omphalocele baby

[elizabells, BSN, RN]

Hey guys, gotta question...

We have a baby that's about 21 days post-op from total serial reduction of a GIANT (literally the size of the kiddo's head, and he was a good-sized term baby) omphalocele. He had a nine-day silo reduction and closure, all went well, the kid is feeding like a champ and almost ready to go home. However, the kid is wicked fussy (we think he's hungrier than what he's being fed) and screeeeeams a lot, and the only thing that calms him is being walked around and bounced. This is my first omphalocele kid, and I'm sort of leery of holding him too tight. Am I going to hurt him if I hold him like a regular baby? His incision is good, there have been NO problems with his gut. When the other kids are screaming, I just hold them prone against my upper chest and bounce a little.

[BittyBabyGrower, MSN, RN]

All gut kids are notoriously crabby! We walk around with them all the time, put them in swings, in bouncy chairs, on mats on the floor with toys, even in a stroller and pass them room to room so that we can take turns entertaining them LOL. Sometimes mylicon drops help, but our theory is they just had their guts squished back in...something is bound to not feel good!

[prmenrs, RN]

Ditto what BBG said. They are just some of the most miserable customers on the planet.

Definitely use the Mylicon gtts. And tylenol if ordered. The baby acts hungry because he's so uncomfortable, he just wants to suck anything not nailed down. As he works that binky/pacifier/thumb over, he swallows a lot of air, which can make it worse.

Sometimes, a warm bath can help. Swaddle the baby loosely in a blanket so he feels secure. Calming music is good, too. When it's time to sleep, a dark, quiet room, maybe a glider, a volunteer cuddler (if you have them). Sometimes, they have to be held firmly to get them to relax. I highly recommend these tapes or something like them:

http://www.amazon.com/gp/product/B00003TFYP/sr=8-1/qid=1147445984/ref=pd_bbs_1/103-3534265-1471824?%5Fencoding=UTF8

Make sure the family understands this baby will be much, much more demanding and irritable than most, and that dad and other family members give mom a break frequently.

These kids eventually settle down, or so I'm told. Meanwhile, LOTS of comfort measures.

[lovemyjob]

Here lately it has been our jejunal atresias who are the worst. Once they get to screaming, and swallowing a lot of air, the only thing to comfort them has been to pull of the air from their stomach. We have one in both nurseries, same bedspace!!

[babynurselsa, RN]

Gut babies rank right up there with methadone babies on the cranky scale sometimes. Usually they are also terrible feeders and pukers also.

My experience is just like the others. Lots of holding, rocking, and swing time. Lots of teaching with the parents too. I would advise them they had better have a swing and a bouncy seat ready at home along with a good supply of batteries for them.

Sometimes swaddl.ing them VERY snug in flexion with their knees drawn up to their tummy helps.

[Mags4711, RN]

Not a lot that I can add, the others above me have really hit about all the tips and tricks I can think of. We have SEVERAL oomphalo's and gastroschesis' right now and OMG, they are the crabbiest kids!

[BittyBabyGrower, MSN, RN]

We have 3 of them in one room at work and we just lay our heads down on the table in the conference room when we see that we are in that room and try not to weep LOL They were up there in decibels last night equivalent to a Rolling Stones Concert, without the fun LOL We have 4 gastroschisis they are following over in antepartum that are slated for delivery in late June or early July....I knew I should have taken my 2 weeks in July!

I feel so bad for the parents....we tell them sometimes, you just have to set them down and walk out of the room and let them scream. We'll put warm pack on their bellies too, but most of the time, if they have and ng or GT we vent it...you can hear the air coming out of them, poor kids! One of them, we have a PRN for versed because she is so out of control sometimes...it is awful...we all think there is something else going on in her gut, but what do we know, right?

[LPN1974, LPN]

Sounds like this might be the kind of infant to watch carefully for

physical abuse?

I see so much of it in the newspapers, about small infants being beat to death for crying, etc.

[Mags4711, RN]

We have three in one room right now, too! And a couple of others scattered throughout the unit. Wonder what is going on with so many belly kids.

[prmenrs, RN]

Sounds like this might be the kind of infant to watch carefully for

physical abuse?

I see so much of it in the newspapers, about small infants being beat to death for crying, etc.

This very true, esp w/young, immature families, or non-intact families. That's why it's absolutely imperative that all caregivers spend lots of time w/baby while in the hospital, and have social work support both in hospital and after d/c.

Support is key to preventing such a problem. And the neighbors need to know this baby is going to cry a lot, so they don't call CPS!

[LilPeanut, MSN, RN, NP]

I love the belly babies, and they seem to love me *L* I always seem to be able to get them to stop crying and go to sleep. It makes me very popular sometimes. Another thing my unit does is with the very stable belly babies, we take them up to the desk for the clerks to hold them.

My city has the highest rate of gastroschiasis in the country, so we have a lot of bellies, all the time.

[wjf00]

All gut kids are notoriously crabby!

And very stable. Sadly, they tend to be in 4 pt. assignments with the slowest feeders which leaves the nurse no time to comfort them. I raise a ruckus when I get them in a 4 pt. assignment... totally unaceptable.