On behalf of Glendale Pediatrics, congratulations on the birth of your baby! The first few weeks are a time of getting to know one another, figuring things out, and sleep deprivation. You will likely feel overwhelmed by the new responsibilities. You may receive a lot of advice from friends and family, online and in books. Our goal is to help you to navigate through this advice and simplify the care of your child. Taking care of your child is more art than science. We have included home care information for your newborn as well as a discussion of commonly asked questions. For any other questions or concerns, please feel free to call our office during our regular office hours.
Important insurance reminder! Please remember to add your new baby to your insurance plan within the first 30 days after birth. If this deadline is missed, it can be much more complicated to obtain coverage for your child.
Feeding
Babies can feed very irregularly in the first few days. They may not easily waken for feedings initially, but it's important to offer to feed frequently. Aim for 8-12 feedings per 24 hours, at least every 2-3 hours. You may need to wake your baby by unwrapping the blankets, changing the diaper or sponge bathing. At night, wake your baby at least every three to four hours for feeds. If your baby falls asleep while feeding, try to feed skin to skin and rub the baby's back. If your baby still refuses, try again in another hour or two. As long as your baby is otherwise healthy, urinating at least once in the first 24 hours and twice in the second 24 hours, and stooling at least daily, do not worry. Also, try to feed more often in the day, so that your baby gets used to awakening more during the daytime.
After the first three days, your baby should be feeding vigorously at least every two to three hours, stooling at least once daily and urinating at least four to five times daily. If this is not occurring, call the office. Feed your baby on demand, which may mean that he/she eats as frequently as every hour. After your baby has regained all of his/her birth weight, we do not usually recommend waking him/her for feedings at night.
Breastfeeding
Breastfed babies will tend to feed more frequently. Aim for 8-12 feeds in 24 hours. Alternate the breast with which you start nursing and burp the baby between breasts. Initially nurse for five to ten 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). Colostrum, the milk present for the first few days is very thick and is full of antibodies and nutrients. It's perfect nutrition for the first few days of life, but it's not high volume.
All babies lose weight within the first few days until mature breast milk comes in (usually about 72 hours after delivery). Breastfed babies become more demanding and ask to feed more frequently over the first few days until the mature milk comes in, and this demand is necessary to teach your body how much breast milk is needed. Unless there is a medical reason, there is no need to supplement with formula. Babies who receive frequent bottles in the first weeks often start refusing the breast, and your mature milk supply can be adversely affected. However, if your milk has not come in by 80-90 hours of life, some supplementation may be necessary.
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 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 who are not already taking a bottle by one month of age will refuse bottles.
Vitamin D supplementation is recommended for all breastfed infants until the transition to whole milk at 12 months. Standard dosing is 400 IU daily.
Bottle Feeding
We generally recommend that you start with a standard milk-based formula. Three well-established US formula brands include Enfamil, Similac and Gerber Good Start. Offer 1-2 ounces every 2-3 hours to start, and then expect it the volume to increase over the next few days. Burp the baby after every ounce. You may increase the volume of the feedings on demand.
Sleep
Newborn babies sleep an average of 16 to 22 hours per day. The safest position for your baby to sleep is on his/her back for the first six months (until he/she can roll over independently). The sleep space should be spare, with no pillows, heavy blankets, sleep positioners, stuffed animals or hats. Wake and stimulate your baby 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. Swaddled babies often sleep longer.
Urination
In the first few days, the baby may periodically have an orange-pink spot in the urine. This is from uric acid crystals in the urine and is normal. It indicates a more concentrated urine. 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 often have a stripe down the center that turns blue when wet (check both front and back!). 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. 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 or more.
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 (one bowel movement). After one month of age, many breastfed babies start stooling much less frequently, sometimes as infrequently as every seven days. If your baby is not bloated or uncomfortable and the stools are not formed, this is normal. Formula-fed babies typically continue to stool at least once daily.
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 leave the hospital, we will remove it in the office. The cord will fall off on its own between one to four weeks of life. Keep the cord dry to facilitate its detachment. Fold the front of the diaper under so that the diaper is well below the cord and the stump is exposed to air. Check the cord every time you change a diaper. If it is moist or a little bloody, you can clean it with rubbing alcohol. Sponge-bathe the baby (every two to three days) 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 with 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 and Vaseline.
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 or Nose Frida to help clear the nasal passages. Be careful not to over-suction and thus cause more swelling of the nasal passages.
Babies hiccup frequently in the first months. This will bother you more than it bothers the baby. Burping may help.
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 12 weeks 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.
Babies often have tremors (shaking of their arms and legs) over the first month. This may be a normal startle reflex which will cause them to suddenly throw their arms open, draw them near and cry. Swaddling your baby can help her to startle less frequently and cry less. Call us if your baby is having rhythmic movements that you cannot easily stop with your hand.
Vaginal Discharge
Females may have a creamy-white vaginal discharge for the first week or two. There may be some blood in the discharge. This is normal and will resolve in a few weeks.
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 three days, continue to reapply gauze with a generous amount of Polysporin ointment with every diaper change. After three days, you can stop using a gauze but continue to apply a healthy amount of Vaseline or Polysporin ointment with every diaper change to complete one week. It often takes about one week for the penis to fully heal. As the site heals, you may notice a yellow tissue covering the head of the penis. This is likely normal healing (granulation) tissue. If you are worried about an infection, give us a call.
We perform circumcisions both in the hospital after birth and in our office until two weeks of life.
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 jaundiced and you are unsure, call the office. Frequent feedings and indirect sunlight to your baby (in just a diaper) lessen the degree of jaundice.
Fever
Normal baby rectal temperature is 98.5 to 100.3. Do not feel you need to take your baby’s temperature regularly, but if your baby is excessively fussy or sleepy, we recommend you take a rectal temperature. Fever in a baby under two months 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 rectally that does not resolve with unwrapping, please call our office or the doctor on call immediately. Even if your baby doesn't have a fever, if he or she is excessively irritable and difficult to console or is sleepy and difficult to arouse for feedings, please call our office or the doctor on call immediately.
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.
"Baby blues" and post-partum depression and anxiety are very common are the birth of a baby. At least a third of women can exhibit these symptoms. We have resources for post-partum psychologists, so please call our office if you are concerned that you may be showing signs of post-partum depression.
Crying
Babies cry for any number of reasons. This is the only way that your baby has to communicate his/her needs. Your child may only need to be swaddled, a diaper change, or a feeding. Try to evaluate what your baby needs. When babies cry, they swallow large amounts of air and therefore need to burp or pass gas 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, swaddling, swinging, and dancing are among things that can help. A car ride usually helps if all else fails.
If your baby is fussy during and/or after feeding (when most babies are calm), he/she may have gastro-esophageal 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.
Rashes
Erythema toxicum (a migrating red rash that often looks like flea bites) and milia (white dots typically over the nose) are common rashes in newborns and no need for worry. Finely peeling skin (especially over hands and feet) is also normal. Lotions are not necessary for babies, but there are some studies indicating that moisturizing with an unscented, sensitive skin cream may help to prevent atopic dermatitis.
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.