Taking your baby home from the hospital is an extraordinary experience, but it can also be overwhelming. Call us anytime with questions about newborn care, and here are some helpful tips to get you started:
Babies need to eat frequently. If you are breastfeeding, this should occur at least 8 – 12 times a day over the first few weeks. Bottle fed babies will need to feed slightly less frequently.
Over the first few days, babies should not be allowed to sleep more than 4 hours to insure adequate intake and avoid dehydration. Skin to skin contact is a great way to ensure that the baby is nearby and can feed on demand.
Make sure that the baby’s position on the breast is good, allowing the baby in an asymmetric feeding position which should not cause pain. Watch for feeding cues, such as rooting, REM sleep patterns (in which the baby’s eyelids are starting to move), or the beginning of a cry to put the baby to breast. Don’t wait until the baby is screaming – it will be much more difficult to latch a screaming, starving baby than a calm waking baby. The baby should feed until he/she is falling asleep.
For the first 4-5 days, the baby will feed frequently and will be getting colostrum, which is high in antibodies and will enhance the baby’s immune system. When the milk comes in, usually on day 4 or 5, the baby will begin to swallow more, and may need to learn how to cope with the volume of milk.
It is very common to feel a tingling at the breast when the milk is starting to flow, and also common to have milk coming out of both breasts at the same time. Please call or come in to the office if the baby seems sleepy and will not latch, if the baby does not have multiple wet diapers and stools, or if pain, bleeding or sores of the nipple occur.
There are multiple choices of formula on the market. Typically we will start your baby with an iron fortified milk-based formula unless medically contraindicated. Most babies will feed every few hours and should wake up to feed. Your baby should be stooling and urinating a few times in the first few days of life, and by five days of life should have 4-5 stools and wet diapers.
Umbilical Cord Care
The umbilical cord should stay clean and dry. You may give your baby a sponge bath but do not get the cord wet. The cord will usually fall off during the second to third week of life. Please call if you see redness around the cord or drainage from the cord. As the cord dries there may be a brown color on the undershirt of the baby – this will go away as the cord fully dries.
You may choose to have your baby circumcised in the hospital. After circumcision, the end of the penis (the glans) may appear slightly swollen or may have a yellow tissue on it called granulation tissue. This is a sign that healing is occurring. The doctor who performs the circumcision will instruct you in after-care. This includes using an antibiotic ointment for the first 24 hours and then petroleum jelly with each diaper change for a week.
It is very common for girls to have mucus and some vaginal bleeding in the first week of life secondary to maternal hormones. Keep the area clean by wiping from front to back – no need to scrub, but just clean with gentle pressure.
Initially babies will have tarry thick stools called meconium. As the baby starts to take in breast milk or formula, the stool transitions into a paste which can be brown, green or yellow. Breast fed babies typically have seedy yellow stools with some surrounding thin yellow liquid.
Babies should sleep on their back. Studies have shown that sleeping on the stomach increases the risk of SIDS (sudden infant death syndrome). Try to change the head position each time the baby goes to sleep so as to decrease the likelihood of flattening at the back of the head. Tummy time is actually good for the baby while he/she is awake and a parent or caregiver is available to watch the baby.
Jaundice is the yellow color of skin caused by increased bilirubin in the blood. In the newborn, the most common reasons for jaundice are a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream, inadequate intake of milk leading to dehydration of the infant or incompatibility of the baby’s blood group with the mom’s blood type. Often improving milk transfer to the baby will help to alleviate jaundice – sometimes a baby will need to be under phototherapy (lights under which an infant will stay) until the level of bilirubin decreases.
Support is essential but family and friends need to realize that new moms and dads are exhausted and need space and time to learn how to acclimate to their new baby. When visitors are around, please make sure that they are well (no cough, runny nose, fever). Encourage them to take a part in the new baby’s life, and to help you to adjust. Ask visitors to wash hands before holding a newborn. Your visitors should listen to your cues and take direction and be there to support you and your new baby.
Babies are often cranky especially in the evening time when they like to feed frequently and seem to settle less easily. Rocking the baby, taking the baby in the stroller or carrying the baby in a sling or carrier, taking the baby for a car ride, or having some white noise in the environment may help to calm a cranky tired baby. Some babies are spitty and arch their back, a possible sign of reflux or milk-protein intolerance which should be discussed with the pediatrician.
Babies who are just cranky and cannot calm with no other medical cause have colic, a condition of a healthy baby in which it shows periods of intense, unexplained fussing/crying lasting more than 3 hours a day, more than 3 days a week for more than 3 weeks. The positive side to colic is that babies outgrow it, usually between 3 and 4 months of age. Concerning symptoms are poor weight gain, diarrhea with blood, projectile vomiting, fever, or lethargy. Please call the doctor’s office if any of these signs occur.