Newborn Care

PREVENTING FATIGUE & EXHAUSTION

For most new parents the first weeks at home with a new baby are often the hardest in their lives.  You will probably feel overworked, even overwhelmed.  Inadequate sleep will leave you fatigued.  You may wonder if you will ever catch up on your rest or work.  The solution is asking for help.  Ideally, you were able to make arrangements for help before your baby was born.  Clarify that your role is looking after your baby.  Your helper’s role is to shop, cook, houseclean and wash cloths and dishes.  If your newborn has a medical problem that requires special care, your doctor may arrange for home visits by a health professional.

The way to avoid sleep deprivation is to get your sleep in bits and pieces.  Go to bed earlier in the evening.  When baby naps you should also nap.  If you don’t take care of yourself, you won’t be able to take care of your baby. 

POSTPARTUM BLUES

Postpartum blues may occur in the days following delivery.  The symptoms include tearfulness, tiredness, sadness and difficulty in thinking clearly.  The main cause of this temporary reaction is due to hormonal changes.  Many mothers feel let down and guilty about these symptoms because they have been let to believe they should be overjoyed about caring for their newborn.  In any event, these symptoms usually clear in 1 to 3 weeks as the hormone levels return to normal and the mother develops routines and a sense of control over her life.  There are several ways to copy with the postpartum blues:

• Acknowledge your feelings.  Discuss them with your partner or someone close to you.
• Get adequate rest.
• Get help with your work.
• Interact with other people and other parents; don’t become isolated.  Get out of the house at least once a week.
• By the third week, setting aside an evening a week for a “date” with your partner is also helpful.

If you have severe symptoms such as thoughts of harming yourself or your baby or don’t feel better by the time your baby is 1 month old, talk to your doctor.

VISITORS

Only close friends and relatives should visit you during your first month at home.  They should not visit if they are sick.  During visits the visitor should pay special attention to older siblings.

NEWBORN DEVELOPMENT & NORMAL ACTIVITY

Each child is unique.  While certain behaviors and physical milestones tend to occur at certain ages, a wide spectrum of growth and behavior for each age is normal.

Babies do many things like cry, grasp, yawn, suck, swallow, blink, cough, gag, sneeze, hiccup, burp and pass gas.  Some actions are reflexes like:

• Grasps whatever is placed in hand
• Sucks whatever is placed in mouth
• Is startled by sudden noises and movements

Your baby’s movements will be mostly jerky, uncontrolled motions like waving arms, kicking legs, with lots of wiggles and squirms.  Newborns may turn their head from side to side while lying on their tummy.  Newborns cannot turn their body or support their head without assistance, and cannot sit without support.  Your baby can see but cannot focus clearly.  A newborn sees best at 8 to 10 inches.

Your baby will smile spontaneously, discriminate between some smells, will begin to turn in direction of sounds, and begin to distinguish the human voice from other sounds.  Your baby may be more sensitive to high-pitched voices, especially the mother’s voice.  It is normal for your baby to cry a lot.  Your baby is best calmed by a soft, rhythmic voice, and may tiny gurgling sounds when content.

CRYING

Crying is the only way your baby has to talk to you.  Crying babies need to be held.  They need someone with a soothing voice and a soothing touch.  You can’t spoil your baby during the early months of life.  You will soon learn to distinguish your baby’s cry, and know what your baby needs.  Trust your instincts.

FEEDING

All babies lose some weight during the first few days after birth.  Most bottle-fed babies are back to birth weight by 10 days of age, and breast-fed babies by 14 days of age.  Then infants gain approximately an ounce per day during the early months.  The normal newborn’s hunger drive ensures appropriate weight gain.  Know your baby’s feeding cues such as:

• Turning his head toward whatever is close, mouth open, searching for a nipple
• Sucks his fingers or fists
• Fusses or cries

Breast milk is the best nutrition for your baby.  A breast fed baby should eat every 2 to 3 hours, while a bottle fed baby should eat 2 to 3 ounces of formula fortified with iron every 3 to 4 hours.  In the newborn period you should not let your baby go more than four hours without food.  You may need to wake your baby during the night for these feedings.  You can tell if your baby is getting enough to eat if there are at least 6 wet diapers each day and 3 or more soft stools per day.  Contact your doctor if you are concerned about your baby’s eating patterns.

SLEEP

It is important to make sure your baby has a safe place to sleep.

Crib Safety:

• Space between the crib bars should be less than 2 3/8 inches (about 4 adult fingers, or less that the width of a soda can).
• Mattress should fit tight so the baby cannot be trapped between the mattress and the sides of the crib (no wider that 2 adult fingers).
• Keep plastic bags, cords and drapery away from your baby’s crib.  Keep blankets, pillows, stuffed animals and toys away from your baby’s head.

Family Bed:

You might choose to have your newborn sleep with you in your bed.  It is especially convenient during the newborn period because babies wake up less often when they sleep with their mothers and it is easier to keep a close watch on the baby.  If you are breastfeeding, you will not have to get up to feed the baby.  It is not safe to have the babe sleep with you if:

• you have a waterbed
• you drink alcohol or use any other drugs including tobacco
• you are taking any medications which may make you drowsy (like pain medicines, etc.)

Remember to place your baby on his back to sleep.

Newborns sleep a lot, about 16 hours per day on average.  Don’t be surprised if your baby has days and nights reversed during the first few weeks.  Soon your baby will adjust to a regular sleep schedule.  Getting enough rest is important for you and your baby.

SAFETY TIPS

• Always use a car seat.  At this age your baby should be in the back seat, facing the rear.  Never place your baby in the front seat of a car, especially if it has a passenger side air bag.
• The safest place for your baby is in your arms.  When she cannot be in your arms, make sure she is away from danger of falling, pets, young children, and other hazards. 
• Maintain a smoke-free environment.  If you smoke, ask your doctor about ways to help you quit.  Even if you smoke outside, your baby is exposed to smoke from residue left on your clothes, skin and hair.
• Know the signs of possible illness in a newborn:
  • Fever – a rectal temperature greater that 100.4▫ F is considered an emergency at this age.  Call your doctor immediately.
  • Difficulty with breathing:  wheezing, grunting, nostrils flare, skin or lips look blue or gray, outlines of the ribs visible if your baby is working hard to breathe.
  • Sleeping more than normal, or acting lethargic
  • Difficulty feeding
  • Severe or worsening jaundice

WELL CHILD VISITS

It is important for your doctor to see your baby regularly to make sure you and your baby are doing well.  Try to develop a habit of jotting down questions about your child’s health or behavior at home and bring this list with you to office visits to discuss with the physician.  If at all possible, both the mother and father should go to these visits.  Most physicians prefer to get to know both parents during a checkup rather than during the crisis of an acute illness.

CALL YOUR CHILD’S DOCTOR IF:

• Your baby shows any signs of illness
• Your baby is not eating well

You can reach a doctor 24 hours a day by calling: 406-862-2515

IMMUNIZATIONS & NEXT DOCTOR VISIT

At this point there are no immunizations which need to be given.  Your baby should have received her first Hepatitis B immunization in the hospital.  Your baby may have blood drawn to test for genetic and metabolic abnormalities at today’s visit (the 2nd in a two part test) if you were released from the hospital before your baby was 48 hours old.

Your baby’s next appointment will usually be at the age of 2 weeks, unless your doctor advises differently.

2-Weeks Care

LEARNING WITH YOUR BABY

By now you are getting to know your baby. Do not worry that your baby is not exactly like other babies as each is different.  In these early weeks your baby changes every day.  It is hard to know what to expect.  Sometimes you might not know what your baby needs or what to do when your baby cries.  It is normal to feel uncertain and overwhelmed.  Soon you will see patterns in your baby’s eating and sleeping.  You will know a hungry cry from a wet cry from a hurt cry.  Trust yourself.  You will learn from each other.

You are your baby’s first and most important teacher.  Hold your baby.  Talk to him.  Show him his world.  Some parts of your baby’s brain were complete at birth.  However, much of his brain will be shaped by what he sees, hears, touches, smells and tastes every day.  If your baby does not use his brain, it will not grow normally.

DEVELOPMENT AND NORMAL ACTIVITY

At this stage, your baby’s movements gradually become smoother and more controlled.  When babies are placed on their stomach, they usually make attempts to lift their chin for a few seconds; however they cannot support their head without assistance.  Young babies will grasp whatever is placed in their hands.

Babies at this age can focus on objects from eight to twelve inches away which is roughly the distance from their eyes to the face of a person who is feeding or holding them.  They also seem to have a natural liking for human faces and will make eye contact with you.  Your baby may smile socially at familiar faces and voices, especially her mother’s voice.  Babies will follow some moving objects with their eyes and turn in direction of some sounds.

Newborns can taste and smell from the time of their birth and tend to have odors they prefer.  In fact their preference for the aroma of their own mother is well known.

FEEDING

Your baby is growing!  Your baby should have surpassed his birth weight by now.  At this age, a baby only needs breast milk or iron fortified infant formula.

Breast-fed babies should feed for at least 15 to 20 minutes at each breast during each feeding which may occur as often as every 2 hours.  Many new mothers feel awkward with breastfeeding at the start.  Stick with it!  It is the best nutrition for your baby, and good for you too!  Talk to your doctor if you are struggling with breast feeding – help is available.

Bottle fed infants should be given only iron fortified infant formula as regular milk does not contain the necessary nutrients important for babies.  Bottle-fed babies take 2 to 3 ounces of formula every 2 to 3 hours now.  If your baby wants to feed more often, try a pacifier as your baby may need to suck but not feed.  Know your baby’s way of telling you she is full.  Remember to only prepare formula in the amount you expect your baby to drink at one feeding.  A bottle that is left at room temperature for more than 2 hours may grow bacteria that can make your baby sick.  It is important to hold your baby during feeding.  Hold the bottle and do not prop it up.  Never heat your baby’s bottle in the microwave.

Mixing formula:  If you use concentrated liquid formula, always mix 1 can of formula with 1 can of tap water.  Keep the mixture in the refrigerator.  If you get powdered formula, mix 2 ounces of water per 1 scoop of formula.  Never dilute the formula to make quantities last longer as this can be harmful to your baby.

CRYING

Crying is a signal that your baby needs something.  When you respond quickly to his cries, you teach your baby that he can trust you and other people.  He learns that he is safe and that you love him.  When your baby cries, pick him up.  Babies usually respond positively to being held, comforted and soft talk.  At this age, you cannot “spoil” a baby by holding him.  With time you will learn that your baby cries differently for different needs (hunger, tired, wet, bored, over-stimulated).  Your baby will make a variety of gurgling and cooing sounds when happy and content.
Never shake or hit your baby.  This can cause permanent brain damage.  If you think you might hurt your baby, put her down in her crib and call a relative, friend, or someone else for help.

SLEEP

Babies usually sleep 16 or more hours a day but may display a wide range of alertness and sleepiness.  They may be noisy and active or lie quietly.  During deep sleep, their frequent eye movements are visible behind closed eyelids.  They may have some body movement and changes in facial expression. , and their breathing rhythm may change.  You should try to sleep when your baby sleeps to avoid excessive fatigue.  Don’t be surprised if your infant has days and nights reversed during the first few weeks.  This well gradually change as your infant becomes used to the pattern of sleep in your house.

Healthy babies should be placed in bed on their backs.  This recommendation is based on information that shows that sleeping on the back reduces the risk of sudden infant death syndrome (SIDS or “crib death”).

STOOLING AND VOIDING

Most babies will strain to pass bowel movements.  As long as the bowel movement is soft, there is no need to worry.  Your baby’s stool (poop) will look yellowish and seedy.  Breast-fed babies will often have 6 to 8 stools or more per day.  This is not diarrhea.  Your baby may also pass a lot of gas.  This is normal.  Ask your doctor about bowel movements that are hard (constipation).  Babies usually wet the diaper at least 6 times each day.  Keeping your baby dry will help prevent diaper rashes.

TAKING YOUR BABY OUTDOORS

Dress the baby with at least as many layers of clothing as an adult would wear for the outdoor temperature.  It is a good idea to carry extra blankets with you.  A common mistake is overdressing a baby is summer.  In winter, a baby needs a hat to protect against heat loss.  Cold air or winds do not cause colds, ear infections or pneumonia.

The skin of babies is more sensitive to the sun than the skin of older children.  Avoid all direct sun exposure to your infant’s skin.  Protect your baby’s skin from sunburn with longer clothing, a bonnet or hat, and sunscreen.

Camping and crowds should probably be avoided during your baby’s first month of life.  Also, during your baby’s first year of life try to avoid close contact with people who are sick because your baby can catch illnesses easily.

SIGNS OF ILLNESS

Call your doctor if you notice any of the following:

• Fever – a rectal temperature greater than 100.4⁰ F is considered an emergency at this age.
• Difficulty with breathing: wheezing, grunting, nostrils flare; skin or lips look blue or gray, outlines of the ribs visible if your baby is working hard to breathe.
• Sleeping more than normal, or acting lethargic

SAFETY TIPS

• The safest place for your baby is in your arms.  When she cannot be in your arms, make sure she is away from danger of falling, pets, young children and other hazards.
• An approved car seat is the safest way for babies to travel in cars and is required by law.  Infant car seats should be placed in a back seat with the infant facing backwards.  Never leave your baby alone or with young brothers, sisters, or pets in the car.
• If you use a crib for your baby be sure to pick a safe location.  It should not be too near a heater or cords and strings.  Make sure the sides are always completely up and that the mattress fits appropriately.  Crib slats more than 2 3/8 inches apart can lead to injury. 
• Keep plastic bags, strings, cords, and pillows away from your baby.
• Mesh netting of playpens should always be in the upright position.
• Make sure your home has working fire alarms and carbon monoxide detectors.
• Turn down the thermostat on the hot water heater to 120⁰ F.
• Never leave your baby alone in the bathtub.
• Quit smoking.  Your baby is more likely to get sick or die from Sudden Infant Death Syndrome (SIDS) if you smoke

CALL YOUR CHILD’S DOCTOR IF:

• Your child develops a fever or other signs of illness.
• Your child is very irritable and you cannot calm him.

You can reach a doctor 24 hours a day by calling: 406-862-2515

IMMUNIZATIONS & NEXT DOCTOR VISIT

At this point there are no immunizations which need to be given. Your baby’s next appointment will usually be at the age of 1 month, unless your doctor advises differently. Your baby usually will not get any immunizations or shots at that visit.

WHAT TO EXPECT

In the next few weeks your baby will become more active and more aware of the world around him. You may see that your baby is clearly more comfortable with familiar persons than with strangers. Most babies cry about 3 to 4 hours per day with a peak in crying behavior occurring at about 6 weeks of age. Your baby will continue to develop a smile, especially when she is feeling good. Sleep will still occupy most of your baby’s time, and the periods of sleep will grow longer.