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Newborns

Congratulations!

Newborns are Special and we’re here to help guide you through this exciting time. While you are in the hospital, your baby will be checked by one of our providers or one of the staff doctors. In the hospital, your baby may receive the hepatitis B vaccine, a hearing test and have a blood test for a variety of inherited metabolic diseases. Call our office to schedule a first visit for your baby within 2-3 days after hospital discharge, or sooner if needed. Here you will find many tips and resources about newborn care and we are always available 24/7 to discuss your concerns.

All babies are born with their own unique temperament or characteristics. It is exciting to get to know your baby and watch him change almost daily. Talk in calm, reassuring tones to your baby and hold her a lot. It is impossible to spoil a young infant. Basically babies cannot 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 at all. 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. Be sure to get rest whenever you can and enlist the help of others for support.

We spend a lot of time at nurse visits and checkups talking about feeding. Basically a newborn eats very frequently, both day and night. Babies are born with extra fluid and initially all babies lose weight, stabilize, and regain their birth weight in the first week or 2. Once growing well they gain between ½ and 1 ounce/day. We encourage breastfeeding! It may take 2-4 days for your milk to “come in.” Breast babies usually feed every 2-3 hours for 20—30 minutes. Sometimes the baby will be sleepy at first – if he is difficult to rouse, try to wake the baby up by removing clothes, tickling his feet and even applying a cool washcloth to his head or feet. It also can be normal for the baby to “cluster feed,” or feed very frequently every half to one hour for a stretch of time. There is a learning curve for most moms and babies for breastfeeding. Don’t get discouraged – the majority of problems with breastfeeding can be solved. Bottle babies usually feed every 3-4 hours and start off with between 1-3 ounces per feed. They typically can take about half their weight in ounces/feed – for example an 8lb baby can take 4 ounces. Use an iron-fortified infant formula. It is okay to use tap water to mix powdered or concentrated formula. Babies do not need supplemental water. It is normal to have a slight coating of milk on the tongue. This is not harmful. Regular feedings, wet diapers and bowel movements are all signs that things are going well. We will help you by monitoring this closely.

Jaundice is an orangey/yellow skin color seen in many babies, most often in the face and upper trunk, caused by a buildup of the pigment bilirubin. Bilirubin is normally cleared in the liver where red blood cells are broken down, 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. Physiologic jaundice usually peaks on the 3-4th day of life. Jaundice is harmless as long as the level of bilirubin does not get high enough to cross into the brain. We can see jaundice at much lower levels and follow it along, sometimes with frequent measurements and/or phototherapy to make sure the level never gets too high.

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.

We will follow your baby closely in the first few days and weeks after birth to be sure the 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 bile, and any rectal temperature >100.4 degrees.

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. Bathing: 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.

Diaper Rash: The area is so sensitive and there is so much contact with urine and stool that it is impossible 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.

Stooling Patterns: 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.

Nasal Congestion: 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.

Spitting: 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.

Sleep: Most babies sleep a lot in the first few weeks, but not necessarily at the times you may hope for! Be patient; try to take naps and sleep when the baby is sleeping. Your sleep deprivation will add up, so you need to take care of yourself. Accept help from others. Some babies need night feedings a bit longer than others. In general a baby over 10-11 pounds and between 2-4 months can sleep through the night without being hungry. Babies should sleep on their backs on a firm surface. We recommend cribs or bassinets. Don’t put any pillows, toys or blankets in the bed. If you must co-sleep, minimize the risk of sudden infant death syndrome (SIDS) by making sure no one in the bed has been drinking or smoking and keep all blankets away from the baby. Your newborn baby is too young to “sleep train.” When the baby cries it is generally to communicate something to you. You are not spoiling your baby by holding him frequently. As he gets older putting him down when drowsy to fall asleep on his own will help him develop natural sleep habits.

Visitors: Babies have 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 visitors hold your baby.

READ MORE about: newborns in general, breast feeding, car seats, how to use a thermometer, sleep position and sleep safety

  • Caring for Your Baby and Young Child: Birth to Age 5 – America Academy of Pediatrics
  • What to Expect the First Year – Heidi Murkoff, Sandee Hathaway, and Arlene Eisenberg
  • Baby 411 – Denise Fields and Ari Brown
  • The Happiest Baby on the Block – Dr. Harvey Karp
  • The Nursing Mother’s Companion – Kathleen Huggins