Tips and advice
for parents and their little ones
Where a wonderful life begins 1
Having a baby is a wonderful experience and at
The Wesley Hospital, we are proud to welcome
over 1300 babies into the world each year. Our
expert team are here to support you on your
special journey from pregnancy right through to
Co n te n ts
settling in with your baby at home.
3
For more information contact your GP
or visit wesley.com.au/maternity
Women’s health
Healthy eating during pregnancy
4
Oatmeal chocolate chip lactation
cookies recipe
7
The supply and storage of expressed
breast milk
9
After birth care
10
Newborns and babies
6
How to settle your baby
12
Introducing solids
14
Children
10
2 The Wesley Hospital
Sleep studies
16
Childhood allergies
17
Toilet training
18
Where a wonderful life begins 3
women’s health
Healthy
eating
during
pregnancy
Healthy eating for pregnancy is important
as it can affect your health and the health
of your baby.
Ensuring you have a healthy diet before and during pregnancy can
help provide important nutrients for your baby’s growth and health into
the future. While there is only a small increase in the amount of food
you need to eat during pregnancy, there are certain nutrients that are
a very important part of a nutritious diet during this time:
Accredited Practising
Dietitian,
The Wesley Hospital
Folate
Iodine
iron
+ Folate (or folic acid) is
a particularly important
nutrient prior to and
during the first trimester of
pregnancy.
+ Iodine is an important
+ Iron requirements during
+ Folate is an important
nutrient for development
of the nervous system and
helps to reduce the risk of
neural tube defects (such as
spina bifida).
+ Foods containing good
sources of folate include
green leafy vegetables (such
as spinach, salad greens,
broccoli and asparagus),
legumes (lentils, chickpeas
and beans), cereals
(including fortified breakfast
cereals and breads), and
some fruit (including fortified
juices).
+ An additional folic acid
supplement is essential
to supplement dietary
folate for pregnancy. It is
recommended women take
a folic acid supplement of at
least 400 micrograms per
day one month prior and
during the first trimester of
pregnancy.
4 The Wesley Hospital
by Melanie Bannister,
nutrient during pregnancy to
help with your baby’s growth
and brain development.
Iodine is needed in higher
dietary amounts throughout
pregnancy and also
breastfeeding.
+ It is recommended that all
pregnant women take an
iodine supplement of 150
micrograms per day, in
addition to consuming good
food sources of iodine.
+ Foods rich in iodine include
dairy foods, bread (fortified
with iodine), seafood and
eggs.
pregnancy are also
increased. Iron is needed
to help form red blood cells
and carry oxygen in the
blood, as well as growth and
development of your baby.
+ Iron rich foods include red
meat, tofu, fortified breakfast
cereals and leafy green
vegetables. Iron from animal
based foods is absorbed
better than plant sources.
+ An iron supplement may
need to be considered if
dietary intake is inadequate.
An accredited practising dietitian
can provide expert nutrition and
dietary advice to help you achieve a
healthy diet during pregnancy and
breastfeeding, and to help give your
baby the best start in life.
References:
National Health & Medical Research Council
Dietitians Association of Australia
Food Standards Australia & New Zealand
Where a wonderful life begins 5
women’s health
Oatmeal chocolate chip
lactation cookies
Anecdotal evidence suggests that eating these cookies regularly may
help increase your breast milk supply…and they taste delicious!
by Lyndel Fuller,
Lactation Consultant,
The Wesley Hospital
Ingredients
Method
1 cup butter or substitute with organic coconut oil
1. Pre-heat oven to 180 degrees celsius. Mix
the flaxseed meal and water together and
leave for 3-5 minutes.
1½ cups firmly packed brown sugar (less is ok)
4 tablespoons water
2 tablespoons flaxseed or linseed meal
2 large eggs
2 teaspoons vanilla
2 cup plain flour or coconut flour, gluten free flour
or half flour/half with almond meal
1 teaspoon baking soda
1 teaspoon Himalayan salt
1 teaspoon cinnamon
3 cups oats
1 cup chocolate chips or a mixture of sultanas,
walnuts, almonds, macadamia nuts or coconut
2-4 tablespoons brewer’s yeast – this is the most
important ingredient and is not to be confused
with bakers or any other type of yeast
6 The Wesley Hospital
2. Cream butter and sugar together until pale
and creamy. Add eggs one at a time and
mix well.
3. Add flaxseed and water mixture, with
vanilla and mix well. Add more water if
appears too dry.
4. Sift dry ingredients together, except oats
and chocolate chips. Add sifted ingredients
to butter and combine. Stir in oats and
chocolate chips/nuts.
5. Scoop and drop dessert spoon size rounds
onto a greased and lined baking tray.
6. Bake in a pre-heated oven for about 10-12
minutes depending on the size of your
cookies.
Where a wonderful life begins 7
women’s health
The supply and storage of
expressed breast milk
1
Aim for 8 expressions in
a 24 hour period, with no
more than a 5 hour break
overnight.
2
Fresh expressed breast
milk can be stored in the
refrigerator for 3-5 days or
frozen for later use.
3
Thawed expressed milk
can be kept for 24 hours in
the refrigerator and then
must be discarded.
Recommended storage by method
Condition EBM
Fresh
Room Temperature
Refrigerate
Freezer
26 °C and below
4°C and below
6-8 hours
3-5 days
2 Weeks in freezer
Still preferable to
keep in the fridge
Store at back of
fridge
Compartment inside fridge
3 months in freezer section
of fridge if separate door
6-12 months in deep freezer
<18°C
Previously frozen,
thawed in fridge (not
warmed)
4 hours or less.
Thawed outside fridge
in warm water
Baby has begun
feeding
24 hours
Do not refreeze
Completion of feed
4 hours or until next
feed
Do not refreeze
Completion of feed
Discard
Discard
(ie.next feed)
Queensland Maternity and Neonatal Clinical Guideline: Breastfeeding Initiation. (2010).
8 The Wesley Hospital
Where a wonderful life begins 9
women’s health
After birth care
Simple steps can be beneficial to help
improve your postnatal recovery.
Rest
This will help to minimise discomfort, reduce swelling and take
the weight off your pelvic floor and lower abdominal muscles.
Aim for 30 minutes, two times a day.
Ice
This is very helpful in reducing pain and swelling in the
perineum. Use ice for 20 minutes every two to three hours and
continue until the pain and swelling eases.
Compression
Wear firm fitting cotton underwear to support your perineum
and lower abdominals. Control briefs may also be beneficial at
this time.
Pelvic floor exercises
The muscles lie deep in the pelvis and act to
support the pelvic organs and control bladder and
bowel. The pelvic floor muscles attach to your
pubic bone at the front and the tail bone at the
back. These muscles may become weakened
during pregnancy due to the hormones and the
weight of the baby. It is important to re-train these
muscles in the early postnatal period to prevent
problems such as incontinence. Healthy pelvic
floor muscles also enhance sexual function.
+ Relax for a few seconds and repeat this three
to five times
You should do pelvic floor muscle exercises every
day.
Exercise 2: Short squeezes
Commence with the following two exercises.
Begin in lying position with your knees bent and
your feet supported and apart.
Exercise 1: Long hold
+ Squeeze around your back passage and your
vagina, like you are trying to stop yourself
passing wind or urine and try to lift the pelvic
floor up
+ Repeat this exercise three times a day
+ As your muscles get stronger you can increase
the hold of each exercise, aiming for 10 x 10
seconds
+ Progress to lifting your pelvic floor in more
functional positions such as sitting, standing
and during activities such as walking and lifting.
+ Tighten the pelvic floor muscles as above, this
time holding for only one second
+ Start with 10 squeezes and build to 20
+ Repeat this exercise three times a day.
Functional Bracing
Remember to tighten your pelvic floor muscles
when you cough, sneeze, laugh or lift.
+ Hold this for two to three seconds. Remember
to keep your abdominals, buttock and thigh
muscles relaxed
Exercise
Pelvic floor and deep abdominal exercises will assist with
healing. They can be safely started in the first couple of days
post delivery provided there is no increase in discomfort.
Back care and correct lifting
+ Bend your knees, keep your back straight and
tighten your pelvic floor and abdominal
muscles. Always hold objects close to your
body.
+ If possible, do no lift anything heavier than your
baby for the first six weeks.
10 The Wesley Hospital
+ Make sure work surfaces are at waist height,
e.g. change table.
+ Ensure feeding is done in a supported position,
a foot stool and feeding pillow may help.
Remember to lift the baby up to your breast or
bottle.
Return to exercise
+ Commence gentle walking as pain and
discomfort allow.
+ Gradually increase your walking distance and
speed as able.
+ Avoid strenuous or high impact exercise
during the first 12 weeks e.g. running, heavy
weights and abdominal crunches.
It is a good idea to check your pelvic floor
strength before returning to high impact exercise.
If you have any urinary leakage or poor bowel/
wind control it is advantageous to see a women’s
health physiotherapist.
If you have any ongoing concerns
post delivery with regards to
urinary leakage, pelvic girdle pain,
bowel dysfunction or abdominal
muscle separation a one-on-one
appointment with a women’s health
physiotherapist may be recommended
to assist your recovery
References: Guide to physiotherapy after childbirth,
The Wesley Hospital
Disclaimer: This information is intended as a
guideline only and reflects the consensus of the
authors, at the time of publication. The sources
used are believed to be reliable and in no way
replace consultation with a health professional.
Where a wonderful life begins 11
newborns and babies
What can you do to settle your baby?
+ Check if they are safe
and comfortable
+Don’t disturb them if they
are settled (even if they
are moving quietly)
+Give extra cuddles
+ Movement and rocking
seem to help
+ Sometimes a ride in a
car gives just the right
amount of vibration and
movement to settle a
crying baby
+Reduce excess noise
and dim the lights for
over stimulated babies
+ Baby massage is helpful
in some cases
+ Include walks, relaxation
baths, playtime or music
in the background
+ Feed when necessary
+ Correct and adjust your
feeding techniques, such
as winding your baby
+ Seek advice from your
child health nurse if the
above measures are not
working
+ See your doctor if you
notice a sudden change
in your baby’s behaviour,
or notice signs of illness
(fever, vomiting etc)
+ If your baby is
constipated, contact
your child health clinic
or doctor for the most
appropriate advice
Crying and fussing in infancy is a normal developmental behaviour
that nevertheless causes considerable distress to parents. Most
babies will decrease the amount of crying with time.
How to settle your baby
Parents and care-givers need to be reassured that this difficult
phase will pass.
Your newborn baby is totally dependent on your loving care and
through you, will begin to learn about the world. It’s important to
remember that all babies will develop and grow at different rates
and in the early stages, regular visits to your child health clinic are
important. Your child health nurse or paediatrician will be able to
help you with any question you may have.
Crying is a baby’s most powerful means of communication. It is a signal
to alert the person looking after them that they need attention. Crying is a
baby’s language, and they cry for many reasons. It is important for parents
to understand why babies cry and to be able to identify certain behaviours.
What are some of the common reasons for a baby to cry
+ Being cold or hot
+ Having a wet or dirty
nappy
+ Being in an
uncomfortable position
+ Being bored
+ Wanting a cuddle
+ Being hungry
+ Having a pain (eg wind)
12 The Wesley Hospital
+ A lack of basic routine
for feeding or sleeping
+ Changes in environment
may unsettle the baby
+ Over handling / too
much stimulation
+ Being tired
+ One of many medical
conditions
Breast feeding problems
+ Under or over feeding
+Dwindling milk supply
Artificial/bottle feeding problems
+ Teat too slow or quick
+ Incorrect preparation of
the feed
+ Constipation – difficulty
passing hard motions
When to call the doctor
+ Persistent temperature
over 37.5°C
+ Diarrhoea
+ Looking pale, lethargic/
drowsy
+ Persistent vomiting,
particularly if bright yellow
or green in colour
+ Disinterested in feeds
+ Rashes
+ Weak or high-pitched cry
+ Rapid breathing, drawing
in of the chest wall
+ Abnormal behaviour such
as lethargy, irritability,
floppy, poor response
+ Less than 4 wet nappies in
24 hours.
Where a wonderful life begins 13
newborns and babies
Introducing your baby to the taste of new foods is both an exciting and
potentially daunting time for many parents. There are a number of things
to consider at this time including which foods to choose, what textures are
appropriate, are the foods nutritional for health and wellbeing and, of course,
whether your baby likes them!
Introducing
solids
Here are a few tips to help navigate this journey and
enjoy this wonderful learning experience
+ “Food Refusal” is common – eating is
a learning experience that involves new
foods, new textures, new flavours. It can
be a very sensory experience for baby
and learning through play can be helpful
to create a safe and enjoyable experience.
Stay relaxed, have fun, and remember
to try new foods or textures a number
of times to assist with learning and
acceptance.
+Enjoy meals as a family – remember
children are learning to eat and you
provide the best role model for behaviours
you wish your children to follow.
+ Children like routine, so creating a
mealtime routine may be helpful to signal
it’s time to eat. Include the same type
of placemat, bowl, plate and even sing
songs about eating to help create a
mealtime routine.
+ Praise good behaviour with plenty of
positive encouragement – give lots of
cuddles and smiles! Avoid focusing
only on the negative or ‘fussy’ eating
behaviours as eating may then become
an unpleasant experience.
The Centre for Food & Allergy Research has recently coordinated a review by the peak health bodies
in Australia regarding the introduction of solids and revised infant feeding guidelines as follows:
by Melanie Bannister,
Accredited Practising
Dietitian,
The Wesley Hospital
1.
When your infant is ready, at around 6 months, but not before 4 months, start to introduce a
variety of solid foods, starting with iron rich foods, while continuing breastfeeding.
2.
All infants should be given allergenic solid foods including peanut butter, cooked egg and dairy
and wheat products in the first year of life. This includes infants at high risk of allergy.
3.
Hydrolysed (partially and extensively) infant formula are not recommended for prevention of
allergic disease.
An Accredited Practising Dietitian can help assess and guide
your child’s dietary intake during these important months in
introducing solids and during toddler years, to help advise on
nutritional intake, dietary requirements for food allergy and
intolerance as well as other health conditions.
14 The Wesley Hospital
References:
Centre for Food & Allergy Research,
Murdoch Childrens’ Research Institute
Dietitians Association of Australia
Queensland Health, Nutrition Education
Materials Online
Where a wonderful life begins 15
Children
children
Childhood allergies
Paediatric Immunologist and Allergist Dr Kim Robertson
performs oral food challenges at the Wesley.
Dr Robertson says cow’s milk, eggs and nuts are
the most common childhood food allergies.
“Egg is the most common food allergy, and the
risk of anaphylaxis is low, so the majority of these
challenges are performed at home. The most
common food trigger for anaphylaxis is a nut, and
these challenges are best conducted in hospital.
sleep studies
Up to 10 per cent of children snore and about a quarter
of these children suffer from obstructive sleep apnoea.
Obstructive sleep apnoea is the narrowing of
the airway during sleep which can cause a drop
in oxygen and or disruption of dreaming sleep
(dreaming sleep is crucial for learning and feeling
refreshed after sleep).
More severe cases can be associated with poor
growth and strain on the heart. The best test for
obstructive sleep apnoea is a sleep study.
Dr Scott Burgess has been doing overnight sleep
studies since May 2014 at The Wesley Hospital.
The child is attached to monitoring equipment
to examine their breathing and the effect of any
16 The Wesley Hospital
breathing problems on the child’s sleep and blood
levels of oxygen and carbon dioxide.
Parents are able to sleep in the same room as
their child during the study.
Working in collaboration with Genesis SleepCare,
Dr Burgess is able to arrange and report full
sleep studies for children aged two years and
older. Screening studies are available for younger
children.
For more information please talk to your GP or
visit wesley.com.au
Other allergies are taken into account, with a third
of egg allergic children also being nut allergic,
and a third of peanut allergic patients having an
allergy to a tree nut. The majority of food allergies
in children are not severe and will disappear with
time. Nut, seed and seafood allergies are more
likely to be lifelong.”
Some of the many theories surrounding the
increased rates of paediatric food allergy are:
hygienic environments with less exposure to
infection in early childhood, modern low fibre diets
leading to reduced microbial diversity in the gut,
changed methods of food processing and timing
of introduction of allergenic foods into the baby’s
diet and vitamin D deficiency.
“The oral food challenge is the gold standard for
determining if a patient is allergic to the food,”
Dr Robertson explains.
Children with allergies are admitted for a morning
in the Wesley children’s ward for the procedure
whereby they are given incremental amounts of
the food in question.
“We use a graded process where we feed the
child increasing amounts of the food every 20
minutes,” Dr Robertson said. “If there is a reaction
Above: Dr Kim Robertson with Willow, 3, during
her oral food challenge
we can recognise this early and treat the reaction
immediately. Kids who are admitted receive oneon-one nursing supervision which is important to
monitor for anaphylaxis or severe allergic reaction.
I am available on site at the Wesley to see the
patient at the start and end of the challenge, and
at any point during the morning if there is evidence
of reaction.”
Being in a hospital can help ease parents’ worry
that they are giving their child foods that may
make them sick but one of the biggest hurdles
can be encouraging the child to eat enough of the
food to test.
For more information please talk to your GP or
visit wesley.com.au
Where a wonderful life begins 17
children
Learning to use the toilet is an important step in your toddler’s life.
Some toddlers get the knack quickly, while others need parental
patience and support.
Don’t start toilet training too early. Children usually
reach two years of age before they can recognise
and respond to toileting signals such as a full
bladder. Premature toilet training will only frustrate
you and upset your child, because they can’t do
what you ask of them.
A child usually masters daytime toileting well
before they can keep their bed dry at night. There
are many practical suggestions you can try to
manage bedwetting. Remember that if your child is
scared of the dark, going to the toilet at night is an
enormous challenge.
Is your child ready?
Does your child seem interested in the potty chair or
toilet, or in wearing underwear?
Can your child understand and follow directions?
Does your child tell you through words, facial
expressions or posture when he or she needs to go?
Does your child stay dry for periods of two hours or
longer during the day?
Toilet
training
Does your child complain about wet or dirty diapers?
Can your child pull down his or her pants and pull
them up again?
Can your child sit on and rise from a potty chair?
If you answered mostly yes, your child might be
ready for potty training. If you answered mostly
no, you might want to wait.
Ready, set, go!
Pull out the equipment. Place a potty chair in the
bathroom or, initially, wherever your child is spending
most of his or her time.
Schedule potty breaks. If your child is interested,
have him or her sit on the potty chair or toilet without
a diaper for a few minutes several times a day. For
boys, it’s often best to master urination sitting down,
and then move to standing up after bowel training is
complete.
18 The Wesley Hospital
Stay with your child when he or she is in the
bathroom. Even if your child simply sits there, offer
praise for trying — and remind your child that he or
she can try again later.
Get there — fast! When you notice signs that your
child might need to use the toilet — such as
squirming, squatting or holding the genital area —
respond quickly. Help your child become familiar with
these signals, stop what he or she is doing, and head
to the toilet. Praise your child for telling you when he
or she has to go. Teach girls to wipe carefully from
front to back to prevent bringing germs from the
rectum to the vagina or bladder. When it’s time to
flush, let your child do the honors. Make sure your
child washes his or her hands afterward.
Consider incentives. Some kids respond to stickers
or stars on a chart. For others, trips to the park or
extra bedtime stories are effective. Reinforce your
child’s effort with verbal praise.
Ditch the diapers. After several weeks of successful
potty breaks, your child might be ready to trade
diapers for training pants or underwear. Celebrate
this transition. Let your child pick out his or her
underwear. Once your child is wearing training pants
or regular underwear, avoid overalls, belts, leotards or
other items that could hinder undressing.
Sleep soundly. Most children master daytime
bladder control first, often within about two to three
months of consistent toilet training. Nap and night
time training might take months — or years — longer.
In the meantime, use disposable training pants or
mattress covers when your child sleeps.
Know when to call it quits. If your child resists using
the potty chair or toilet or isn’t getting the hang of it
within a few weeks, take a break. Chances are he or
she isn’t ready yet. Try again in a few months.
References:
http://www.mayoclinic.org
https://www.betterhealth.vic.gov.au
Where a wonderful life begins 19
Wesley Maternity
3232 7432
Where a wonderful life begins
+ Over 20 leading obstetricians
+ Antenatal classes
+ 80 midwives caring for new mums
and babies
+ Breast feeding class & support post
discharge
+ Comfortable private en-suited
rooms
+ Assisted birth
+ Expert lactation consultants
+ Home visiting service
+ Special care nursery
Wesley Paediatrics
3232 7000
Continuing to care for kids
+ Over 20 leading paediatrics
specialists
+ Children’s play facilities and areas
that cater for adolescents
+ Dedicated paediatric ward with
full time senior doctor
+ Easy access via train, bus and
ferry, onsite parking
+ Family friendly ward with 13
private rooms with ensuites
Wesley Emergency Centre
3232 7333
Providing 24/7 care for patients
+ 19 emergency beds
+ Dedicated paediatric room
+ Latest patient monitoring
equipment
+ Short wait time
+ 15 senior emergency doctors
+ Treatment of a comprehensive
spectrum of paediatric
presentations
+ 24 hour access to senior
paediatricians and access to
dedicated paediatric inpatient
ward
Women’s Health Physiotherapy
3232 6190
No doctor referral required
+ Personalised, private
consultations with experienced
women’s health physiotherapists
+ Competitive prices with access
to HiCAPs for an effortless rebate
with your health fund
+ Continuity of care and onsite
hospital location so patients can
see their doctor/specialist on the
same day
+ Minimal waitlist, and urgent
appointments available within
48 hours
For more information contact your GP or visit wesley.com.au