All about Newborns (+spanish)
Congratulations! We hope these notes will help with the millions of questions that will come up about your new baby.
Feel free to call us for other quick questions; we don't want you to worry any more than you already will as a new parent. If you have questions that so urgent they cannot wait until office hours you can call (510) 652-1743 for after-hours contact instructions.
If you have many questions or a concern that something may be physically wrong with your baby please make an appointment and see one of us as soon as possible. We'll all feel better about it.
Don’t forget to add your new baby to your insurance plan as soon as possible!
Funny Things That Newborns Do Normally
Hiccup a lot
Sneeze - because they haven't learned to blow their nose
Make funny noises in their sleep (that keep you awake)
Spit up after feeding (giving you "sour milk shoulder")
Punch and scratch themselves in the face (but almost never hurt themselves)
Cry a lot
Quiver their chins
Arch and throw out arms and legs when startled
Have frequent mild mottled color changes of their skin
Breastfeeding: Breastmilk is the perfect food for infants. It provides the best nutrition and helps fight diseases. Frequent breastfeedings (>8 per day) in the first days will help your milk to come in faster. Call us if the baby is not wetting 5 or more diapers daily and stooling 4 or more times daily by the 4th day of life. Don't be tempted to give formula if you think you aren’t making enough breastmilk. If you're worried, call us. We have many ways to help or reassure you if you're having any concerns about nursing. You are always welcome to bring your baby in for a quick weight check; just give us a call first.
There is no schedule for nursing. Mom and baby need to work out a schedule that makes them both happy. Babies nurse to eat and to fulfill the need to suck. Nearly all the milk is delivered to the baby in the first 10 minutes of nursing. Some babies nurse quickly, and others take their sweet time. If your baby seems to be sucking for pleasure at the end of a feeding, you may try to free your nipple and slip in a finger (or a pacifier after breastfeeding is going well). Breastfeeding babies do not need extra water; their mothers do. It is recommended that breastfeeding babies take a Vitamin D supplement. We’ll discuss this at one of the early well visits.
Bottle Feeding: Most newborns take 15-24 ounces a day as 3-4 ounces every 3-4 hours. In between, they may like to suck on their hands or a pacifier to fulfill their need to suck.
New bottles and nipples should be sterilized in boiling water for 5 minutes. After that, good washing with hot, soapy water or in a dishwasher is fine. The tap water around here is fine for making formula; just let it run out of the tap for a few seconds before using and use cold water. If you use bottled water, get the kind with fluoride or let us know so that we can give the baby a fluoride supplement at 6 months of age.
Spitting Up: It is normal for babies to spit up a little after feedings. If your baby spits up a lot you can try burping the baby more often, giving smaller but more frequent feedings, and raising the head of the bed about 30 degrees (try putting a fat phone book under the end of the crib mattress). Try not to bounce the baby after feedings. If you're worried that the baby is spitting up too much, come in. Good weight gain is what is important and it's easy to check.
Solid Foods: Don't even think about solids, including cereal, for 5-6 months.
Babies should sleep “ABC” - Alone, on their Backs, in a Crib or Cradle! There is evidence that SIDS (crib death) is more common when babies sleep on their stomachs. There is also evidence that using a pacifier may prevent SIDS. Some newborns catnap; others sleep 3-4 hours at a time. The average baby sleeps 14-16 hours a day. If the baby stirs and fusses just a bit, wait a moment and he may resettle himself back to sleep (let's hope!). During awake times let the baby spend time on both stomach and back to exercise all muscle groups.
Always use the car seat when riding in the car!!! Make sure all straps (including the seat belt) are fastened. Contact 1-866-SEAT-CHECK (732-8243) or www.seatcheck.org to find a car seat installation check station in your area.
Make sure that your home or apartment has smoke alarms and carbon monoxide detectors that work. Plan your escape in case of fire.
Don't allow smoking in the house or car. It increases the baby’s risk for developing asthma, respiratory infections and ear infections.
Babies squirm around early. Do not leave them on the edge of a bed or couch where they may fall. Do not leave them unattended in the bath as they can drown in small amounts of water. Also, use 2 hands to carry your baby unless you are using a carrier.
Some babies have died of suffocation in sling-type baby carriers. Do not use these until your baby is at least 4 months old and has good head control.
We recommend that parents and household members get Tdap and Influenza (in season) vaccines to prevent spreading whooping cough (pertussis) and influenza to their infants.
Parent Mental Health
Realize that your new baby is both a new joy and a new stress in your life. This new intruder will change your life in many ways. Your relationship with your spouse/partner will change since you have to share your time and attention. You also have many new things to argue about (the baby's hungry...no he's not. She's too bundled up...no she's cold).
It is normal for new moms (and dads) to feel sad or depressed at times. Share your thoughts with other friends and helpful relatives. Call us, or the Family Paths Support Services 24-hour hotline, (510) 893-5444 or (800) 829-3777, if you need more help.
Leave the baby with a relative, friend or sitter and get out as soon as possible for some time alone and with your partner. As little as 1 hour, or even just a walk around the block, can be very refreshing.
Everybody (even total strangers) will have advice to give about your baby. You will get to know what your baby likes, dislikes and needs better than anyone else (including us, sometimes). So listen politely, but do what you feel comfortable doing.
At And Below The Belt
Umbilical cord: The remaining stump of the umbilical cord (navel cord) will separate in 1-4 weeks. When it separates you may notice a small amount of bleeding and/or some light green discharge for a few days. If the bleeding causes more than a small spot on the diaper or lasts more than 3 days, call us. If the discharge does not go away in 3-4 days or if the skin around the navel is red, swollen or tender, call us. Don't worry about the awful odor that the healing navel has; it's normal.
Stools: Newborns have dark, sticky green stools for the first 2-4 days. These are called meconium stools. Then the stools change. Breastmilk stools are like thin, lumpy mustard - a real mess but they don't smell too bad. Formula stools can be thin or firm, depending on your baby. Babies can stool after every feeding or (with breastfeeders after the first month) as infrequently as every 2 weeks! And all babies tend to strain when stooling, regardless of how soft the stools are.
Urine: Babies pee a lot since all their food is in liquid form. It is common for babies to have a bit of salmon-pink colored residue in their urine that you may notice on the diaper. Normal urine crystals of uric acid cause this.
Baby Boy Genitals: Warning - watch out whenever this guy's penis is exposed! The uncircumcised baby should have exposed parts cleaned gently. Never force the foreskin back! This can cause small tears that can scar preventing normal foreskin retraction. The membranes (called adhesions) that hold the foreskin to the head of the penis gradually loosen so that nearly all boys will have a fully retractable foreskin by 3-10 years of age. If your son has had a circumcision we will give you instructions on how to care for it during the healing process.
Baby Girl Genitals: In the beginning your baby girl will appear to have unusually large labia (the "lips" at the vaginal opening) and may have breast buds as well (baby boys can have these, too). These are effects of the mother's hormones that came through the placenta. The labia and breasts will get smaller in a few weeks. Your baby girl will also have some mucus in her vagina for 1-2 weeks and may even have a mini "period" with a small amount of vaginal bleeding as her mother's hormones wear off. Let us know if this bleeding lasts more than 3 days or is more than a little spotting. Clean the inner labia and vaginal opening very gently. Gently get all the stool off but do not try to get off all the mucus or white material. A cotton ball with warm water works very well.
Do not overdress the baby. Dress the baby in the kind of clothes that you would want to wear if you were lying around napping. If you feel that a sweater is appropriate, then the baby should also wear a cap because babies lose a lot of heat through those big bald heads. Normal room temperature of 68-70 degrees is fine, but avoid drafts.
Less is usually best for all baby skin products. Lotions and powders rarely improve the baby's skin, and their perfumes and additives may even cause rashes. Clean warm water is all that you need to bathe your baby. You can use a mild soap or baby shampoo for the hair. Over bathing may dry the baby's skin; 2 baths a week is usually plenty. Give only sponge baths until the umbilical cord stump is totally dry.
All babies peel at 1-3 weeks of age. Lotion or baby oil doesn't help, but may make the peely skin greasy.
Common Newborn Rashes (that you shouldn't worry about)
Milia: Little white bumps on the nose, chin and even the roof of the mouth. These are caused by plugged skin pores with collection of dead skin and secretions. They usually go away in the first month, but may last up to 3 months.
Erythema Toxicum: Small, firm, yellow-white bumps on a pink or red base. These are very common in the first few weeks of life. We sometimes call these "baby hives". They look like small fleabites.
Nevus Simplex: "Stork bites", "angel kisses" or "salmon patches" are the pink patches on the eyelids, upper lip and back of the neck. The patches on the face fade in several months and the ones on the back of the neck get covered with hair. These are caused by blood vessels close to the surface of the skin.
Mongolian Spots: Blue or slate gray patches of color on the back and buttocks and occasionally the wrists and ankles. These are very common is Black and Asian babies but are seen on occasion in all races. They usually (but not always) fade in the first few years of life.
Sucking Blisters: Small blisters can occur on the arms, hands or upper lip. These are probably caused by the baby sucking in the womb. They heal in several days without bothering the baby.
Neonatal Acne: Pimples and blackheads just like teenage acne but usually smaller, often develop at around 3-4 weeks of age on the forehead, cheeks and chin. This can take a few weeks or many months to clear up. Just wash gently with clean water. It may blemish a photo, but doesn't bother the baby.
Basic Diaper Rash Treatment: Change the diaper often. Clean the area gently with clean, warm water. Dry well, but gently. Leave the diaper area uncovered for a while1-2 times a day if possible. If this is not working, or the rash has persisted more than 3 days, call us.
Rashes That Need Medical Attention
We need to see any pustules or blistering rashes on your baby. These include round, raw circular areas may have had thin blisters that rubbed off. These are often seen in staph infections.
Many normal newborns will get goopy mucus collecting in one or both eyes. This is usually due to plugging of the tear duct that normally carries tears and eye debris from the inner corner of the eye into the nose. The baby's tear ducts are very narrow and can plug easily. Massaging from the inner corner of the eye down the edge of the nose may help.
If the baby has eye discharge and also has redness of the white part of the eyeball or redness or swelling of the eyelids call us right away. This may be an infection.
Baby's First Cold
You can be sure that the baby will get a cold sometime in the first 6 months. Don't blame yourself or anyone else; all babies get colds. Call us if the baby has a temperature over 100 degrees, is breathing very hard or fast, is very inactive, won't nurse or drink the bottle, or has poor color. Otherwise you can try a vaporizer, salt water drops in the nose to loosen the mucus (you can buy these or mix 1/4 tsp salt in 8 oz water), and a bulb syringe to gently suck mucus out of the nose. Many infants with colds are more comfortable sleeping in their infant seats so that the mucus drains down their throat. Please call if you have other questions about the baby's cold.
When Your Baby Is Sick
Call and be ready to tell us:
Symptoms: Vomiting, diarrhea, rash, runny nose, etc.
Temperature: Rectal temperature is most accurate, but armpit, ear or temporal temperature is a good first screen. Digital thermometers (the $3-$12 type) are the handiest for armpit or rectal measurements. Call for any temperature over 100 degrees if your baby is less than 2 months old.
Activity: Alert or listless, fussy or too quiet?
Appetite: Nursing or bottle-feeding OK?
Exposure: Is anyone else at home sick?
When you call please be clear about whether you want the baby to be seen or you just need some advice or you aren't sure which you need.
Now Check These Out
Text4Baby is a nice service of helpful reminders to new parents. Text the word “Baby” (or “Bebe” for Spanish) to 511411 to get started.
HealthyChildren.org is the American Academy of Pediatrics website for parents.
Now enjoy your new baby, get as much rest as possible, get as much help as you need, and call the office for your first appointment.