Friday, July 31, 2015

Cord care

As many of you in our practice know, some of the most common questions that the advice nurse team field on a regular basis have been addressed in past blog posts.

When we get a call, we will often send a link to a past blog post that addresses the topic. It saves us from repeating the same information over and over again. Of course we encourage follow up calls if you still have unresolved questions.

Recently for some reason we have been getting lots of calls about cord care. It often goes that way; things tend to occur in bunches. It was pointed out that this is one of the topics that I haven’t written up, so this week’s post is for the new kids on the block. I will do a more broadly based post next week.

Before birth, the umbilical cord is the connection between the baby and the mom through which the baby receives nourishment and oxygen. After birth it becomes useless.

One cord trend that comes in and out of fashion is the discussion about cord banking. The idea is to save your baby’s stem cells as an insurance policy in case there is a future medical need. In theory it is great. Unfortunately it is very expensive and it is hard to predict if the bank you choose will still be around in the future should you need it. Very few of our patients opt to do this.

The optimal timing for clamping the umbilical cord after birth has been a subject of controversy and debate. There is a current trend to delay clamping for a few minutes after birth.  It is best to discuss this with your OB ahead of time. The important thing is that the baby is tended to. If everything is lovely, by all means, delay the clamping for a moment or two. If for some reason the baby needs attention, the clamping is done immediately, and you don’t get that extra time, please don’t focus on this as something to fret about. I imagine your baby's chances of becoming president one day won’t hinge too closely on how quickly they got their cord clamped!

Whenever it occurs, the umbilical cord is clamped and cut close to the baby's body. There are no nerves in the cord, so this is a painless procedure.

The cord clamp should be removed prior to leaving the hospital. It is a good idea to check. We occasionally  get newborns in our office for their first visit with the clamp still on. Once the clamp is off, an umbilical stump remains attached to your baby's navel.

There is not much you need to do to care for it. Often, the less you fuss with it, the sooner it will fall off. It tends to fall off between 7-17 days (not everyone follows those rules.) At some point it will be hanging by a thread and you will see who the lucky person is who is changing the diaper when it comes off.

The newborn diapers that have the little cut outs are very useful. You want to avoid having it rubbed and irritated. Hopefully you won’t need more than a few boxes of those. If you have a larger baby who is too big for size one, just roll down the diaper to avoid rubbing.

We want to keep the area dry, so sponge baths are recommended until it is off. Yes, babies get some pee and poop on there, don’t freak out. Just clean it as best as you can. If the cord gets smelly (trust me, you will know if it is smelly or not) call the office to get it  checked out. This can signal that the baby has an infection (called omphalitis.) The docs will do a good cleaning and get in there in a way that the parents often aren’t comfortable doing. If needed, the doctor may apply silver nitrate. This is a chemical that cauterizes the area. That will leave a grayish/black discoloration around the area that may take a few weeks to fade. It may take more than one application for the cord to be healed.

Once in a while a small piece of the cord stays in place. This is called a granuloma. If the baby is acting perfectly fine in every other respect, there is no need to rush in, but we will want to take a look if things are not healing up. A persistent granuloma will need attention.

Once the cord is off, it is normal for it to continue to ooze a bit for another week or so. It is quite common to have a bit of green or yellow stain on the diaper or shirt. Sometimes there is also what looks like blood. Unless there are actual drops of blood coming from the area, I am not concerned about little staining. At this point you can clear around the area with a bit of alcohol and a dab of Neosporin.

Another thing that we get lots of calls about are umbilical hernias. An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries or strains causing the baby's belly button to protrude. This is a classic sign. Some of these are as big as golf balls. Usually this resolves on it’s own. As long as you can gently push the belly button back in, it is not a concern. If you have an inconsolable baby and the area seems to be stuck on the outside, that would need an immediate evaluation.

Before your know it, that cord will be off and most likely you won’t be giving much thought about your kid’s navel until they are teenagers and begging for permission to get it pierced. (It is also quite possible that when they turn that C in geometry into an A you will reluctantly give your blessing, as we did with our daughter Lauren!)

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