Newborns And Expecting Parents

What to expect, and how to care for your new baby

Congratulations!

You’ve already made the first step towards being an awesome parent!

What to expect in the Hospital:

  • Nurses, or even a whole team, will be there at birth to make sure your baby is healthy
  • A pediatric “hospitalist” will see your baby daily
  • They may check for: low blood sugar, jaundice, signs of infection
  • Prophylaxis: eye drops (to avoid eye infection)
  • Vitamin K (to avoid bleeding)
  • “Newborn Screening” = blood sample sent to the State (results will come to us about 10 days later)
  • Hearing Screen to check for congenital hearing loss
  • Oxygen Level to check for Congenital Heart Disease
  • Immunizations begin: the first dose of hepatitis B vaccine
  • Lactation Consultation and/or classes to help with Breastfeeding

***Don’t worry, all babies lose weight… and many will look yellow (jaundice)

***Feeding, Sleeping, Peeing and Pooping (or lack thereof) will become common topics of conversation!

When do I start going to the Pediatrician?

  • Within 1-2 days of going home from the hospital
  • Call to schedule an appointment if you know you are going home that day
  • We want to support you from the beginning, and we know the first week is tough
  • The first 1-2 weeks we will continue to monitor feeding, weight, and jaundice

How often will I need to go to the Pediatrician?

Typical well-child visits (“check-ups”) in the first year occur at:

  • 3-5 days
  • 2 weeks
  • 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 1 year

WHAT TO EXPECT FROM YOUR NEWBORN:

APPEARANCE:

  • They were in a tight space until delivery.
    • “Molding” (weird head) or positional abnormalities (crooked feet) can be normal
  • Hands and feet may look blue or purple.
    • Check to see if they are cold and how you have been holding him/her
    • Call your doctor if you think your baby’s lips and tongue look blue
  • Jaundice (yellow color of eyes and skin) is physiologic and may last 2-4 weeks.
    • Check with your doctor if it is increasing, or not going away by 1 month
  • Rashes are common, peeling skin is normal.
    • Be a minimalist with products the first few weeks
      • Then choose fragrance-free products (lotions, soaps, detergent, etc.)
  • Birthmarks are common. They may be brown, pink, red, blue…
    • Ask your doctor about it. Some stay, some go away.
  • Crusty eyes are usually normal.
    • Check with the doctor if eyes are red, or lots of eye drainage is present
  • Watery eyes are normal as well.
    • Some babies are born with blocked tear ducts and this usually goes away by 9 months
  • Crossed eyes, or wandering eyes are normal until 3 months of age.
    • Speaking of eyes… all babies have deep blue/grey eyes at birth.
      • You will see them start to change color between 2-6 months of age
  • Breast lumps are normal and will go away with time  (this goes for girls AND boys)
  • Umbilical Cord: slimy at first, and then dries up and falls off (1-2 weeks)
    • Keep it clean and dry, (alcohol is not necessary)
      • Call your doctor if it is draining pus, won’t stop bleeding, or looks infected
  • Vaginal Discharge is common and normal
  • Baby fingernails are soft, but they can scratch and grow fast!
    • Try keeping them covered with mittens or capped sleeves
      • Avoid cutting them until after 1 month of age
  • Think your baby is developing a “flat head”?
    • Do more tummy time, change positions for play and feeding more often.

BEHAVIOR:

  • Temperament:
    There is no “good” or “bad” baby!
    The first week or so they are usually either the “sleepy baby,” or the “feisty, hungry baby”.
    Once they get into a rhythm after 2-4 weeks, you will see their true colors.
  • Feeding Schedule:
    First 1-2 weeks: most babies do best eating “ad-lib” (on demand).
    Your doctor will let you know if there is a max interval at which you need to wake your baby to feed.
    Cluster-feeding happens once they start to gain weight. They may want to eat every hour! Go with it.
  • Peeing: at least once in the first 24 hours.
    Sometimes it looks orange in the diaper after your newborn pees.
    (This is not blood, but is a sign your baby may be dehydrated and needs more to eat)
    Eventually your infant should have 6-8 full “pee” diapers per day.
  • Pooping: at least once in the first 24 hours
    First poops are “meconium” = dark green to black, sticky like tar.
    “Transitional” poops are lighter green, slimy and sometimes lumpy.
    “Normal” baby poop is yellow like mustard and seedy like cottage cheese (yum.)
    Call your doctor if the poop looks white like clay or has blood in it.
    Once your baby is feeding well, he/she may poop with every feeding.
    Eventually after 1 month of age the pooping slows down.
    (Anything between 5 to 10x per day, and once every 5-10 DAYS can be normal)
  • Days and Nights are “confused” for a few weeks… BUT, your baby is NOT confused.
    Babies are just not developmentally ready to participate in this loud, bright, chaotic world.
    Give it 2-3 weeks, he/she will adjust.
  • Congestion and noisy breathing are common. Noisy does NOT always equal sick.
    If you see boogers, try some nasal saline and then suction his/her nose.
    Look at your baby while plugging your ears. If they LOOK comfortable, they probably are.
    If your baby can eat, or suck on the pacifier, he/she is probably fine.
    If you are still worried, take a video and bring it to your doctor’s appointment.
  • Sneezing is common, and not a sign of illness or allergies in your newborn
  • Squeaks, gasps, wheezes, and coughs are common
  • Hiccups happen
  • Spit-ups happen
    Try burping more, feeding less at a time, laying baby on incline, or holding upright after feeds.
    If your baby is happy and gaining weight, he/she is healthy.
    Spitting up usually gets better after 3-4 months of age.
    Call your doctor if the spitting up is projectile, or is green, or has blood in it.
  • Babies startle easily. It is a reflex and is normal up to 6 months of age.

*** Babies cry! *** On average, 2-4 hours per day!
Be patient.  Never shake your baby.
You will learn what things soothe him/her and eventually what different cries mean.
You cannot “spoil” a newborn. Snuggling and skin-to-skin contact is good. The more, the better!
Babies have a hard time self-soothing until 2-4 months of age. “Crying it out” will not work.

WHAT TO EXPECT AS A NEW PARENT:

ALL PARENTS:

  • Sleep deprivation
    Rest and sleep when your baby is sleeping.
  • Lots of friends and family calling and texting
    Don’t be afraid to ask them for help. Give them chores or shopping lists.
  • Unsolicited advice (just smile and say “thanks”)
    Try to stick to your instincts, pediatrician, and these “baby basics”.
  • Lots of people that want to come over and hold your baby
    Beware of toddlers and germs, try to avoid a lot of visitors.
    Nobody comes over sick.
    Everybody should be up-to-date on vaccines.
  • FEAR. There are a lot of “what-ifs,” but being prepared can’t hurt.
    • Find an Infant First Aid and CPR class
      • Search your local American Heart Association or American Red Cross for classes
      • Select Babies-R-Us provide these classes
      • “Infant CPR Anytime” Home Kit for learning the basics: www.aap.org
      • Your Pediatric or OB-GYN office may offer classes
      • “Big Steps for Saving Small Lives” DVD from CPR Associates of America

MOMS

  • The “BABY BLUES” are real.
  • There are a lot of changes in your body and your hormones after birth.
  • Most moms describe their mood as chaotic and unpredictable.
  • Some moms are flat-out sad.
  • If you feel sad, blue, panicky or overwhelmed for more than a few days, call someone to come help.
  • Call your doctor.

PARENTS OF BOYS: To circumcise or not to circumcise?

  • Medical evidence to suggest benefits outweigh the risks
  • However, this is truly a personal decision for you and your family to make
  • DO: decide before birth
  • May be done in most hospitals, or in our office
  • Tell someone if there is any family history of a bleeding disorder
    • He may need labs checked before the procedure
  • The procedure should be done before 1 month of age (if you want it done during infancy)
    • I prefer to do them before 1-2 weeks of age
  • After the circumcision, the penis will look red and develop a yellowish crust/layer over this fresh skin.
    • Apply vaseline every diaper change 
    • The area usually heals within 7-10 days
    • Call your doctor about bleeding, or a decrease in wet diapers

NUTRITION FOR YOUR BABY: What’s To Eat? Breasts, Bottles, and Pumps, OH MY!

NUTRITION BY THE WEEK:

  • Feeding during the first 1-7 days:
    • Feed your baby EVERY 2-4 hours, try to pick up on early hunger cues, before he/she starts wailing.
    • If breastfeeding, encourage your baby to latch and feed for 15-30 minutes.
    • If bottle-feeding, start with about 15ml per feed and slowly increase to about 60ml (for most babies). 
  • Feeding during the second week: 
    • Most babies are gaining weight at this point.
    • His/her “cues” for feeding become more consistent.
      • Hunger cues: sucking, rooting, putting hand to mouth, fussing
      • Satiety cues: turning away from breast or bottle, closing mouth, relaxing hands
    • He/she may start to “cluster feed”
      • Feeding small amounts frequently (every 20-45 minutes) for 2-5 hours at a time
        • (And yes, this will definitely occur in the middle of the night)
  • Feeding during the third week and beyond:
    • Most babies are back to or beyond their birth weight
    • Babies usually fall into a more predictable pattern of feeding (anywhere between every 2 to 4 hours)

TIPS FOR EVERYONE:

  • Do not give your baby WATER unless instructed by your doctor.
  • If feeding formula, check the instructions on amount of water to add (if any).
  • Your baby does not need any “solids” until at least 4-6 months of age.
  • Cereal is for spoons, not bottles.
  • DO NOT give your baby HONEY during the first YEAR of life
    • Babies are at risk for Botulism during this time

If you choose to bottle-feed, or supplement, or pump…

  • Standard cow’s-milk based infant formula with iron is appropriate for most babies.
  • After the first few weeks, a few good “rules of thumb”:
    • Babies will probably not take more than 1/2 their weight in ounces PER FEEDING.
      (ie: if they are 8 lbs, 4 ounces is likely their MAX amount to take at a time)
    • Babies will take about 2 1/2 ounces per pound of body weight PER DAY.
      (ie: if they weigh 8 lbs, they will take around 20 ounces per day)

BREASTFEEDING:

  • Start Breastfeeding in the Delivery Room (if possible).
  • Even if you do not plan to Breastfeed, give it a try for at least the first few days.
    Your baby will get the COLOSTRUM that is rich in nutrients and IMMUNE PROTECTION.
  • Your milk may not “come in” until 2 to 5 days AFTER your baby is born. Don’t worry! Babies don’t need that much in the first few days. Your goal is to establish consistency with getting your baby to latch to the breast, and to stimulate your breasts and body to increase milk production.
  • There are a few instances in the first few days where formula may be recommended temporarily (or to supplement breastfeeding) by your doctor. This may include jaundice, low blood sugars, trouble breastfeeding, weight loss that is more than expected, or if your baby has not peed or pooped in over 24 hours. Don’t worry! Your baby will still learn how to latch to your breast.
  • Benefits of Breastfeeding:
    • Breastmilk is FREE, and your breasts are portable!
    • Your baby will have less risk of infection, and decreased risk of SIDS.
    • Long term, infants will (probably) have decreased risk of food allergy and obesity.
    • Moms also get benefits from breastfeeding.

If your choice is to breastfeed:

  • Try to establish a consistently good latch from your baby before introducing the bottle or pacifier.
  • Take care of yourself: eat plenty, and drink plenty of water!
  • Keep taking your prenatal vitamins daily.
  • Your baby will need daily Vitamin D (400 IU).
  • There are lots of resources to help with BREASTFEEDING:
    • Your Pediatrician
    • Lactation consultants
    • Many hospitals offer breastfeeding classes for moms after they leave the hospital
    • WIC has nursing supplies and nutritional support for breastfeeding moms
    • Breast pumps are often available through your insurance
    • www.healthychildren.org answers several common breastfeeding questions
    • “New Mother’s Guide to Breastfeeding” is a great book at www.aap.org

SAFETY for your newborn/ infant: PREVENTING ACCIDENTS!

SLEEP SAFETY:

“Safe Sleep” practices:
  • firm mattress with sheet only
  • no bumpers or pillows or stuffed animals
  • swaddling baby positioned on his/her back
  • located in your room (but not in your bed) for the first 6-12 months
  • crib with closely placed slats (less than or equal to 2 3/8 inches apart)
  • keep room temperature comfortable and baby dressed appropriately
  • CAR SEATS are not crib alternatives
Preventing SIDS (Sudden Infant Death Syndrome)
  • Back-to-Sleep. ALWAYS.
  • No co-sleeping
  • No smoke exposure
  • Pacifier during sleep from age 1-12 months may help
CAR SAFETY: CAR SEATS
  • Positioned REAR-FACING in the back seat in the middle (driver’s side if middle is not possible)
  • Never position in seat with a passenger air-bag
  • Children should remain rear-facing until they outgrow the height/weight limits for YOUR seat
  • Information on installation, positioning, and which seat is right for your child:
  • There is no one “best” or “safest” car seat
  • Take into account the size of your child and the size of your car
WATER SAFETY:
  • Preventing burns: set your water heater so that it is less than 110-120ºF
  • Always check bath water with your wrist before you put your baby in the water
  • Have all supplies needed for bath-time available and within reach
  • While bathing, do not multi-task and do not turn your focus away from your baby
AVOIDING FALLS:
  • Do not leave your baby unattended on ANY elevated surface (beds, changing tables, couches, etc.)
  • Do not set any baby chairs, car seats, etc. on any elevated surface (while your baby is in it)
BABY-PROOFING:
  • Try to stay one step ahead of what you think your infant could do or get in to!
  • For infants, don’t forget “strangle” hazards
SUN EXPOSURE:
  • Try to avoid sun exposure for any prolonged period of time, (especially 10am to 4pm)
  • Sunscreen use is not recommended until 6 months of age
  • Use shade, hats, and UPF clothing

ILLNESS

If babies get a fever in the first 3 months of life, it can be the sign of something serious. Babies often show only subtle signs of illness, and cannot tell us when they feel ill. Their immune system is immature, and cannot fight off some types of bacteria. They also cannot mount a very strong immune response when exposed to germs. In the first 2 months of life, they also have not received any vaccination yet against things like whooping cough and meningitis.If at any time your baby has a fever in the first 3 months of life, call your doctor immediately!Identifying a fever:
  • 100.4F (38.0C) degrees and above
  • Temperature MUST be taken rectally (most accurate)
Recognize signs that your baby may be sick: Take a rectal temperature and call your doctor if your baby:
  • Feels warmer than usual and has a temperature of 100.4 or more
  • Is not wanting to (and will not) feed for more than 1 feeding in a row
  • Is irritable and crying more than usual and very difficult to console
  • Is acting more sleepy than usual, and does not respond to your normal ways of waking or interacting with him/her
How to decrease the risk that your baby gets sick:
  • Wash your hands frequently
  • Have anyone that is going to touch or hold your baby wash their hands first
  • Avoid crowded areas
  • Have anyone that is known to be ill stay away from your baby
  • Unless they are siblings, avoid toddlers and school-age children
VACCINES are the best defense against many life-threatening illnesses.
  • All caregivers and close contacts should have had a dose of TdaP which helps protect babies against whooping cough
  • Moms will get a dose of TdaP in the third trimester of every pregnancy
  • All close contacts of infants should be vaccinated yearly against influenza
  • Your baby will get his/her first set of vaccines at 2 months of age
  • Schedule your baby’s shots as early as 6 weeks if they will be going to daycare or be exposed to toddlers or school-aged children on a regular basis
  • For info on shots, go to www.cdc.gov or search for CHOP Vaccine Education Cente
Medications for babies (whether “sick” or “well”):
  • Ask your doctor about ANY over the counter medication you want to give your baby in the first 3 months of life
  • Tylenol may be given after 3 months of life for fever or discomfort
  • It is important you know a recent weight estimate of your baby in order to dose correctly
  • Ibuprofen should not be given until AFTER 6 months of age
  • Beware “all natural” and “homeopathic” remedies you may want to give your baby, some CAN cause harm
  • Remedies that are not proven helpful, but have been studied and do no harm:
    • “Gas drops” (simethicone
  • Remedies that may be helpful and have been studied and determined safe:
    • “Gripe water” with GINGER which is the helpful ingredient (NO “BICARB”)
    • Probiotic: L. Reuteri (especially in breastfeeding moms)
  • It is always better to check with your pediatrician first