Facts About Caring For Your Newborn
1. When to call the doctor
If babies are feeding well and are happy, they are not seriously ill. But if they exhibit any of these symptoms, call your doctor at once!
FEVER – Rectal temperature 100.5 or higher are fevers. (Only rectal temperatures, preferably with digital thermometers, are reliable!)
FORCEFUL VOMITING – All children for the first 4-6 months of life will spit up, but if they truly vomit with force, consult your physician.
PERSISTENT COUGH – Especially if interfering with sucking. Babies often sneeze, but they should not be coughing!
NOT FEEDING NORMALLY – For any reason.
OVER-SLEEPING – Difficulty waking to feed, and increased irritability.
Never assume that if a baby does not have a fever, it is not sick! Small babies can be very sick and have no fever. If your baby does not look or act right in any way, err on the side of calling.
2. Feeding Baby
BREASTFEEDING – Breast milk is the perfect food for babies! Women should breastfeed as much as possible for at least the first 6 months of life. Breast milk nourishes as well as protects babies against infection-something formula simply cannot do! Babies breastfeed initially about every 2 hours. Do not allow sucking more than 15 minutes per side. Only the first ten minutes, at most, is nutritive. After that the sucking is just for pleasure, which is fine-but over-sucking can irritate nipples and interfere with future feeding. After feeding, apply a lanolin-containing cream to nipples to moisturize and soothe them. Over the first week of breastfeeding, the milk usually becomes more liquid and increases in volume. If you have difficulties or questions with breastfeeding, call your pediatrician. Do not take medications, or even herbal remedies, without consulting us to ensure they will not enter breast milk and cause problems for your baby. You do not need to drink milk yourself; water and calcium-fortified juices are sufficient. The calcium in breast milk comes from your bones, so you do need good calcium intake. However, sometimes cow’s milk proteins can enter the breast milk and cause problems for your baby. This is especially important if you have a strong family history of allergies. It is okay to supplement breastfeeding with refrigerated breast milk (pumped or expressed); and formula, again as long as there is no strong allergy history in your family. If there is, avoid formula.
BOTTLE FEEDING – You do not need to sterilize bottles in the US-the water is safe! Wash bottles as you would any dishes. Dishwashers do sterilize the bottles. Bottle-fed babies may feed a bit less often, from every two to four hours.
BOTH – All babies need burping with feeds. Burping improves comfort and reduces spitting up by getting rid of air swallowed when the hungry baby gulps down food. Babies need no solid foods until at least 4 months of age. Until then, they cannot digest any foods beside milk. Never give honey to babies under one year of age! Impurities in honey can cause paralysis in babies. Also never give “tonics” to children without discussing first with your doctor. Some of these home remedies can contain very dangerous levels of lead or other toxins.
3. POTTY FACTS
Breastfed babies can have a stool with every feeding. It is usually watery, with seedy-looking yellow components. Formula-fed babies’ stools are more solid. Babies should have at least six wet diapers daily. Modern diapers are absorbent, so you may need to press on them or weight them to detect the urine. Bottle-fed babies have one to four formed or soft stools daily. Give more formula or water if the baby is not having at least one stool daily, or is straining to have a bowel movement.
4. SKIN AND UMBILICAL CORD CARE
Sponging with warm water is sufficient until the umbilical cord falls off. It is dead, so it will shrivel up and look gooey. This is normal. Once the cord dries and shrivels, you can gently tug on it and it may come off in your hand. Do not worry if there is a drop of blood when this happens. Once the belly button looks just like yours, you can safely immerse the baby in arm water. Call the doctor immediately if the skin around the cord looks red or even salmon pink, especially if the baby is fussy. Even without fussiness, this is an emergency indicating a potentially serious infection! Use gentle, non-perfumed baby powders (not talcum powder), creams or ointments are fine for creases and around the baby’s rectum. All babies have lots of rashes for the first four months of life, as the skin matures. Lots of bumps can occur as skin glands open to the surface or from maternal hormones transferred to the baby before birth. Call the doctor only if skin is peeling off in sheets, or the rash is very dry and scaly.
Diaper rashes may be treated by applying a combination of 1% hydrocortisone cream combined with an anti-fungal cream (same as women use for vaginal yeast infections) such as clotrimazole (Gyne-Lotrimin) or miconazole (Monistat). These are available without a prescription at pharmacies and many supermarkets. Applying twice a day for five to seven days is usually sufficient. If the rash does not resolve or gets worse despite this treatment, then by all means call the doctor.
Many babies appear a bit yellow after birth. This is called jaundice. It is caused by the breakdown of newborn blood cells and the slow maturation of the liver’s ability to metabolize and excrete the pigment from these cells (bilirubin). Until the body can better handle these pigments, they are deposited in the skin. The yellow pigment is first deposited where there is the most blood flow-baby’s head, eyes, and neck. The yellow color then moves down to the body, with hands and feet last. This is rarely a problem for the healthy newborns, but please call a doctor if the yellow color appears on the abdomen, sot eh situation can be monitored.
5. THE BABY’S GENITALS
Just wash with warm water and avoid soap use directly where the baby urinates. Follow skin care advice for the rest. You do not need to pull on an uncircumcised foreskin. The adhesion of the foreskin to the penis tip will release at or before adolescence. In girls, there may be some blood from the vagina, and some milk from the breast area. This is normal. Mom’s hormones act on the baby, just as they will at puberty. This will resolve naturally by about two weeks of age, after all of mom’s hormones that crossed through the placenta are metabolized by the baby.
6. CARE OF NEWBORN STUFFY NOSES
All babies are “stuffy” for at least the first four months of life. Before that time, they do not know how to breathe through their mouth, except when crying. Even after that, nasal congestion can make sucking difficult. To clean your baby’s nose, put three to four drops or one to two sprays of nasal saline in each nostril, and then wait about two minutes while the “boogers” soften up. Then clean each nostril using a nasal suction device. The best ones have a short, hard plastic tip and a rubber bulb, not an all-rubber bulb with a long rubber tip you may have been given at birth. You need to pull as much as eight to 10 times in a row. The nasal discharge may come out like a string.
7. SAFETY AND PROPER POSITIONING
Newborns must be in car seats cinched tightly into the back seat and facing backwards. Never put children in the front seat, especially if the car has airbags! These are designed to protect adults, but they can injure children. Be especially sure that if you transfer from one car to another that the car seat is positioned and tightly cinched in. Take your time and be sure your baby is safe. Put the baby on its back to sleep. This position greatly reduces the chance of sudden infant death syndrome. When the baby is awake, give the baby some time on its tummy. If the baby is always on its back, there can be flattening of the back of the head. Wait about 20 minutes after feeding for tummy time in order to prevent increased spitting up.
8. ENVIRONMENTAL TOXINS
Babies must never be exposed to tobacco smoke. Never allow smoking inside your house or car, even with the windows open. Smoking encourages respiratory infections in children and is bad for everyone’s lungs. If either parent insists on smoking, they must do so outside. Quitting smoking is the most important decision anyone can make to improve their health. The presence of a new baby in the home is the perfect motivation for parents to quit! Medical therapies are very effective-see your primary care practitioner for advice. If any parent handles toxic chemicals at work or for a hobby, be sure to advise them to wash their hands and take off the exposed clothing before going near your baby. Never use insect sprays near your baby. Do not allow fumigation unless you leave the house with your baby for at least the period recommended, which is usually 24 hours. Similarly, do not remodel houses built before 1960 with your baby in the house, due to danger of exposure to lead dust.
9. IS MOM FEELING DOWN?
As hormones change after the birth of a baby, moms may notice mood swings, often called “baby blues”. Coupled with sleep pattern changes as moms wake up to feed and change the baby every two to three hours, there may be feelings of anger, irritability, sadness, and frustration. This is very normal, but it should pass in a week to 10 days. If these feelings persist after that, or worsen, mom may be having true depression, and should contact a health professional or counselor immediately! Ignoring signs of true depression can be dangerous. These feelings may also indicate a purely medical problem-low thyroid hormone which also leads to weight gain. So please, call your primary care practitioner, obstetrician, or our practice if you have any concerns.