Newborns are Special
What to expect in the first few days and weeks
All babies are born with their own unique temperament or characteristics. It is exciting to get to know your baby and watch them change almost daily. Talk in calm, reassuring tones to your baby and hold them a lot. It is impossible to spoil a young infant. Basically they can not do anything for themselves, so your job is to do it for them-24/7! They need to be warm, dry, loved and not hungry. All babies cry, for many reasons. They may be hungry, too warm, too cold, over-tired, over-stimulated, or may seem to have no reason. Your job is to try to figure it out and calm them when possible. Sometimes they will cry and calm themselves. As they get older their ability to self calm will get better and better.
We spend a lot of time at nurse visits and checkups talking about feeding. Basically a newborn eats very frequently, both day and night. Initially all babies lose weight, stabilize, and regain their birth weight by 2 weeks of age. When growing well they gain between ½ and 1 ounce/day. Breast babies usually feed every 2-3½ hours for 20—30 minutes, and bottle babies every 3-4 hours. About half the infants’ weight can fit in their tummy at each feed; for example, an 8 lb baby can take up to 4 ounces. Regular feedings, wet diapers and bowel movements are all signs that things are going well. We will help you by monitoring this closely.
A WORD ABOUT JAUNDICE:
Jaundice is a yellow skin color seen in many babies caused by a buildup of the chemical bilirubin. Bilirubin is normally cleared in the liver, but it takes a few days for a newborn’s liver to get up to speed. If there are any extra risk factors, like prematurity, ABO blood type incompatibility, or bruising, the bilirubin may climb higher and the baby may look more yellow. Jaundice is typically harmless as long as the level of bilirubin does not get high enough to cross into the brain. When we see jaundice we sometimes follow levels with frequent measurements and or phototherapy to make sure the level never gets too high.
CONCERNED ABOUT ILLNESS?
All babies spit up, sneeze, sound stuffy, hiccup, snort, squeak and make all sorts of noises. They all have gas, and squirm, grunt or make noise when they pass gas or have a bowel movement. You can often hear their stomach gurgling. Some babies sleep a lot and cry very little and others cry a lot and sleep very little. Babies change almost daily so what seems normal one day may be different the next day. Eating well and sleeping well are the best signs that your baby is healthy. There may be fussy periods, but a baby should not be excessively irritable, very sleepy and difficult to arouse, or lose interest in feeding. If you are worried check your baby’s temperature rectally. If the rectal temperature is greater than 100.4 in the first 3 months of life call us immediately.
OFFICE VISITS and EMERGENCIES
We will follow your baby closely in the first few days and weeks after birth, to be sure weight gain is adequate and your baby is thriving. We will answer all your questions and show you how your baby is developing. If you have questions about routine care in between office visits call our nurse line during regular hours. If you become worried about your newborn call us anytime. We always want you to call for: excessive irritability, lethargy, poor feeding, vomiting yellow or green fluid (bile), and any fever.
Umbilical Cord: No special care is needed. Normal healing may create a “yucky” look and may smell. This material at the base can be wiped away with water. In the old days alcohol was used to speed drying. Typically the cord comes off in 1-2 weeks. Sometimes there is a small amount of bleeding when it separates, which is ok. Within a week after separation the area should be dry. Many babies have umbilical hernias, which looks like a pouching out of skin and intestine through an opening at the base of where the cord was. This usually resolves on its own. Ask us to explain how.
We recommend waiting to put your baby directly in water until the cord and/or circumcision heals. Your baby has been soaking for 9 months and the skin is waterlogged, often peeling, and very sensitive. It is ok to wash the diaper area and face with warm water. No soap is needed. A mild shampoo can be used for the hair. Bathing every 2-4 days is plenty. It is not necessary to remove the mucus many girls have in the vaginal area.
The area is so sensitive and there is so much contact with urine and stool that it is uncommon to not get at least a mild rash from time to time. Change the diaper frequently, use the right size diaper, and keep as dry as possible. Zinc (Desitin), Cetaphil, Aquaphor work well as barriers. Use water or low alcohol wipes to clean stool. No wipes are needed for urine. If a pimply looking rash develops after several days of irritation yeast may be present and Lotrimin or other yeast cream may need to be added.
The initial tarry meconium stools transition to soft sometimes seedy stools. Initially there may be stools with each diaper change but later on many babies, especially breast fed babies will stool once every several days. What matters is not how often the baby goes, but that the stools remain soft. Babies grunt, grimace, and make a lot of noise as if in pain, but this is normal.
Babies noses may sound congested, especially when the air is dry. Most of the time this bothers us way more than it bothers the baby. If it seems to interfere with eating or sleeping a cool mist humidifier and/or saline nose drops with gentle aspiration may help.
Most babies spit up at least a little, although it can seem like a lot comes out. If the baby is growing well, not very fussy with arching of the back and not having scary coughing or choking spells this is normal. Vomiting is more forceful with retching most often from overfeeding. Excessive vomiting requires medical attention.
Some babies need night feedings a bit longer than others. In general a baby over 10-11 pounds and around 6 months can sleep through the night without being hungry. If your baby learns to fall asleep in his bed when drowsy he will more likely be able to comfort himself and fall back asleep when older and waking during the night. (we all wake and fall back asleep many times a night on our own).
Babies have an under developed immune systems and any illness, even a virus, can be much more serious in the first few months of life. Limit visitors and travel, and require good hand washing before letting anyone hold your baby.