The Baby Manual: Instructions for your new Kiddo

by Joshua Goldman, MD, MBA | goldman@myhousecallmd.com

adapted from the American Academy of Pediatrics’ HealthyChildren.org

How many times have you heard new parents say that they wish their new baby came with an instruction manual?  Well, we made one.  It’s by no means the comprehensive novel that comes with a new car (and no, your baby doesn’t come with power windows), but the slimmed-down guideline below will get you started when it comes to caring for your new family member.

THE ESSENTIALS

Find a Pediatrician: Most healthy newborns go home after two or three days in the hospital at which point their new pediatrician (with your assistance, of course) will take over their medical care.  Try to find a pediatrician you’re excited about before the delivery. You will need to follow up with your pediatrician within a week or so of heading home so identifying one beforehand is a big help.  Still looking?  Try HealthyChildren.org’s pediatrician finder to find the perfect doctor for you in your area.

Medical Problems to Watch for in Newborns: Now that you’re home with your baby, you are the entire medical team.  While the majority of babies continue to grow and develop without any problems, we always want to be on the lookout for bumps in the road.  The following are the most common medical problems to arise in newborns.  If you are concerned about any of these issues, call your Pediatrician right away.

1. Dehydration: Babies are tiny and it doesn’t take much for them to become dehydrated.  Be sure to feed the baby every 2 hours and talk to your pediatrician if you’re having trouble with feeds.  The following are signs of dehydration in newborns:

  • Plays less than usual
  • Urinates less frequently (for infants, fewer than six wet diapers per day)
  • Parched, dry mouth
  • Fewer tears when crying
  • Sunken soft spot of the head in an infant or toddler

2. Jaundice: Jaundice happens in almost every baby, peaking in the first week as newborns learn to excrete the yellow pigment called bilirubin in their stools. The bilirubin level generally peaks by about 5 days for term babies and about 1 week for those born prematurely. Your baby had it’s bilirubin checked every 24 hours while in the hospital and, most likely, at your visit to the pediatrician during the first week or two.  If your baby continues to have signs of jaundice — very yellowish skin and eyes — after day four, give your pediatrician a call so they can investigate.  Worst case scenario, your baby may have to spend a day or so under UV lights to help break down the excess bilirubin if the level gets too high.    

3. Infection: Your little once can pick up an infection during birth or from people other than the parents handling the baby (think grandma and siblings). Signs of infection can include high OR low temperature (babies often become cold during infection), poor sucking during breastfeeding, a lack of appetite, poor weight gain, weak crying, and increasing irritability.

DAY-TO-DAY BUSINESS

A baby’s existence is pretty simple.  All they really do is eat, sleep, and poop (we miss those days).  As a new parent, your job is to monitor these three activities to make sure everything is going as expected.

EATING: A baby should eat every 1-3 hours for a total of 8-12 times per day.  As you know, breastfeeding is strongly encouraged for a host of reasons we won’t bombard you with.  If you’re having trouble with breastfeeding, talk to your pediatrician or see a lactation specialist so we can get you back on track ASAP. Along with feeding comes a number of other bodily functions:

Burping: Young babies naturally fuss and get cranky when they swallow air during feedings (wouldn’t you?) which occurs more often with bottle feeding.  The best approach is to be proactive: burp the little one frequently, even if they show no signs of discomfort. The pause and the change of position alone will slow their gulping and reduce the amount of air they take in.

Hiccups: Most babies hiccup from time to time which bothers parents more than the infant.  If hiccups occur during a feeding, wait until the hiccups are gone to resume feeding. If they don’t disappear on their own in five to ten minutes, try to resume feeding for a few minutes. Doing this usually stops them. If your baby gets hiccups often, try to feed him when he’s calm and before he’s extremely hungry. This will usually reduce the likelihood of hiccups occurring during the feeding.

Spitting Up: Spitting up is another common occurrence in newborns and is rarely a cause for concern…but often freaks parents out.  We don’t spit up; why should they? Sometimes spitting up means the baby has eaten more than her stomach can hold; sometimes she spits up while burping or drooling. It almost never involves choking, coughing, discomfort, or danger to your child, even if it occurs while she’s sleeping.  What if your baby spits up a LOT? Some babies spit up more than others, but most are out of this phase by the time they are sitting. A few “heavy spitters” will continue until they start to walk or are weaned to a cup. Some may continue throughout their first year. Gross but not horribly concerning.  The most important thing for you, as a parent, to do is to differentiate normal spitting up and true vomiting. Unlike spitting up, which most babies don’t even seem to notice, vomiting is forceful and usually causes great distress and discomfort for your child. It generally occurs soon after a meal and produces a much greater volume than spitting up. If your baby vomits on a regular basis (one or more times a day) or if you notice blood or a bright green color in your baby’s vomit, call your pediatrician.

POOPING & PEEING: Just like adults, the frequency of bowel movements varies widely from one baby to another. Many pass a stool soon after each feeding (this is a result of the gastrocolic reflex, which causes the digestive system to become active whenever the stomach is filled with food).   How many times should you expect to be changing their diaper each day?  We expect a minimum of 4-6 wet diapers a day and like to see at least one stool per day.  More than that is totally normal and healthy.  If your baby is having fewer wet diapers or isn’t pooping, give your pediatrician a call.

Changing Diapers: Preparation is key here.  There’s nothing worse than getting knee deep in poopie diaper and realizing you don’t have a clean one ready to go.  What do you need? Not much: 1. a clean diaper, 2. some baby wipes, 3. a trash can.  That said, some particularly messy episodes might require not only a new diaper, but also an extra pair of hands, a new outfit, and even a trip to the tub. Also of note (and we speak from experience here), babies have a tendency to pee as soon as they are exposed to open air.  Protect yourself by keeping their pistol covered as much as possible during the whole changing process.  Not sure how exactly you change a diaper? Check out a great video tutorial here.

CRYING: There’s nothing more unnerving than a crying baby.  It’s true.  Evolutionarily, that’s exactly the point of crying.  Rather than helplessly suffer through long bouts of crying, try these great tips to calm your upset kiddo.  Most of them strive to emulate the baby’s time in the womb (a.k.a. their happy place).  If at first you don’t succeed, try, try again.  With a little practice, you’ll find out what works and what doesn’t for your baby.

  • Swaddle your baby in a large, thin blanket.  Being swaddled reminds them of their quality time in the womb and helps them feel safe.
  • Hold your baby in your arms close to your chest. The sound of your heart, again, is calming as it reminds them of the womb. You can place their body either on their left side to help digestion or on their stomach for support.
  • Turn on a calming sound. You can’t hold the baby close to your heart 24-7…OK, you could try but it might get weird.  Sounds hat remind babies of being inside the womb are calming, such as a white noise device, the humming sound of a fan, or the recording of a heartbeat.
  • Walk your baby in a body carrier or rock her. Calming motions remind babies of movements they felt in the womb.
  • Avoid overfeeding.  Feeding is important…arguably the most important aspect of a baby’s new life…but we don’t want to overdo it.  Wait approximately 2 hours from the beginning of one feeding to the beginning of the next to give the little one time to digest.
  • If it is not yet time to feed your baby, offer the pacifier or help your baby find her thumb or finger. Many infants are calmed by sucking. Weird but totally helpful.
  • Keep a diary of your baby’s habits (when are they awake, asleep, eating, and crying). Keep track of how long it takes your baby to eat or if your baby cries the most after eating. Identifying their triggers can go a long way in helping your manage them.
  • Limit each daytime nap to no longer than 3 hours a day. Your baby has no idea what a circadian cycle is like and it’s up to you to begin to train them.  Help your baby stay asleep during the night by avoiding bright lights and loud noises during nighttime feedings a diaper changes.

SLEEP: Babies do not have regular sleep cycles until about 6 months of age. While newborns sleep about 16 to 17 hours per day, they may only sleep 1 or 2 hours at a time. As babies get older, they need less sleep. However, different babies have different sleep needs. It is normal for a 6-month-old to wake up during the night but go back to sleep after a few minutes.

Here are some tips that may help your baby (and you) sleep better at night:

  1. Keep your baby calm and quiet when you feed or change her during the night. Try not to stimulate or wake her too much.
  2. Make daytime playtime. It would be awesome if you and your baby were on the same schedule.  While this isn’t entirely possible, you can start to shift them in that direction.  Remain interactive with your baby during the day to lengthen their awake times. This will cause them to sleep for longer periods during the night.  Everyone wins!
  3. Put your baby to bed when drowsy but still awake. You want the little one to learn to fall asleep on their own in their crib. If you get in the habit of holding or rocking them until they are completely asleep, it can be harder for them to go back to sleep if they wake up in the middle of the night.
  4. Wait a few minutes before responding to your child’s fussing. See if they can fall back to sleep on their own. If they continue to cry, check on them but do so stealthily (i.e. don’t turn on the light, play with them, or pick them up). If the crying continues, there’s probably something going on which requires your intervention including hunger, poopie diapers, or a fever.  Odds are that the fuss is being caused by #1 or #2 so try those first before busting out the thermometer.

The “To Go” Wrap: Babies love being wrapped up.  It’s freakish but true. It’s more of that womb-like business that has a calming effect on them.  If you want to learn how to do this professional style, learn from the experts: the nurses in the newborn nursery. These baby-bundling phenoms take uncomfortably free and exposed newborns and almost effortlessly have them bundled in blissful, no-flailing-allowed slumber in the blink of an eye. If you are already home and either missed out on the hospital demo or want a refresher course, follow the steps below:

  1. Lay a thin baby blanket out like a diamond in front of you.
  2. Fold the top corner of the blanket down a bit so that the folded corner almost reaches the middle of the blanket.
  3. Place your infant on his back, centered on the blanket with his arms at his sides and his head just above the folded edge and his shoulders just below it.
  4. Take one of the side corners of the blanket and fold it over your baby’s shoulder and across his body, making sure to tuck the corner underneath him on the opposite side.
  5. Then take the bottom corner of the blanket (below your baby’s feet) and fold it up over your baby. If the blanket is large enough that the bottom corner reaches up to (or over) your baby’s face, you can simply fold it back down until his face is no longer covered or bring it over one or the other shoulder and tuck it under him.
  6. Finally, take the only remaining corner and pull it over your baby’s other shoulder and across his body. Again, tuck this corner snugly under your baby’s opposite side.

Sleeping Position: This is a hot topic but for good reason and the take home message is to place your baby on its back to sleep.  Based on an evaluation of current sudden infant death syndrome (SIDS) data, the American Academy of Pediatrics recommends that healthy infants, when being put down to sleep, be placed on their backs. Despite common beliefs, there is no evidence that choking is more frequent among infants lying on their backs when compared to other positions, nor is there evidence that sleeping on the back is harmful to healthy babies.  Since 1992, when the American Academy of Pediatrics began recommending this sleep position the annual SIDS rate has declined more than 50 percent.  We think it’s safe to say it’s working.

HYGIENE

Bathing: Babies aren’t like adults.  They don’t spend the day in the great outdoors getting covered in dirt and sweat.  The dirtiest thing they come in contact (hopefully!) is their own poopie diaper.  As such, if you do a good job with diaper changes, you may only need to wash your baby three times a week during their first year.  Thinking this is isn’t enough?  Bathing a baby more frequently can dry out their skin. Use fragrance-free soaps and wash the soap off completely before drying.  Pat them dry and use fragrance-free, hypoallergenic moisturizing lotion immediately after bathing to prevent skin drying. If the umbilical cord is still hanging on, full-blown baths are a no-go.  Stick to sponge baths until the cord is off to prevent it from getting infected.

You’re probably wondering, “How do I give them a sponge bath?”  First, keep them wrapped in a towel and expose only the parts of their body you are actively washing. Use the dampened cloth first without soap to wash their face, so you don’t get soap into her eyes or mouth. Pay special attention to creases under the arms, behind the ears, around the neck, and, especially with a girl, in the genital area.

For more bathing tips, check out the resources on HealthyChildren.org.

Nail Care: Nails are simple: all you have to do is trim them. How, you ask? You can use a soft emery board, baby nail clippers, or blunt-nosed toenail scissors.  If you decide to go with the clippers or scissors, be extra careful not to cut your baby’s fingers (obviously).  Cutting them while the baby is asleep may be easiest.  You can also enlist a partner to help soothe the baby while you work your nail salon magic.  You want to make sure to keep their nails short to prevent them from scratching their face, which they will invariably attempt to do.  You may also notice that their toenails are softer and grow much slower than their fingernails; again, totally normal and healthy.  Unless you have a contortionist on your hands, you don’t need to cut the toenails as often since they won’t scratch themselves with them.

The Umbilical Cord: What should you do with that little stump? Simply keep it clean and dry as it shrivels and eventually falls off. To keep the cord dry, sponge bathe your baby rather than giving them a full-blown tub bath. You should also secure the diaper so as not to cover the cord (nobody wants pee pee on their cord). When the cord falls of, you may notice a few drops of blood on the diaper…this is totally normal and not a big deal. If the cord if actively bleeding, on the other hand, call your baby’s doctor immediately. The cord can also become infected, although this is relatively rare. Signs of infection include:

  • Foul-smelling yellowish discharge from the cord
  • Red skin around the base of the cord
  • Crying when you touch the cord or the skin next to it

When will it fall off? On average, the cord falls off after about 10 days but up to three weeks is considered within the normal range.  If it remains beyond three weeks, it’s time to follow-up with your pediatrician.

FUN WITH THE NEW ONE

Babies are a lot of work but that doesn’t mean you can’t have a little fun with them.  Newborns are packed full of entertaining instincts, hard-wired into their developing brains.  As they age, these instincts fade but they can be a the source of plenty of laughs for mom and dad while they last.

1. Palm Squeeze: If you squeeze a baby’s palms (gently, now), they will open up their mouth.  We still don’t know how this is useful but it invariably works.

2. Mouth Circles: If you swirl your finger around a baby’s mouth, it will open wider.  This reflex helps a baby latch on to mommy during breastfeeding.  If your baby isn’t latching well, give it a try to make sure they open up nice and wide before latching.

3. Rooting: If you stroke a baby’s cheek, they will move their head towards it and try to suck on it.  You can imagine how this is useful.

4. The Morro (a.k.a. startle reflex): If you startle a baby, their instinctual response is to throw their hands wildly out to the side.  You can instigate they by slightly lifting them up by their arms and letting go.  They looked totally freaked out but, remember, it’s just an instinct.

5. The Infamous Babinski: When firmly stroke the sole of their feet, the big toe bends back toward the top of the foot and the other toes fan out.  Adults will do the opposite (if you want to give it a try on your significant other although this is usually followed by a smack to the arm).


6. The Step: This reflex is also called the walking or dance reflex.  If you hold a baby upright with his/her feet touching a solid surface, they will appear to take steps or dance.  One of our favorites!

7. The Suck: When the roof of the baby’s mouth is touched, the baby will begin to suck. This is great for calming a crying baby in a pinch seeing as how it’s physically impossible to suck and cry simultaneously.

We’d like to leave you with a few words of encouragement, gleaned from our time in the newborn nursery.  First of all, as terrible as this sounds, babies are hard to kill.  They desperately want to survive, they are pre-programmed to survive, and they will do everything in their power to make that happen.   They have been surviving for thousands of years, before modern medicine ever existed.  Feed them, change their diapers, and shower them with love and they will thrive.  Yes, their bodies are delicate (i.e. do NOT drop your baby) but, overall, they are extremely resilient.   With a little food and love, they will grow into big people just like you.  Congratulations mom and dad!  Enjoy the journey.

Questions? E-mail the Author: goldman@myhousecallmd.com

References:

1. HealthyChildren.org. Ages & Stages: Baby. American Academy of Pediatrics.

2. Lucile Packard Children’s Hospital at Stanford University. Newborn Reflexes. Patient Educational Information.

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