Newborn’s Normal Appearance Newborn Reflexes and Behavior Skin: Rashes and Birthmarks Normal Newborn Development For your consideration Time to go home Common Concerns

Caring for your Baby

Time to go home...

Prior to discharge, your baby will have a newborn screen (testing for inherited diseases that are treatable), a hearing test (to screen for congenital hearing loss), for boy’s a potential circumcision, and lastly a bilirubin level will be drawn to determine if your infant is at risk for significant jaundice (yellowing of the skin). After all is well and after almost a year of anticipation, it’s time to take your new little person home. Please consider the following:

First Weeks at Home with a Newborn

Preventing Fatigue and Exhaustion
For many mothers, the first weeks at home with a new baby are often the hardest in their lives. You will probably feel overworked, even overwhelmed. Inadequate sleep will leave you fatigued. Caring for a baby can be a lonely and stressful responsibility. You may wonder if you will ever catch up on your rest or work. The solution is asking for help. No one should be expected to care for a young baby alone.

Every baby awakens one or more times a night. The way to avoid sleep deprivation is to know the total amount of sleep you need per day and to get that sleep in bits and pieces. Go to bed earlier in the evening after your baby’s final feeding of the day. When your baby naps you must also nap. Your baby doesn’t need you hovering while he or she sleeps. If sick, your baby will show symptoms. While you are napping, take the telephone off the hook and put up a sign on the door saying MOTHER AND BABY SLEEPING. If your total sleep remains inadequate, hire a baby sitter or bring in a relative. If you don’t take care of yourself, you won’t be able to take care of your baby.

The Postpartum Blues
More than 50% of women experience postpartum blues on the third or fourth day after delivery. The symptoms include tearfulness, tiredness, sadness, and difficulty in thinking clearly. The main cause of this temporary reaction is probably the sudden decrease of maternal hormones. Since the symptoms commonly begin on the day the mother comes home from the hospital, the full impact of being totally responsible for a dependent newborn may also be a contributing factor. Many mothers feel let down and guilty about these symptoms because they have been led to believe they should be overjoyed about caring for their newborn. In any event, these symptoms usually clear in 1 to 3 weeks as the hormone levels return to normal and the mother develops routines and a sense of control over her life.

There are several ways to cope with the postpartum blues. First, acknowledge your feelings. Discuss them with your husband or a close friend as well as your sense of being trapped and that these new responsibilities seem insurmountable. Don’t feel you need to suppress crying or put on a “supermom show” for everyone. Second, get adequate rest. Third, get help with all your work. Fourth, renew contact with other people; don’t become isolated. Get out of the house at least once a week—go to the hairdresser, shop, visit a friend, or see a movie. By the fourth week, setting aside an evening a week for a “date” at home with your husband is also helpful. Take-out food and a rental movie can help you tap back into your marriage. If you don’t feel better by the time your baby is 1 month old, see your health care provider about the possibility of counseling for depression. If the blues are making it impossible for you to care for yourself and your baby, get help as soon as possible.

Sibling Rivalry Toward a Newborn

What is sibling rivalry?

Sibling rivalry refers to the natural jealousy of children toward a new brother or sister. Older siblings can feel jealous when the baby arrives until they are 4 or 5 years old. Not surprisingly, most children prefer to be the only child at this age. Basically, they don’t want to share your time and affection. The arrival of a new baby is especially stressful for the firstborn and for siblings less than 3 years old. The jealousy arises because the older sibling sees the newcomer receiving all the attention, visitors, gifts, and special handling.

The most common symptom of sibling rivalry is lots of demands for attention. For example, the older child wants to be held and carried, especially when the mother is busy with the newborn. Other symptoms include acting like a baby again, such as thumbsucking, wetting, or soiling. Aggressive behavior—for example, handling the baby roughly—can also occur. All of these symptoms are normal. While some can be prevented, the remainder can be improved within a few months.

How can I help prevent sibling rivalry?

In the hospital

Coming home

The first months at home

When should I call my health care provider?

Call during office hours if:

Helpers: Relatives, Friends, Sitters

As already emphasized, everyone needs extra help during the first few weeks alone with a new baby. Ideally, you were able to make arrangements for help before your baby was born. The best person to help (if you get along with her) is usually your mother or mother-in-law. If not, teenagers or adults can be hired to come in several times a week to help with housework or look after your baby while you go out or get a nap. If you have other young children, you will need daily help. Clarify that your role is looking after your baby. Your helper’s role is to shop, cook, houseclean, and wash clothes and dishes. If your newborn has a medical problem that requires special care, ask for home visits by a public health nurse.

The Father’s Role

The age of noninvolvement of the father is over. Not only does the mother need the father to help her with household chores, but the baby also needs to develop a close relationship with the father. Today’s father helps with feeding, changing diapers, bathing, putting to bed, reading stories, dressing, disciplining, homework, playing games, and calling the doctor when the child is sick. The father needs to be his wife’s support system. He needs to relieve her in the evenings so she can nap or get a brief change of scenery.

A father may avoid interacting with his baby during the first year of life because he is afraid he will hurt his baby or that he won’t be able to calm the child when the baby cries. The longer a father goes without learning parenting skills, the harder it becomes to master them. At a minimum, a father should hold and comfort his baby at least once a day.

Visitors

Only close friends and relatives should visit you during your first month at home. They should not visit if they are sick. To prevent unannounced visitors, the parents can put up a sign saying MOTHER AND BABY SLEEPING. NO VISITORS. PLEASE CALL FIRST. Friends without children may not understand your needs. During visits the visitor should also pay special attention to older siblings.

Feeding Your Baby: Achieving Weight Gain

Your main assignments during the early months of life are loving and feeding your baby. All babies lose a few ounces during the first few days after birth. However, they should rarely lose more than 7% of the birth weight (usually about 8 ounces for a 7 pound birth weight). Most bottle-fed babies are back to birth weight by 7 days of age, and breast-fed babies by 10 days of age. Then infants gain approximately an ounce per day during the early months. If milk is provided liberally, the normal newborn’s hunger drive ensures appropriate weight gain.

A breast-feeding mother often wonders if her baby is getting enough calories, since she can’t see how many ounces the baby takes. Your baby is doing fine if he or she demands to nurse every 1 ½ to 3 hours, appears satisfied after feedings, takes both breasts at each nursing, wets 6 or more diapers each day, and passes 3 or more soft stools per day. Whenever you are worried about your baby’s weight gain, bring your baby to your health care provider’s office for a weight check. Feeding problems detected early are much easier to remedy than those of long standing. A special weight check 1 week after birth is a good idea for infants of a first-time breast-feeding mother or a mother concerned about her milk supply.

Bowel habits

Newborns’ stools differ in color, consistency, and frequency. Normal babies have a bowel movement as seldom as once every 2 days or as often as after each feeding. Initially, the stool will be greenish-black and “tar-like.” After a few days, stools become yellow, green, brown, or orange depending on the type of feeding (formula versus breast milk). Nursing babies over 4 – 6 weeks old are prone to have stools only once or twice a week, because mother’s milk is better digested than formula.

All babies strain, squirm, make faces and draw their legs up while they move their bowels. Constipation refers to hard, dry stools which are difficult to pass. Call us if you think your baby may be constipated.

It is not important whether you use cloth or disposable diapers. The main things to consider are cost and convenience. Change the diaper and wipe with warm water as soon as possible after your baby has had a stool, and keep the diaper area dry. It you use the new ultra-absorbent diapers, they my feel dry even after your baby has wet.

Sleep Patterns in Babies

What is a normal sleep pattern for a baby?

New sleeping patterns are one of the biggest changes caused by a new baby’s arrival. New parents can have bleary eyes and sleepless nights. Getting to know your baby’s schedule and communication cues takes time. Try not to feel rushed or pressured into having your baby sleep through the night or follow a specific nap schedule.

How long do most babies sleep?

Newborn babies sleep an average of 16 hours a day. Most of the time a new baby sleeps in 3 to 4 hour blocks of time. Sadly, that usually does not match an adult sleeping schedule. At first, babies do not know the difference between day and night. As time goes on, your baby will find his or her own internal clock to guide wake-sleep cycles. Eventually, your baby will be more awake during the day and sleep longer at night.

Most babies start sleeping 6 to 8 hours at a time during the night at about 3 months of age or when they weigh 12 to 13 pounds. By 6 months of age, many babies will sleep 8 to 10 hours at night. If your baby is still not sleeping through the night, don’t worry. Each baby is different and has his or her own temperament and personality that affect their sleep patterns. Some babies do not sleep through the night until 1 year of age or older.

What about naps?

A baby’s sleep time is divided between nighttime sleep and daytime naps. The total amount of sleep time is about the same for babies, whether they sleep for longer times, but less often, or sleep for shorter times more often.

How can I help my baby develop good sleeping habits?

Babies learn to link certain things with sleeping. For example, if your baby is fed and always falls asleep in your arms, this may be the only way the baby is able to fall asleep. When your baby awakens during the night, he or she cannot fall back to sleep without being fed and held. Other associations may include rocking, walking, and being with you. Eventually, babies need to learn to fall asleep on their own. If your baby can fall asleep without assistance when first laid down, chances are more likely your baby will fall asleep easily after waking in the middle of the night.

Dealing with Crying

Crying babies need to be held. They need someone with a soothing voice and a soothing touch. You can’t spoil your baby during the early months of life. Overly sensitive babies may need an even gentler touch. A newborn’s only way of communicating is to cry. This may indicate that the baby is wet, cold, hot, wanting attention, hungry, tired or in pain for some reason. Some babies need to cry to help them settle down to sleep. If you are sure your baby’s needs are met, try cuddling or rocking, or offer a pacifier if you wish. It is not necessary to feed your baby for every crying spell. During the first few weeks, your baby will learn to cry in different ways to indicate different needs. Normal babies have increasing amounts of crying for the first six weeks, and then they cry less as they learn other ways of communicating.

Sleep Position

Remember to place your baby in his crib on his back. As of 1992, this is the sleep position recommended by the American Academy of Pediatrics for healthy babies. The back (supine) position reduces the risk of Sudden Infant Death Syndrome (SIDS).

Taking Your Baby Outdoors

You can take your baby outdoors at any age. You already took your baby outside when you left the hospital, and you will be going outside again when you take him or her for the two-day or two-week checkup.

Dress the baby with as many layers of clothing as an adult would wear for the outdoor temperature. A common mistake is overdressing a baby in summer. In winter, a baby needs a hat because he or she often doesn’t have much hair to protect against heat loss. Cold air or winds do not cause ear infections or pneumonia.

The skin of babies is more sensitive to the sun than the skin of older children. Keep sun exposure to small amounts (10 to 15 minutes at a time). Protect your baby’s skin from sunburn with longer clothing and a bonnet.

Medical Checkup on the Third or Fourth Day of Life

Early discharge from the newborn nursery has become commonplace for full-term babies. Early discharge means going home in the 24 hours after giving birth. In general, this is a safe practice if the baby’s hospital stay has been uncomplicated. These newborns need to be re-checked 2 days after discharge to see how well they are feeding, urinating, producing stools, maintaining weight, and breathing. They will also be checked for jaundice and overall health. In some cases, this special re-check will be provided in your home.

The Two-Week Medical Checkup

This checkup is probably the most important medical visit for your baby during the first year of life. By two weeks of age your baby will usually have developed symptoms of any physical condition that was not detectable during the hospital stay. Your child’s health care provider will be able to judge how well your baby is growing from his or her height, weight, and head circumference.

This is also the time your family is under the most stress of adapting to a new baby. Try to develop a habit of jotting down questions about your child’s health or behavior at home. Bring this list with you to office visits to discuss with the health care provider. Most physicians welcome the opportunity to address your agenda, especially if your questions are not easily answered by reading or talking with other mothers.

If at all possible, both the mother and father should go to these visits. Most physicians prefer to get to know both parents during a checkup rather than during the crisis of an acute illness.

If you think your newborn starts to look or act sick between the routine visits, be sure to call us for help.

Sick Newborn: Subtle Symptoms

A newborn is a baby less than 1 month old. He or she mainly eats, sleeps, cries a little, and needs a lot of love and his or her diapers changed frequently. If a newborn is ill, the symptoms can be subtle. Also, an ill newborn can very quickly get much sicker. If a newborn is sick at all, the illness can be serious.

When should I call the office?

Call IMMEDIATELY if:

General Newborn Care

Bathing

You may bathe your baby daily, but for the first few months, 2 or 3 times a week is often enough for a full bath. Clean your baby’s drools and spills as they happen and keep the face, hands and diaper area clean. Keep the bath water level below the naval or give sponge baths until a few days after the navel cord has fallen off. Submerging the cord could cause infection or interfere with its drying out and falling off. Getting the cord a little wet doesn’t matter.

Use tap water without any soap or with a nondrying baby soap. Don’t forget to wash the face and neck; otherwise, chemicals from dribbled milk and food can build up and cause an irritated rash. Also rinse off the eyelids with water.

Don’t forget to wash the genital area. However, when you wash the inside of the female genital area (the vulva), never use soap. Rinse the area with plain water and wipe from front to back to prevent irritation. This practice and the avoidance of any bubble baths before puberty may prevent many urinary tract infections and vaginal irritations. At the end of the bath, rinse your baby well; soap residue can be irritating.

Changing Diapers

After you remove a wet diaper, just rinse your baby’s bottom off with a wet washcloth or diaper wipe. After soiled diapers, rinse the bottom under running warm water or in a basin of warm water. You can’t clean BMs off the skin with diaper wipes alone. Millions of bacteria will remain and cause diaper rashes. After you clean the rear, cleanse the genital area by wiping front to back with a wet cloth. In boys, stool can hide under the scrotum, so rinse carefully there. If you have a girl, carefully clean the creases of the vaginal lips (labia).

Shampoo

Wash your baby’s hair once or twice a week with a special baby shampoo that doesn’t sting the eyes. Don’t be concerned about hurting the anterior fontanelle (soft spot on the head). It is well protected.

Lotions, Ointments, and Powder

Newborn skin normally does not require any ointments or creams. Especially avoid putting any oil, ointment, or greasy substance on your baby’s skin because this will almost always block the small sweat glands and lead to pimples or a heat rash. If the skin starts to become dry and cracked, use a baby lotion, hand lotion, or moisturizing cream twice a day.

Cornstarch powder can be helpful for preventing rashes in areas of friction. Avoid talcum powder because it can cause a serious chemical pneumonia if inhaled into the lungs.

Umbilical Cord

Try to keep the cord dry. Put rubbing alcohol on the base of the cord (where it attaches to the skin) at least twice a day (including after the bath) until 1 week after it falls off. Although using alcohol can delay the separation of the cord by 1 or 2 days, it does prevent cord infections, and that’s what is most important. Air exposure helps the cord stay dry and eventually fall off, so keep diapers folded down below the cord area. If you are using disposable diapers, you can cut a wedge out of the diaper with scissors so the cord is not covered.

Fingernails and Toenails

Cut the toenails straight across to prevent ingrown toenails. Round off the corners of the fingernails so that your baby doesn’t scratch himself or others.

Trim the nails once a week after a bath, when the nails are softened by the bath. Use clippers or special baby scissors. This job usually takes two people unless you do it while your child is asleep.

Circumcision Care and Problems

What is a circumcision?

A circumcision is the removal of the normal male foreskin. The incision is red and tender at first. The tenderness should be minimal by the third day. The scab at the incision line comes off in 7 to 10 days. If a Plastibell ring was used, it should fall off by 14 days (10 days on the average). While it cannot fall off too early, don’t pull it off because you could cause bleeding.

Any cuts, scrapes, or scabs on the head of the penis may normally heal with yellowish-colored skin if your baby has been jaundiced. This bilirubin in healing tissue is commonly mistaken for an infection or pus.

How can I take care of my child?

When should I call my child’s health care provider?

Call IMMEDIATELY if your child has been circumcised recently and:

Call during office hours if:

Foreskin Care and Problems

What normally happens to the foreskin?

At birth the foreskin is normally attached to the head of the penis (glans) by a layer of cells. Over the next 5 or 10 years the foreskin will naturally separate from the head of the penis without any help from us. It gradually loosens up (retracts) a little at a time. Normal erections during childhood probably cause most of the change by stretching the foreskin.

What problems can occur?

The foreskin generally causes no problems. However, overzealous retraction before the foreskin has fully loosened can cause it to get stuck behind the head of the penis, resulting in severe pain and swelling. If retraction causes bleeding, scar tissue may form and interfere with natural retraction. Occasionally, the space under the foreskin becomes infected. Most of these problems can be prevented.

How can I take care of my child?

Some health care providers feel that parents should not try retraction, but this runs the risk of smegma collection and infection. In general, the foreskin requires minimal care. The following suggestions will help maintain good hygiene.

During the first year of life, clean only the outside of the foreskin. Don’t try to retract the foreskin. Don’t put any cotton swabs in the opening.

Gentle, partial retraction can begin when your son is 1 or 2 years old. It can be done once a week during bathing.

Perform retraction by gently pulling the skin on the shaft of the penis downward toward the abdomen. This will make the foreskin open up, revealing the end of the glans.

During retraction, the exposed part of the glans should be cleansed with water. Wipe away any whitish material (smegma) that you find there. Smegma is simply the accumulation of dead skin cells that are normally shed from the glans and lining of the foreskin throughout life. Do not use soap or leave soapy water under the foreskin because this can cause irritation and swelling. After cleansing, always pull the foreskin forward to its normal position. (Note: A collection of smegma that is seen or felt through the foreskin, but which lies beyond the point to which the foreskin is retractable, should be left alone until normal separation exposes it.)

Avoid vigorous retraction because this can cause pain, bleeding, or the foreskin to become stuck behind the head of the penis (this is called paraphimosis). Retraction is excessive if it causes any discomfort or crying.

By the time your son is 5 or 6 years old, teach him to retract his own foreskin and clean beneath it once a week during baths to prevent poor hygiene and infection. Gentle reminders are necessary in the early years.

In general, foreskin retraction is overdone in our society. Keep in mind that any degree of foreskin movement is normal as long as your boy has a normal urine stream. There should be no rush to achieve full retraction. Full retraction always occurs naturally by puberty. As the foreskin becomes retractable on its own, your son should cleanse beneath it to prevent infections.

When should I call?

Call IMMEDIATELY if:

Call within 24 hours if:

General Safety Tips

We will talk about safety from time to time in the office. If you have any questions, write them down, and feel free to discuss them.