Anticipatory Guidance of the Newborn

INSTRUCTIONS: YOUR NEWBORN

How often does my child need to eat?

Newborns should eat on demand, as often as they want. Usually this is about every few minutes to every few hours. If he is burping up large volumes after every feed, you may restrict each feed to a few minutes shorter than the usual and burp; then feed more if he still seems hungry. If your child is eating less than usual, do not be concerned unless the amount of urine he is producing, or the number of diapers that you are using, decreases. If this happens, you should call your doctor.

My newborn has noisy breathing, especially at night. What do I do?

It is very common for babies to have nasal congestion and noisy breathing. You can try to suction the nose with a plastic suction bulb. If unable to suction anything out, you may add some water or saline drops to the nose (your child will not like this), wait a few minutes, and then try suctioning again. Concerning signs associated with noisy breathing include grunting with each breath, movement of the nostrils open and closed, and movement of the skin of your child’s chest between each rib with breathing. If you notice these signs, you should call your doctor.

My baby sleeps during the day and then is awake all night! What do I do?

It is normal, especially for newborns, to have an opposite sleep-wake cycle from the rest of us. Bear with him/her, it will get better, usually within the first 4-8 weeks. Several factors can help train newborns to become synchronized with the new external environment: 1)cycled lighting, 2)feeding schedules—as the infant tolerates more food, lengthening the time between feedings helps allow for longer sleeping periods. Demand feeding, as opposed to fixed feeding, schedules help the baby develop a day-night cycle as well. 3)decreased stimulation at nighttime also helps babies develop more normal cycles. Studies have shown that frequent nighttime feeds, soothing and staying with the child until asleep, and cosleeping may prolong sleep disturbances.

Does my baby look yellow?!

Your baby’s skin may be yellow during the first week of life. This is called jaundice and it occurs in 60-70% of infants born in the U.S. It is caused by an accumulation of a substance called bilirubin, which is a natural antioxidant that may have some benefits for infants. It more often occurs in babies that are breastfeeding and in babies born before they are due. If the baby is feeding well, not acting overly-sleepy, and urinating normally, you should feel reassured. If the color continues to get worse after a few days, if it appears in the first 24 hours of life, or if there are any concerning signs, you should call your doctor. If the levels of bilirubin get too high, it may be dangerous and your baby may need treatment.

My new baby girl has some blood in her diaper! What can this be?

Newborns in the first few days of life may have pink or orange urine that looks like there is blood in it. Girls may have some vaginal bleeding due to the withdrawal of mom’s hormone levels. There also may be some blood in the baby’s mouth or in the first few stools that was swallowed during delivery.

When will the umbilical cord fall off?

The umbilical stump usually falls off after about 2 weeks. There is no special care required of the area, just soap and water when you bathe the baby. There may be some blood from the area. If there is any foul-smelling discharge or pus from the area, you should call your doctor.

How often should I bathe my new baby?

Babies should be bathed about once a week. If bathed too often, their skin is likely to get dry and flaky. It is best to use gentle, non-perfumed soaps and shampoos.

How do I cut my baby’s long nails? They grow so fast!

There are special nail clippers for babies that are safe to use or you may use manicure clippers. Do not be concerned if there is a little bleeding while clipping. You may also use your own mouth to bite the nails shorter, although some argue this may increase the likelihood of introducing an infection.

How often should my baby poop?

Anything between once every 5 days to 5 times each day is normal. Do not be alarmed if your baby is constipated—it is very common. Things you can do to stimulate a bowel movement: encourage more often feeds, give an ounce or two of fruit juice such as apple or prune,add karo syrup to feeds, or you can try using a rectal thermometer to stimulate the area.

How do I know how much my baby should wear to stay warm?

Babies don’t control their temperatures as well as we do. It is a good rule of thumb to dress them in one layer more than what you are comfortable wearing. Two piece outfits are easiest until the umbilical stump falls off.

When is it safe to go to public places with my baby? Or for people to come over and visit? Or travel on a plane?

There are no strict rules for this. In general it is best to stay at home with your baby for the first day or two of life. After that, it is important to have any visitors wash their hands before visiting the baby. Some people recommend waiting a week or two before going to crowded public places such as the mall, and four to six weeks before traveling on a plane.

It looks like my baby has a rash! What do I do?

It is very common for babies in the first six months or so to have rashes, especially on the face. These may be present at birth or develop later. Some common rashes look like pimples, red spots, and white bumps. If your child is acting normally, eating well, and does not have a fever, most likely the rash is not concerning and will go away with time. Also common is scaly skin on the scalp that may look like dandruff. It is not harmful, but you may use some oil on the scalp and a fine comb to brush away the flakes.

What do I do if my baby cries inconsolably for hours on end? It’s driving me crazy!

This may be due to a condition called colic, which is really common but no one knows what causes it. The most important thing to know is – it will get better. The guilt and sleepless nights parents experience is torturous and overwhelming and it is therefore really important that parents have good support. The condition usually disappears as quickly as it appears at about 3-4 months of age, regardless of what is done. The best things to do include taking rest breaks away from the baby and developing strategies for dealing with crying episodes. It may help to change the baby’s formula, if formula-fed, to a hypoallergenic or soy formula; herbal teas such as chamomile, vervain, licorice, and balm mint also have shown some benefit; reducing stimulation, especially in the evening, music, and parental attention are effective in some cases.

The baby’s father smokes, but he goes outside to do it. Is that OK for our baby?

It is best for the baby to not be exposed to cigarette smoke directly OR indirectly. The problems with smoke exposure can even occur if the baby is around the clothes or the breath of a smoker. Studies have definitely shown that exposure of any kind can increase the number of colds and ear infections the baby has, the risk of developing allergies and asthma, and the likelihood of food intolerances. Having a new baby in the house is an excellent reason to stop smoking. If there is a smoker in the house, it is best for that person to smoke outside and to change clothes, bathe, and brush their teeth before handling the baby.

Should we circumsize our new baby boy?

The best answer to this question is that it is the choice of the parents to make. There is no medical reason to circumcize a newborn. Reasons to do it include: there may be some protection from urinary tract infections of childhood, which are rare in both circumcized and noncircumcized babies, religious or cultural beliefs, enhanced hygiene, and a desire for the appearance of a circumcized penis for social reasons. Reasons NOT to do it include: it is not a necessary procedure, infants cannot consent to the procedure, the procedure is painful, it may cause decreased sexual sensitivity, and there are possible complications of the procedure. Doing the procedure at a later age is possible but more difficult and carries with it more risks. You should have a complete discussion with your doctor about this if you are not sure what to do.

The baby’s grandmother has a fever blister, or cold sore, on her mouth. Is it OK for her to cuddle with our new baby?

Herpes virus causes these sores of the mouth, and this virus can cause a very severe illness in a new baby. It is important that no one with a mouth sore come into contact with a new baby until the sores have healed. If your baby is exposed and becomes ill or gets a rash, notify your doctor immediately.

Is it OK to use a pacifier?

Yes, it is OK to use a pacifier. After 6 months of age, the pacifier should only be used while falling asleep to avoid teeth problems and mouth infections. At 10 months of age it is time to wean the pacifier and stop use all together.

How long do we need to use a car seat and where does it go?

The infant car seat should be facing to the back and in the middle of the backseat until about one year of age, or 20 pounds. Next a front-facing child seat should be used until the child is 40 pounds. After this you should transition to a booster seat and the car seat belt until the child is 80 pounds, or about 8 years old. All kids less than 12 years old should sit in the back seat.

RANDOM TIDBITS

You can store pumped breast milk in the freezer for up to 3 months or in the refrigerator for up to 48 hours. Unused pumped milk must be thrown away, so it is best to store it in small amounts. Warm in a warm cup of water as heat destroys the good antibodies that baby is getting from mom.

The color of poop means nothing unless it is red.

Cow’s milk should not be given until 1 year of age.

Honey may be dangerous to a child less than 2 years old.

Nighttime feeds are not needed after 4 months of age if the baby is gaining weight. You may substitute water feeding at night.

Try using a cup at 6-12 months. Throw the bottle away at 9-18 months. No need to wean the bottle.

Even after reading this whole darn thing I still have questions? What do I do?

Swedish Hospital has a nurse phone line devoted exclusively to answering questions about children and babies. The number is (206) 386-MOMS. Less urgent questions you should write down and remember to take them to your next appointment with your doctor. Also, there are physicians on call and may be reached by dialing the clinic number and going through the answering services, any time day or night for emergent concerns.