Newborn Care Highlights!
Some of you have had the pleasure of listening to the 10 to 15 minute newborn care monologue that I give parents before discharging their newborn from the nursery. Don’t worry; I am well aware that most of you forget 90% of what I say while trying to figure out how to fasten the car seat into the car on your way home from the hospital, and the remaining 10% during the next week of sleepless nights. So I decided to try to condense my approximately 15 minutes of rapidly paced anticipatory guidance into two paragraphs of information dispersed through a song short enough to hold your attention (apparently I failed: at about the 5 minute mark my daughter asked: “why is it so long?” and wandered out of the room). Ultimately, it didn’t work – I couldn’t fit it all in. But here’s my best attempt – and I think it hit a lot of the highlights. I hope you like it – and maybe if you listen to it a few times, you’ll even remember a few of the things I told you before you left the hospital!
Feeding – A very approximate guide of what to expect: every 1-2 hours for the first week, every 2-3 hours for the second week, every 3-4 hours from then on. Over time, she will start spacing out her night feeds, but you should not expect a solid night of sleep (6-8 hours) for at least a few months!
In general, kids will feed around 10-12 times per day for the first week or two, then 8-10 times per day over the next few weeks, hopefully down to around 6-8 times a day after a month or so. As long as they are getting approximately that many feeds, you shouldn’t need to wake them for feeds; let them set their own feeding schedule – longer between some feeds, shorter between others. As long as your newborn is gaining weight well (i.e. good urine output, reassuring weight at your check-ups), you should be able to let them sleep as long as they want (usually 4-6 hours would be as much as you can expect in the first month). Just know that after their (and your) long nap, they may want to feed every 1-2 hours for a few feeds to catch back up – and that is fine.
Spit-ups – Most babies do it; it’s okay as long as it doesn’t cause pain for the baby, shoot across the room, have blood or dark green bile in it, or have a large enough volume that the baby doesn’t grow or urinate adequately (at least 6 wet diapers daily). Don’t worry if it looks like curdled milk – it was just in her tummy; what did you think you’d get when you mix stomach acid and milk?
Rashes – They happen frequently in the early months of life. As soon as one gets better, a new one will start; red, bumpy rashes all over start on day 1 or two of life. If they don’t hurt the baby, don’t worry about them. If the skin is dry, put on petroleum jelly (vaseline) or something similar. If the rash is painful or looks like small blisters – seek medical attention.
Vitamins – First, I should say that breast milk is fantastic and better in every way than formula – except in one way. Vitamin D supplementation is recommended for babies that do not receive at least 32 ounces of formula per day; in other words, babies that get all or part of their nourishment through breastfeeding should be on vitamins. Some formulations are vitamins +/- iron (usually 1 ml per dose), vitamin D (1 ml per dose but taste better than the multivitamin formulations) or vitamin D drops (my personal favorite: 1 drop per dose – sweet!). Most of these formulations are readily available online – and you are obviously an internet savvy parent!
Umbilical cords – Don’t mess with them (I don’t recommend alcohol or anything). They are just big, dangly scabs. Keep them dry until they fall off in 10-21 days. They may be moist or have tiny amounts of bleeding for several days after falling off. That’s normal (imagine if you had a scab fall off a few days early). If the bleeding is more of an oozing or large drops or the drainage is persistent, see a provider.
Circumcisions – Fill the front of the diaper with vaseline until the skin is dry and healed (about 5-7 days). Yes, the diaper will leak, but at least the circumcision won’t stick to the diaper – that’s the most important thing because that will HURT! Usually there is some mild redness and yellow discharge on the tip of the circumcision when it heals – that is normal. If the circumcision, umbilical cord or any other part of the body is tender, red and oozing pus, see a doctor quickly because it’s infected – but that’s rare.
Colic – Probably will eventually be the topic of another song. There are many theories about what it is; mine is that it has something to do with the maturing intestines transitioning from zero bacteria at birth to billions of bacteria in the first months of life. The bacterial flora is changing from day to day and week to week. That’s got to give a kid an upset stomach! Plus, remember that kids are taking 10-20% of their body weight in milk every day (think about how much that is. . .); wouldn’t drinking 20 pounds of milk give you gas (or worse!)?
Generally, the fussiness is worst at around 6-8 weeks and better by 3 months. Your job is just to keep your baby comfortable (massage, bicycling the legs). Medicines and formula changes have not been shown to make any difference in these symptoms (of course the kids like gas drops – they’re sweet! But they probably don’t actually do anything for the tummy) in otherwise healthy children (exceptions might be those kids with milk protein allergy). In my opinion medicines and formula changes just end up confusing things (what made him better – the formula, the medicine, the full moon?).
Here is the one thing that should concern you with the colicky baby. If he can console with feeding or holding, he just has colic – poor guy! It’s part of being a baby. If he cannot be consoled no matter what you do, please have him seen by a doctor, perhaps he’s fussy because there’s something wrong.
Fevers – The song says it all (also check out “Don’t Fear the Fever” for a lot of additional information). Rectal temperature (the most accurate way to take a temperature in a newborn) of >100.4 is an ER visit. The younger children (usually in the first 6 weeks) will have blood, spinal fluid and urine checked, the older ones may just have urine checked if they seem healthy. The younger or more ill ones are likely to require admission to the hospital. I recommend rectal temperatures in the first 3 months of life because the difference between 100.3 (stay at home or come in for a routine visit) and 100.4 (an ER visit and lots of tests) is very important. In older children over 3 months, you can take the temperature any way you want, because precision isn’t quite as important anymore.
Common illnesses – Kids get colds (most kids will get several in the first year – even up to 10-12 might be normal!) and occasional diarrhea and vomiting. They can be pretty miserable – and thus you are pretty miserable too. I will probably also eventually do a song about these illnesses. The take home point, though, is that kids can usually get better at home, because the illnesses are usually mild and resolve on their own. Your job is to keep them hydrated while the illness resolves itself (in a kid that won’t keep fluids down, try small amounts frequently – as little as a teaspoon of Pedialyte every 10 minutes is enough to keep a baby hydrated). Reasons to be worried (and see a doctor) are concerns for hydration (less than 4 wet diapers, dry mouth, no tears when they cry), breathing (too fast, sucking in their chest to breath, flaring their nostrils) or your baby just isn’t acting well (too tired, difficult to console). Of course if there is blood or mucus in the stools, that’s also a reason to see the doctor, but I don’t usually have to tell anyone that. This is a big topic that I have scarcely addressed in this paragraph; in short, if you are worried, see your doctor.
Whew! There, that is my whole newborn talk! Here is way more information – compiled by multiple pediatricians and deemed trustworthy by the American Academy of Pediatrics. I gave you some brief talking points above. Please click here for more extensive answers to your questions at HealthyChildren.org.