Newborns
On behalf of all of us at Glendale Pediatrics, congratulations on the birth of your baby. The first two weeks are a time of getting to know one another, and you may feel overwhelmed by the new responsibilities. You may find that you will hear a lot of advice from friends and family as well as from books. Our goal is to help you to navigate through all of this advice and simplify the care of your child. Child care is more art than science. We have included home care information for your newborn as well as some discussion of commonly asked questions. For any other questions or concerns, please feel free to call our office during our regular office hours.
IMPORTANT REMINDER TO THE PARENTS OF OUR NEWBORNS
Please remember to add your new baby to your insurance plan within the first 30 days after birth. If this deadline is missed, many insurance carriers may exclude coverage of what they consider to be pre-existing conditions that developed during the first month of your baby’s life.
Feeding
Babies feed very irregularly in the first few days. They may not easily waken for feedings for the first two days. You need to wake your baby to offer to feed her at least every three to four hours by unwrapping her blanket, sponge-bathing her, or changing her diaper. Premature infants need to be fed at least every three hours. If your baby refuses feeding or falls asleep while feeding, try undressing her and stimulating her to wake. Feeding “skin to skin” may stimulate more feeding. If she still refuses, this is OK. Try again in another hour or two. As long as your baby is otherwise healthy and is urinating at least once in the first 24 hours and twice in the second 24 hours, do not worry. Also, try to feed more often in the day, so that your baby gets used to awakening more during the day.
After the first three days, she should be feeding vigorously at least every three to four hours and urinating four to five times per day. If this is not occurring, call the office. Feed your baby on demand, which may mean that she eats as frequently as every hour. After the baby has regained all of her birth weight, we do not usually recommend waking the baby for feedings at night.
Nursing
Breastfed babies will tend to feed more frequently. Alternate the breast with which you start nursing and burp the baby between breasts. Initially nurse for five to twenty minutes per breast. Gradually increase feeding time to ten to fifteen minutes per breast. Be sure that the baby’s gums are behind the nipple on the areola (the dark skin around the nipple).
Unless there is a medical reason, there is no need to supplement with formula. Babies who receive frequent bottles in the first two weeks often start refusing the breast. However, if your milk has not come in by 80-90 hours of life, some supplementation may be necessary. If you are having any nursing problems, we can help you arrange lactation assistance. We also have Medela breastfeeding supplies available for purchase.
At 2 1/2 to 3 weeks of age, breastfeeding is usually well-established, and we recommend that you start introducing a bottle of either your expressed milk or formula at least every other day. This is to prevent bottle refusal, allowing you to both nurse and bottle-feed your child. Most babies will not take a bottle after one month of age if they have not been taking one bottle every day or two before that time.
Bottle Feeding
We generally recommend that you start with a standard milk-based formula, such as Enfamil Lipil, Similac Advance, or Good Start with DHA & ARA. Offer two to four ounces every three to five hours. Burp the baby after every one to two ounces.
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Sleep
Newborn babies sleep an average of sixteen to 22 hours per day. Place him on his back for the first six months until he can roll over by himself. The sleep space should be spare, with no pillows or heavy blankets. Wake and stimulate him more and respond more quickly during the day. At night, respond more slowly and feed the baby in dim light with little noise to encourage day-night recognition.
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Urination
In the first few days the baby may have an orange-pink spot in the urine. This is from uric acid crystals in the urine and is normal. Babies should urinate at least once during the first 24 hours and at least every eight hours in the first few days until the feedings increase or the milk comes in. If this is not occurring, recheck the baby’s diaper. Disposable diapers will only feel heavier, but often not wet. If there is no sign of urine, try giving some extra feedings or supplement with a little formula. If no urine is forthcoming, call the office. You may find it helpful to keep a chart of feedings, urination, and stool for the first week.
After four to five days of life, the urine should increase to five to six times a day. By one week, he should urinate six to ten times per 24 hours.
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Stools
Babies usually stool at least once in the first 24 hours. Initially, the stools will be thick, sticky, and very dark green, almost black; this is called meconium. You may find that keeping a coating of Vaseline on the baby’s bottom will help you to clean off the very sticky meconium stools. Over the next few days, the stools will change color to light green, yellow, or orange. They may be soft, mushy, liquid, or seedy. This is all normal. Bottle-fed babies may initially have two to seven stools per day. Breastfed babies may have a stool after each feeding (up to twelve or more per day). Babies may pass three to four small stools in several minutes. This is one bowel movement. Between one and two months of age, many breastfed babies suddenly start stooling much less frequently, sometimes as infrequently as every seven days. If she is not bloated or uncomfortable and the stools are not formed, this is normal.
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Cord Care and Diaper Changes
Over the first two days the cord will become dark and hard. If the clamp is not ready to be removed by the time you are leaving the hospital, have the nurses show you how to remove it. The cord will fall off between one to four weeks of life. Clean the base of the cord with an alcohol-soaked cotton ball once or twice a day. Move the cord side to side and clean down in the crevices. The cord has no pain nerves, so cleaning the cord is not a painful process. Check the cord every time you change a diaper. If it is moist or a little bloody, clean it with alcohol. Fold the front of the diaper under so that the diaper is well below the cord and the stump is exposed to air. Sponge-bathe the baby until the cord falls off. Call immediately if there is any foul-smelling discharge, actively dripping blood, or redness extending beyond the umbilical stump onto the abdomen.
Avoid using commercial wipes for diaper changes in the first month or so. Newborn skin is often very sensitive and can develop rash with exposure to wipes. Instead, use a soft cloth or Viva paper towels and warm water to clean your baby’s bottom. You may also wish to use a barrier cream to prevent diaper rash. Examples of barrier creams include Desitin, Balmex, Aveeno, A+D, and Vaseline.
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Congestion, Sneezing, and Hiccups
Most babies will sound congested and sneeze considerably over the first few days. The congestion may persist for more than a month. You do not need to worry unless the baby is having difficulty feeding because of blocked nasal passages. In that case, you may use nasal saline irrigation solution and a bulb syringe to help clear the nasal passages. Be careful not to overuse the bulb syringe and thus cause more swelling of the nasal passages.
Babies also hiccup frequently in the first several months. This will bother you more than it bothers the baby. Burping may help.
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Crossing Eyes, Irregular Breathing, and Tremors
Many babies will periodically have crossing or wandering eyes. This is normal and decreases over the first two months of life. Let us know at your appointment if this is still occurring beyond two months of age or is continuous. Infants can initially see about the distance of the crook of your arm to your face.
Babies also tend to have irregular breathing patterns, called periodic breathing. Parents often notice that their infant will breathe very fast for a few seconds, and then pause for a few more seconds before breathing again. This is normal as long as your child does not have any color changes or consistently fast breathing.
Finally, babies often have tremors (shaking of their arms and legs) over the first month. This is normal. They have a normal startle reflex which will cause them to suddenly throw their arms open, shakily draw them near, and cry. Often, swaddling your baby can help her to startle or tremble less frequently, and thus cry less.
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Vaginal Discharge
Female babies may have a creamy-white vaginal discharge for the first week or two. There may be some blood in the discharge from time to time. This is normal and will resolve in the next two to three weeks.
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Circumcision
After the circumcision, we will place gauze with antibiotic ointment on the penis to help protect the penis from sticking to the diaper. For two to three days, continue to reapply gauze with Polysporin with every diaper change. After three days, simply apply Polysporin to the tip of the penis until the circumcision heals (about five to ten days).
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Jaundice
Most babies will have a yellow discoloration of their skin between one to five days of age called jaundice. The discoloration starts at the face and eyes and spreads downward. If the jaundice is at the face and shoulder level, this is not concerning. If it progresses to below the umbilical cord or if your baby looks very jaundiced and you are unsure, call the office. Frequent feedings and indirect sunlight lessen the degree of jaundice.
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Fever
Normal baby rectal temperature is 98.5 to 100.3. Fever in a baby under six weeks of age is concerning. If your baby is in a warm room or is over wrapped, she may have an elevated temperature. If your baby has a fever of 100.4 or higher that does not resolve with unwrapping, please call our office or the doctor on call immediately.
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Mom Care
Rest and take as many naps as you can. Nap when the baby sleeps. You should not be burdened with entertaining guests for the first few weeks. Avoid any visitors who are sick, including those with minor colds. Try to limit visitors and phone calls to a specific time of the day. Allow friends and family the opportunity to help you when they offer.
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Crying
Babies cry for any number of reasons. This is the only way that your baby has to communicate his needs. He may only need a diaper change, less coverings, or some cuddling. Try to evaluate what your baby needs. When babies cry, they swallow large amounts of air and therefore need to burp or pass wind more.
Many babies begin to have a fussy time around two to four weeks of age. This usually occurs in the evening and lasts two to six hours (usually three to four hours). This fussy time gets worse for a few weeks and wanes by three to four months. This is a time when babies are more awake and sensitive to their surroundings. They are easily sensory-overloaded. Generally, some sort of rhythmic motion helps calm them. Massages, stroller rides, swinging, and dancing are among things that can help. A car ride usually helps if all else fails.
If your baby is often fussy during and/or after feeding (when most babies are calm), he may have gastroesophageal reflux or colic. Call the office during office hours so that we can help you sort this out.
If your baby is excessively irritable and cannot be consoled, or if your baby is excessively sleepy and will not arouse for two or more feedings, call our office or the doctor on call immediately.
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References
What to Expect in the First Year. A. Eisenberg.
Nursing Mother’s Companion. K. Huggins.
Infants and Mothers. Brazelton.
The Happiest Baby on the Block. H. Karp.
Care of Your Baby and Young Child: Birth to Age Five. AAP, S. Sheldon.
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