Today is the day-the day you have spent the last 9 months preparing for-the day to bring your newborn home from the hospital. But this day and the days that follow bring with them many questions about what is and what is not normal.
Here is the ‘head to toe newborn chat’ I give to all of my patients on discharge day from the hospital. It answers the questions I am most frequently asked at the first office visit. I hope it puts your mind at ease and helps make the transition to new parenthood easier.
First, we will start at the head: All babies have “soft spots” or fontanelles. They are present to allow for the brain to grow inside of the skull. The fontanelle that is easiest to feel is the anterior fontanelle, or the one in the front. It is usually open until 15 months of age. You can touch it gently-you will see your pediatrician do this at practically every visit. Even though there is no bony protection over the fontanelle, there is still padding so you don’t have to worry about causing injury to your child with gentle touching.
Moving down to the eyes: It is normal for babies’ eyes to cross in the first six months of life. It takes time for them to develop proper muscle control over their eyes. If it persists after 6 months, talk to your pediatrician about it.
You won’t know your babies eye color at birth. Usually by 6-12 months, the eyes will reach their permanent color.
Many babies have watery and even goopy discharge from the eye. Often times this is caused by a clogged tear duct (also called dacrosynostosis). In this instance, the white part of the eye remains white. If this is the case, you can massage the little duct located between the eye and the nose and wipe away any tears or discharge with a wet cotton ball. A clogged tear duct can come and go, but should resolve by 9 months. If you are still seeing watery eyes at that age, talk to your pediatrician about seeing an opthamologist (or eye doctor).
If the white part of the eye becomes red, then it’s possible your baby has developed ‘pink-eye’ or conjunctivitis. This may require treatment so be sure to contact your pediatrician.
Moving down to the nose: Sneezing is perfectly normal in newborns. It does not necessarily mean they have a cold or that they are cold. Their nasal passages are small and even tiny dust particles can cause them to sneeze.
Moving down to the mouth: Hiccups are also perfectly normal. You don’t need to feed your baby or give him water. Just comfort him. They will resolve on their own.
If you are breastfeeding your baby, it’s hard to know how much milk the baby is getting. It’s definitely a leap-of-faith for many moms! Be sure to look for at least 4 wet diapers a day. As long as you are seeing wet diapers , and your baby is gaining weight at doctor visits, she is most likely getting enough milk.
Most breastfed babies poop almost every feeding but not all. I am frequently asked by my patients about constipation. My definition of constipation has much more to do with the consistency of the stool than the frequency. As long as the stool is soft, it’s not constipation.
Many parents also ask about nighttime feedings. My general rule of thumb for a full term baby is to awaken the baby for feedings at least every 4 hours until the baby has returned to birth weight. All babies loose weight in the first few days after birth. Until your pediatrician has confirmed adequate weight gain, you want to maximize the number of daily feedings. After that, my rule is to never wake a sleeping baby at night.
A caveat: this may not be the case for a premature baby, so in that case, speak to your pediatrician.
A word about burping: Not all babies are the best burpers, especially if they are being breasfed. Give it a minute or two, if your baby doesn’t burp you can put him or her down. You don’t want to spend 45 minutes in the middle of the night trying to burp your baby before putting him back to sleep-you will be one tired parent!
Moving down to the belly: All babies must sleep on their backs. There is an increased risk of sudden infant death syndrome, or SIDS, in babies who sleep on their bellies.
The umbilical cord: It usually falls off in the first two weeks of life. In the meantime, just keep it clean. Some hospitals recommend cleaning it with alcohol and others do not. As long as it remains clean and dry, it should fall off on its own without any problems.
Until the cord falls off, you want to only give the baby a sponge bath. Once the cord is off, wait a day or two and then you can give your baby the first tub-bath. Make sure that if you are bathing in the kitchen sink that the faucet is turned away from the baby so that he or she cannot accidentally turn on the hot water with a good kick.
For bathing, use a mild soap and water. Even though many newborns have dry skin, you do not need to use moisturizer. This can sometimes be irritating to sensitive skin.
Moving down to the diaper area: For the first month of the baby’s life, I recommend using cotton balls and water instead of baby wipes. It reduces the risk of a diaper rash during this sensitive time. However, keep wipes in the diaper bag. If you are on the go, it’s okay to use them-even during the first month.
A mild diaper cream will create a protective layer between the baby’s skin and the moist diaper. If your baby seems prone to diaper rashes, talk to your pediatrician about a good thick barrier diaper cream.
Dressing your baby: My general rule of thumb is to dress your baby in one more layer of clothing than you would comfortably wear. Babies have a harder time maintaining body temperature than adults, but one extra layer is usually sufficient to keep the baby warm.
When can we go outside?: I recommend that a newborn baby be kept out of public places for the first 6-8 weeks of her life. This includes grocery stores, restaurants, and major family functions. If it’s a beautiful day and you want to take the baby for a walk, that is okay. Just keep admirers at a distance. It’s the germs, not the outside air that are a risk to the baby.
A word about fever: If your baby feels warm or isn’t acting right, take a rectal temperature. I recommend a digital thermometer. If the reading is 100.4 degrees Fahrenheit or more in the first two months of life, call your doctor, even if it’s the middle of the night. Do not give a fever reducer without talking to your pediatrician during this time period.
To protect your newborn baby from getting a fever, make sure that everyone washes their hands (including Mom and Dad) before holding the baby. Keep anyone who isn’t feeling well away. And remember viruses are contagious the day before the symptoms emerge so it’s always smart to avoid contact with young children until the baby is 2 month old. Of course, siblings are excluded from this recommendation!