Newborn Concerns

Introduction

Your baby is unique. You are witnessing the beginning of a new person with unique thoughts, feelings, and temperament. As your baby begins to explore the world, you will be there to help shape those very first impressions. Through you, your baby will learn about loving and caring. You will be the first person
to help your baby form an image of himself or herself.

This may seem like a big responsibility, but no one is better suited for it than you. Soon you will get to know your baby better than anyone else. You will come to recognize normal patterns for eating and sleeping and begin to sense what different moods and cries mean.

All parents feel unsure of themselves at times. There is no such thing as a perfect parent. Many of your worries will disappear as you begin to care for your baby. With experience, most parents find that they are able to provide the nutrition, warmth, attention, and love that their baby needs. Reading this post, and talking with us in the office, can also help you understand your baby better and feel more confident. Soon you will be the expert!

Bowel Movements

The frequency and consistency of a baby’s bowel movement can vary with the type of feeding. After three or four days, newborns usually have several bowel movements each day. Formula fed babies may decrease the frequency of stools after the first few weeks. Breastfed babies should have two or more each day. These are yellow (usually loose and seedy) and often have a watery ring around them.

After four to six weeks of life, babies may go several days without a stool. This does not mean the baby is constipated unless the stool is hard or marble-like when it occurs. Many babies grunt, strain, and turn red when having a bowel movement. This is normal. It does not mean your baby is constipated as long as the stool is soft. Babies need to learn how to coordinate the muscular task necessary to have a bowel movement over time.

Breasts

Some babies (both boys and girls) have enlarged or swollen breasts which may have a thin discharge from the nipples. This is normal and will go away by itself. Call if there is any redness of the swollen breasts.

Colic

Colic is a pattern of crying in a healthy baby under the age of three months. It usually occurs at the same time each day and lasts more than three hours. If you should see this pattern with your infant, please call to discuss possible causes and receive suggestions for management.

Comfort

Room Temperature - Try to keep an even, comfortable temperature in your home (typically around
70 degrees).
Crib - Cover the mattress with a waterproof cover, quilted pad, and soft baby sheet. Avoid putting pillows, comforters, bumper pads and stuffed toys in the bed due to suffocation.
Clothing - A full-term baby does not require any more clothing than an adult. Dress your
baby as you would dress yourself for the same activity and temperature.

Crying

All babies cry during the first few months of life. Crying is the infant’s way of signaling a need. Babies may cry if they are hungry, tired, uncomfortable, overstimulated or sick. In order to consider all causes...
1. Does your baby need a diaper change?
2. Is it feeding time?
3. Is it time for sleeping?
4. Does your baby need to be held?
The following are suggestions for comforting your baby:
1. Give the baby more physical contact by walking, rocking or holding.
2. Change the baby’s position.
3. Wrap the baby snugly.
4. Offer a pacifier, try a swing or take the baby for a car ride. If nothing seems to help, it is okay to close the bedroom door and leave the baby in the crib. Check on your baby frequently.

Eyes

Some babies may have yellow drainage during the first few days of life. Please contact our office if the eyes are watering excessively, have thick drainage, or are red.

Many babies cross their eyes during the first few months. Eye muscles are not fully coordinated. Facial features may also give this appearance. Crossing should become less frequent as the baby gets older. The baby should be able to track an object across the visual field by two months of age.

Feeding

Feeding is the time when parents communicate closely with their new infant. Whether breast or bottle feeding, this is the time to hold your baby close to you. A positive experience with feeding sets a good precedent for future interactions with your child.
 
Most babies will spit up at times, some more frequently than others. This is normal. Spitting up must be differentiated from vomiting, which is forceful throwing up of large amounts of stomach contents. Burping your infant frequently may help to reduce this occurrence but will not eliminate it altogether.

Breastmilk is the ideal food for your newborn infant. It offers the perfect balance of nutrients as well as some protection against disease. However, don’t feel guilty if you prefer to or must bottle feed your baby. Millions of children have grown up healthy and strong with formula. We do not recommend making
changes in your baby’s diet without consulting us first. Our recommendations are based on experience, nutritional knowledge and awareness of your baby’s needs.

Breastfeeding

Breastfeeding goes smoothly from the start for some mothers and babies. Sometimes it takes a little time and several attempts to get the process going effectively. Like anything new, breastfeeding takes some practice. This is perfectly normal. Help is available from your pediatrician, a nurse practioner, a lactation consultant, or a breastfeeding support group. Remember, the most important keys to successful breastfeeding are proper positioning and correct latch-on. Excellent resources are listed at the end of this post.

Breastfed babies feed more often than formula-fed babies, (usually 8 to 12 times a day). The stomach empties much more quickly because human milk is easily digested.

Initially, your newborn will probably nurse every couple of hours, regardless of whether it’s day or night. Your baby may start sleeping longer at night by the end of the first month. Let your baby feed on demand. Watch for different signals from your baby (rather than the clock) to decide when to nurse.

A hungry baby may do any of the following:

  • Nuzzle against your breast
  • Show the rooting reflex with the mouth
  • Make sucking motions or put hand to mouth
  • Cry
    • It is best not to wait until your baby is overly hungry before you breastfeed. Some newborns can be sleepy and hard to awaken. Do not let your baby sleep through feedings until your milk supply has been developed, usually about 2 to 3 weeks. If your baby is not demanding to be fed, then awaken in 3 to 4
      hours. If this persists, call your pediatrician.

      When you breastfeed, alternate breasts. You may want to keep a safety pin or short ribbon on your bra strap to help you remember on which breast your baby last nursed. While you should try to breastfeed evenly on both sides, your baby may prefer one side over the other and nurse much longer on that
      side. When this happens, the breast adapts its milk production to your baby’s feedings. Remember, your baby’s feedings control how much milk your breasts produce. It is important to let your baby nurse on both sides so that each breast gets stimulation over the course of a day.

      Signs that baby is getting enough milk are as follows:

      • Steady weight gain after the first week of age
      • Pale yellow urine, not deep yellow or orange
      • Sleeping well, yet baby looks alert and healthy when awake
        • Adequate bowel movements and wet diapers:

          • First day home: 2-3 bowel movements and wet diapers
          • Day 3: Should have 3 of each/day
          • Day 4: Should have 4 of each/day
          • Day 5: Should have 5 of each/day
          • After the first few weeks babies should continue to have a wet diaper with each change but bowel movements can become less frequent.
          • Bowel movement will change from a sticky, tarry type to a yellowish color during the first week of life.
            • Most breastfed babies do not need any additional water, vitamins, or iron for at least the first 6 months. Human milk provides all the fluids and nutrients a baby needs to be healthy. Breastfed babies require 400 IU of Vitamin D daily until they 1) transition to taking more than 28 ounces of formula or 2) are weaned to whole milk at one year of age. Vitamin D is available as Vitamin D drops or multivitamin drops at most pharmacies and grocery stores. Starting at 6 months of age, you should introduce your infant to baby foods that contain iron.

Genital Area

Female 
The genital area can be cleansed with a cotton ball or washcloth soaked in warm water, wiping from front to back. Many newborn girls have a white mucous discharge from the vagina which may be slightly blood-tinged. This is normal.
Male 
A boy’s penis should be gently cleansed with warm water each day. If uncircumcised, do not retract the foreskin forcefully. If circumcised, and the Gomco method was used, a small amount of Vaseline can be applied to prevent irritation. If the plasti-bell was used, no special care is required. The plastic ring should fall off by itself in about one week. Call if there is excess swelling, redness or any yellow discharge. Do not tub bathe until the plasti-bell is off and the circumcision is well healed.

Jaundice

Jaundice refers to the yellow color that commonly is seen in a newborn’s eyes or skin. It is caused by a buildup of bilirubin, which is removed by the liver. After a few days, the baby’s liver gets better at removing this. Jaundice usually appears first in the face and then moves to the chest, stomach, arms and legs as the bilirubin level increases. Jaundice may be harder to see in babies with darker skin color.
 
Most infants have mild jaundice that is harmless, but in unusual situations the bilirubin level can get very high and might cause brain damage. This is why newborns should be checked carefully for jaundice and treated to prevent a high bilirubin level. Most jaundice requires no treatment. When treatment is necessary, placing your baby under special lights while he or she is undressed will lower the bilirubin level. Depending on your baby’s bilirubin level, this can be done in the hospital or at home. Treatment can prevent the harmful effects of jaundice.
 
If you are breastfeeding, you should nurse your baby at least 8 to 12 times a day. This will help you produce enough milk and will help to keep the baby’s bilirubin level down. If you are having trouble breastfeeding, ask your baby’s doctor, nurse or a lactation specialist for help.

Call your baby’s doctor if:

  • Your baby’s eyes or skin look more yellow
  • Your baby’s tummy, arms, or legs look more yellow
  • Your baby is sleepier, fussier, or isn’t feeding well

    • Adapted from the AAP handout “Jaundice”, 1/24/11

Skin Conditions

Milia and Baby Acne
It is common for babies to develop little white bumps (milia) on their chin, cheeks or nose. They may also develop raised red or white bumps on the forehead or cheeks called “newborn acne”. This usually occurs at approximately one month of age and usually disappears by 8-12 weeks of age.
No special treatment is required other than keeping the area clean and dry.

Cradle Cap
Cradle cap (seborrhea) is a thick, yellowish, crusty rash on the baby’s head. It usually appears during the second month of life. It may also appear behind the ears, on the eyebrows or around the navel, where it appears red and scaly. You can treat cradle cap by removing it with a soft brush or fine tooth comb. The rash can be treated with 1/2% Hydrocortisone cream applied 2 to 3 times daily. If it persists, call for instructions regarding the use of a special shampoo.

Diaper Rash
Newborns less than two weeks of age may have skin irritation or breakdown from frequent bowel movements. If you see extensive rash, pustules or pimples, call our office.

A diaper rash can have many causes. One of the most frequently seen causes is contact with a wet diaper or stool. The rash may become infected with yeast or bacteria. Most diaper rashes show signs of improvement in 3 days. If the rash appears to be worsening, rather than improving, a secondary
infection may have occurred and you should call the office.

Since the majority of diaper rashes are due to skin contact with urine or stool, careful attention to the following should help:

  • Change the diaper frequently and cleanse area well
  • Expose the skin to air for 5 minutes three times a day
  • Blow the diaper area dry with a hair dryer on LOW/COOL setting from a distance
  • Sitz baths for 15 minutes twice a day (warm water)
  • Desitin, Vitamin A & D and other diaper creams may be used

Saftey Outdoors

A baby’s delicate skin can burn easily. Shade your baby from the hot rays of the sun. Protect the baby from the reflected rays of sand and water. Sunscreens are safe to use in children of any age. Look for a sun protection factor (SPF) of 30 for children. Avoid peak sun hours between 10 AM and
4 PM. Be sure to dress your baby in proper clothing and use sunglasses. Reapply sunscreen every two hours (or more frequently if needed).

Children older than two months of age can use DEET-containing insect repellents. The DEET concentration should be between 10-30% and should be applied sparingly on exposed skin only (not under clothing).

Sleep Patterns

Your baby should sleep on his or her back only. Babies spend most of their time sleeping and will awaken every 2 to 4 hours to eat. They gradually begin to sleep less during the daytime and longer at night. There is no evidence that giving cereal from the spoon or bottle will make babies sleep through the night sooner.