As a new parent you are filled with joy and wonder as you hold your newborn. You may feel overwhelmed by the awesome responsibility of parenthood. With careful planning and preparation you can be well-equipped to nurture your newborn. Education and proper advice will help to minimize frustrations and maximize success. This section is intended to answer only some of the most frequently asked questions.
IS MY BABY NORMAL?
Babies will burp, sneeze, hiccup, spit up, pass gas, make faces, grunt and cross their eyes. All of this is NORMAL.
Your baby’s head may look lopsided from molding during the birth process. This will gradually go away in a few days. All babies have soft spots where the skull bones will eventually come together. The largest is on the top of the head in front. It may pulsate.
The eyes may have a small amount of yellowish discharge which can be wiped away with a clean cloth and warm water. If the discharge continues after a few days, call the office during regular hours. Many babies will have a blocked tear duct which causes the collection of mucous in the eyes. The eyes may also tear. Most blocked tear ducts will resolve on their own by 6 months of age. Babies can see short distances and like bright colors. Over the first 2 months they begin to focus better and track moving objects. At times, they may appear “cross eyed”.
Your baby’s nose may become congested during the first few weeks. If the congestion is not relieved by the baby sneezing or use of the bulb syringe, you may use saline nose drops (Ayr, Ocean). These can be purchased over the counter at any pharmacy. Use 2-3 drops in each nostril, wait a few seconds then suction with the bulb syringe. Notify our office if the congestion interferes with feeding or is persistent.
Enlarged breasts occur frequently and are often due to hormones received from the mother at the time of birth. Do not squeeze, massage or apply lotion to them.
The genitals of both males and females may be swollen at birth. Females may have a white discharge with some blood. It is perfectly normal and should disappear within 1-2 weeks of delivery. Males may have a swollen scrotum, or hydrocele, which resolves on its own during the first few months of life.
The umbilical cord often causes more concern for new parents than anything else about the baby, but it should not. Clean the area with alcohol 2-3 times daily, getting down into the navel. It is best to tape the diaper so that it does not cover the cord. Occasionally there will be some blood from around the cord. This is normal. The cord will usually fall off 2-3 weeks after birth at which time you may tub bathe your baby. Do not be alarmed if you notice some bulging of the skin at the navel. This is normal and usually regresses in time. Call our office if you notice excessive discharge, bleeding more than a few drops or redness around the navel.
You may notice that your baby has an irregular breathing pattern. He or she may have quiet, shallow breaths for a few seconds then increase to deep breaths. Your baby may also “sigh” and catch his or her breath. These patterns are normal.
CARE OF GENITALIA
Girls: There is some protrusion of the genitalia in baby girls, but this is perfectly normal. There is usually a thick whitish substance between the labia which is normal and needs cleaning gently. Occasionally there is some acute bleeding from the vagina. This should cause no alarm as it is normal and caused by the disappearance of a hormone which has been received from the mother’s blood.
Boys: If you wish to have your son circumcised, it can be done more easily during the newborn period. If it is not done, you will be given further instructions on the care of the foreskin. If your baby is circumcised, the area may be covered with Vaseline or A&D ointment. A small piece of Vaseline gauze may be applied when the baby leaves the hospital and may be left on a day or so.
SKIN, HAIR AND NAIL CARE
Bathing: Bathe your baby with a soft washcloth, mild soap (Dove, Neutrogena) and water from the first day home. Sponge baths should be used until the cord falls off. Do not use baby oils or lotions unless instructed to do so to avoid rashes and skin irritation. You may clean around the outside of the ears with a washcloth or q-tip, but do not insert the q-tip into the baby’s ear. Never leave your baby unattended while near water.
Jaundice: Jaundice is a yellow/orange color of the skin. It usually becomes evident at 2-3 days of age and will peak around 5-7 days of age. Call our office if your baby is not feeding well or you have a hard time arousing your baby to eat, if your baby is having less than 1-2 bowel movements per day and less than 3-4 wet diapers per day. We will set up a time for you to bring the baby in for an evaluation and to obtain a Bilirubin level at the hospital. In some cases, home phototherapy is required to decrease the Bilirubin levels.
Skin: Your baby’s skin may be scaly especially around the wrists and ankles. This is normal and no oils or lotions are needed to correct it. Other rashes and birthmarks include:
- "Stork Bites": patches of deep pink, usually on the bridge of the nose, lower forehead, upper eyelids, back of head or neck. These disappear over the first few months.
- Mongolian Spots: flat areas that contain certain extra pigment, they appear green or blue (like a bruise) on the back or buttocks. This is very common in dark-skinned babies.
- Milia: tiny white bumps across the tip of the nose or chin caused by skin gland secretion. Although they appear raised, they are flat and smooth to the touch. Milia disappear in the first 2-3 weeks of life.
Diaper rash is a general term for redness in the diaper area. Keeping the area clean and dry will usually prevent irritation. The redness and irritation may be treated with A&D or another zinc oxide preparation. If it does not clear after application of these products, it may be a yeast infection. Call our office for treatment instructions.
Cradle Cap: yellow scales and crusts on your baby’s scalp may indicate cradle cap which is common in infants. Applying oil to the scalp before shampooing will help soften them. After using a mild baby shampoo, scrub the scalp with a baby brush then rinse well.
Fingernail/toenail care: Fingernails grow rapidly. Use care when trimming them so as not to trim the underlying skin. Toenails usually do not grow as rapidly as and will not need trimming as often as fingernails. Sometimes the toenails may appear ingrown, but there is no cause for concern unless the skin alongside the nail becomes red, inflamed or hard. Use small clippers, a soft emery board or blunt nosed toenail scissors. A good time to trim the nails is after a bath or when your baby is asleep.
SLEEP
The latest recommendation from the American Academy of Pediatrics is to allow babies to sleep on their side or back. The stomach position is to be avoided due to the increased risk of Sudden Infant Death Syndrome (SIDS). This recommendation applies to infants from birth until the time they are able to roll over on their own. The crib should be free of pillows, comforters and anything with strings in which your baby could become entangled. In the early weeks, babies will sleep 16-20 hours per day. The hours of sleep needed decrease with age, being about 13-15 hours at one year.
FEEDING
Breastfeeding: Breast milk is nature’s perfect baby food. It has just the right amount of nutrients to fully nourish your baby. Breastfeeding is a natural process, but it may take practice to master. Your baby will be put to breast as soon as possible after delivery, but it is usually 3-4 days before breast milk appears. Babies should be fed at least every 3-4 hours, but breastfed infants usually want to eat more than this. You will know that your baby is receiving enough milk if he or she has at least 6-8 wet diapers per day and at least 2 stools per day. (For more information on stools, see the sections entitled “Stools”). Breastfeeding mothers require a well-balanced diet with plenty of fluids such as water.
Formula: If you are unable or choose not to breastfeed, your baby will be put on formula to suit his or her needs. In the first few days of life, many babies only take 1½-2 ounces per feeding. This will gradually increase as the baby grows. Full-term babies may be offered 3-4 ounces every 3-4 hours. The milk should flow from the nipple by drops, not in a steady stream. Do not “prop” bottles. This takes away precious “cuddling” time with your baby and it contributes to tooth decay.
Hiccups: Parents are usually more bothered by hiccups than their babies. If your baby develops hiccups, try to change their position or get them to burp.
Spitting Up: This usually means the baby has eaten more than his or hear stomach can hold. Some babies will spit up more than others and most have outgrown this by the time they are sitting. The amount of spit up may be decreased by:
- Making sure feedings are calm and at a leisurely pace
- Avoiding interruptions and distractions
- Avoiding feedings with the baby lying down
- Placing the baby in an upright position after feedings
- Not bouncing or vigorously playing after feedings
- Making sure the hole in the nipple is the correct size.
It is easy to differentiate between vomiting and spitting up. Spit up usually does not cause any discomfort. Vomiting is forceful and distress. Vomiting will also produce a greater volume than spitting up. If you have any concerns that your baby is spitting up too often or that he or she is vomiting, please call our office.
STOOLS
Your baby’s stools will vary in frequency and consistency depending on feedings. Babies will often strain, grunt and turn red in the face to pass a stool. If your baby is breastfed, stools will be a light mustard color with seed-like particles. The consistency is soft and sometimes runny. It is not unusual for them to have a stool with each feeding. Formula fed babies have yellow or tan colored stools that are firmer than that of breastfed babies, but should not be firmer than peanut butter. Occasional variations of frequency, color and consistency are normal. Infrequent stools are not a sign of constipation and are not a problem as long as they are soft. Please call our office during regular hours to discuss any questions you have about your baby’s stool pattern.
THRUSH
If your baby has white curd-like patches that coat the gums, tongue and/or side of the mouth, he or she may have thrush. Thrush is caused by a fungal or yeast infection and is usually seen in babies who are nursing or bottle feeding. If you believe your baby has thrush, call our office during regular hours and a prescription may be phoned in. If breastfeeding, mom may also need a prescription. While being treated for thrush, all nipples and pacifiers need to be boiled or soaked in hot water for 15 minutes.
CRYING/COLIC
Babies cry for various reasons. They may be calling for help when they’re hungry or uncomfortable; they may be shutting out sights, sounds and sensations that are too much for them or they may be releasing tension. Some babies have fussy periods when they are not hungry or uncomfortable and no matter what you do will console them. This crying seems to help get rid of excess energy. You will soon learn the different cries your baby has and how to respond to them. The best way to handle crying during the first few months is to promptly respond. You cannot spoil a baby by giving him or her attention. Prompt response helps your baby develop trust. If all else fails, sometimes the best approach is to leave your baby alone. Some babies cannot fall asleep without crying. Crying should not last long if he or she is tired. Babies who have a regular fussy period each day, especially in the evening may have colic. There is no known explanation for colic. About one-fifth of all babies develop colic, usually between 2-4 weeks of age and it usually resolves by 3 months.
The following are ways to console your baby:
- Rocking, either in a chair or in your arms from side to side
- Gently stroking the head or patting the back
- Swaddling
- Singing or talking in a gentle voice
- Walking, either in your arms or in a stroller
- White noise
When your baby is crying, try to remain calm. Babies are sensitive to your moods and will react to them. Don’t take your baby’s crying personally-it’s not because he or she does not like you. If you feel you cannot handle the situation, enable the help of family or friends. No matter how impatient you are, DO NOT SHAKE YOUR BABY. Shaking can cause blindness, brain damage and death. If your baby is inconsolable, he or she may be sick. Please contact our office for an appointment.
