaddled so for the first 3-4 weeks, possibly longer (Fig. 99). With 3-4-day life, if in the house is warm enough (22 degrees), full-term healthy children wrapped in both diaper, starting approximately from the axillary, but so that the handle, he was free (Fig. 100). In this form they are put in the crib and cover the top of the blankets.

Fig. 99. Swaddle the baby in the first days of life.
Fig. 100. Swaddle the baby after 5-b days.

For newborns in maternity wards should be allocated special light house, easily accessible for ventilation and sunlight. On the Windows of the chambers should be blinds or curtains to protect children from the direct action of the sun and warning overheating of the chambers.
For each child in the house should have no less than 2-4 m2 of floor surfaces; desirable norm - 3-3,5 m2.
The atmosphere of the chamber should be as streamlined and should not contain unnecessary items. In addition to beds, should be 1-2 locker daily supply of linen, Cabinet for dressing material and the most necessary medicines (iodine, the solution of silver nitrate, sterile oil, powder, and so on), scales on a separate table for weighing children, 1-2 small table, a Desk for current entries in the stories of the development and special table for examination by the doctor. The tub for bathing children must be in a separate, nearby room, and in its absence - here in the house. House of newborns should be provided around the clock with warm water.
At home in the room allocated accordingly furnished area of the newborn.
The question of daily baths for a newborn does not find a single permit. A daily bath is very positive hygienic event for maintenance of the newborn, but frequent wetting water balance of the umbilical cord slows down the mummification process and delays the moment of its separation and final umbilical wound healing; this, however, is not certain, but easier infection during the baths of the umbilical cord, in our opinion, are also not subject to doubt. Therefore, we recommend to refrain from daily baths until the fall of the umbilical cord and the umbilical wound healing. Daily baths can be replaced by a thorough daily washing the whole body of a child. After 1-2 days after deciduation of funic when umbilical wound several heals, the bath should be done daily, if possible, of boiled water temperature 37-38 degrees.
Subsequent daily care of the rest of the umbilical cord requires personnel newborns, great attention and strictly aseptic approach; this issue is devoted to great literature and proposed countless variety of methods. The challenge in this case is before pediatrician, is that to minimize the possibility of infection of the remainder of the umbilical cord, ensure the possibility of early cessation and most speedy healing remaining umbilical wound.
The juiciness of the umbilical cord creates favorable conditions for the growth of bacteria. Long ago there was a desire to reduce the danger of possible short obrazovaniem umbilical cord. With this purpose a number of authors have proposed special clamps imposed for 12-24 hours for the remainder of the umbilical cord at the very belly of the child (Fig. 101). The umbilical cord is cut off just above the instrument: after removing the clamp remains thin, like parchment membrane, disappearing in a few days and leaving a normal umbilical wound.

umbilical terminals
Fig. 101. Umbilical terminals.

This method is known advantages, but at the time of the final umbilical wound healing is no different from conventional methods aseptic dressing. He has a negative side: occasionally tight stops bleeding due to too short remainder of the umbilical cord. Some midwives recommend, on the contrary, left much greater the stump is about 15-16 see
The previously used in conventional cotton-gauze bandages of different powders, accelerating the drying of the residue of the umbilical cord (kseroforma, vioform, dermatol, salicylic powder and so on), now generally not recommended. Good results the use of alcohol bandages. We prefer to use a dry sterile gauze bandage without wool and without drying and disinfecting of powders.
To cover dressing often use gauze bandages, width of 10-12 cm, circular which turns around the belly and bandage the stump. This armband is the least desirable: imposed weakly, she quickly moved up or down, and the cord is still open imposed tight - concerned about the child.
In recent years, we are successfully used and consider the most appropriate pear bandage proposed Chistyakova.
On the umbilical cord, greased with iodine, 2% alcohol solution of streptocide, or 5% solution of potassium permanganate, superimposed sterile gauze bandage, consisting of two square gauze napkins with a side length of 10-12 see the First piece of gauze stacked directly on the umbilical cord (Fig. 102 and 103), and the second is a triangle and kerchiefs tied a knot on the border between the umbilical ring and the rest of the umbilical cord. We must make sure that the node was tight tightened the skin rings, but that he didn't conquer the skin. Separate stages ligation can be seen from Fig. 104 and 105.

Fig. 102. The bandage on Chistyakova. The newborn with neperevyazannymi the remainder of the umbilical cord.

Fig. 103. The bandage on Chistyakova. The 1st time.

Fig. 104. The bandage on Chistyakova. 2nd time.

Fig. 105. The bandage on Chistyakova. 3rd time.

This dressing in the delivery room after primary toilet skin, usually not replaced until the 5th day; at random surface contamination replaced only the outer napkin. Of course, if the bandage wet, soaked in blood, will appear sharp redness in the field of umbilical ring or bandage will start emitting a putrid stench, you should change it, carefully examine the remainder of the umbilical cord and find out the reasons of wrong mummification process.
On the 5th day, the doctor removes the blindfold, carefully examines the rest of the umbilical cord and adjacent to it the skin, oil cord iodine or alcoholic solution of streptocide and re-imposes the same dry sterile dressing. In institutions with high culture of service staff the rest of the umbilical cord of a newborn baby can be left without any dressing.
After deciduation of funic that in normal conditions often occurs around 7-9 days after birth, the wound daily smeared 1-2% solution of silver nitrate in 70oC alcohol, prisypaetsja bioforma, kseroforma or dermatol and left open. Healing occurs quickly and without suppuration.
It is necessary to pay special attention to hygiene of the skin. The child must not lie in a wet or dirtied diapers; many children, especially prone to exudative phenomena, the system of transferring them just before feeding often leads to the appearance of diaper rash and other skin irritations.
After each urinating of the child should wipe dry, and after the bowel to first wash with warm water, then RUB sterile vaseline or vegetable (almond, sunflower, peach, and so on) oil or sprinkle a thin powder inorganic origin. * Coarse powder, giving the big lumps should not be used.
The face and eyes of a child daily washed cotton swab dipped in boiled water or 2-3% solution of boric acid. The mucous membranes of the oral cavity in no case should not wipe.
To the dummy-dummy, of course, it is not necessary to teach the child, but very troubled children sometimes have to solve; it is necessary to pay attention to strict aseptic storage nipples.
Personnel should be qualified and strictly disciplined; before all the manipulations with the child should wash hands. In order to reduce the risk of infection with influenza and other drip infections, it is advisable to wear staff gauze mask that covers the nose and mouth. To care for a newborn in no event it is impossible to prevent persons suffering from any purulent processes (impetigo, furunkoulez, felon, and so on).

* Zincum oxydatum, talcum veneturn, bolus alba bisteril. and others, but not organic (potato flour, Likopodija and others).