While in the hospital, your baby will nurse every 1 to 3 hours. Allow your baby to feed for as long as she or he wants unless you feel tenderness; in that case, ask the nurse or lactation consultant for assistance. Your baby may be sleepy and not wake spontaneously to feed. If it has been 3 hours and this occurs during daytime hours, try to stimulate your baby to nurse. Try changing the diaper, undressing to the diaper, and skin-to-skin contact. Learning to assess hunger cues is important; behaviors such as rooting, lip licking, and hand sucking are good indicators. Try not to wait until the baby is crying.
Colostrum (the first milk) is highly nutritious and sufficient to satisfy your baby until your milk supply increases. This happens approximately 3 to 5 days after delivery.
When you take your baby home from the hospital, we encourage you to nurse the baby at least 8 times per 24 hours. It is normal for your baby to be fussy and want to nurse more frequently during the evening hours. These are called “cluster feedings.” This does not mean your milk supply is low. It is simply less abundant during the evening hours, which means that your infant can nurse frequently without causing upset stomach. Try to reduce over-stimulating your infant during the day—for example, limit visitors or outings with large groups of people—to help reduce evening tension. After “cluster feedings,” babies usually go into a deep sleep for 4 to 6 hours.
We recommend waiting at least 2 to 4 weeks to introduce a bottle. This lets you establish a full milk supply, and it may be less difficult for your baby to go between breast and bottle. Babies may refuse the bottle; if this happens, call the office for advice. You may also want to use the pad of your finger for a “pacifier,” rather than an actual pacifier, if your baby is still fussy and you’re sure she or he is full. Pacifier use should be avoided or minimized during the first few weeks of breast-feeding.
Manual and electric breast pumps can be purchased, or electric pumps can be rented. Breast milk can be used for up to 4 hours at room temperature. It can be stored in the refrigerator 4 to 5 days and frozen 4 to 5 months. When in the freezer, your breast milk needs to be in the coldest part, and NEVER kept in the door. A convenient way to store breast milk is in an ice cube tray with a lid. One cube equals approximately one ounce of breast milk. Cubes are easy to pop out and warm up. It is also acceptable to supplement with formula if needed. Formula in powdered form is most convenient so that smaller amounts can be prepared and there is little waste.
It is sometimes difficult to know how much milk a breast-fed baby is receiving. If your baby nurses at least 8 times per 24 hours, swallows for at least 10 minutes per feeding, appears content after feeding, and has at least 4 to 5 bowel movements each 24 hours, the baby is getting enough milk. The bowel movements should increase to at least 4 times a day after the first 4 to 5 days since birth. After the first 1 to 2 months, the bowel pattern may change and your baby may go several days without a bowel movement. If you have concerns about whether or not your baby is getting enough milk, call our office.
Try burping your baby after each breast. Some babies burp easily, while others do not. If you have tried to burp your baby for 1 to 2 minutes without success, go on to the next breast.
Discomfort with breastfeeding
Sometimes breastfeeding can result in sore breasts. There are several causes. Engorgement of the breasts occurs in the first few days of breast-feeding and is the result of milk production and fluid retention in the breasts. Frequent feedings help prevent it. The fluid retention is only temporary and will resolve in a few days. During this time, hot compresses just before and during nursing may help the milk flow more readily. Expression of milk manually or with a breast pump might relieve engorgement, but avoid excessive pumping. Ibuprofen (Motrin and Advil) or acetaminophen (Tylenol) may be taken for breast pain.
Tender nipples can occur if the baby does not have a wide-open mouth when he or she latches on or if she or he is suckling incorrectly. Many new mothers notice discomfort with the first several sucks at each nursing for 8 to 10 days, but if you have other discomfort while breast-feeding, call our office. Proper positioning is the best way to prevent or treat sore nipples. To minimize tenderness, make sure the baby has as large a mouthful of breast as possible. Breaking the baby’s suction seal with your finger after feeding will help minimize tenderness as well. Sometimes after discharge from the hospital, small blisters or cracks in the nipples may develop. This can be helped by rinsing your nipples with plain water after each feeding and then applying lanolin or hydrogel dressings. If you experience persistent cracking, call your personal physician.
During the first 2 to 3 days after birth, your baby may not be too eager to feed. That is normal as babies are born with enough extra fluid to get by for several days. Most babies are taking 1 to 3 ounces per feeding by the time they go home. Formula is available in three forms; ready-to-feed is the most expensive and the least amount of work. Concentrate and powder are more popular. When mixing, tap water can be used, unless you use well water that has not been tested for bacteria and nitrates.
Water and bottles do not need to be sterilized. Washing with soap and hot water, or in the dishwasher, is adequate. The type of nipple or bottle best taken by your baby varies, so any type can be tried. When bottle feeding, burp your baby after each 1 to 2 ounces, until you know how frequently your baby needs to be burped. Use caution if bottles are warmed in a microwave because the milk can get very hot in spots but the container stays cool.
Food do’s and don’ts
Solid foods should be introduced between 4 and 6 months of age. Foods and juices can cause your baby problems if introduced too early. Because of a small risk of infant botulism in the first year of life, babies should not be given honey during this year.
Sneezers and wheezers
Several things that babies do may seem abnormal to you, but actually are normal. For example:
- Sneezing, sniffling, snorting, and sounding congested can often happen. These are not usually due to colds, but just small nasal passages with mucus.
- Babies often spit up, sometimes after every feeding. If there is no projectile or forceful vomiting, this is OK.
- Babies often breathe funny – sometimes fast, sometimes, slow, and sometimes even stopping for a few seconds. This is referred to as periodic breathing.
- Hiccups also occur frequently. This sometimes happens with every feeding. It does not seem to bother the baby, and nothing needs to be done about it.
- Eyes often move in an uncoordinated manner, and occasionally the baby will appear cross-eyed. Until 6 months of age, this is normal, unless it seems to happen most of the time.
- Sometimes the eyes develop matter in them after birth. This is usually due to poorly draining tear ducts. If this becomes a yellow or green pus and needs wiping every hour, call your doctor.
Stools vary in babies. At first, dark green or black tar-like stools, called meconium, will appear. After a few days, the stools become more “normal” and may be yellow, green, or brown. The baby may have 6 to 8 stools per day or may have one stool every 6 to 7 days. They may be watery (but not pure water) or semi-formed. Constipation is when the baby has rock-hard stools and pain with passing. If this happens, 1 teaspoon of Karo syrup can be offered in 3 to 4 ounces of breast milk or in the formula, but use a maximum of 6 teaspoons of Karo syrup per day. Call your doctor if you feel the child is not having appropriate stools or the abdomen is enlarged and hard.
Babies will, at first, retain fluids waiting for the breast milk to come in. You may only see 1 or 2 wet diapers per day. After 4 or 5 days, however, your baby should have 5 to 6 wet diapers per day. Occasionally a pink crystal-like or dusty material may appear in the wet diapers. This is normal and usually passes in a few days. “Ultra” diapers may develop gelatin-like granules when wet; this is not harmful to your baby.
Your baby’s skin will naturally appear dry and may peel in the first 3 weeks. This is normal, and no special attention is needed. Lotions are not necessary. Bathing after the cord falls off is appropriate, and 2 to 3 times per week is usually adequate. Mild soaps, such as liquid baby bath soap, may be used. Shampoo for the scalp can be used as needed. It is common to notice cradle cap, or a yellow greasy crustiness of the scalp, which can be treated by lightly combing after rubbing in a baby shampoo. It rarely makes the baby uncomfortable, but if it concerns you, talk with your doctor at the baby’s checkup. Many babies also develop a facial rash (“infant acne”) during the first few weeks. This is normal and does not bother the baby.
Wipers and diapers
Keep the diaper area clean and dry. No specific lotions or creams are needed routinely. It is not necessary to wash after each wet diaper. Stools, however, are more irritating than urine and should be cleaned off right away. If a diaper rash develops, diaper rash ointment can be applied. If the rash gets worse, call our office. Do not be afraid to cleanse the folds and creases of the labia. Always wipe “front to back” over the vaginal area. A cheesy substance from birth is often present in the creases of the labia and will work itself out with gentle cleansing over time. A milky vaginal discharge may also develop, which will resolve in the first few months of life. Occasionally a small amount of blood may be found in the vaginal area during the first week. This is normal.
In babies who have been circumcised, no special care is needed after 24 hours. If the baby’s penis tends to stick to the diaper, apply Vaseline to the end of the penis as needed. The penis can be gently cleansed when needed.
The cord should be left open to air as much as possible. In 2 to 3 weeks it will fall off. It may get very smelly and gooey the last few days. After the cord falls off, tub baths can be given. 2 or 3 baths per week are adequate. Call your doctor if the skin around the cord gets red, raised, and hard or if the cord site continues to be moist or bleeds for several days after the cord has fallen off.
Yellow (jaundiced) babies
Most babies develop a yellow tinge to their skin, which is called jaundice. This is most often caused by an immature liver not removing bilirubin (a breakdown product of red blood cells). This usually peaks at 4 or 5 days old. With breast-feeding, jaundice may sometimes persist for several weeks. Call your doctor if you think the baby has severe jaundice.
Urgent situations requiring a call to the doctor
Fortunately, there are not many newborn emergencies. However, some events should be shared with your pediatrician:
- Fevers over 38°C (100.4°F) in the first 2 months. In this young age group it is difficult to tell how sick a child really is.
- Projectile vomiting after every feeding, when occurring in the first 2 months.
- Other events obvious to you, such as a non-waking infant, bloody stools, etc.
For non-acute problems, call the office during weekday office hours. If you have an emergency after hours, call the office number for a recording about how to reach the pediatrician.
Older siblings can feel jealous about a new baby. Basically they do not want to share your time and affection. Therefore, the older child may demand more attention. To ease the situation:
- Stay in touch with the sibling while in the hospital.
- Spend the first moments with the sibling when you come home.
- Give a gift to the sibling from the baby.
- Say “our baby.”
- Encourage the sibling to touch and play with the baby in your presence.
- Enlist the older child as a helper.
- Give extra time, “sibling’s time,” as one-on-one quality time each day.
- Accept regressive behavior.
- Give time-outs for aggressive behavior.
It is always difficult to know how you should dress your baby, especially with frequent weather changes. Common sense will be your best guide, but realize that in the hospital nursery the temperature is 75°F and the babies have an undershirt and two thin receiving blankets. If you keep your home warmer or cooler than that (68°F - 76°F), you must make the appropriate adjustment in clothing. We are usually guilty of over-wrapping our children. If the baby is getting hot and sweaty, take off some layers.
One of the biggest challenges in caring for babies is trying to figure out why babies are crying. Obviously, if it has been 2 or more hours since the last feeding, the child may be hungry. But if you’ve just fed your baby, perhaps he or she is hot, cold, wet, or having abdominal gas cramps. Gas cramps will sometimes occur after feedings, and the baby may scream in pain. He or she may pull up the legs and turn red. Often they will act like they want to suck, as that’s the only way they know how to comfort themselves when in pain. If this is happening, it sometimes helps to change positions—try walking, bouncing, or rocking. Applying a warm wash cloth on the baby’s abdomen sometimes helps. A feeding can be tried, although sometimes this makes it worse. Sometimes babies just have to cry themselves out of it. Should these crying times last most of the day, notify your physician.
Self-quieting skills of each baby differ because of temperament. Just because your baby is not as easily consoled as other babies does not mean you should blame yourself for this.
Parents often ask if they spoil their baby. This will not happen the first several weeks. Be aware, however, that not every baby will fall asleep in your arms. Some babies need to be lying quietly to fall asleep, and the more they are held, the more disrupted their schedule can be. As your child gets older, it will be prudent to let your baby fall asleep in the crib, rather than in your arms. It will teach your child to fall asleep independently. You can, of course, rock the child for a time before he or she falls asleep.
At night, many babies wake up frequently, cry briefly, and fall asleep again. You do not need to jump right up and pick up the child if it is not feeding time. Many times a gas cramp or pain will wake the child briefly. Keep in mind that if you respond to every cry your baby makes, neither you nor your baby will get much sleep.
Effects of smoking
If you smoke, be aware of the effects it will have on your baby, including more respiratory diseases, especially wheezing; more ear infections; and long-term hazards of increased cancer risk, heart disease, abnormal lung function, and increased risk of sudden infant death.
We encourage all smoking parents to consider quitting. To help you quit, consider speaking with your physician. If you have tried to quit before, don’t be discouraged. The odds of success actually increase with each attempt. If you or someone else in your household is unable or unwilling to quit, smoke outside. Even smoke from another room eventually reaches your baby.
If this is your first baby, many aspects of your life are about to change, and you will be making more adjustments to your life as time goes by. One adjustment will be the realization that you now have a responsibility to provide a safe environment for your child.
In the first few months, please remember:
- Place the baby on his or her back for sleeping.
- Place the baby where he or she cannot roll off onto the floor. Occasionally, even a newborn will roll over accidentally.
- Monitor siblings when they are too young to know they could hurt their baby sibling.
- Do not place objects in the crib that the child could place in the mouth and choke on.
- Do not place the baby on soft cushions, pillows or water beds, especially face down. Babies do not need pillows to sleep.
- Crib bars should be no more than 23/8 inches apart.
- Be certain that any paint on the crib is not lead-based.
- Avoid inhalant irritants, such as insecticides, paint, paint remover, formaldehyde, smoke, etc.
- Babies sunburn easily, so avoid exposing your baby to direct sunlight for long periods of time.
- Use infant car seats with every ride.
- Learn and review CPR techniques. Issues involving older children will be discussed as you return for well child exams.
Parents often feel the need to provide stimulation to maximize their child’s development. There is no evidence that educational toys, music, movement classes, or watching educational recordings enhances child development. We feel that the most important stimulation for infants is loving interaction with the parents. Let babies be babies.