Head Control Milestones and Infant Care Concerns

The definition of "head elevation" and other related terms?

Hello Dr.
Tsai,
1.
I see many people discussing at what age their children can lift their heads, and I noticed in the child development handbook that there are specific angles mentioned for head lifting at certain ages.
I have a question: how long does a baby need to hold their head up for it to be considered adequate? Is it enough if they can lift it that high for just a moment? My daughter is currently 2 months and a few weeks old, and she really dislikes the effort of lifting her head.
Others have suggested letting her practice tummy time, but I’ve tried a few times and she gets upset after just 1-2 minutes.
I don’t want to ruin her good mood.
However, when I hold her upright, I do feel that her neck is becoming more stable.
2.
I would also like to ask about the Apgar scores at 1 and 5 minutes after birth.
What do these scores signify? I have been unable to find relevant information.
Is a higher score better? What is the maximum possible score?
3.
Lastly, regarding the vernix caseosa in the labia majora, should I make an effort to clean it thoroughly? Some say it should be washed off during bath time, while others suggest that warm water sitz baths will help it fall off naturally.
When I bathe her, I try to touch it slightly, but she immediately straightens her legs and closes them.
I change her diaper when she’s in a good mood to avoid struggles, and I use wet wipes to gently clean it, but she still reacts by pulling away.
I’m hesitant to continue.
Even now, when I open the labia majora, there is still some white residue.
What should I do about this? Will it have any effects?
Thank you for taking the time to answer my questions.

Haoqi de Lin, 20~29 year old female. Ask Date: 2005/06/30

Dr. Cai Zhengxian reply Pediatrics

Dear Ms.
Lin,
I hope this message finds you well.
As a dedicated pediatrician at Tainan Municipal Hospital, I would like to address your concerns one by one:
1.
In the neurological examination of infants, I often need to assess the baby's muscle strength as well as their muscle tone.
When you mentioned the angle of head lifting being between 45 to 90 degrees, this refers to muscle strength.
It is sufficient for the baby to achieve this maximum angle, and there is no need for it to be maintained for a specific duration.
Conversely, when parents hold the baby in their arms, the ability of the baby to maintain neck stability is an assessment of muscle tone, which should be observed for a duration of 4-5 minutes.
Therefore, it sounds like your baby has good neck muscle tone and strength, which is appropriate for a 2-month-old infant.
2.
The Apgar Score is a vitality assessment for newborns created by the renowned American professor Virginia Apgar.
It consists of five criteria: heart rate (presence of a heartbeat over 100 beats per minute), respiratory effort (whether breathing is regular or there are regular cries), muscle tone (good muscle tone), skin color (normal body color), and reflex response (grimace or sneeze in response to stimulation of the mouth/nose).
Each criterion is scored from 0 to 2, with a total score ranging from 0 to 10.
An average score above 7 indicates good vitality at birth, assessed at one minute and five minutes after delivery.
I believe your baby must have been born with great vitality!
3.
The white vernix caseosa found in the genital area of female infants does not require any special treatment and will naturally shed on its own.
Vernix serves to lubricate the baby during birth and protects the newborn's skin from infections.
Wishing you and your baby a safe and healthy growth journey!
Best regards,
Dr.
Tsai Cheng-Hsien
Pediatrician, Tainan Municipal Hospital

Reply Date: 2005/06/30

More Info

Hello! Thank you for your questions regarding infant care and developmental milestones. Let's address each of your concerns in detail.

1. Head Control Milestones: Head control is a crucial developmental milestone for infants. By around 2 months, many babies can lift their heads to about a 45-degree angle when lying on their stomach. However, the duration of head lifting can vary. It is not just about the height but also about the ability to hold the position for a few seconds. If your baby is not enjoying tummy time, it’s essential to make it a positive experience. You can try shorter sessions, perhaps starting with 1-2 minutes and gradually increasing as your baby becomes more comfortable. Engaging with your baby during tummy time, using toys, or lying down face-to-face can help make this activity more enjoyable. If your baby shows signs of frustration, it’s okay to take breaks and try again later. Consistent practice is key, but it should be done in a stress-free manner.

2. Apgar Scores: The Apgar score is a quick assessment performed on newborns at 1 and 5 minutes after birth to evaluate their physical condition and determine any immediate need for extra medical or emergency care. The score ranges from 0 to 10, with higher scores indicating better overall health. The five criteria assessed are heart rate, respiratory effort, muscle tone, reflex response, and skin color. A score of 7 or above is generally considered normal, while lower scores may indicate the need for medical attention. It’s important to note that while a higher score is better, it is just one of many factors that contribute to a baby's health.

3. Cleaning of the Labia: Regarding the presence of vernix caseosa (the white substance you mentioned) in the labia, it is generally not necessary to aggressively clean it. Vernix is a natural substance that protects the skin of the fetus in utero and can help with moisture after birth. It typically sloughs off naturally over time. Gentle cleaning during bath time is sufficient. If your baby is showing discomfort or resistance when you attempt to clean, it’s best to avoid causing distress. Instead, you can use warm water during bath time to help loosen any residual vernix. If you notice any unusual discharge, redness, or irritation, it would be wise to consult your pediatrician for further evaluation.

In summary, it’s important to approach each of these developmental milestones and care practices with patience and understanding. Every baby develops at their own pace, and what works for one may not work for another. Regular check-ups with your pediatrician can provide reassurance and guidance tailored to your baby's specific needs. If you have ongoing concerns about your baby's development or health, don’t hesitate to reach out to your healthcare provider for personalized advice. They can help monitor your baby’s growth and development and address any specific issues you may have. Wishing you and your little one all the best!

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