Congratulations on the birth of your new infant! Nothing compares with the miracle of creating a new human life. From the first moments with your new baby comes an unparalleled feeling of love and joy coupled with a great sense of responsibility. The adventure of raising your son or daughter has begun.
You will probably never forget the first time you see your baby. Some newborns appear quite disfigured with a coned head, blue face, puffy skin, and covered with slime. Not to worry, your infant’s appearance will change significantly over the first few days. Just after your infant is born, the nursery team will take your infant to a warmer and assure that the child has adjusted to life outside the womb. At one and five minutes of life they will assign the baby an Apgar score which grades the child on color, breathing, tone, and response to stimulation. There are ten possible points, however nine is generally the highest score given. After the staff determines that your infant is healthy, you will be allowed to spend time together. Most infants are awake for the first one to two hours of life and will feed during this time. Thereafter, they sleep the majority of the first day. The first two hours of life is a wonderful time to cuddle and get to know your newborn. Ask the nursing staff to allow you to spend this time with your infant, unless there are health reasons which require your infant to go to the nursery urgently. After you have spent time with your newborn, he or she will go to the nursery for routine care by the nursing staff.
Although newborns appear unsophisticated in sensory and communication abilities, they have more capacity than most realize. Newborns can recognize the voices of their parents. Studies have shown that infants recognize the smell of their mother. Newborns have blurry vision but they can see a short distance. Many will follow the outline of a parent’s face and will visually track parents as they move back and forth. Most have distinguishable cries for different needs. Many newborns will respond to a parental voice and touch with repetitive movements of arms, hands, and face. You will learn much about your infant as you take time to carefully observe your newborn’s reactions and response to stimulation.
What Do They Do To My Baby?
Your infant will have several routine things done while in the nursery. Soon after birth your child will have an antibiotic ointment put in his or her eyes to prevent infection that causes blindness. The nurses will give a vitamin K injection to prevent serious bleeding that can occur in up to 1.7% of babies. A Hepatitis B shot will be administered. Hepatitis B is a virus which can cause cirrhosis, liver failure and liver cancer. Thirty to forty percent of these infections are acquired during childhood. Therefore, vaccinating early, before a child is potentially exposed to this virus, is critical. Soon after birth, your baby may have a blood sugar test to screen for hypoglycemia or low blood sugar that can cause nervous system problems. The nurses will perform a routine assessment and monitor vital signs to assure your new baby is healthy. Your infant will receive his or her first bath to remove all the secretion evidence of a trip through the birth canal so you can be reunited with a lovely smelling and appearing newborn. All of these things can be done within an hour or so and if there are no problems you should be reunited with your baby soon.
The first twenty-four hours of life is generally a sleepy time for babies. Both mother and infant team need rest after the exhausting delivery. Many parents worry that their child will become dehydrated or malnourished due to lack of feeding during this time – this is not true. The mother/infant team is beautifully designed to allow rest without risk of dehydration. If the pregnancy was normal and your infant healthy, the baby has stored extra fluid to survive the first few days of life; this is partly the reason most babies appear puffy after they are born. Most babies will only eat three to four times in the first day. Attempt to feed your infant at least every three hours but do not feel anxious if they prefer to sleep. Newborns will urinate infrequently to conserve fluid in the first two days. They may lose 2 –4 ounces each day for the first three days. On the second day of life, your infant will begin to awaken for more feedings.
You will be asked if you plan to breastfeed or bottle feed your newborn when you are first admitted to the hospital. We recommend exclusively breastfeeding because of proven medical benefits associated with breastfeeding. The Affordable Care Act requires insurance companies to include breast pump rental as a benefit. Ask your delivering provider to write a prescription for one. Your nurse or a lactation consultant is available at the hospital to help you with breastfeeding during your stay.
Attempts at breastfeeding should occur at least every three hours. Depending on the temperament of your newborn you may have to awaken the infant to initiate feedings. Breast-feeding tends to be a comforting and sedating activity, and many infants will fall asleep when they start to eat. Feedings may go better if you awaken the newborn by removing excess blankets, elevating to an upright position, and gently stroking cheeks and lips. Breast milk generally does not come in until two to three days of life. Effective breastfeeding a minimum of every three hours after the first day will provide sufficient calories and fluid. Some infants desire to eat every hour to hour and a half. Fourteen feedings a day can be normal. The best way to optimize milk supply is with frequent feedings of short duration. Five to ten minutes on each breast of vigorous sucking may be sufficient to empty the available milk. If your child tends to poke along at feeding, more time may be necessary.
Any sign that your infant desires to eat should prompt you to breastfeed. Some infants will cry when they are hungry, but more commonly, they awaken and make rooting motions with their mouth. These subtle cues of readiness to breastfeed will be picked up better by the mother; thus, it is best to keep your baby with you as much as possible rather than have the child in the nursery. The nurse will periodically need to take your infant to the nursery for routine examination; ask the nurses to bring the infant back to you as soon as possible. It is tempting to leave your infant in the nursery through the nighttime while you sleep, and some nurses may even recommend a sleeping pill to help you rest; however, it is best to keep your baby in the room with you if possible and attempt to feed at least every three hours through the night. It can be especially helpful for you to have someone in the room with the mother and baby to assist this process.
Breast-feeding in the first few days of life can be extremely frustrating, especially if your infant is not a naturally gifted breast feeder. Don’t be afraid to ask for help. If you have any problems with breastfeeding, try to avoid bottles and pacifiers until breastfeeding is well established, because the technique the infant uses to suck on a bottle and pacifier is different than the technique used for breast feeding. Ask the nursing staff to post a sign on the crib stating your desire to not give bottles or pacifiers to your baby. Although most babies can both breast and bottle-feed, some infants will prefer the bottle once exposed to it and will not breast feed. If you wish to introduce a bottle or pacifier, wait until breastfeeding is well established. If you have any problems with breastfeeding, please ask the nursing staff to provide you with a lactation consultant.
Breast fed babies will need vitamin D supplementation started in the first few weeks of life. Work on breast feeding first and discuss this with our pediatricians at the follow up visits.
For more information, click on the link below for our breastfeeding blog.
Can I Take Pain Medication While Breastfeeding?
Most women are in pain from an episiotomy, cramping uterus, and the general strain of childbirth for the first several days after delivery. Pain medication will be available and is very safe for the baby. Small amounts of narcotic medication found in medicines like Percocet and Lortab may enter the breast milk; however it is uncommon for infants to be affected by this small amount of medication. Only if your baby is excessively sleepy would it be necessary for you to decrease the use of narcotic medication, otherwise, it is important for you to treat pain frequently and consistently to optimize recovery. Acetaminophen and ibuprofen are less potent but extremely safe alternatives to narcotics.
Many mothers feel bad if they can’t breast feed but sometimes for medical reasons or other circumstances breastfeeding isn’t possible. Some infant or maternal conditions will require supplementing with a bottle or formula. Infant formula technology is creating formulas increasingly similar to breast milk and babies generally do fine if formula fed. The amount of formula your infant takes will gradually increase over the first few days. Many will start by taking only a half an ounce at a time and then gradually increase the volume to the proper amount for their growth. Healthy term newborns are capable of determining the proper amount of formula needed. After the first day of life they should eat at least six to eight times a day. The most important role for parents is to learn to follow their child’s lead in determining the volume and frequency of feeding. Some infants cry when they are hungry but many just open their eyes and make rooting motions. If your infant is excessively sleepy and does not awaken to eat at least every three to four hours after the first day of life, you should awaken your infant.
A pacifier can be a very helpful asset in calming an infant; however, some potential problems should be understood. Pacifiers have been proven to decrease the chances of successful breastfeeding. If you choose to breastfeed, pacifiers should be started only after breastfeeding is well established. Remember, if your infant acts hungry an hour after eating this may not be a good time for a pacifier since they may need to eat again. If your infant has a good breastfeeding and still seems hungry, consider having him suck on your finger instead of a pacifier. The American Academy of Pediatrics recommends using a pacifier to decrease the risk of Sudden Infant Death Syndrome but only after the first month of life.
Fifty percent of infants have gastroesophageal reflux, which means they have recurrent spitting. All infants spit up occasionally. Most spitting is harmless; however, there are some complications that should prompt notification of a physician. The key is to distinguish normal spit ups from dangerous vomiting that may indicate an intestinal problem.
Normal reflux is effortless and not bothersome to the infant. The volumes may intermittently be large but they are not expelled under pressure with fire hydrant force spewing across the room. Normal spit-ups exit the mouth effortlessly and cascade down the front of the child splattering onto floors, furniture, and parents. The child is calm and content before he throws up and remains pleasant afterward. Parents of course many not find it too pleasant.
The early breast milk or colostrum can have a slight yellow tinge and this should not prompt alarm. Very large amounts of reflux with each feeding may lead to dehydration or weight loss. Excess choking or gagging during feeding may indicate airway or feeding abnormalities. The best treatment for gastroesophageal reflux is to have the infant in an inclined position on the abdomen for 10 to 15 minutes after feeding. This should only be done with supervision with a parent or guardian holding the infant.
Signs that your infant is having problematic vomiting and not just reflux include the following: green stomach contents, acting sick while vomiting, looking pale or seeming distressed, projecting large vomits that shoot or spray a distance out of the mouth, repeated waves of expelling stomach contents, or looking miserable after vomiting.
Green vomit is an emergency symptom in an infant indicating possible bowel obstruction and requiring immediate attention. One must assume the intestines are obstructed and that the blood supply to the intestines may be compromised until proven otherwise. Any child vomiting green should be seen by a physician immediately.
Some episodes of spitting up can appear alarming when accompanied by choking, gagging, or breath holding. It is extremely unusual for these episodes to be threatening because of the strong protective mechanisms in place to guard the infant’s airway. You should notify a physician about any prolonged episodes of breathing pauses, blue discoloration of the face, or loss of consciousness. The best management of choking episodes is to place the infant tummy down in an inclined position such as over your shoulder. This will allow gravity to assist in clearing secretions from the airway and minimize further reflux. Keep the airway in neutral position with chin at a 90 degree angle from the neck.
The front of the mouth can be suctioned with a bulb syringe. Do not suction too deeply in the mouth because this will stimulate further gagging.
The safest position while sleeping is on the back. Many parents worry that the back position will cause the infant to choke on secretions and not breathe again. The risk of crib death has been studied in very large population studies and has been found to be lower in the back position, even in babies who have gastroesophageal reflux. This is likely due to the strong mechanisms in place to protect the airway.
For more information, click on the link below for our Intestinal Obstruction blog.
Umbilical Cord Care
The umbilical cord may come off anytime in the first month of life. Overly aggressive applications of antiseptic agents like rubbing alcohol can delay separation. Keep the cord dry by lifting periodically and removing any drainage with a dry cotton swab. Do not soak the cord in water during a bath; however, getting the cord wet briefly will not cause a problem. Fold the diaper down to avoid putting pressure on the umbilical cord, which can result in irritation of the skin.
A rare infection called omphalitis, which may be life threatening, can initiate at the separating umbilical stump. The key sign is any redness on the skin of the abdomen surrounding the umbilical cord. A physician should be notified immediately if symptoms of omphalitis occur.
Newborn skin will peel over the first several weeks of life since all babies are born with retained layers of dead skin. Peeling skin does not mean the skin is dry. Newborn skin is more sensitive than skin of older children and can rash or dry out easily. Avoid over bathing your infant. Newborns only need bathing a few times a week, unless they emit a foul odor. Soap can easily dry the skin out and care should be taken to use a mild soap such as unscented Dove, which does not have added dyes or perfumes. If you feel your infant’s skin is dry, use a moisturizing cream rather than a lotion. Be cautious about products labeled “baby” as these often contain dyes and perfumes that are irritating to the skin. Aquaphor or Eucerin are good choices. Many infants develop normal rashes on the face and body, which resolve in the first few weeks of life.
For more information, click on the link below for our Newborn Skin Care blog.
Baby’s skin has a natural protective barrier to deter diaper rash, but sometimes the barrier gets overwhelmed and rash develops. Some infants have more delicate skin than others and seem to rash easily. Babies who have several bowel movements a day are more prone to the irritation effects of stool exposure. General good skin care, as discussed in the above section, is the most important part of preventing diaper rash. If your baby gets diaper rash easily, or if mild redness occurs, then Aquaphor or Vaseline should be used after each diaper change to protect the skin. Once significant rash occurs a barrier paste should be applied. Examples are Desitin Max with 40% zinc oxide or A&D with lanolin and petrolatum. Barrier creams must be applied thickly to prevent stool exposure to the skin. The creams will rub off in the diaper so reapply at least every hour during the day and with feedings or diaper changes at night. If the applied cream gets soiled with stool, it is not necessary to remove all of the cream. Simple clean off the stool and apply more barrier cream. Baby wipes contain alcohol and can be irritating on diaper rash skin. Consider using a warm wet washcloth or packaged water wipes during this time. Please follow up in the office if your baby’s rash is not improving to consider other causes such as yeast infection.
Fingernail and Toenail Care
Finger and toenails in small infants are very thin and pliable. The surrounding skin is normally puffy appearing and thus can elevate the nails into an unusual curved shape. Most newborns don’t require any nail trimming, and even if the fingernails are trimmed short babies can still scratch their face. The best prevention to avoid scratches is to apply mittens. If you desire to trim the nails, take care not to damage the surrounding delicate skin. A fine nail file will usually work well.
Sometimes the skin adjacent to the nail will look pink or light red. It is very unusual for this skin to get infected but in the event of progressively worsening redness and swelling, one of our pediatricians should take a look.
Your little girl will have secretions from the vaginal area for a few weeks. Some little girls have normal vaginal bleeding similar to a period from withdrawal of exposure to mother’s hormones. The vaginal area does not need to be cleaned aggressively. The membranes are delicate, and soap or wiping can cause inflammation. When changing the diaper, wipe over the top of the genitals without separating the labia. If the inside of the genitals is soiled, clean very gently.
Circumcision is encouraged by the American Academy of Pediatrics but not routinely recommended. Sound confusing? This is because circumcision decreases rare illnesses such as cancer of the head of the penis, HIV infection, infection of the foreskin called balanitis, constriction and inability to retract the foreskin called phimosis, and urinary tract infection in young infants. These illnesses are significant enough for the AAP to encourage people to consider circumcision but not frequent enough to strongly recommend circumcision for everyone. It is confusing. Parents should do what they feel is the best.
If you choose not to circumcise your boy then leave the foreskin alone, don’t try to retract it. The skin will naturally begin to pull back over several years – about 60 – 70% by five years old and the rest later. Just clean over the foreskin like any other part of the body. If your little boy has been circumcised, the head of the penis may be sore for five to seven days. Yellow drainage called serum may accumulate like a scab on the head of the penis and is not a sign of infection; this drainage does not need to be removed. Care for the circumcised penis by keeping the head well lubricated with Vaseline. This prevents it from sticking to the diaper and also prevents the remaining skin from forming adhesions to the head of the penis. With each diaper change pull the remaining skin off the head of the penis and place a generous amount of Vaseline on the head. If stool should contaminate the head of the penis, wipe it off with a wet wash cloth. It is not necessary to do routine vigorous cleaning. The circumcised penis can get wet in bath water but should not be soaked in water until the head of the penis completely heals. Infection after circumcision is very rare; however, watch for redness and swelling spreading up the shaft of the penis. Bleeding is a rare complication and the nurse will watch for this for about 15 minute before your baby comes back to the room with you. Once home, if you notice active bleeding around the circumcision site, or if there is more than a quarter size amount of blood in the diaper, call our office to be seen by one of our pediatricians.
Most infants have nasal congestion. This is because the role of the nose is to filter and humidify the air breathed into the lungs. Most babies are obligate nose breathers meaning they don’t easily establish an oral airway and mostly breathe through their nose. Because babies’ nasal passageways are small, they frequently sound congested with even minimal amounts of secretions. For the most part the congestion will cause noise but not problems with sleeping or eating. If your baby sounds stuffy but sleeps and feeds normally, leave the congestion alone. Secretions return quickly once removed and removing them without good reason will be bothersome to your baby and a futile expense of time for you. If your baby has nasal congestion that interferes with feeding or sleep, you should notify one of our pediatricians. Often this problem is dealt with by using saline drops in the nose. Your baby will need to be examined to assure there is not an obstruction or other problem causing the congestion.
Normal newborn stools look like tar, black and thick. This stool is called meconium and can stick to your newborn’s skin and be difficult to remove. A lubricant like Aquaphor applied after each diaper change can keep the meconium from sticking quite so much. Patiently remove the meconium with gentle rubbing but don’t scrape too firmly as this can cause an irritation rash. Your newborn should have a meconium stool within the first two days of life – otherwise notify one of our pediatricians.
As feedings increase, the stool will change color and consistency from black tar to yellowish green liquid stool. Change in stool color is a good sign of adequate fluid intake. There is a broad range of normal infant stool color, consistency, frequency, and volume. Normal stool color can be virtually anything except for red, black (after the meconium stage) or white. Red would indicate blood from the lower intestine. Black would be a sign of blood from the upper intestine. White would signal a possible liver problem with too little bilirubin pigment in the bowel. Most infant stool will be some shade of yellow, green or brown, and may vary with feedings – if you have concerns about stool color indicating a problem, please ask one of our pediatricians.
Baby stool can be pure liquid or formed like a link sausage. It should never be hard and round like marbles or long and large like a hotdog.
Most babies have bowel movements several times a day. Some will skip a few days and occasionally- especially with breastfeeding, babies won’t have a bowel movement for a week. If babies have several liquids a day, the stool should mostly stay in the diaper and not frequently explode up the back or down the legs. After the first two weeks, it is normal to skip bowel movements for a few days but the stools should not be hard. Babies occasionally skip days in the first two weeks but they should be examined to assure fluid intake is adequate. Breast fed babies may go a week or longer between bowel movements after the first two weeks. Most babies will remain quite content but some will start to fuss after several days of no stool. This is not constipation but related to the movement or motility of the intestines. A glycerin suppository can be used for infrequent stools if needed.
Some signs of concern should prompt you to notify one of our pediatricians: hard stools, persistent fussing and straining, stools that are white, red, or black after meconium passes, large liquid stools blowing out the diaper more than five times a day.
Childbirth is an exhausting experience for both parents. Labor and delivery takes great energy; then comes the fatigue of frequent feedings, entertaining visitors, and healing from delivery. Newborn babies’ sleep patterns are erratic – there is no predictable or dependable time for rest from day to day. Generally there is a clash between parents’ and newborn’s biorhythms. Most babies are awake more at night than during the day because the fetus was lulled to sleep in the womb during the day by mom’s movements and then aroused more at night when mom rested in bed. Many parents are not able to rest well during the daylight hours because their internal clock is set to be awake during the day. Babies’ biorhythms will gradually adjust to parents schedule but this adjustment takes weeks rather than days.
The first two weeks of life is unavoidably a time of living with fatigue. Do your best to rest when possible and rely on others for help. Swaddling your baby tightly may make him feel more comfortable as if in the familiar womb environment. Swaddling should be done with the knees directed up and outward rather than down and together as this has been shown to increase the risk of hip dysplasia. For more information see this article. http://hipdysplasia.org/developmental-dysplasia-of-the-hip/hip-healthy-swaddling/
If a pacifier helps your infant go to sleep at night, there is no harm in offering a pacifier at this age once breastfeeding is well established. Begin some simple steps now to prepare your child for better sleep in the future.
The first step in establishing healthy sleep patterns, which should start immediately, is to teach your baby to sleep in his or her own bed. This is a new sensory experience your baby must adjust to and may not come easily. For nine months your infant has been warm and snuggled in a fluid filled womb. The sensation of being separate from the mother is uncomfortable and new. It may take practice, but allow your child to sleep separate from you in a bassinet near your bed. All infants awaken several times during the night, sometimes to eat and sometimes just wanting to be held. It is tempting to sleep and feed your baby in bed with you to decrease the disruption in your sleep. This practice will leave you more tired in the long term and has been shown to increase the risk of crib death.
Don’t feed your baby in bed unless someone is in charge of moving your infant back to the bassinet after the feeding is over. Exhausted mothers easily fall asleep while feeding and this can increase the risk of crib death. If no one is with you to help with feeding, make yourself get up and sit in a chair during feeding time, then put your infant back in the bassinet before you return to bed.
The next step in establishing sleep patterns is to help your baby learn to sleep more at night than during the day. Sleep states in the brain are light sensitive so allow your baby to sleep with the lights on during the daytime and keep the lights dim at night. Spend more time talking and interacting with your infant during the day and make interactions and feedings brief at night time. More will be needed later to help your child sleep well, but for now focus on getting as much quality rest as possible and allow other people to help you with the needs of living so you can focus on your new baby.
Many women will feel some depression after childbirth. This occurs as a result of fatigue, sleep deprivation, and the fluctuation of hormone levels. Some women feel guilty about feeling depressed since they believe their emotions are a reflection of how they feel about their new infant. Partners may not understand feelings of postpartum depression because it appears there should be feelings of elation regarding the new infant. This may create some feelings of guilt or even create resentment between partners. It is important to appreciate that postpartum depression is very common and natural. The new mother will need emotional and physical support to adequately recover from childbirth. It’s best for new moms to try to be open with expressions of emotions so others know how they are feeling. Some new mothers don’t understand why they are feeling depressed, and expressing this to others can help them know it’s not their fault. .Most postpartum depression will resolve in a few weeks. If depression is not improving within two weeks, consult with your physician. Some women will not recover from postpartum depression without medical assistance.
Sudden Infant Death Syndrome is a worry to most parents. The truth is that SIDS is a rare problem. There are a few things that have been shown to be helpful in preventing SIDS.
- A baby should go to sleep on his back, not on the side or abdomen.
- A separate but proximate sleeping environment from the parents is recommended.
- Have your child sleep on a firm mattress without pillows.
- Avoid any cords near the sleep area. Also avoid attachments on the pacifier.
- Keep soft objects out of the infant’s sleeping environment such as blankets, pillows, comforters, sheepskins, stuffed toys, etc.).
- Consider using a warm infant sleeper, pajama, or a wearable blanket such as a Halo sleep sack so that loose blankets aren’t needed . If blankets are to be used, they should be tucked in around the crib mattress so that the infant’s face is less likely to become covered by the bedding and reaching only to the level of the infant’s chest.
- Avoid bumper pads.
- Make sure the mattress fits snug against the crib side.
- Don’t use old cribs with drop down sides. These have been associated with injury.
- Avoid cigarette smoke exposure.
- Offer a pacifier at nap time and bedtime. For breast fed infants, wait until after breast feeding is well established. The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep.
- Avoid over-bundling and overheating.
We have no control over Sudden Infant Death Syndrome other than the above suggestions; frequent checks throughout the night will do nothing more than make you tired.
For more information, click on the link below for our SIDS blog.
The amount of crying your baby does will be influenced greatly by the infant’s temperament traits. Some infants are very calm and rarely cry, while others are intense, sensitive to stimulation, and difficult to calm. One of the most challenging tasks is to determine what your infant needs when it fusses and how to calm your infant. No one enjoys hearing a baby cry. Most parents interpret crying as meaning something is wrong or a need is not fulfilled, and parents generally seek to calm crying infants at all costs. A careful balance should be sought between fulfilling the infant’s needs and being overly sensitive to crying. Some crying occurs because infants are hungry or uncomfortable. Some crying may result from feeling tired. Other crying results because the infant prefers the comforting feeling of parental attention and soothing. Occasionally, a cause for crying cannot be established. Newborns may be more capable than most people realize in learning to calm themselves.
A healthy approach to crying is to satisfy your infant’s needs as well as possible and help the babies learn to calm themselves. As time progresses, you will learn what will best comfort your infant by how they act and the type of cry they exhibit. Consider a mental checklist of ideas for soothing: feeding, changing, cuddling, holding upright to burp, talking, etc. If you are certain that all needs on the checklist are satisfied, do not feel badly about allowing your infant to fuss for a time to see if they can calm themselves. All people have a finite amount of frustration they can tolerate before becoming uncontrollably upset. Respect your limits of tolerance and never feel bad about putting your infant down to cry, while you take a break. This will not harm your child; however, becoming upset and shaking your infant, even gently, can cause death.
Newborns have a poorly developed immune system; therefore, they can rapidly become very ill. You should notify a physician immediately if your infant acts sick. Watch for the following signs: fever, lethargy, irritability, and labored breathing. A fever is considered a temperature of 100.4 or greater degrees Fahrenheit by rectum. Temperatures taken under the arm, by mouth or ear are not accurate in a newborn. Studies show that parents can detect almost all fevers by feeling the child’s forehead with the back of the hand, however, any suspected fever by touch should be verified with a rectal temperature. Any temperature over 100.4 rectally should prompt immediate notification of a physician. Lethargy implies decreased activity and decreased response to stimulation. Most newborns will sleep up to sixteen hours a day for the first few months, but they should awaken periodically to eat and should have good response to stimulation during their awake time. Persistent feeding dysfunction can be a component of lethargy and indicate illness; if your child is not feeding well as discussed above, a physician should be notified. Most infants will cry periodically. Persistent irritability may be a sign of an illness. Irritability implies non-stop, intense crying, which does not respond to soothing measures. Persistent, rapid breathing, especially if labored, may indicate illness. Infants will often normally have intermittently fast breathing punctuated by periods of slow respiration, but the breathing shouldn’t persistently be fast or labored.
Good hand washing or use of hand sanitizer by you and visitors prior to holding your baby is the single most important step in preventing infection. This may be a rigorous challenge if you have many loved ones and friends visit. You may find it awkward or intrusive to ask loved ones and friends, who have come to support you, to wash their hands; however, your true friends will not be offended. Consider having bottles of hand sanitizer available and offering a dose to visitors who desire close contact with your newborn.
Vaccines for household contacts of newborns can help prevent some serious illnesses in infants. Influenza vaccine is available September to February and should be given to any child over six months old and any adult who will be in close contact with your newborn. Influenza in children less than two years of age has been shown to be associated with a higher rate of complication such as pneumonia. Pertussis or whooping cough is a severe, life threatening illness in small infants. Pertussis immunity from vaccines wanes in adolescents and adults without booster immunization. This presents as a chronic severe cough in older children, adolescents and adults, but in infants it presents as coughing spells associated with life threatening apnea or pauses in breathing. Infants are not considered immune against Pertussis until the second vaccine at four months of age. Adolescents and adults are the greatest distributors of Pertussis and young infants have the most severe complications of whooping cough; thus, it is important to immunize potential contacts. Please assure that anyone who will be close to your baby has been vaccinated for Pertussis within the last 6 years.
Cold sores caused by Herpes Virus are a potential danger for young infants. These sores usually occur on the lips of children and adults but can also occur on the inside of the mouth or on the face. Young infants can become seriously ill if they contract herpes and, thus, any children and adult with mouth or face sores should not kiss babies and should take extra caution for good hand hygiene prior to holding infants.
For more information, click on the link below for our Sepsis blog.
The newborn disease screening is drawn with a heel prick close to discharge. This was formerly known as the PKU test but is now called a metabolic screen since it tests for not only PKU (phenylketonuria), but also thyroid disease, galactosemia, hemoglobin abnormalities, and several other inborn errors of metabolism. These are all diseases that can cause newborn brain injury if not detected and treated early. This disease screening will be repeated in two weeks at the first follow up visit. Be sure to bring your metabolic test envelope to the two week well visit. The health department aggressively follows up on any abnormal tests.
A hearing test will be done prior to discharge. Please inquire about the results. One in ten infants will fail this test due to fluid behind the eardrum. All infants have fluid behind the eardrum at birth, and this fluid must be replaced by air for normal eardrum function to occur. This fluid usually resolves in the first few days of life but can take up to a few months to clear. There is nothing parents can do to speed up the resolution of middle ear fluid. If your baby fails the hearing screen, don’t panic – it doesn’t mean she can’t hear. The nursery will schedule a follow up hearing screen in a few weeks. Please let us know if the test was abnormal at the two week well-visit and we will help you know what to do.
Before discharge your baby will have a screening with an oxygen monitor for congenital heart disease. Our pediatricians will check for this on physical exam but this oxygen test detects diseases that don’t present on physical exam until later in life. It’s rare that the congenital heart oxygen screen is abnormal, but if it is, more testing will be done to assure your infant is ok.
A bilirubin test will be done prior to discharge. Bilirubin is the yellow pigment responsible for jaundice which is manifest by a yellow color in the skin and eyes. Over half of all newborns develop jaundice. Bilirubin comes from hemoglobin which is a product of red blood cell breakdown. Typically, jaundice occurs at three to four days of life. Most jaundice is normal, but if excessive, can lead to brain and ear injury. The best way to avoid jaundice is good feeding. Stool color changes from black to brown to yellow over the first few days of life, and the yellow color is the bilirubin being excreted in the stool. Feeding with water will worsen jaundice. Putting the infant in the sun exposes the child to excess harmful sun rays before any benefits are obtained. Routine screening of bilirubin levels prior to discharge may indicate that a follow up blood draw is necessary. We can do this test on site at Canyon View Pediatrics at the first follow up visit.
- Make sure you know how to transport your newborn in the car. This video link will help.
- Look at the section and blog article on preventing crib death. Make sure the sleep environment is safe.
- Consider taking a newborn CPR class at the hospital.
- Don’t allow anyone to smoke around the infant and especially never in bed.
- Be careful microwaving bottles – hot spots in the milk can cause burns.
- Do routine home safety: have a fire extinguisher, smoke and carbon monoxide detector, keep the guns locked up, etc.
- Know signs of dangerous illness in your baby. See the sepsis and intestine blog articles.
- Don’t leave your infant alone with small children or pets.
Preparing Siblings for Change
A new baby in the home changes family relationship patterns and family functioning in major ways. Rightfully so, the newborn becomes the focus of mom’s attention, time, and energy. Sleep deprivation depletes many capacities for providing loving responsiveness to other children and partners. Much of the first few months of helping baby thrive are a matter of survival for the rest of the household. Siblings and significant others may not appreciate the reason for the change in dynamics or that the change is not permanent.
Mom’s attention is the most powerful force in most young people’s and spouses’ lives. When this attention is withdrawn many people begin to seek this attention even through misbehavior. Negative emotions can add stress to moms and even create feelings of guilt for bringing a new baby into the home. Some family members may openly express resentment towards the new baby and mother for the intrusion in their lives.
Some simple things can help:
- Try not to change anything other than the newborn’s presence in the home. This is not the time to rearrange sleeping quarters, remodel the kitchen, etc if you can avoid it.
- Assure everyone, as best they can understand, that mom will be back on track soon and that the new baby is not a permanent family wrecker.
- Invite others to join in caring for the new baby. Even if it’s easier to do things without others help, invite them over to help change, bath, feed, burp, etc.
- Help the family members feel like the baby is there for their benefit. Refer to the newborn as your brother or sister and remind them how much fun and love they will experience as he or she develops.
- Provide young children with dolls and toy babies that they can use to copy what they see. Children resolve conflict and learn through play. You may hear them saying some harsh things to their baby doll – let it go, it’s part of the coping.
- Do special time. Special time is formalized, one on one attention that is planned in advance. Ideally this is done daily for short periods of time and is a play activity the recipient chooses. First thing in the morning ask, “What do you want to do for our time together today?” Show them on a calendar when it will be and then remind frequently over the day when they’re being good about this special time together. Make the time uninterruptible and focused – no multitasking with cell phones. This works for significant others as well.
- Catch them being good and try to ignore misbehavior. Reinforcing negative attention seeking behavior will create more of what you don’t want.Try to ignore some naughtiness as long as it doesn’t cross the line of reason and focus on finding good behaviors to reinforce with your attention and appreciation.
- If negative behaviors accelerate and are disrupting family functioning, see one of our pediatricians. Sibling rivalry can be very detrimental and may be the harbinger of other problems that need to be addressed.
Your insurance company may require that you add your new infant onto your insurance plan within thirty days in order to be eligible for charges incurred in the hospital. This may not be readily apparent by the wording in your insurance contract; so even if you frequently spend leisure time reading insurance literature, you may miss this detail. The insurance jargon may say “newly eligible member” or some other code words rather than refer directly to newborn babies. Most people assume the insurance company already knows they are having a baby since they have been submitting maternity claims for several months. If you fail to add your infant to your plan within thirty days, the insurance company may not only deny charges for the baby incurred in the first thirty days, but may also refuse to add your infant to the plan until the next open enrollment at the end of the year. If your infant has health problems and requires hospitalization, you can imagine what a financial disaster this could be. A phone call to the insurance company may be sufficient to add your child to the plan; unfortunately, you can’t always trust the office staff at the company to properly process your information. When dealing with insurance companies always obtain documentation of decisions in writing or, at a minimum, record your conversations with insurance staff.
Ready for Home
After discharge from the hospital your baby will need to be seen by one of our pediatricians in two to three days. We can answer many questions that may arise at that time. Please be sure to write down any questions you may have so we can discuss all of your concerns. There are some things you should watch for and call right away if they occur.
Be sure your infant is receiving enough fluids. When you go home from the hospital you can be assured that your infant is getting enough to eat if they urinate at least three times a day, and eat well at least every three hours. Another good sign of adequate intake is frequent stools and stool color change from the black, meconium stools in the first day of life to brown, transitional stools and eventually to normal, yellow, breast feeding stools. Please call immediately if your baby is not feeding well, doesn’t have at least three wet diapers a day or one bowel movement a day. (see above section on baby stools for more detail)
Any sign of illness should prompt immediate evaluation since babies can become very ill quite quickly: fever of 100.4 degrees Fahrenheit or greater rectally, baby acts ill and seems cold with a rectal temp less than 97 degrees Fahrenheit (don’t routinely take the temperature – only if your baby feels warm or seems ill), persistent rapid or labored breathing, blue color on the inner lips or tongue (babies often have a normal light blue color around the lips or on the fingers or toes) decreased activity, vomiting or just doesn’t seem right to you.
The journey of raising your infant will soon begin. Your new miracle will bring wonderful feelings to your home and add joy to your life. Their tiny frame will grow rapidly in the next few weeks. Enjoy this special time with your newborn.
Please call before discharge from the hospital for a two to three day follow up appointment. One of our pediatricians will let you know the best day for a follow up visit. Don’t hesitate to call the office or after hours number for questions or concerns.
Written by John Bennett M.D. FAAP
Visit our blog for more articles on caring for your newborn.