The Newborn

PRENATAL PREPARATION

Advice

Once you announce to the world "We’re going to have a BABY!" you’re going to get lots of advice. It seems to become expert in babies; you just need to have one! Of course, all parents should become an expert...but only with their own baby. Don’t expect the advice, that your well-intentioned friends and relatives learned from their baby, to fit your baby. Your own parents will come the closest to advising you about their grandchild. But Grandma and Grandpa are under a lot of pressure...they feel like they should advise you, but it’s been 20-30 years since they had a baby in the house!

The Prenatal Visit with your Pediatrician

If you schedule a visit with us during your third trimester, we’ll be happy to discuss any question or concerns you have about our role in caring for your expected new arrival. This is an excellent opportunity to see if our philosophy matches your own. We’ll also assist you with learning what our role is in the hospital and what the charges are for our service. You pay your pediatrician to give you advice from their training in growth and development (and the wisdom of their long years of experience in seeing how that training applies to real kids.) You may also read the books written by the most knowledgeable of doctors, some of which are mentioned in a reference list at the end of this advice book. Still you need to exercise caution and judgment in accepting anyone’s advice...even the doctor's! This book and all other references from "experts" can only talk about the average child. In the final analysis, only you will become experts in this child. Meanwhile, if the advice doesn’t fit you and your family’s life style, throw it out and keep the baby!

NEWBORN CARE AND APPEARANCE

Several topics require immediate attention right after your baby is born. This is because a newborn baby has several unique features, more in keeping with a fetus than a baby. For the most part, your baby will only have these features for the first month or so of life. If you acquaint yourself with your newborn’s body, it will save you some worry later on.

WEIGHT. As soon as you learn the baby’s birth weight it starts going down. This weight loss may continue for the next 5- 7 days and be as much as a half-pound or more. The baby is wet at birth and when (s) he dries out he gets lighter. Moreover, Mother Nature knows newborns usually have to learn how to feed. Extra calories and water are stored during the last month of pregnancy. Even if your baby were not fed for 1-3 days after delivery, (s) he would use this extra weight for living.
HEAD. The newborn’s head is usually deformed by the pressures of labor, so that the bones which make-up the head overlap at first. After a few weeks the head will round up. The head also has 2 "soft spots," or fontanels, one in front and one behind. These are really not soft. These openings in the skull have extremely tough coverings, which are flexible and allow brain growth. They are very tough and must be flexible to allow the brain to grow. You can’t hurt the baby by touching and washing these soft spots.
SCALP. Cradle cap is a type of baby dandruff, which sticks to the scalp because of oily secretions. Simply shampooing, scrubbing, and avoiding oils can prevent this.
SKIN. Cradle cap may also be present on the face and shoulders as an oily rash. The newborn’s skin in general may not be very attractive. She will have many rashes, dry flakiness, and peeling as the newborn sheds its skin for the beautiful skin of an infant. Most of the time, this process requires nothing from you. Avoid powders, oils, and lotions, wiping and worrying. Soap and water are all that’s usually necessary. In the diaper area, removing the diaper and letting the baby dry naturally usually prevents and treats diaper rash. Diaper rash is no more common in one kind of diaper than another...it comes from diapers, all diapers.
EYES. Are usually not visible at all as the baby tries to avoid the glare of light. The eyes are usually puffy due to the pressures of labor. It is unusual for the eye to react to the modern ointment of Erythromycin placed in all babies’ eyes to prevent blindness due to venereal disease. These same pressures may cause tiny blood marks in the whites of the eyes, which are not serious and will fade. The eye color is gray now: you’ll see the final color in about 3 months.
EARS. Are frequently wrinkled at first. Only after a few weeks can you decide if you like their shape.
NOSE. Just before birth the baby was "breathing" water. The nose usually sounds stuffy, sneezes and snorts, as the baby gets used to breathing air. The hospital gives you the first bulb-syringe and for the next 2 years the only way to blow the baby’s nose is to use this gadget. You may need to drop some salt-water in the nostrils and suction gently with the bulb. You may buy saline nose drops or make your own by adding ½ tsp. salt to a cup of water.
BREASTS. Many parents are surprised when they find that mother’s hormones from the uterus make baby’s breasts enlarge. They may even give milk! Not to worry, as they will be gone in a couple of weeks only to reappear in about 10 years.
CORDS. The belly button or umbilicus unfortunately has this unsightly thing hanging out, which was the baby’s lifeline in the womb. We then paint this thing purple, not to improve its appearance, but hopefully to prevent infection. Most of the time if you did nothing, it would still fall off in 1-3 weeks. If you must do something, drop a little alcohol on it. This may keep the smell down, as it must rot to fall off. Avoid tub baths until it does and put off any decisions about "innies and outies" for another few months.
HANDS AND FEET. Are cute but the baby has no use for them unless she has learned to suck on his finger in the womb. Many babies are born with a sucking callus or blister. There is nothing you can or should do about this. Blue hands and feet are common for the first few days; babies are smart. They simply do not pump blood well to parts they don’t need. For accurate skin color, trust the lips and tongue...that’s where the action is!
GENITALS. The VAGINA will need to be cleaned by spreading the labia and rinsing with a moistened delicate cotton ball. You may find feces, a normal secretion called smegma, and in 1-3 weeks menstrual blood, from withdrawal of feminine hormones. The PENIS gets all the attention on the first day of birth, as parents ponder the great question, still groggy from labor. Circumcision is a religious custom for some, but it offers no proven medical benefit. For many, it has become a tradition, so that Jr. will look like Daddy or Brother, or whoever. The American Academy of Pediatrics and the College of Obstetrics and Gynecology have a joint statement that newborn circumcision is unnecessary. Still, we do it. When you give your permission for this minor cosmetic surgery, remember three things: (1) it is not medically necessary and only done for religious and cosmetic reasons, (2) it hurts the baby...he can feel, and (3) it is possible that you will like the way the baby penis looks, with or without circumcision. The choice is yours, but you should make an informed choice.
NERVES. You will be aware of your own nerves raising a baby, but you can go a long way toward calming a lot of your anxieties by understanding a newborn’s nervous system. The newborn’s nervous system is much like that of the fetus. This immature nervous system has several features not found in older infants: the startle reflex, the rooting reflex, the tonic neck reflex, and tetany, or twitching of the hands and feet. These are responsible for "kicking" in the womb and after birth are all accompanied by involuntary crying! These are not conscious movements, but are the same as a "knee jerk" in older people. They do not go away until after age 3 months.

INFANT CRYING

Nothing is more distressing to parents than a crying baby. That is as it should be. I often feel that Mother Nature builds babies with a "cry" so that they won’t be ignored. Unfortunately crying usually works too well. Let’s answer several questions parents ask about crying:

Why does my baby cry? Babies, of course, may cry because they are hungry, tired, uncomfortable, or in pain. It is difficult to convince new parents that their newborn may cry for no apparent reason. The best explanation for unexplained crying in the first 2-3 months of life is the infantile reflexes. All of these occur like an adult’s "knee-jerk"...a muscle contracts, then stretches, when stimulated. But in babies they all end with a cry! Understanding and controlling these reflexes decreases crying.
How do I decrease reflex crying? Rooting causes crying when the baby can’t fill the mouth when his cheeks are stroked. The tonic neck reflex causes the baby to cry anytime the neck is turned from the mid-line. The startle reflex occurs whenever the neck goes back, the knees pull up, or the arms go out. By wrapping the baby firmly with the legs down, the arms by the side, with nothing touching the cheeks, and with something in the mouth for sucking prevents these reflexes. Sounds complicated, doesn’t it? It Shouldn’t! The treatment has been used for a long time ... the Bible called the treatment for reflex crying "swaddling"...Indians used a "papoose." It still works!
Why won’t my baby tell me what’s wrong? Relax...communication with your child is a skill that both you and your baby must learn. Be patient with yourself and you will be amazed how you can begin to recognize what the different cries, looks and body language mean. Unfortunately, this language may be different with each child. Communication with your child begins with the first cry and certainly gets no easier by the time your child becomes an outspoken teenager.
Can I spoil my child? It’s a lot easier to spoil food! Frequently parents say this to mean they are teaching their child behavior they do not like. Six months has been called the "spoiling age." By this age your baby has learned from you all your teachings, but you have changed your mind by 9 months...no longer is it "cute."
Why does my baby cry at night? We know a lot about night crying. The newborn has never learned that "night" means "sleep"...remember those kicks when you were pregnant, which wakened you from a sound sleep? By teaching your new baby to expect care, feeding, and play at frequent intervals during DAYTIME (and avoiding baby at night) most babies learn to sleep through the night by 2 months. At 6 months the baby again cries at night, as it begins to spend more time at a lighter stage of sleep (and to perhaps dream). If parents respond appropriately, by limiting daytime naps and not rewarding night waking, this is a short period of 2-3 nights. Older children may sometimes need to re-learn their go-to-sleep technique. Parents can help by putting the child to bed awake, so he can learn how to go to sleep. Limit bedtime rituals to a brief story, a drink, rocking or soothing. If he "fights sleep" by crying, screaming, or banging his head, don’t worry. Really, the object is not to abandon him to let him cry himself to sleep, but to allow him the opportunity to learn. You cannot really teach him to stroke his face, rub his blanket, or to assume that position we all have learned which induces sleep. This he must do himself.
Why can’t doctors cure colic? The best definition of colic is a baby who cries inconsolably, but is healthy by every medical test. Of course it is important to rule out food intolerance and a painful medical illness, which may mimic colic. Doctors and parents need not feel guilty because they can’t manage their colicky infants. It may not be our faults; indeed many doctors think colic may be inborn! Dr. T. Berry Brazelton became famous with his Personality Index for Infants. Dr. Brazelton has devised a way to predict lifelong personality types in the first days of life. These range from hyperactive, easy to stimulate, easy to cry infants to easy-going, slow-moving contented babies. The jittery newborn, who cries easily and demands a lot of attention from his parents, may have screaming fits. These fits may not match his parents concept of a baby; they feel guilty that maybe they are raising a monster! Understanding that this trait is inborn may help them tolerate the crying spells. Understanding the child’s personality and helping to channel that personality positively may reap its rewards. The easily stimulated infant frequently grows into a bright easily motivated child, eager to learn and to please.

INFANT FEEDING

BREAST OR BOTTLE feeding is a personal decision. Breast milk is not necessarily the only way to feed your baby. Modern formulas have been developed to simulate breast milk. The most important thing is that families be comfortable with their babies. It is not even important that you make a decision before the baby. Many parents decide to give their babies breast and bottle at first and then choose the method that works best in their family.... kids are usually a lot more flexible than we are!

BREAST FEEDING

Before you decide how you will feed your baby, you may want to consider the advantages of breast-feeding for both baby and mother. Many factors will enter into your decision - the attitudes of your obstetrician, your pediatrician, your husband, your lifestyle, your personality, and your feelings about mothering. You may want to breast feed, but have many questions that neither your mother nor your friends can answer accurately. This is a real good topic to discuss with your obstetrician and the pediatrician you have selected before your baby arrives.

Nursing a baby often fulfills an instinctive drive for the new mother, and a great deal has been written and said for the psychological benefits the baby derives from breast feeding. The husband’s encouragement is vital to the success of the nursing mother, and if given, provides an excellent time to build and strengthen the bond they already share through his love and support. Nursing an infant can also be a very educational experience for an older child, giving mother a perfect opportunity to provide some elementary sex education in an easy, natural way. The child who observes his little brother or sister at the breast learns some of the biological differences between men and women, and gains a sense of the function and beauty of the human body.

There is nothing complicated about breast-feeding. An important factor to the success of the nursing mother is a degree of encouragement exhibited by husband, friends, physicians, and relatives. Three other very important factors are

Knowledge about breast feeding
Confidence that you are doing the right thing for your baby and yourself
Determination to persist in the face of any minor setbacks that you may encounter.

The first 3 days after birth: you will produce very little breast milk. During these first few days, babies do not require much milk. However, the thin, watery fluid is rich in antibodies and works to prevent infection in the newborn. During this time, you’ll be tempted to give up because "the baby seems hungry and isn’t getting anything!" Actually, the baby is not hungry, as she has never eaten before. Gnawing and sucking are normal reflexes in a newborn and are not necessarily related to a need for food. Your milk may come in all of a sudden. Some may experience engorgement and leaking; now the baby learns what milk is and may attempt to nurse continuously. Again you may be tempted to stop nursing now because you have too much milk. If you’re patient, supply begins to equal the baby’s demands by the 3-4^th week and things level out.

How Much and When?

I like to think that breast-feeding provides both nourishment and nurturing. It is impossible to tell you how often, and how much to feed your baby. A good rule of thumb is that you are the best judge of "how often" and the baby is the best judge of "how much". Start nursing on day 1 for about 3-5 minutes on each breast every 3-5 hours. Work up to about 10-15 minutes on each breast every 3-5 hours and continue nursing for as long as you enjoy it. In this way, you will be providing all the nourishment your baby requires. Now for the nurturing...you can always pacify your crying baby by putting your nipple in his (her) mouth. How often you soothe your baby depends on your other time demands. This is can be a very pleasurable time for both mother and baby. But a word of caution; don’t confuse the nourishing and the nurturing. You can teach a baby to expect your breast whenever it cries.

Working mothers may chose to begin the baby on a bottle feeding once or twice a day during the working hours at 4-5 weeks of age or a week before returning to work. In this way, you may continue to nurse. The key is a gradual change so that your breasts adjust to any changes in demand with supply slowly over 1-2 weeks. If your baby is flexible, she will readily accept a bottle if the breast is unavailable. Stubborn babies sometimes require stubborn moms!

Formulas

Fortunately, in the United States, every mother has the option to choose the way she will feed her baby, whether it is the breast or one of the many formulas available today. Besides the psychological advantages, breast milk offers some immunity from diseases, especially in the first few weeks. Most prepared infant formulas today simulate the nutritional advantages of breast milk. As we learn what the composition of foods and minerals are in breast milk, formulas are continuously altered to resemble nature as closely as possible. Indeed, the continuing argument among various manufacturers is which of their products is most like breast milk.

If your time demands, family lifestyle, work, or personal preferences do not permit breast feeding, rest assured a formula such as SIMILAC or ISOMIL will provide excellent nourishment for your child. We usually choose the ROSS FORMULA SYSTEM, because we’ve had the most successful experiences with these products. All babies cannot tolerate all formulas. However, most infant behaviors, crying, spitting up, gas, and diarrhea are not caused by the formula. Because of the possibility of illness, it is usually best to discuss symptoms with your doctor before getting on the Formula Switching merry-go-round.

A modified demand feeding schedule is recommended. Feed the baby when she’s hungry, but remember it takes 3-4 hours for the stomach to empty. Most babies who cry more often need soothing or pacifying. However, it is all too easy to get in a sip and sleep pattern every ½ hour. This is fine for the baby’s nourishment, but is exhausting for parents! Sterilization may not be necessary with modern city water systems; if in doubt discuss this with us. Some babies do not demand that their bottle be warmed. The recent development of easily prepared powdered formula seems the easiest way to bottle feed, as it is only necessary to add a sufficient amount of powder, adjust the temperature of the water tap, shake and go. There is usually no need for a separate sterilizer, bottled water, and formulas that you must prepare and refrigerate a day ahead of time. Begin by offering your baby 2 oz. of formula at a time. Increase if there is no formula left after feeding. Again, baby is the best judge of how much; you are the best judge of what and when.

INFANT SAFETY

In the crib, it is easier for your baby to control vomiting without choking if you position your baby lying flat on the stomach, or turned on the left side. Recent evidence, however, suggests that babies placed on their backs have a lower incidence of Sudden Infant Death or SIDS. Most babies are more comfortable when wrapped tightly to simulate the womb; this also provides a measure of safe control. Never leave your baby unattended on a high place. The first time most infants roll over, they usually hit the floor.

Don’t Smoke Near your Baby! We know now that passive inhalation of tobacco smoke by babies is a leading cause of bronchitis in infancy. Smoking by adult family members around the baby is also a leading cause of a whole host of respiratory diseases such as ear infections, and is especially bad on allergic kids.

A word about crib death...this is properly called Sudden Infant Death. For unknown causes, a healthy infant dies quietly in his sleep. This is a parent’s deepest fear for his baby. Let’s look at this horror: we must understand that although much is known about SIDS, medical science doesn’t know the cause or prevention. Parents never cause this to happen; they cannot prevent it (nor can doctors.)