The birth of a baby often comes with a lot of emotions. These can include excitement, joy, fear and even sometimes sadness and depression. Many moms experience the “baby blues” after birth which can include mood swings, crying episodes and some anxiety. This is usually very manageable and resolves in a couple of weeks. However, some new moms may experience a more severe feeling of depression that does not improve. This is called postpartum depression. This can just be a complication of childbirth even for someone who has no history of depression and is no one’s fault. This does not mean you don’t love or want your baby. It is really important that you talk to a medical provider to get support which can include counseling and sometimes medication for a period of time. We want you to be able to enjoy this experience!
Here are some links with additional information:
Full term babies usually come home from the hospital 2 days after a vaginal delivery and 4 days after a Caesarian Section. It can be overwhelming once you have left the hospital and are home alone with your newborn or newborns. In our practice, we will usually schedule the first newborn check-up in our office 2 days after discharge, unless otherwise recommended by the discharging pediatrician at the hospital. We can see your child even sooner if needed. This will hopefully answer many of the questions that you may have in those first few days home from the hospital. We have a 24 hour telephone call service, which means that you can call anytime and either a nurse or doctor will call you back to answer your questions. Our office is open every day of the year. In addition to our normal business hours Monday through Friday, we have abbreviated hours on Saturday, Sunday and holidays for urgent care. We recommend calling early if you need to be seen on a weekend or holiday. In emergency situations, we advise calling 911. You may certainly call our office as well, but true emergencies should be directed to 911 for immediate care. It is important to remember that each baby is an individual and may not be exactly the same as their brother, sisters, cousins or friends. It is wonderful to get advice from friends and family, but do not be discouraged if your baby is not the same size as another, as good a sleeper or feeder as another.
Almost all babies will lose weight in the first week of life. Breast fed babies will be more likely to lose weight than bottle fed babies, because it takes a few days for breast milk production to begin. We like to watch babies very closely in the first 2 weeks of life for weight loss. Most babies will regain weight after the first week of life and are often back to birth weight by about 2 weeks. Initially babies may be slow to feed by both breast and/or bottle. Labor is work for babies too and they may be too tired for frequent feeding in the first few days. It can be tough to get babies on a schedule until they regain birth weight, so do not get frustrated if feeding is difficult in the beginning. However, some babies will be ready to feed frequently in the first few days and may feed every 2-3 hours. We usually recommend trying to feed babies at least every 3 hours during the day and at least every 3-4 hours at night until they are consistently gaining weight. Once back to birth weight, it is easier to feed babies on demand and feeding times may stretch out. Your doctor may recommend more frequent feedings if your baby has lost a significant amount of weight or is jaundiced. Breast feeding has many benefits for you and your baby. Doctors, nurses and lactation specialists can give lots of support to nursing mothers. Many families decide not to breast feed and that is fine. Each family should decide for themselves which is the best way to feed their child; breast, bottle or both.
First time breast feeding mothers should expect milk production to begin around 72-96 hours after birth. If a mother has breast fed with previous children, the milk may come in sooner. Mothers will recognize when their milk has come in, because breasts will become heavy when filled with milk. If you would like to breast feed, we recommend putting the baby to breast frequently to stimulate milk production. Also remember to stimulate both breasts; otherwise milk supply will be uneven between breasts. Even though babies do not initially get full milk, they do receive colostrum.
Breast feeding has many benefits including passing of immunity from mother, no preparation of bottles and it is free. There are other benefits that you may like to discuss with your doctor.
Breast feeding mothers should remember to hydrate, sleep and get proper nutrition to keep a sufficient milk supply.
Bottle feeding is an alternative to breast feeding and many mothers decide that bottle feeding is a better fit for them. Some mothers may be advised to bottle feed rather than breast feed due to certain medications which are not recommended while breast feeding. If you have questions, please check with your doctor.
Bottle fed babies may need to eat as much as every 2-3 hours. We recommend feeds at least every 3 hours during the day and at least every 4 hours at night and perhaps more frequently if your doctor recommends, until your child is back to birth weight.
There are many types of bottled formula out there and it is hard to know which one will be best for your child. Most formulas are classified by which protein is contained in the formula. We usually recommend starting with a cow’s milk based formula. Every leading formula brand has one and these are essentially the same from brand to brand. Some babies may need a soy protein based formula because they are unable to tolerate the cow’s milk protein. We will sometimes recommend soy formula instead, but you should check with your doctor as to what is recommended for your child.
There are also hydrolyzed formulas, which are predigested formulas. These formulas are necessary for babies that are unable to tolerate cow’s milk protein and soy protein. These formulas can be expensive, so we do not recommend arbitrarily changing to a hydrolyzed formula. Your doctor should determine if this type of formula is necessary.
We recommend formulas that are enriched with iron. Iron in formulas does not cause constipation. Iron supplements may contribute to constipation, but iron in formula does not. We do not routinely recommend low iron formula for a healthy baby. Iron is important for red blood cell production and low iron formulas do not contain enough iron for proper red blood cell production. Please check with your doctor if you are considering a low iron formula.
We watch urine output in the hospital to determine hydration status in babies. Some babies may only urinate once in the first 24 hours of life and that can be normal. After discharge from the hospital we prefer babies to have at least 4 wet diapers in 24 hours. Urine output is important to watch in breast fed babies, jaundiced babies and babies with significant weight loss. If you child’s urine output has decreased, we recommend increased feeds and a call to our office. Once your child is gaining weight, wet diapers will be plentiful and it is not necessary to count each one.
Initially babies pass meconium; which is the green, black, brown stuff that sticks to everything. Usually the first stool output occurs within the first 24 hours of life. In the first few days of life babies will pass meconium and then they will transition to looser stools that may be yellow, brown, green and sometimes they are seedy, especially with breast fed infants.
Babies may stool every feed and that is okay. Over time stools will decrease in frequency and sometimes babies may only stool every few days, which can also be normal. Counting stools at home is not essential. As long as babies are comfortable, do not worry about the frequency or lack of stools. If you are only feeding breast milk or formula the stools are going to be soft. Babies will often start to strain at some point while having a stool, i.e. the legs go up and the face gets all red. This is very natural and as long as the stool is soft and not hard pellets, it is okay. It is good to remember that you would struggle too, if you had to poop lying on your back! We do not recommend solid foods including cereal in the bottle until at least 4 months or per directions from your doctor. Water is also unnecessary in the first several months of life and not recommended, because it has no calories. We do recommend calling the office if you note blood in the stool.
Burping is a natural part of your infant’s life and while it can be uncomfortable for adults, it is not necessarily uncomfortable for babies. Some babies are better burpers than others. Do not get frustrated if your baby does not burp, it will eventually come out the other end. However, we do recommend attempting to burp after a feed, even if unsuccessful. It may also be necessary to burp your child frequently during feeds. Remember, when babies feed and when they cry, they swallow air. The more air swallowed the more air that either has to come out the top or the bottom. Try to keep your babies head above its stomach while feeding to reduce air intake. You may need to change bottles or nipples to reduce air intake, you should check with your doctor if you have questions regarding specific nipples or bottles.
All babies are going to have gas to some degree. While gas can be uncomfortable for some babies, it is not always uncomfortable. Many babies will quite happily pass gas. Gas may also be accompanied by stool, so be careful. Ask your doctor for remedies if your child is in distress due to gas.
Most babies are going to spit up or have reflux at some point; some babies may spit every feed. Some may spit up with burps, some may dribble if overfed and some may even projectile vomit every once in awhile. Expect that you are probably going to need a change of outfit when going out and expect babies to produce a lot of laundry (your clothes and theirs)! Spitting up may reflect too much air or too much breast milk or formula. Spitting up may be reduced by frequent burping and/or by keeping their head elevated after a feed. If your child spits up blood, projectile vomits every feed or is not gaining weight due to spit ups, consult your doctor. Your doctor will know when it is necessary to treat reflux with medication.
Pacifiers are a great way for your baby to be soothed. At first babies are unable to soothe themselves and will need to suck for comfort. Try to avoid using the breast as a pacifier, instead use a finger or a binky. The best ones are given out at the hospital. Do not worry about your child confusing the binky with the breast or the bottle, a baby will not be soothed by a binky if it is truly hungry. The binky can be a good way to comfort your child between feeds. If your child just had a good feed and is still crying, they probably want to suck for comfort. Usually around 2 months old, a baby will start to suck their 6 own hand or thumb and by 4 months most everything ends up in the mouth, which is a great time to discontinue the binky!
All of these things can cause discomfort in adults, but usually are not distressful for infants. Almost all babies will cough, sneeze and have some congestion. In the first 6 months of life, babies breathe mostly through their nose. Remember that the nostrils are not the size of an adult’s, which means that they filter everything through their nose including dust, dander, pollen, etc… this adds up to congestion. Sneezing is a way of clearing out their airway and coughing is a way of protecting their airway from post nasal drip. You will be able to recognize a cold by the increased thickness of secretions and mucus is much more plentiful with a cold. During the winter, the heat dries up the air and the airway can become filled with mucus. The nasal bulb suction can be very helpful and you can usually take home the one used in the hospital. We also recommend using a humidifier when the air is particularly dry and the congestion is at its worst. Elevating the head may also relieve some congestion. Remember that if you breathed mostly through your nose for a day, you would be congested too! Hiccups are very natural. Most babies had them in the womb too. They are a normal part of babies learning to feed and breathe at the same time. Most babies will be able to feed and sleep through hiccups.
Babies will sleep most of the day and night when they are first born. Once they are back to birth weight, you will see some more awake time. Initially babies are trying to conserve energy until they reach birth weight. It may be necessary in the beginning to wake your child for feeding. We recommend putting babies to sleep on their backs for naps and nighttime. Sleeping on the back keeps the airway open and may help reduce the risk for SIDS. It is also a recommendation of the American Academy of Pediatrics. We also do not recommend babies co-sleeping with parents. With co-sleeping there is a risk for suffocation by parent, blanket or pillow. Adult mattresses may not be as firm as infant mattresses and may lead to airway compromise. Please discuss sleeping with your doctor if you have concerns. Initially babies will prefer to be bundled for comfort, but after a few weeks when they can kick out or suck on their hand it is no longer necessary to bundle. Sleep sacks are a good nighttime alternative to blankets.
In the hospital, nurses check babies’ temperatures frequently. Once you are home, it is not necessary to check your child’s temperature unless there is a concern, i.e. they are acting different than normal, they feel hot, or signs of illness like a cold. When checking a baby’s temperature it is best to unbundle and take a rectal temperature. The rectal temperature is the most accurate reflection of temperature. If your infant is less than 3 months and has a temperature of 100.4 degrees or above or under 97 degrees it is important for you to call the office, your child will need to be seen. Infants under 3 months old can be at risk for newborn infections, and fever can be the only sign. You can artificially elevate a baby’s temperature by over-bundling. Keeping babies clothed with one more layer than you are wearing is usually sufficient.
Until the cord falls off, it is recommended to only use sponge baths to reduce risk for infection. Once the cord has fallen off, supervised tub baths are okay. Your child really only needs a bath weekly or if they are dirty. Remember that you are cleaning the dirty parts when you change diapers. Frequent baths can lead to dry skin, by washing off the natural layer of oils which protect a baby’s skin. We do not recommend using lotions. Babies’ skin is sensitive and too many lotions may make it even more sensitive. If your child’s skin is truly dry, vaseline may be helpful or your doctor can recommend safe products to use. Powder is not recommended due to risk of breathing powder into the lungs.
The cord is like a scab, it will fall off when it is ready, usually within the first few weeks. In the meantime, you may use alcohol or soap and water to care for the cord. If you notice a small amount of blood or small amount of yellow on the washcloth or diaper that is okay. If the cord is actively bleeding or your child develops a red ring on the skin around the cord, call the office. You may note more bleeding or yellow discharge if the cord is accidentally knocked off too early. This occurrence can be normal, call the office if you have concerns.
After the circumcision, we usually recommend bacitracin and/or vaseline during the healing process, usually about one week. After the healing process, you may notice some white discharge around the head of the penis. This is a natural secretion, which keeps the 8 skin from sticking to the head of the penis. It is not necessary to clean all of the white discharge off.
Uncircumcised Penis Care
We do not usually recommend retracting the foreskin in infants. You may pull the foreskin back as far as it will go without using force. By forcefully pulling back the foreskin, you may put the infant at risk for adhesions. The foreskin will naturally retract over time. You may also notice white discharge, which is a natural secretion that keeps the foreskin from adhering to the penis. If the foreskin becomes red and swollen, please call the office.
Baby girls may have vaginal bleeding in the first several days of life. It looks bad, but it is completely normal. The infant is responding to withdrawal of mom’s hormones with a mini-period.
Girls may also have white discharge in the vaginal area. This is a natural secretion which helps keep the infant from developing labial adhesions. We do not recommend washing all of this white discharge off, just try to keep the area clear of stool.
Cradle cap is the yellow flaking that you may notice on babies’ scalp, eyebrows or behind the ears. It is not necessary to do anything for cradle cap. If you do feel the need to combat the cradle cap, you may use baby oil and comb on the scalp and behind the ears only, do not use near the eyes. Each doctor has their own recommendations for cradle cap, check with your doctor if you have questions.
Baby acne is the red and white bumps that can occur all over face and sometimes even on to the chest. Usually it occurs around one month of age, just when you are ready to take pictures. We do not recommend anything special for baby acne; it usually clears by itself around 2 months old.
Diaper rash is a fact of life for most babies. It develops from frequent stools, frequent changes and from sensitive skin rubbing against a diaper all day long. Zinc oxide can be a helpful barrier for the skin from rubbing against the diaper, but be careful about using too much, because the more you use, the more you have to rub off. If your child develops a severe diaper rash which is not resolving with diaper cream, call the office for additional help.
Unfortunately everyone wants to touch your baby. Friends, relatives and even strangers feel that babies are public property. You must remember that a simple cold in an adult can cause a baby to become very sick. It is okay to ask friends and relatives to stay home, if they have a cold. Use good judgment when it comes to crowds. Handwashing can be good infection control. Try to keep other children with illness away from your child. If your child develops a fever, is hard to arouse, becomes limp, has excessive crying or is acting in a manner that concerns you, call the office immediately.
Jaundice is when the skin, including the eyes becomes yellow. Jaundice is very common in newborns and can occur for many different reasons, but most often it occurs due to dehydration in infants. Jaundice is a buildup of bilirubin. Doctors monitor bilirubin levels by physical examination and heel sticks. Your doctor will closely monitor your child for jaundice and may order a bilirubin check while in the hospital or after discharge. If you have questions or concerns about jaundice, please call the office.
Remember to use common sense while caring for your child. Although we do understand that most parents of newborns are sleep deprived. If you are uncertain about something, never hesitate to call, even at night. Doctors care for newborns all the time, so you are probably asking the same questions that every parent asks. Each doctor may have their own way of dealing with common things like cradle cap, etc..So do not get discouraged if you end up with several different recommendations. Friends and relatives can be a good source of information as well, but if you are unsure, just check with your doctor. We hope this handout is useful; however these are only guidelines for healthy babies and remember each baby is different!