One of the attendings pointed out the other day that the well baby nursery is the only place in the entire hospital where your patients are healthy. While normally the chief complaint of one of my patients is "stomach pain" or "shortness of breath," this week the chief complaint of all of my patients is "new baby." To be fair, that's one hell of a complaint; you try being ripped from your dark, warm, quiet home and being told to breath and eat and poop on your own for the first time. But existential complaints aside, all of these babies are healthy. If they weren't they would have been transferred to the neonatal ICU.
One awkward part of our job in the nursery is to provide what's known as "anticipatory guidance," which essentially means advice as to what to do and what to expect between now and the next time you see your primary pediatrician. This is super helpful and much appreciated for a first time mother. But when you have a mother of 4-now-5 as a patient, they know (or, at least, think they know) everything about babies.
The hardest part is if the mother's old habits are outdated or just plain wrong. It takes some skilled diplomacy to get them to even hear you out, much less actually follow through with your recommendations once they leave your care. Say advice without conviction and they'll tune you out; but get too preachy and they'll ignore you out of spite. Add into the mix that most of the medical students and residents don't have kids of their own yet (you know, with all that time we have) and it's amazing if anyone listens to us.
Switching gears, remember those cheap molded plastic toys like green army men or monkeys in a barrel? You know how there was always a little nub of plastic that shows you where they injected the mold? Well babies have those too. The most obvious one is, of course, the umbilical cord - the literal connection to the mom. But there are a couple other vestiges of the manufacturing process that we are very keen to check in the hours and days after birth. One such remnant is the end of the neural tube, which is like the primitive tube (for once biologists actually named something intuitively) that the spinal cord develops in.
For a good chunk of early human development, this tube is open to the fluid around the fetus. Sometimes this tube stays open on one or both sides. If the top end remains open, it's called anencephaly; if the bottom does, it is a meningocele or myelomeningocele - collectively known as spina bifida.
TIL: Diastematomyelia is when the tail end of the spinal cord is split down the middle by bone or cartilage. The symptoms often include foot or leg numbness or weakness progressing to bowel and urinary dysfunction.
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