Caring for Your Newborn
There are no two adults alike and there are no two babies alike. Your baby is different from all other babies. Babies have their own personality, likes, and dislikes. Therefore, advice given by friends and relatives may not apply to your baby.
Caring for your baby should be a pleasure, but you can make it a burden by the way you choose to care for him. Remember that the baby is just another member of the family and should not be the hub around which the whole family revolves. The manner in which your baby is reared during the first few years is very important to his future stability
What every young infant needs during the nursing period is proper nourishment and rest. Do not pick him up every time he cries. This does not mean that you should not love and cuddle your baby; you should, but don't over do it! Sudden movements, loud noises, and crowded rooms should be avoided with the new baby. If at all possible, allow the baby to have a room to himself. This should preferably be located where you will not disturb him. This room can then serve all the baby's needs – eating, sleeping, changing, etc. The temperature in the room should be 70 - 75F and never warmer than 75F. In fact, a room that is too cool is more desirable than one that is too warm. A baby tolerates cold better than heat.
If you will dress and cover your baby with as many layers of clothing or covers as you need to be comfortable yourself, you will not, as a rule, over dress him. Most mothers don't realize that an infant's body functions are set at a faster pace than an adult's. They eat more food per pound of body weight, use more energy, have a faster heart beat and circulation and, therefore, are just warmer in general than an adult. This is reason enough not to over dress or cover him with more than would be enough for you.
Facts About the Newborn Baby
The following peculiarities of infants are being explained to relieve any apprehension you may have about them. These might alarm you if you did not understand that they are normal.
1. In the first few days, the baby's eyes may be swollen and have some discharge. This may be due to the ointment that was placed in the eyes in the nursery. The discharge should be kept washed away with sterile or distilled water.
2. The baby's eyes usually do not focus and may cross or wander independently. This is not abnormal and may last for months.
3. Newborns are often sleepy and difficult to arouse the first few days of life. They do not have much of an appetite for the first couple of days and need no milk. The colostrom of a nursing mother or a small amount of formula may be taken during this time. The baby's appetite and activity level will increase over the next few days. This is normal newborn behavior.
4. Spitting up is a common occurrence. Some babies spit up more than others and for longer periods. If it is a small amount, it should cause no concern. If it appears to be all or most of the feeding, and if repeated several times, it should be reported.
5. The startle reflex is present in all babies. They respond to loud noises or a sudden change in position with a mass reaction consisting of stiffening out, extending the arms and legs, then quivering. This lasts only a second or two and then relaxes. It can occur during sleep or when awake.
6. Some babies have frequent trembling movements in the early months. The chin may quiver, or the arms or legs may tremble, especially at the times when the baby is excited, or when he is cool just after being undressed. The trembling is due to immaturity of the baby's nervous system and will pass with time.
7. Many babies have bluish discoloration and coldness of the hands and feet. This is due to inadequate circulation and is normal. No effort should be made to warm them by over dressing or covering them.
8. The umbilical cord gradually turns brown to black and usually drops off in 7 - 10 days, but occasionally may hang on for a month. Do not be disturbed by its coming off promptly. Some oozing of blood will occur before or when the cord falls off. This is normal. Cotton balls and alcohol or hydrogen peroxide should be used to clean around the cord before it comes off, and to clean the stump afterwards.
9. Many babies have a collection of red, mottled spots or birthmarks, on the forehead, upper eyes, bridge of nose or back of the head. These disappear by one year of age and are normal. Other types of blue or brown marks, if found, will be discussed with you by your physician.
10. If the abdominal wall is weak at the navel, there may be a bulge when the baby cries. A band will not prevent this. These umbilical hernias are present in 30% of infants and almost 100% disappear in 12 - 24 months.
11. The baby's first bowel movements are dark green or black in color and are made up of a sticky, gelatinous material. As they receive water and milk, their stool becomes yellow. The stools may be frequent and may be green with white curds. These are called transitional stools. This is not diarrhea. Babies may vary a great deal as to the type and frequency of bowel movements. Some babies may have a movement five times a day and others every three days. If the stool is of good consistency, the frequency is not important. Most babies strain and become red in the face as they try to pass their stools. They may cry or scream is if in pain. This is not due to pain, but is simply normal newborn behavior.
12. Sneezing occurs commonly in newborn babies, and for a purpose. This is the only way a baby has to clean his nose. It does not mean that he is allergic or has a cold. Keep nasal discharge sucked out often with a plain rubber bulb syringe (ear type, not nasal aspirator; medium or small size).
13. Hiccoughs occur often in the early months, usually after nursing. They mean that the stomach is full, and they require no treatment. Water may help.
14. Jaundice (yellow skin) occurs in many babies from two to several days of age and lasts for varying periods. The yellowness may vary in depth of color and length of time it persists, but is normal unless you have been instructed differently at the time of the nursery examination. Jaundice occurs because liver function takes a few days to mature. If jaundice deepens after discharge from the hospital, consult your doctor.
15. Skin rashes are common. In the first month there is a rash on the cheeks, forehead and scalp that looks much like a heat rash. There may be a few "whiteheads" noted in the same areas. This is due to overactive oil glands during the fast growth period. No treatment is needed as it will clear itself. Do not use oil or petroleum jelly on the baby's skin routinely.
16. In the early weeks, babies have white blisters on the lips from sucking. These clear up in time and need no treatment.
17. Swollen breasts may occur in both boys and girls after birth. Nothing should be done about this. Do not massage or put any medicines on them. This breast enlargement is due to hormones received from the mother before birth. They will go down to normal in a few days.
18. Due to hormones passed from mother to baby, some female newborns may have a brief period of menstrual blood flow in the first week of life. This clears up spontaneously and requires no treatment.
19. All babies lose weight after birth. This may amount to 10% of the birth weight. Bottle fed babies are usually back up to birth weight in 14 days, but it may be 21 days before breast fed babies are back to birth weight.
20. Diapers may be soaked in a borax product before washing. Wash ONLY in mild soap, NOT harsh detergent.
21. Use only baby lotion or baby cream on your baby's trunk and extremities. Do not use oil or powder – these just irritate the baby's skin.
22. Place all babies on their back or side in their bed for sleeping, unless the doctor has instructed you otherwise due to frequent episodes of spitting up.
Nutrition
There will never be a time when nutrition is more important for your baby than the first year of life. Proper nutrition during this time provides the basis for your child's growth and development.
For that reason, we recommend that you breast feed as long as possible during your baby's first year. Breast feeding gives your baby the optimum nutrition he needs. In addition to proper nutrition, breast feeding offers protection from disease and fosters that special closeness between you and your baby.
If you have chosen not to breast feed, or if you expect to miss an occasional breast feeding, the infant formula that your physician chooses will meet the special nutritional needs of your baby. It has been thoroughly researched and backed by many years of feeding experience.
The formula your physician recommends should be continued at least until your baby's first birthday. Your physician will be glad to discuss your baby's feeding needs at any time, but please be sure to check with your physician before making any feeding changes. Never will nutrition be more important than in your baby's first year!
Breast Feeding
Unrestricted breast feeding means the infant is put to the breast immediately following delivery and nursed on demand thereafter. There may be ten or twelve feedings a day in the early weeks, with the number gradually decreasing over the first year of life. Breast milk continues to be a major source of nourishment in these infants. Almost all mothers can successfully breast feed if they wish. There are many advisory groups available to help, including the Women's Center at Huntsville Hospital, LeLeche League, and the physicians and nurses at Pediatric Associates.
The mother's diet should be balanced and contain all the food groups unless there is a particular sensitivity such as cows milk, for which 1000 - 1500 mgs. of calcium substitution will fill the need. Foods that give the mother indigestion will probably give the infant problems also. Mothers should continue to take their multiple vitamin supplements as long as they are nursing. They should drink at least three (3) quarts of fluid a day (10 ounces at each breast feeding) and expect to lose 600-800 calories each day in milk.
Breast feeding should be on demand and begin as soon after delivery as possible, starting with five (5) minutes at each breast per feeding. The time should be increased to 20 - 30 minutes as the infant needs. Expect the infant to be sleepy for the first 1 - 3 days and nurse infrequently. About Day 3, the baby should start awakening and nurse every 2 - 2 1/2 hours, 8 - 12 times per day. Some infants are very effective and vigorous and may be finished in a few minutes, but most take longer and some must stop and rest frequently. Each infant is different, and mother and infant must adjust to each other as bonding increases. As milk production increases and nursing efficiency increases, the interval will increase. But every 10 - 12 days, the infant will be very hungry and nurse very frequently, which will stimulate more milk production. Only by nursing more frequently will the mother keep up with the needs of her infant. Substituting formula for breast feeding in the early weeks will make establishing a good feeding pattern difficult.
Painful nipples can best be avoided by avoiding application of various creams and ointments, and never cleaning them with soap, alcohol or other cleansers. Allowing the skin to dry after nursing by air exposure, or dry heat from a 60 watt light bulb (18 inches distant) or a hair drier on low heat for 20 minutes four times a day will help. Allowing breast milk to dry on the nipple will also help. Wearing a support bra and keeping an absorbent pad inside the bra to help keep the nipple dry will assist also. Uterine cramps are common during nursing in the early days and help the uterus return to normal size. Marked swelling of the breasts is normal. It may be very uncomfortable during the first week and may require acetaminophen, but frequent nursing will relieve the engorgement best. "Caking", or plugging of the collecting ducts, can make tender lumps in the breast. These are best treated by heat, frequent nursing, and massaging the breast toward the nipple while the infant is sucking. Increasing the mother's water intake will also help. Mastitis (infection of the breast) should be treated by continued nursing and treatment with antibiotics that will not harm the infant. It is important, however, for the mother to continue nursing.
Expect infants to lose approximately 10% of their birth weight in the first week of life. Usually full term infants will not require stimulation to nurse, but the more premature infants may need to be encouraged to nurse more frequently. If the infant has not begun to look fatter and is not wetting 6 to 8 diapers per day by the time he is a week old, you should bring him to the office to be weighed and examined.
Bottle Feeding
Bottle feeding schedules are no longer attempted. The time and amount a newborn baby eats should be determined by the infant himself. Feed the baby when he is hungry. This will vary from 2 1/2 to 4 hours. In a few days, a baby will establish his own schedule. If the baby sleeps as long as 5 - 6 hours during the day, it is best to wake him for feeding. At night, allow the baby to set his own feeding times. The amount needed to satisfy the baby may vary. The baby may take one ounce one feeding and six ounces the next. Feed the baby as much as he wants each feeding.
Give your baby formula mixed according to instructions. When this prepared formula is used, vitamins are not necessary. Sterilization will be discussed with you. You may use several methods which are acceptable.
The type of bottles is not important as long as they are easy to wash and sterilize. The nipple openings should be large enough to allow milk to drip freely, at about one drop per second when the bottle is held upside down. If holes are too small, enlarge them with a red hot needle. Do not feed the baby when he is lying down. Hold the baby on your lap or in your arms at about a 45 degree angle. Do not prop the bottle. This is the time that a bottle fed baby should be cuddled and given a feeling of security.
Don't forget to burp the baby at least twice during the feeding. Hold the baby over your shoulder or sit the baby upright in your lap with your hand over his abdomen and chest.
Bathing
Sponge your baby with nothing but plain water until the navel has healed. Do not use oil, soap or powder as these are apt to irritate the baby's skin. After the navel has healed, the baby may be given a tub bath using some mild soap. A baby lotion may be used, but never use oil unless specifically recommended.
Check Ups and Preventive Measures
Your baby deserves the advantages of careful pediatric supervision. Problems such as developmental errors, dietary deficiencies, etc. can be picked up early and corrected in this way. Your baby should have a weight check at two weeks, a complete examination at ages 1 month, 2 months, 4 months, 6 months, 9 months, 1 year, 15 months, 18 months and 2 years*. Your baby should also be protected against whooping cough, tetanus, diphtheria, and polio during the first year; measles, german measles, and mumps during the second year.
*Call our office and schedule an appointment for the two week weight check and the one month well check soon after discharge from the hospital.
Suggested Reading
What To Expect The First Year. Eisenberg, Murkoff, Hathaway, Workman Publishing.
Your Baby and Child. Penelope Leach
Dr. Mom. Mariann Neifert, M.D., Signet Paperbacks.
Disclaimer:
All pages and contents are provided as information only. This is not a substitute for medical care or your doctor's attention. Please seek the advice of your physician. Huntsville Pediatric Associates presents this data as is, without any warranty of any kind, expressed or implied. It is impossible to cover every eventuality in any answer, which makes direct contact with your health care provider imperative. In view of the possibility of human error or changes in medical sciences, neither the authors nor Huntsville Pediatric Associates nor any other party who has been involved in the preparation or publication of this work are held responsible for any errors or omissions or for the results obtained from the use of such information.
Copyright 1997 Huntsville Pediatric Associates
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