Newborn Care Guide
Congratulations on the birth of your child! There is something magical about the birth of a baby. After all, many months ago, an egg and a sperm began a long, arduous journey culminating in the birth of a living, breathing human being with a face, a name, and yes, a personality. And if that wasn’t amazing enough, this baby is all yours!
But the miracle doesn’t stop at birth. Each day, each week, each month and each year brings new dimensions of the miracle. And like Peter Pan, if you are somehow able to capture just a small pinch of that pixie dust, of that joie de vivre that is a child, it will change your worldview forever.
You have undoubtedly given much thought to caring for your newborn child. Some parents make elaborate plans including the buying of furniture and clothes. Some are a bit more reticent and spend their time making psychological, rather than practical preparations. With all the anticipation and planning, there always is a measure of anxiety as well. How will I measure up as a parent? How can I translate my dreams into reality? Am I up to the task of taking care of all the unknown variables? Most jobs today require some experience, but this, the raising of a child, a task equal to the most demanding 9-5 job, comes without any requirements or formal preparation.
This guide is designed to begin to put your mind at ease. There is one primary goal for this practice and that is to produce educated, self-confident parents and healthy, self-confident children. To that end, we aim to make sure that you know what to do in all situations and more importantly, why you are doing so. We will serve as your friends, your advocates and your trusted guides. But we will encourage you to use your own common sense to take care of the myriad of on the job decisions that arise daily.
This guide will attempt to take you through those first few hours, days and months of your child’s life. It is by no means fully exhaustive. There are plenty of excellent baby books on the market that provide encyclopedic detail and once we meet your child and begin to appreciate his personality, we will be happy to provide you with relevant reading materials. In general, during wellness visits, we try to touch upon the most important and anxiety provoking aspects of a child’s life. This guide will hopefully do the same for early perinatal life. Please note that for ease of presentation, the word “he” will be used representationally for a child of either gender.
THE BIRTH PROCESS
The eviction from the womb that we call birth, is comparable to the forceful ejection from one’s warm and inviting bed, into the cold, mid-winter streets, naked and without nutrition. In such circumstances, any intelligent adult would immediately seek clothing, not out of excessive modesty, but out of absolute necessity - to prevent significant heat loss. He might cut off excess blood supply to his skin and appear a little “blue”, again, to prevent heat loss. And he might knock on a friend’s door, seeking shelter and a heated environment. The newborn child acts, in exactly the same manner, only he needs our help to achieve these ends. That is why babies appear a little blue at birth and sometimes breathe a little more rapidly. In most cases, they are just plain cold and need to be swaddled and carefully warmed.
Following birth, the average healthy newborn undergoes three predictable periods of responsiveness:
- A period of reactivity - In the first 15-60 minutes after birth, the normal infant will be highly responsive to many different stimuli. There is a lot sniffing, grimacing, sucking, chewing, crying, hiccupping and trembling. But it is also the time when many infants are able to turn their heads toward sounds, follow faces and be taught to mimic. Enjoy the quiet, alert periods that occur during this time because they often disappear rapidly, not to reappear again for almost a month.
- A relatively unresponsive interval - The next 60 minutes are characterized by a lack of responsiveness and a lower rate of metabolism although there may be a few spontaneous jerks during sleep.
- A second period of reactivity - Between 2-6 hours, responsiveness returns and there may be periods of rapid respiration, gagging and vomiting and the passing of a greenish, sticky bowel movement called meconium. Newborns continue to be very responsive during this period.
Understanding these distinct periods of reactivity will help you with initial expectations. Everything you have learned in Lamaze or infant care classes works for the periods of reactivity and responsiveness. Babies nurse or eat well, make eye contact, and are very endearing during this period. But during the period of sleepiness, all the tickling and undressing in the world will often not wake a baby up, so relax and catch up on your own sleep.
Over the first few days, infants pass in and out of six states of consciousness with some degree of regularity:
- Quiet sleep
- Active sleep
- Quiet alert awake
- Active alert awake
Be prepared for the quiet alert state for it is during this time that a newborn can learn to imitate facial expressions, identify his parent’s voice, select a visual pattern and follow objects. Audio-visual capacities are most acute during this period. And nursing is often most effective at this time. Babies sleep 14-21 hours/day during the first few months. Remember that if you are lucky enough to have a 21 hour sleeper, your child will do little more than eat, burp and poop. So enjoy the break and catch up on your own sleep.
The human infant can see faces and objects within 8-12 inches, which is probably, not coincidentally, the distance from the maternal breast to the infant’s eyes. At any other distance, babies have very poor vision, which gradually improves until 6-9 months when vision becomes 20:20. Important points to remember include
- Infants are sensitive to light and can see lights considered dim by adult standards.
- Infants prefer curved lines, bright colors and objects with high contrast. Thus, a white shirt and a pair of jeans provide wonderful visual stimulation.
- Visual capacity can only be demonstrated when a newborn is in the quiet alert state. It can be completely masked by things like hiccups and bowel movements.
- When babies are over-stimulated, they shut out the world and nothing you do will attract their attention. Just give up and try again later.
As we have emphasized already, the goal of the first two months of life is for your child to adapt to his world and for you to adapt to having a child. Spending valuable interactive time trying to stimulate your child is less likely to improve SAT scores and more likely to make you exhausted and frustrated.
The human infant can hear and is responsive to sounds from 4 months of gestation onwards. An interesting, but frightening, study demonstrated that women who listened to soap operas during pregnancy had children who were calmed by the music of those soap operas. It’s too late to affect the pregnancy milieu but not too late to make some constructive changes in the postnatal environment. Important points to remember include
- Female voices with high pitched tones elicit an awake or orientation response. This makes sense since it has been the mother who has traditionally fed the child and it is difficult to feed a sleeping child.
- Male voices with lower tones quiet an infant. So after the mother completes a feeding, hand the baby over to his father for additional comforting.
- Babies respond to their mother’s voice in the first day of life and to their father’s by 3 days of life.
- Short bursts of speech produce a far greater response than longer unpatterned speech. So no long orations please.
- Low pitched lullabies and human heart tones are consistently the most helpful to quiet a child. So sing to your child while he lies on your chest for the most effective calming possible. And remember, your child is listening.
- Infants do not respond to loud claps or white noise. They also don’t respond to your voice when your face is smothered against their own. Tell that to the well-meaning guests who come by to visit.
TASTE AND SMELL
Infants have a greater number and wider distribution of taste buds than do adults. They also have a well-developed sense of smell. Important points to remember include
- Breast milk is sweeter than formula and may be preferred on this basis alone.
- Despite this well developed taste bud system, most babies react to texture rather than to taste; hence, the refusal of many solids is usually not because of taste.
- Each person’s odor is unique and infants as young as 3 days can differentiate their mother’s odor from the odor of other women.
- This attention to smell is another good reason to hold a baby close.
Dr. T. Berry Brazelton in his wonderful book, Infants and Mothers (Dell Publishing Co., 1983) describes 3 types of infant personalities.
- Average children respond to everything in an average fashion. They cry in response to certain stimuli, suck in response to other stimuli and quiet in response to still other stimuli. Most baby books are written for average children and perhaps 80% of children fall into this category.
- Quiet children do everything quietly. At birth, they tend to have colder extremities, appear a little more bluish, seem to cry less or not at all and tend to have blunted startle reflexes. These babies tend to sleep more and are more difficult to arouse, they choke with the first few feeds because their gut takes longer to gear up for eating and they don’t seem to want to relate. Sometimes these babies are so quiet that their parents become concerned that their child is deaf. It is important to recognize that quiet babies simply have more economical body systems. They use energy more efficiently. And although it might frighten a ‘go getter’ parent to have such a ‘lazy’ baby, it is important to realize that one can have every bit as enriching a relationship with such a baby. They are usually a pleasure to take care of and seem to enjoy a more watchful, and sensitive type of existence.
- Active children do everything with gusto. They cry vigorously and often intolerably, eat noisily and gulp in much air, strain when they have a bowel movement, sleep 4-5 hours less than average babies and, until they are accepted as active babies, can drive their parents crazy. In general, they respond to the most minimum of stimuli in an exaggerated fashion. And so, they need much swaddling, much swinging and little stimulation. These babies do not have a disease called colic; they are simply active children. If you somehow manage to survive the newborn period with your ego and sanity intact, you will discover these babies to be delightful, for that same energy that went into crying in the first few months will go into laughing, giggling and rolling over in the subsequent few months.
We have not included this section on infant personality to scare you, but rather to intrigue you and help you realize that each baby is unique and exciting to deal with in his own way. Identifying your child’s personality on the activity scale will help you enjoy the experience of the first few months more fully and make you better prepared to deal with the various manifestations of that personality for the remainder of his life.
THE NEWBORN EXAMINATION
- Skin - Most babies are covered by a clay colored, greasy substance called vernix which usually is cleaned off by the nursing staff. This is a protective substance that is no longer necessary once the child is born. Some post dates babies will have cracked, peeling skin. Imagine sitting in a bathtub for two weeks (or 9 months and 2 weeks) and you can understand why many babies have this type of skin. In general, oils and creams will just block pores and cause blotchy rashes. So except for the ankles and wrists (which sometimes crack and bleed and for which any inexpensive moisturizing cream will suffice), allow the skin to peel and there will be a beautiful butterfly underneath. For the first few weeks, most babies will have cold and even bluish hands and feet (see above). This is due to an immature circulation and it will resolve with time. Using mittens and booties makes grandma feel better, but does nothing for the child. Some babies, especially those with dark complexion, will have a greenish-blue discoloration on their backs. It’s called a Mongolian spot simply because it was first noted in people of Chinese extraction. It usually becomes lighter over time and never degenerates into malignancy. Reddish birthmarks called hemangiomas are commonly found on the eyelids, bridge of the nose, forehead and neck. These are collections of blood vessels that appear redder when the baby is crying (thereby increasing blood flow). The ones on the face usually disappear in the first few years; the ones on the neck (so-called stork bites because that’s where the stork grabbed the baby in the process of delivery… you know better!) often last for longer periods. Newborn rashes are also common. Because of some of the hormonal fluctuations at birth, newborn acne is common in the first 2 months. If it is oily with little whiteheads, just wash the face with cool water and it will disappear on its own. (By the way, there is no correlation with adolescent acne, so don’t go looking for a dermatologist.) Erythema toxicum is a blotchy, hive-like rash that also presents in the first 2 months. This rash comes and goes and also needs no intervention. Some babies have newborn eczema, which is dry and scaly. This rash usually does not appear for 1-2 months and seems to respond to standard moisturizing creams. Almost all newborn rashes are not serious but if you’re just not sure, please call.
- Head - The newborn head is, proportionately, the largest organ in the body. There are usually two defects (or soft spots) in the bony skull: the anterior fontanelle in the front and the posterior fontanelle in the back. These enable the skull to continue to grow as the brain beneath grows. The size of the soft spots is not important. Moreover, you can scrub pretty hard over the soft spot; in fact, you would have to stick a pin in about an inch before hurting the baby. All vaginally delivered infants have their heads squished through a small cervix and most come out looking like coneheads. This process called molding is normal and the head will normalize in the first few weeks. Some babies have a little scalp swelling called caput; this is fluid in the scalp (not the brain) and occurs as the head pounds against part of the mother’s anatomy during labor. A cephalohematoma often occurs during a vacuum assisted delivery in which the suction cup causes a little bleeding in the scalp (again, not the brain). The resulting soft swelling often lasts for months but should eventually be reabsorbed by the body. Some babies are born with lots of hair and others with very little. How much hair a child has at birth does not correlate with later hair development. And because of a process called telogen effluvium, babies (and their mothers) often lose lots of hair after about 3 months.
- Face - Most babies look like other babies and not exactly like either of the parents, and their appearance often appears to change on a daily basis. One study of facial characteristics suggests that adults focus in on only certain characteristics at a time. Often the mouth will look like one parent, the eyes like another and the ears like one of the aunts. So when the child is crying, we focus on the mouth, when the child is laughing, we focus on the eyes; hence the child, who is really a composite, appears to be a chameleon. Most babies are born with blue eyes. Eye color is established by 6 months. So, at this stage, it is a little too early to tell if the blue eyes will stay. There is very little structure to most newborn ears so if they look a little squished don’t be alarmed. Some babies have little holes on the face next to the ears called branchial cleft sinuses. These are remnants of an in-utero developmental stage and rarely cause any problems.
- Mouth - Many babies are born with a little white bump on the top of their palate called an Ebstein’s pearl. This is a little extra piece of skin that will slough off in the first 6 months. Bohn’s pearls are similar pieces of skin on the gum line that are often mistaken for teeth. They too will fall off over time. Nursing blisters are not true blisters but areas of hardened skin caused by rubbing against the nipple. They are not painful, just simply a curiosity. Thrush is a yeast infection of the mouth that appears as white patches inside the cheeks and on the lips. If the tongue is white but there are no patches elsewhere, you are probably just looking at taste buds on end. Thrush is not painful and usually does not need to be treated (it is a pain to treat anyway) but it can give a nursing mother a yeast infection of her nipples that causes burning in between feeds. In nursing mothers, we usually treat both baby and mother.
- Chest - Neonatal breast tissue is present in almost all babies. The same hormonal stimulation that leads to the development of maternal breast tissue will cause breast enlargement in both male and female newborns. And this breast tissue may persist for 6-9 months. Please do not squeeze the breasts. If a female child develops an infection of her breasts, called mastitis, it can have a lasting effect on her ability to nurse her own children. It is impossible to tell whether nipples will be inverted in adulthood based on their newborn appearance. And whether inverted or not, almost all women can be helped to successfully breastfeed. Many babies are born with an indented breastbone called a pectus excavatum. This is a normal variant and rarely causes any cosmetic problems. Babies breathe in a intermitted fashion, rapidly at first and then not at all, a pattern called periodic breathing. This pattern is normal for at least the first few months.
- Abdomen - Babies often suck their abdomens in and out while breathing, a pattern called abdominal breathing. This too is normal. When the cord falls off, some babies have a weakening of their abdominal wall muscles that leads to a bulging ‘belly button’ called an umbilical hernia. This resolves in 2-4 years in most children and putting silver dollars or other belly tape on the hernia does not accelerate the healing process.
- Genitalia - In the first few weeks of life, most females have a thin white vaginal discharge similar to the discharge that many women see prior to having a period and caused by the same hormonal changes. For similar reasons, many females will have some vaginal bleeding. Essentially it is your daughter’s first period; fortunately, the next one doesn’t come for many more years. By the way, you do not need to clean a female newborn from front to back. The newborn vaginal lining appears to be impervious to stool and so the front to back process need not begin until after the child is toilet trained. Many males have a little swelling in their scrotum called a hydrocele; this normal variant resolves by one year in most children. The urinary stream in a male should be effortless, straight and arching out; if it is deflected downward or appears to require straining, please call us. Straining to make a stool however, is very common because babies are unable to push down or use normal gravitational forces to have a bowel movement. (see below, Stool Patterns).
- General - Studies show that 90% of women decide on a feeding method by the end of the second trimester and that 95% feed their infant as originally planned. Our job is not to make your decision for you but to help facilitate your decision. We will be happy to discuss the pros and cons of each position and will serve as a resource for all questions.
- Breastfeeding - Breastfeeding is hard work in the first week or two but usually becomes more manageable after that. Please see our Guide to Breastfeeding for detailed information about the nursing process. If you have questions about what medications are permissible while nursing, please ask us for our exhaustive guide. (Click here) In general, acetaminophen or ibuprofen for pain and Benadryl™ or Claritin ™ for colds are okay while nursing. Our practice has one of the most robust support networks around for breastfeeding women. We have lactation consultants on staff on a routine basis and our strong affiliation with Breastfeeding Medicine of Northeast Ohio provides you with the tools any woman needs to be as successful as possible in the breastfeeding experience.
- Formula feeding – For those who cannot or are not interested in breastfeeding, it is important to know that there are many excellent formulas on the market. Cow’s milk based formulas such as Similac, Enfamil and Carnation Good Start, have been around for decades and have an excellent safety profile. And the Wal-Mart and Target brands called Parent’s Choice are made by a national formula company with over 50 years of experience. All formulas now contain iron because iron is necessary for brain development. Study after study has shown that iron in formula does not cause constipation. You should probably be consistent in the formula that you use; however, be aware that in the hospital there is a monthly rotation and so you need not continue with the same formula at home if cost or availability is a consideration. Each formula comes in three forms.
- Ready to feed is the most convenient but also the most expensive.
- The concentrated form is cheaper (and available on WIC) and comes in 13 oz cans that require dilution with one part water to provide 26 oz of proper formula.
- The powdered form is the cheapest and most convenient (especially for trips). Following the directions, one scoop is placed in 2 oz of water and the product is shaken. For both the concentrated and powder forms, the water added need not be boiled despite what it says on the can (In general, no sterilization of infant materials is necessary; washing all formula related items in hot, soapy water or in a dishwasher is sufficient.) And please remember to use tap water or bottled water with fluoride. The fluoride has been shown to help in eliminating tooth decay.
- Feeding frequency - There is no hard and fast rule. Most infants feed every 2-3 hours (breast feeders closer to 2 and formula feeders close to 3) but it is really useful to allow the baby to determine his own schedule.
- Non Nutritive Sucking - Remember that crying is not synonymous with hungry. Babies require 2-3 hours a day of non-nutritive sucking on a finger or pacifier. This is like a glass of wine, a hot shower and a back rub all wrapped together. It is a developmental and maturational need that when not provided, makes for a very cranky baby.
- Feeding Amounts: The average formula fed baby is taking 1.5-2.5 ounces per feeding (12-18/day) in the first few weeks that increase to 24-28 ounces by 2 months of age. If your child is taking much more, he is probably not getting enough non-nutritive sucking.
- Vitamins - Formula fed babies do not require any extra vitamins. However, breastfed babies do not receive adequate Vitamin D and should be supplemented with 400 IU of Vitamin D daily to prevent rickets, an old disease which has recently reared its ugly head. This amount can be given conveniently as a dropperful of Tri-vi-sol which is available at most local pharmacies over the counter. A generic version is fine to use as well. Extra iron is not necessary for any infant until they are six months old at which time babies who are continuing to strictly breastfeed should be taking of Poly-vi-sol daily. We will discuss this switchover with you as your baby grows.
- General - Pediatricians have an affinity for stool. We probably spend more time talking about the gut and its products, normal and abnormal, than any other part of the body except for the nose. As the parent of a newborn, you will rapidly become an expert in identifying the particular characteristics of your child’s stool.
- Odor/Color/Consistency - The first few bowel movements are greenish, gooey and odorless. This meconium stool can even be passed in utero (that can occasionally be a problem) but may be passed as late as 48 hours after delivery. Stool has form only when it contains undigested particles of food. The newborn stool is formless because it is composed solely of bowel secretions. As the infant digests more food, the stool takes on more odor, color and consistency. Please do not concern yourself with any of these attributes of stool. Odor depends on the byproducts present in undigested milk. Breast milk is almost completely digested and hence, has very little odor. Color is dependent on the presence or absence of various minerals, most notably iron; consequently, babies taking iron containing formulas or breastfeeding babies whose mothers are taking their prenatal vitamins with iron, will have greener stools. Consistency depends on transit time. Breast milk tends to pass through the system more rapidly and is therefore, looser.
- Constipation – Constipation means hard stool, not infrequent stools. Even breastfed babies may have stools only every 4-5 days and that’s okay as long as they are soft. Straining is common; imagine having a bowel movement while lying flat on your back. It’s not easy. That’s why we adults use toilets and push down to have a bowel movement. Iron is not constipating despite the view of 9 of 10 grandparents. Double-blinded studies where the parent and physician aren’t aware of the type of formula prove that there is no difference in constipating character of iron vs. so-called low-iron formulas. However, it is well known that intelligence is a function of iron stores; the severely anemic child may score lower on standardized testing.
- Diarrhea – Diarrhea means many, excessively loose stools. It is uncommon to have true diarrhea in infancy. Breastfed babies often have stools that literally soak through the diaper and that is a good sign of excellent feeding practices.
There are many disposable diapers on the market and the variety and style increases daily. Then of course, there are cloth diapers. A few guidelines are in order.
- Buy what works for your child. What works for one, may be terrible for another, even within the same family.
- Experiment! Use the coupons that come in the mail and try all the generics. In general, for most children, generics are as good as the brand names.
- No diaper will completely prevent diaper rashes.
- Don’t use a particular diaper exclusively because of its impact on the environment. Cloth diapers use more soap and hot water while disposables use up more landfill space. Most studies suggest the environmental impact is a wash (no pun intended).
- Change your baby’s diaper when it becomes wet or dirty. Diaper alarms are a waste of money; your nose is a much better indicator.
- The use of diaper creams is a personal matter. Some people swear by the old reliables, Desitin and A and D ointment. In general, those with zinc oxide (it’s what confers the white color) seem to provide a better form of protection. Balmex and Johnson and Johnson have recently developed strong constituencies as well.
- Diaper rashes are of two basic types. Irritant rashes are red and sunburn like. They respond to barrier ointment protection such as zinc oxide. In truly raw rashes, try alternating some Caldasene™ powder with Butt Paste. Remember not to shake powder from the bottle. It can be dangerous when powder particles are inhaled into the lungs. Butt Paste can be purchased or made up in your home by combining Aquaphor, a liquidy cream with Maalox, an anti-acid in approximately equal amounts. (If you make it too liquidy, it will leak all over.) Finally, some parents swear by Pink Sav, made by a local Cleveland company. Yeast infections are redder, more bumpy and spread up the abdomen. They respond to over the counter creams with clotrimazole (Lotrimin™).
The umbilical cord is the blood connection between the fetus and the mother. Prior to discharge from the newborn nursery, the cord is treated with either alcohol alone or a bluish, antibacterial dye called triple dye followed by alcohol. Recently, studies have shown that neither alcohol nor triple dye are necessary. The cord heals by becoming slightly infected. It will therefore, appear gooey, smelly and yellowish green. As long as there is no redness spreading up the abdomen, it is okay. If it gets really gooey, drip some alcohol from a cotton ball 3-4 times per day to help dry up the cord, which usually falls off between 7 days and 7 weeks. There are no nerve endings in the cord; hence, alcohol on the oozing cord is not painful, but rather cold on the adjacent tissue.
Until the cord falls off, your child should not be immersed in water; however, sponge bathing every few days is perfectly fine. Once the cord falls off, the infant can be bathed as one would an adult. Daily bathing is okay but can be very drying; if your child seems to have dry, irritated and sensitive skin, keep the baths to a minimum (1-2/week). Use a mild soap such as Dove™ or the various baby soaps on the market. For hair care, use a commercially available baby shampoo and scrub vigorously in all areas including the soft spots. You cannot hurt the baby by scrubbing too hard but can leave him with a dry thickened scalp called cradle cap by being too gentle. If that should happen, use a small amount of cooking oil (vegetable or corn oil) and massage it into the scalp. Then use a soft adult toothbrush, scrub out the scale and wash it with shampoo. Repeating this daily for a few days will resolve the problem. If you can’t seem to get rid of the thickened “cradle cap”, give us a call. We have lots more tricks up our sleeves.
At birth, various forms of eye drops are routinely instilled into your child’s eyes to prevent eye infections. Traditionally, they have been used to prevent the ravages of untreated venereal diseases. However, even if that is not an issue with your child, many studies have shown that the incidence of chronic eye drainage later in the year is reduced in children treated with drops at birth. A yellowish and even greenish eye discharge is common in the first few weeks and is usually caused by a blocked tear duct. After using a warm compress, if you massage the eye vigorously (it will look like the eyeball is bulging) from the nose side of the eye to the eye socket above, 3-4 times per day, you can usually resolve the problem. Drops are rarely necessary unless massage for a few weeks days has not made a difference. Please note however, that blocked tear ducts can manifest themselves for 9-12 months and attention to massage remains important throughout. Vision is never affected.
Ear wax (or cerumen) is a combination of oils produced by the ear canal and dead skin. The drier the child, the more dead skin, the more earwax is produced. In general, you need do nothing about earwax because it spontaneously drains. The old adage about placing nothing in the ear canal that is smaller than your elbow continues to remain in force. Despite what you read in magazines, ear infections are uncommon and are not contagious. Moreover, pulling or rubbing your ear is rarely a good sign of an ear infection; more often than not, it is a sign of teething.
For many decades, the American Academy of Pediatrics (AAP) had stated that circumcision was a matter of personal or religious choice. However, because of mounting evidence that routine circumcision may reduce the incidence of severe urinary tract infections in children under a year of age, and because of studies in Africa that suggest that routine circumcision can help eliminate the transmission of HIV/AIDSA, the new recommendations acknowledge that there may be a medical reason for continuing the practice (see Circumcision-click here). In Ohio, for malpractice reasons (OBs carry surgical malpractice), the OB does the circumcision. The most important part of the aftercare program is to place some type of ointment on the diaper so that the penis does not stick. The site will ooze and bleed and smell a little, but an infected circumcision site is almost unheard of.
In the first 8 weeks, ‘average’ children cry 2-3 hours a day, while ‘active’ children can cry for longer periods (see Colic). It is important to view crying as the only means an infant has of communicating. Babies cry because they are hungry, dirty and need to be burped. But perhaps 50% of the time, they cry because they are babies. For example, if your stomach growls or your chin quivers, you are likely to say, “Gee, that is interesting.” Babies often cry in those circumstances. The point is that you should not immediately assume the baby is in pain even if it sounds like a painful cry to you. If a baby is feeding well, it is not likely that there is anything seriously wrong. However, in the first 6-8 weeks, most of us (especially grandparents) assume that the child is hungry, gassy or colicky. It is usually more helpful to assume that the baby needs more sucking and use of a pacifier or finger to facilitate the process. The average child needs about 3 hours a day of non-nutritive sucking during this period, and it is a rare crying child who actually gets the allotted amount of sucking. Just an aside on pacifiers. Most people have strong feelings about pacifiers having seen 2 year olds running around with them. Babies need non-nutritive sucking for the first 3 months of their lives. After that age, most children abandon their pacifiers more easily. However, at that age, many parents become hooked on the pacifier and continue to push it back in, thus creating a dependency. So it is okay to use a pacifier as long as ‘you’ are able to give it up in a few months. And remember, if all else fails, swaddle the baby, place him in a swing and walk away for a few minutes of needed perspective. There is nothing wrong with your parenting skills; it is just stressful to take care of an infant at this age.
The most important safety issue to remember is the car seat. The most common cause of death in childhood is accidents and most occurs within 3 miles of your destination. And if that is not enough to scare you, please remember it’s the law to place a child in a car seat until approximately age 4 (rear facing until 20 pounds and front facing until 35 pounds) and then in a booster seat until 80 pounds.
THE ART OF PARENTING
After learning everything there is to know about the technical aspects of caring for a baby, our goal is to help you make the transition from a couple to a family or from a small family to a bigger family. To that end, we have a few thoughts worth considering.
- STAR - Smile, Take A Deep Breath and Relax. Our Parent Coach, Amy Speidel teaches this approach as a sure fire way of reducing stress. When you are stressed, you shift blood flow away from the thinking areas of your brain and towards the emotional areas. Smiling shunts blood back to the thinking areas so that you can actually ‘make the right decision’. Taking deep breaths releases serotonin, the chemical responsible for relaxation. So smile even if it hurts. Practice the deep breaths you learned in Lamaze class and you are less likely to be yelling at your spouse and more likely to make the right decisions.
- It takes 2 months: It takes 2 months to get to know any human being, especially one that speaks a different language. On the days when nothing makes sense, when one of you is saying to the other, “Whose bright idea was this anyway?”, remember that it is always 3 steps forward and 2 steps backward. On those many 2-step-backward days, remember that tomorrow will be a better day.
- Pace yourself! Taking care of a newborn is intense no matter how many children you have had, and no matter what the personality of your child. It’s like running a marathon and if you burn yourself out in the beginning you’ll be wasted in the end.
- Ask for help! Ask for help from anyone who offers and ask for help even from those who don’t offer. Arrange for outside help, be it in the form of a babysitter, friend, parent etc. By the way, use grandparents for what they are willing to offer. Don’t try to make a grandmother wash the floors when she really likes to shop even if you need the floors washed. If someone offers to make or buy meals, take them up on the offer. There is no room for pride when caring for an infant. And if all else fails, call us for help.
- Don’t be afraid to take the baby outside! Dress him appropriately (diaper and undershirt when it is hot, snowsuit when it is cold) but get out and do things. It will clear your head of cobwebs and besides, cool air is like a tonic for a fussy baby. Unless the wind chill factor is below 20 degrees, it should be fine to go outside for brief periods. Remember, colds are caused by viruses and are transmitted by other sick people, most of whom are inside, sneezing on the baby.
- You can’t spoil a newborn! If the baby is crying, pick him up, swaddle him and gently rock him. If you find yourself shaking him, you’re probably overdoing it.
- Don’t worry about providing stimulation! If it is your first child, he is already getting plenty of stimulation because he is the only game in town. Many children cry simply because they are passed around and stimulated too much! Trips are always over stimulating. To see your parents or your friends is important, but expect to pay a little bit in wakefulness the following night.
- Try to understand how awkward the grandparents feel! For first time grandparents, the only previous child rearing experience they have had, was a generation ago. They are groping for the right response just as you are. Many grandparents become overprotective; others spend time offering advice. But all are motivated by love, even if their responses sometimes seem inappropriate. Use us to run interference. If all else fails, you can blame it on the doctor.
- Call! We want to hear about your frustrations. Sometimes just a kind or gentle word can go a long way. No doubt, you are doing a wonderful job; you just need someone to tell you so once in a while and we are excellent cheerleaders. And remember, there is no such thing as a silly question; each question is motivated by your love and that’s all that is important.
- Trust yourself! Your job is to care for your child; our job is just as facilitators. And in over two decades of experience, we have never seen a parent miss a serious disease. You may not know what the problem is; that is our job. But you will always be able to help us distinguish between an uncomfortable disease and a serious disease.
- Above all, enjoy! The birth of a baby is an unparalleled miracle. We are privileged to be involved in the care of and nurturing of this miracle. We certainly hope that you enjoy the experience as much as we do!