Babes In Arms

Babies bring out the concerns of even the toughest cutthroat adult. They have us mystified and muddled and they have all read the books on “How to Train Your Parents….Early”. Even a newborn is versed in the cunning art of getting grown ups to do exactly what they want…RIGHT NOW! Seriously though, children are a concern in this Island society, where opinions of East and West clash, and good medical advice is difficult to come by. Here are a few of the more frequently asked questions that cross my desk.

Q. My daughter was born with a very bruised bottom. She is now 6 weeks old and the bruise is still there. How long should it take to go away? This is very embarrassing and I am worried that people will think that I have been beating my baby.

A. This is not a bruise at all, but a birthmark commonly known as a “Mongolian Blue Spot” or “Oriental Blue Patch”. This birthmark typically appears around the sacral region or lower back, and can range in size from a few centimeters in diameter, to almost covering the entire buttocks. The color can range from a light blue-ish tinge to dark gray. This birthmark frequently occurs in mixed children of Caucasian, Asian, or Mediterranean decent. There is no treatment for this lesion, and it usually disappears by the age of 2 to 3 years.

Q My cousin (Balinese, and living in the village) has recently given birth to a baby that I think may have Downs Syndrome. The baby is a poor feeder, seems “floppy” compared to my son who is the same age, and has a flat head and squinty eyes. I am afraid to say anything in case I am mistaken. Their local doctor has also made no comment. How can I help this couple?

A. Be very careful here. Even the most experienced pediatrician can have trouble giving a definitive diagnosis for Downs Syndrome. This condition does have classic signs, however children affected by this syndrome can range from very mildly, to severely affected. Mild cases are very difficult to differentiate from perhaps just an unusual looking baby. Some of the classic signs to look for would be:

Large protruding tongue, with downward turned mouth.
Low slung small ears.
Hypotonia or “floppy baby”.
Stumpy fingers, often with only one plantar crease (palm fold)
Head appears “flattish” when viewed from the side.
Eyes slant upwards.
Behind in developmental skills.

Unfortunately, the only sure way to make diagnosis in a difficult case would be through genetic studies, and I am quite sure that this is not available here in Bali. It may be a “watch, wait & see” situation in this case, and even if it looks with some certainty that there is a problem, there may be difficulties in explaining this condition to the parents, and even bigger difficulties getting them to accept it. It should be stressed that this is no way a “punishment”, or related to anything that the parents may have dome during or before the pregnancy.

Q. My 6 month old baby is due for vaccinations and my Australian baby vaccination book shows that the vaccines should be given at 2 monthly intervals, and yet my local pediatrician insists that they are given every month The nurse gets very irate with me when we do not comply. What should I do here?

A. Firstly, change your pediatrician, or tell him to change his nurse. Practitioners that are not willing to be flexible, or listen to your concerns on treatment variations are not worth listening to. No one practitioner should “insist” that you do anything with yourself or your child without a very good explanation, and even then, the choice is ultimately yours. I must have seen immunization programs from just about every country in the world, and I can tell you that they are all slightly different. The content of the program often depends on the disease risks of any particular area. What is a valid vaccine requirement in Africa, may not be necessary in Canada. Having said that though, vaccine programs from developed countries tend to be much the same. One thing that I have noticed, as you have pointed out, is that some recommend that the basic DTP / Polio program be given at one month intervals and some at two. There is no danger in giving these vaccines at monthly intervals, however, according to the immunologists, the vaccines are more effective, and have a higher antibody response if given at two monthly intervals.

Q. My baby seems to find a lot of comfort in just sucking. I would like to use a dummy but my mother-in-law says it may ruin the shape of his teeth. Is this correct?

A. I guess you could say that I graduated from the school of “If it feels good, do it”. Some babies just do love to suck; some babies will spit a dummy half way across the room and will have nothing to do with it. If the baby wants it, give it…. however there are rules:

v Never dip the dummy in honey or syrup. It is not necessary, and is a surefire way of giving the child rotten teeth.
v Always make sure that the dummy is cleaned (sterilized) properly each day, or after it is dropped. (Sucking the dummy yourself is not cleaning it!)
v Dental authorities do advise that it is wise to lose the dummy before the age of 18 months to avoid any effects on tooth development.

Q. My baby is one year old and as yet has no teeth. She is not yet walking unsupported, and yet my neighbor’s baby of the same age has 6 teeth and is walking alone. Is my baby abnormal?

A. No. By the time your baby is 18 years old she will have all her teeth, and she will be walking, and running very well! Why is it that we torture ourselves with comparison of our offspring to the extent that we feel so inflated if ours is the first to win the potty training race, and so devastated if we lose the tooth cutting final! Can you imagine a group of adults sitting around comparing their own body weights, toileting behavior, or dental state and getting seriously upset if they are not the same as the next person…I don’t think so!
All babies will develop at different rates, within a large variant of “normal”. If you feel that your baby really is behind in all or some aspects, have them assessed by an experienced Child Development professional, not by your neighbors, friends, or family.

Q. My 2 month old baby seems to cry constantly with colic. Sometimes I think I am going mad, as I cannot seem to console her, and have even considered putting a pillow over her face just to get some peace! My husband spends more and more time away from home as he cannot stand the crying either, but I am stuck with it. Please help me bring some sanity into our home.

A. Babies cry for a reason, and it is never to intentionally bring discord into the home. It is their only method of communicating with you, and it always means that something is not right. First of all get a good assessment done on your baby to make sure that the source of the problem really is colic. A truly colicky baby will usually draw its knees towards its chest during painful bouts. Here are some tips on treating a truly colicky child.

Make sure that babies milk is not flowing too fast. If your breasts are over full feed baby lying on your back. If the bottle teats are flowing too fast, change the teat for a slow flow teat.
After feeds make sure that you put baby up over your shoulder and gently rub her back, this will help baby to “burp”. If no burp happens in 5-10 minutes, it’s not going to happen at all.
Rub aniseed oil into her belly after feeds. The locals have been using it for centuries (known as minyak telon), and the aromatherapy association of Australia now recognizes it, as a treatment for windy infants.
Use a commercially available infant formula (infacol, gripewater). These items are not locally produced, and will need to be brought from overseas, or purchased at one of the international clinics.

Babies can test the patience of saints. If you ever feel that you may do your baby harm, hand her over to someone else. If there is no one else available, make sure that she is in a safe position, leave the house and go for a 10-minute walk. You will feel better for it, and the baby will still be alive when you return.

Good luck with your babes in arms…until next edition, stay happy, stay healthy and stay young!

“ Kim Patra is a qualified Registered Nurse / Midwife, and mother of three, who has been living and working in Bali for past 15 years. She has assisted many traveller (… and others) either as a flying medical escort or just a voice on the end of the phone! Kim is happy to discuss any health concerns that your may have. Her e-mail contact is

Copyright © 2002 Kim Patra