New Born Guide

Article by: Dr. Andy Sagan

Where Can I Find Answers To My Questions?

For non-urgent matters you should consult other resources before calling your pediatrician's office. A ready and reliable source of info is a good parenting book, such as Baby 411 or The AAP's Caring for Your Baby and Young Child.

When Do I Bring My Baby To The Office?

You should schedule a first visit within the first week after leaving the hospital, unless otherwise instructed. Call as soon as possible to schedule.

What Is The Baby's Hospital Routine?

Here's what newborns usually experience during their hospital stay:

• Vitamin K injection at birth to prevent hemolytic (bleeding) disease of the newborn.
• Antibiotic ointment in the eyes to reduce the chance of bacterial infection.
• Daily examination by a pediatrician.
• Hepatitis B vaccination.
• Hearing test (Failed tests are common and almost always normal when repeated).
• Blood glucose testing for quite large babies.
• Blood test for Newborn Metabolic Screening, to make sure the baby does not have a rare but serious metabolic disease.
• Circumcision: If you want it done please advise your obstetrician to have it done during the hospital stay, as it is difficult to arrange after your baby leaves the hospital.

Common Parent Concerns

These are some of the topics we are commonly asked to discuss during the early newborn period.

• Umbilical Stump Care: In addition to cleaning around the stump with each diaper change, it is a good idea to clean the base of the stump with alcohol once a day. To do so, gently pull the stump away from the body and swab underneath. It is normal for the stump to appear yellow and moist or bleed mildly as it decays. Do not immerse the stump in water until a few days after it falls off. Make an appointment if the area around the stump is getting very red. The stump usually falls off within a few weeks.
• Bathing: Less is best for infant skin care. Bathe every 1-3 days, using a washcloth without immersion until after the cord stump is gone. Use a mild soap (e.g. Cetaphil, Dove) for skin fold or exposed areas like the neck, buttocks, armpits, behind the ears and face. "No tears" shampoo is fine for the scalp, and non-scented petroleum jelly is good for dry skin. Bath water additives are not necessary.
• Cutting Baby's Nails: Keep the nails trimmed. You may find a small scissors easier to use than a clipper, as it allows you to see the blade against the underside of the nail, avoiding the skin of the fingertip.
• Bottle Feeding: Use iron fortified powder formula of your choice mixed with fluoridated water (filtered tap water or bottled nursery water). Most newborns are satisfied with 2-3 ounces every 3-4 hours, more as the weeks go by. Feed to the point of satisfaction, not beyond. Sterilizing bottles, nipples and water is no longer recommended, though hot soapy water cleansing and air-drying are important.
• Pacifiers: Non-nutritive sucking calms young infants. We have no objection to using pacifiers whether you are bottle or breast feeding.
• Stool Quality and Gas: Thick, sticky and dark stool is normal until formula is given or breast milk arrives. Breast-milk stools are loose and seedy, formula stool can be mushy. As long as the stools are not firm or hard, have no blood and come out regularly they are okay, regardless of color. Gas is common. Try burping more frequently and using over-the-counter infant gas drops if needed.
• Circumcision Care: Gauze and petroleum jelly are used to keep the penis from sticking to the diaper between changes. Do this until the redness disappears, usually a few days. If the penis needs cleaning, rinse it with warm water, then air dry and apply the dressing.

Cleaning a Baby Girl's Genitals: Do not be hesitant about cleaning a baby girl's genitals. Use a soft cloth and warm water, and wipe gently between the folds.

Establishing Sleep and Feeding Patterns
Helping your baby organize sleep and feeding schedules is a great idea, but not too soon. Trying to modify your baby's behavior earlier than two month may lead to frustration. By two months most babies are receptive to learning from a consistent, organized parenting style. So wait until later to take a more directive role and for now, simply relax and go along with your baby's tendencies.

Is That Normal?

All of the following things are normal in the early newborn period, but sometimes worrisome to new parents:

• Pimples, dry skin and mild rashes.
• Lumps under a baby's nipple.
• Mucusy or bloody vaginal discharge.
• Rusty red discoloration in the urine.
• Regurgitating (spitting-up) after feedings.
• Hiccups.
• Occasional coughing to clear the throat.
• Sleeping up to 18 hours per day.
• Brief episodes of rapid, non-labored breathing.
• Day and night "confusion." (Cluster feeding late at night.)
• Sneezing and noisy nasal congestion with normal breathing.
• Sucking blister at the center of the upper lip.
• Crying for diaper comfort, feeding or warmth.
• Not calming unless being held or cuddled.

Keys To Establishing Lactation

If you plan to nurse your baby you should now focus on establishing lactation, i.e. getting your milk in as soon as possible! This usually proceeds without difficulty, but a few common pitfalls exist. Please follow our suggestions to help avoid problems:

• Rest and Recover: Exhaustion and pain can delay your milk arrival. Lack of sleep and an increasingly demanding baby eager for your milk to arrive can test your reserves over the next few days, so please prioritize your recovery and rest.
• Establish Proper Nursing Technique: Establishing proper latch-on will provide effective stimulation and help you avoid nipple damage, excessive pain and possibly an end to nursing. Ask your nurse to help if you're not sure that your baby is latching-on comfortably and correctly.
• Keeping Track: We want you to keep track of your baby's intake and output, at least until the milk arrives fully. Write down when you start the feedings, how long they last, and when the diapers have stool and/or urine present.
• Knowing What to Expect Helps Reduce Anxiety: You can expect your milk to arrive around the third full day and sense the baby is finally drinking well on the fourth day. Try not to worry if the baby does not seem satisfied before the big volumes of milk arrive. Colostrum is present prior to milk. It is essential and enough, but not very abundant. So until the milk is flowing you can expect the baby to be increasingly hungry and act unsatisfied. Please do not feel something is wrong if this happens. (See "Dehydration" in next section.)
• Bottle Use and Nursing: Experienced parents often give a little formula before mother's milk arrives to help their increasingly hungry newborn settle down, or to help mom get some sleep! This is not usually necessary from a health standpoint, but using a little formula for practical reasons is fine. Avoid using bottles if your baby has problems latching-on, since nipple use can reinforce incorrect latching technique. Also, avoid giving too much formula or giving it too frequently. Too much formula can make a baby disinterested in the breast, leading to engorgement. If you choose to supplement do it after nursing sessions, infrequently and give just a little formula.
• The Goal: A Satisfied Baby: Eventually the milk is flowing, the baby gulps it down, falls asleep groggy, wets the diaper heavily and awakens in a few hours to do it all again. Congratulations, you did it.

When To Be Concerned

Significant problems are uncommon in the early newborn period, but we want you to be aware of a few situations which warrant concern should they arise.

• Dehydration: While it is normal for a healthy newborn to lose "water weight" until the colostrum is replaced by free-flowing milk, there is a limit to how long a nursing newborn can wait for satisfying feedings to begin. Most babies can wait about 4 full days (24-hour periods). If your milk does not come in on time your newborn may become dehydrated. This is very uncommon but be aware just in case. Up until the point of adequate milk let-down your baby should feed at least 8 times in 24 hours, have at least 3 wet diapers per 24 hours, and remain eager at the breast during feedings for at least 30 minutes per session. If at any time before you are certain that your baby is drinking well the baby becomes lethargic at the breast, has diminished urine output, or won't keep up with an every 3-4 hour feeding schedule you should give formula from a bottle and call the doctor immediately.
• Fever: A rectal temperature > 100.4° F (38° C) in a baby less than two months of age warrants immediate attention. If you suspect heavy bundling caused the fever, you may unwrap the baby for 15 minutes then recheck the temperature and if > 100.4° F (38° C) recheck it again in a few hours to be certain. You should have a rapid read digital thermometer available at home and know how to take a rectal temperature. These are widely available and inexpensive.
• Significant Jaundice: The yellowing of the skin is called jaundice, and it is common in newborns. It is caused by a buildup of a natural pigment called bilirubin. Jaundice is especially common in breast-feeding newborns. Nonetheless, excessive jaundice can be harmful. As the bilirubin levels climb, the yellowing proceeds downward from the head. Yellowing of the whites of the eyes occurs early. You may have read other instructions elsewhere, but please follow these guidelines: we want you to call us if the jaundice passes beyond the hips into the thighs, or if you cannot determine how far down it goes. This is not an emergency, but rather serves as an "early warning" should significant jaundice be coming.
• Severe Eye Irritation and Discharge: Creamy or mucusy eye discharge in small amounts daily is common and known as nasolacrimal, or "tear duct" obstruction. However, a large amount of yellow or green discharge associated with lid swelling and irritation is more concerning and should be seen by a doctor promptly.