Newborn Care
ALL THE LITTLE THINGS YOU FORGOT TO ASK…
Umbilical Cord The umbilical cord stump will generally fall off in a week or 2. Please keep the area dry. You do not need to apply anything (i.e. alcohol) and please do not bathe the baby until it falls off. Keep the area as open to air as possible. When the stump falls off, it may be moist, bleed a bit, or have a yellow discharge. These things are all normal and will quickly dry-up. Please call your pediatrician if the area is very red or draining fluid regularly.
Bathing A warm wet washcloth, every 2-3 days, is all you need until the cord falls off. Newborn’s skin is very dry and flaky. This is normal and will go away on its own. Plain Vaseline on any dry, cracked areas is safe to use. There is no need to use anything on the skin other than water and Vaseline.
Nail Care Newborn’s nails grow very quickly, and your baby may have been born with very long, sharp nails. Using an emery board to file the nails, or very carefully using small nail clippers is safe.
Eyes Sometimes, newborns have eye discharge or crustiness on and off for several weeks/ months. This is often due to a clogged tear duct. If the eyes are red and/or there are large amounts of discharge all day long, please call the pediatrician. It is normal for up to one year to have intermittent eye discharge/crustiness (without redness), especially after sleep. This can be gently wiped away with warm water on a clean washcloth.
Vaginal Discharge Newborn girls can have a swollen vaginal area with thick, white, clear, or even bloody discharge after birth. This is due to hormones passed to the baby from mom and will resolve on its own (may last longer if breastfeeding). You may gently wipe any discharge away while changing the diaper.
Breast Bumps Both newborn boys and girls may have swollen breast tissue for a few weeks. It is completely normal.
Reflexes Most of your baby’s initial movements are reflexive. Things like rooting (looking for a something to suck, like a nipple), grasp, and sucking are automatic reflexes present after (and before!) birth. Another more dramatic one you will see if the Moro (“startle”) reflex. It may appear that the baby “jumps” or startles frequently with a loud noise, or for no reason at all. This generally peaks during the first month and disappears by 2 months.
Hiccups & Sneezing Both occur frequently in the newborn period, are normal, and don’t require treatment. Sneezing does not mean the baby is getting sick or has allergies. The baby may sneeze or have the hiccups several times in a day. If your baby seems to be coughing, breathing rapidly, or making a grunting noise with each breath, please call your pediatrician
Nasal Congestion Nasal congestion and mucus are very common and both completely normal for babies, and may occur intermittently during the first year of life. If the baby has just spit up, or had a “wet burp”, milk will often get stuck in the back of the nose causing congestion. The congestion may seem worse when they are lying flat on their backs during sleep, since gravity is not helping. You can use normal saline drops in the nose as needed, and a nasal aspirator if the child is so congested they cannot feed well, but please do this very gently because “digging” in the nose can actually cause more congestion. Otherwise, we recommend ignoring it. A cool mist humidifier is also worthwhile in the winter months. Another thing to try is NoseFrida http://www.fridababy.com/shop/nosefrida/. Please remember to NEVER put a baby to sleep on their stomach.
Spitting up ALL BABIES SPIT UP. It is normal and expected, and can last for several months. If the spit-ups are very forceful, frequent, and/or the child seems very uncomfortable while spitting up, please call the pediatrician. Projectile vomiting across the room or vomit that is persistently brown, green, or yellow requires medical attention.
Most babies are “happy spitters”-they spit up all over you and are smiling right afterwards.
Burping and Gas You should try to burp at the end of the feeding or if the baby interrupts the feeding. Try for a couple of minutes. If you don’t get a good burp, don’t worry. Some babies are good burpers, some aren’t, and some are only good sometimes. Don’t worry.
Crying All babies cry. There can be absolutely nothing wrong with them and they will still cry. Almost all babies will have a fussy period in the evening/late night hours. It is part of their normal neurologic development. Many parents blame gas on the fussiness, saying their baby has “colic”, however it is usually during these normal periods of crying that the baby swallows more air, and thereby has more gas. These fussy periods of crying usually improve by 3-4 months of age. Until then, how do we keep our sanity? Here are a few tricks…
● The probiotic, L. reuterii, by BioGaia, was shown to reduce crying time in colicky breastfed babies and may be helpful. ● Gripe water, an old time, natural remedy made from fennel seed, chamomile and ginger,may calm the baby and help with digestion, but is not regulated by the FDA. Consult your physician prior to giving if you have questions. ● Simethicone Gas Drops help gas bubbles become more manageable. Consult your physician prior to giving if you have any questions. ● “The Happiest Baby on the Block” book and DVD, by Dr. Harvey Karp, reveals valuable secrets on how to calm a fussy baby.
● Pacifiers, while not recommended in the first days of life while babies are learning to latch and suckle on mother’s breast, can be helpful to soothe a crying baby. Babies love to suck, so it may help calm them. There is evidence that pacifier use may decrease a baby’s risk of SIDS. It is NOT a good idea to tie the pacifier to a string around the baby’s neck or attach the string to their clothes. This is a strangling hazard and must be avoided.
● Hold them- Babies love to be held. YOU CANNOT SPOIL A BABY IN THE NEWBORN PERIOD. It is the baby’s instinct to want to be held constantly and will help calm the baby.
Signs of Illness A baby cannot tell you if they are sick or something hurts. Trust your gut and look for the following signs:
● Appetite changes ● Personality changes A rectal temperature equal to or greater than 100.3 F. This MUST be done rectally for at least the first 6 months. You CANNOT assume the baby does or doesn’t have a fever by feeling the baby’s head. If your baby is less than 12 weeks old and has a rectal temperature of 100.3 or higher, please call your pediatrician right away--day or night.
Sterilizing You DO NOT need to sterilize bottles! Just wash everything the way you do the dishes you eat off of-- soap and water-- or top shelf of dishwasher. Using the bags you stick in the microwave are also fine, but unnecessary.
Temperature Keep the temperature in your home at what you would normally keep it. It is not necessary to make your house warmer for the baby. It is always better to be on the side of cooler than too warm. You can use fans (which have been shown to reduce the risk of SIDS), air conditioners, heating systems, etc- whatever is needed for the time of year. Additionally, most new parents tend to overdress their new babies. The same amount of clothing that you feel comfortable wearing is what your baby should wear. Put on as many layers as make sense, counting the blankets, and then touch the baby’s chest after being in that environment after 10-15 minutes. If the baby’s chest feels cold, put on a layer, if it feels sweaty, take off a layer. Never use the baby’s hands and feet as a guide to their temperature... they are always colder (and often bluish in color which is also normal).
Going Outside/ Visitors On any day above freezing temperatures, please take the baby out for a walk! It is good for all of you to get the fresh air and exercise. Limit visitors as much as possible, especially those with illness. You want the number of people that are close to and touching the baby to be minimal due to risk of infection. Make sure everyone washes their hands well before touching the baby. Teach other children to only touch the baby’s feet rather than their hands or face. Use common sense with crowded areas (malls, restaurants, churches, etc). Remember that people LOVE to touch babies, and for the first few months you want to minimize this as much as possible.
Car Seat Safety To obtain information on car seat safety, you may call the toll-free Department of Transportation Vehicle Safety Hotline: 1-800-424-9393.
Your baby's safety is very important. Accidents are the leading cause of death and serious illness to children. Because of this, we make safety a primary concern. First, it is the law in Pennsylvania that you seat your child in a car safety seat. You may not even take your child home from the hospital without such a seat. If you do not have an approved safety seat, the nursery will loan you a car seat until you can purchase one. We also have a list of federally-approved car seats, which gives additional information on prices and type of harness.
For more information on car seats for all ages visit: http://www.safercar.gov/parents/RightSeat.htm.
Local Car Seat Checks: http://www.nhtsa.gov/apps/cps/map/findfitting.htm?q_State=PA&q_Zip= http://www.chop.edu/service/injury-prevention-program/car-seat-safety/car-seat-checks.html
Jaundice & Weight Loss Most babies experience a yellowing of the skin in the first days after birth caused by a build-up of a chemical in the body called bilirubin. The baby's bilirubin level is checked frequently while in the hospital, and most babies do not require any treatment. Once the baby hits about 4-5 days old, the liver starts effectively removing the bilirubin from the body, and the level will start to get better. The baby (especially a breastfed baby) can look a bit yellow for a couple of weeks. In some cases, we need to help the baby get rid of the bilirubin by placing special lights over the baby. This is one reason why it is very important to take your baby to the pediatrician 1-2 days after discharge from the hospital...your pediatrician needs to assess the amount of jaundice in the baby.
Along with jaundice, babies tend to lose some weight after birth. It is typical for the weight to drop 8- 10% of birth weight. Your pediatrician will also assess the baby's weight at your first appointment...this helps us know if the baby is getting enough to eat. It often takes a week or 2 for a breastfed baby's weight to get back to birth weight.
NEWBORN SLEEP
Sleep The baby should only sleep on the back. BABIES SHOULD NEVER SLEEP ON THEIR BELLY AS THIS INCREASES THE RISK FOR SIDS. Positioners are not recommended! The baby should be the only thing in the crib or bassinet. No loose blankets (however, they can be swaddled), no pillows and no toys should be in the crib or bassinet. Bumpers are not recommended (increased risk of injury/suffocation). “Breathable Bumpers” are safe to use. We do not recommend your baby sleeping in the bed with you (also increases risk of injury/suffocation). Newborns sleep up to 22 hours/day after they are born. Until the baby regains birth weight, they should be awakened to be fed every 2-3 hours (breastfed baby), and every 3-4 hours (formula fed baby). Once the baby is gaining weight and otherwise healthy, you do not need to wake a sleeping baby to feed. Babies are also very active sleepers-they may
make a lot of noise and move around a lot in their sleep. This is normal. Don’t worry. It does not mean anything.
For more information about safe sleep and reducing the risk of SIDS visit: http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Preventing-SIDS.aspx
Day/Night Reversal When you were pregnant, as you moved around during the day, you were rocking the baby to sleep. At night, when you were still and trying to sleep, the baby became more active. Babies often follow this schedule for the first few weeks after they are born. To help reset this rhythm, make the daytime environment loud, bright, and active. Speak in full voices, keep lights on, let the dog bark, vacuum, etc. At night, make the lights dim, try not to speak to the baby at all, move slower, etc. This is a great time to start a bedtime routine!
CARE OF THE PARENTS
Postpartum Feelings After most women have a baby, they have feelings of tearfulness, tiredness, sadness, and difficulty thinking clearly. The main cause of this temporary reaction is probably the sudden decrease in maternal hormones after delivery. Having a baby is overwhelming and a huge adjustment for the entire family. All new moms “melt down” at some point. It is a completely normal feeling, and you are not alone. There are several ways to cope with these feelings:
● Acknowledge your feelings and know that you are not alone. ● Discuss them with your spouse or a friend. ● Don’t try to suppress crying or put on a “supermom” show for everyone. ● Get as much rest as possible. ● Get help at home. ● Go out for walks and get some fresh air. ● Get out of the house at least once a week alone, even if it is just for an hour. ● Join a new mom group Take a shower! Strap the baby in the carrier car seat, put him on the floor of the bathroom and take a nice shower. Nothing bad will happen if the baby cries for 10 minutes. You will feel so much better. ● Use a carrier to carry the baby- one of the hardest transitions for new moms is the loss of efficiency. Using a carrier to hold the baby gives the new mom an opportunity to brush her hair, check her emails, throw the chicken in the oven for dinner. It makes a huge difference through this hard transitional period.
We encourage you to seek medical assistance if feeling overwhelmed. There is the Postpartum Stress Center in Bryn Mawr (610) 525-7527, http://www.postpartumstress.com and Main Line Health has the Women's Emotional Wellness Center. http://www.mainlinehealth.org/WEWC.
Vaccines for parents Flu Vaccine: During flu season all parents and caregivers should receive the flu vaccine. Especially if mom is breastfeeding, this will provide antibodies to the baby through the breast milk for the flu (babies are not eligible to receive the flu vaccine until 6 months of age). The flu shot cannot cause illness or the flu.
Pertussis or Whooping cough Vaccine: All parents and caregivers should receive the Tdap vaccine to protect infants from whooping cough. Especially if mom is breastfeeding, this will provide antibodies to the baby through the breast milk for whooping cough (babies are not eligible to receive the pertussis vaccine until 2 months of age). Go to http://www.soundsofpertussis.com/,for more information on the importance of this vaccine.
FEEDING
We firmly believe that breast is best! However, if you use formula, please make sure you mix it properly according to the directions on the can (usually 1 scoop per 2oz of water). Not mixing the formula properly (“stretching it”) can make your baby very sick. You DO NOT need to boil the water you mix the formula with. Simply use whatever water you normally drink (tap, bottled, filtered...all are fine and safe). Babies do not need to drink water until they are 6 months old...they get all of the hydration they need from breastmilk/formula.
Breastfeeding in the first few days Breastfeeding is demand & supply. The more your baby sucks, the more hormone telling your brain to tell your breasts to produce milk is released, and the more milk you make! So get that baby on your breast frequently!
Full-term, healthy babies can be very sleepy and uninterested in eating for the first few days after birth. THIS IS NORMAL. Offer your baby the breast every 2-3 hours, but don’t stress if the baby doesn’t seem hungry. You do not need to give your baby formula. You are not starving your baby. Unswaddle the baby and even take the clothes off...the baby likes skin-to-skin contact and will often feed better this way. If the baby sucks well for a few minutes and then falls asleep, try repositioning or moving the baby around a bit to stimulate him. Healthy, full-term babies are made to not get much milk for a few days while waiting for mom’s milk to come in. It is normal for mom’s milk to come in on the 3rd or 4th day after delivery.
● Aim for 8-12 feedings in 24 hours (every 2-3 hours--measure time from the beginning of one feed to the beginning of the next feed, regardless of how long the baby feeds) ● Mom should drink as much as possible (aim for 2 liters of fluid per day) and don’t forget to eat! ● We recommend you not introduce a bottle to your baby until your milk supply is well established (about 4 weeks). If you need to pump milk due to oversupply, put it in the freezer!
Poops Nothing worries parents more than poop. To know if the baby is getting enough milk/formula, it is more important to watch the urine output than the stools. Stools can really vary in frequency-from once with every feed to once a week. As long as the baby is feeding well and the poops are soft, the frequency isn’t important. Constipation in infants is not defined by the frequency, but by the consistency. Hard dry pebble-like stools are actual constipation. In the first few days of life, the poops are still meconium-thick, sticky and black. After that, normal stools can vary a lot in color. Normal poop can be orange, yellow, green or brown (or the colors of the food your baby is eating once they start solid foods). They often also contain “little seeds” in them which is also normal. Normal poops are anywhere from watery and explosive, to soft and smooshy. Breast milk fed babies especially tend to have watery poops-this is not diarrhea. All babies tend to strain while pooping too-they can get very red in the face, cry, grunt and seem like they are pushing really hard to get the poop out. This is normal and will improve as the child gets older.
Urination Newborns urinate 4-6 times/day. Urination is the best sign that the baby is well hydrated and getting enough milk. Sometimes, it is hard to see if the baby urinated since the diapers we use now are so super absorbent and early urine can be very concentrated and low volume.
ESSENTIAL ITEMS
Medicine Cabinet Here are a few things we recommend you always have in your home when you have a child:
● A working thermometer--remember to change batteries when needed! Use a digital rectal thermometer in all babies until they are at least 6 months old. ● Acetaminophen (in an age-appropriate form) - do not give to your baby under 2 months of age without calling your pediatrician first. ● Ibuprofen (in an age-appropriate form) - do not give to your baby under 6 months of age without calling your pediatrician first. ● Benadryl Liquid - do not give to your baby under 6 months of age without calling your pediatrician first ● A&D Ointment (OTC general skin emollient) ● Neosporin (OTC triple antibiotic ointment) ● 1% Hydrocortisone Cream (OTC for itchy rashes) ● Saline Nasal Drops and bulb suction (to help with congestion and nasal dryness) ● Cool mist humidifier/vaporizer (for cough/congestion/dryness)