Newborn Care

General Characteristics of Behavior of the Newborn

1. Sleeping

You will notice that your baby has different stages of sleep.  Babies slip in and out of these stages frequently while sleeping.  During deep sleep he will not wake easily and not move much.  During light sleep you will often notice eye movements, arm and leg movements and sucking. Your baby may be restless and wake from time to time and cry.  Give him a chance to go back to sleep if it is not a feeding time.  His breathing may be noisy or quiet and this is something you will get used to in time.  Wrapping your baby in a blanket may make him feel more comfortable for sleeping.  The amount of time a newborn spends sleeping varies greatly. Do not be surprised if your baby sleeps more or less than you had anticipated.

The American Academy of Pediatrics recommends sleeping on the back (facing up) as the safest position to prevent crib death (SIDS) in infants.

2.  Eating

Be relaxed and have a lot of time when you are feeding your baby.  If you are rushed or upset, she may not feed well.  The breast milk or formula alone will be sufficient nutrition for your baby for the first four to six months.  Some babies are slow and some are fast eaters, so there is no set length of time for feeding (see infant feeding).

3.  Burping

Some babies burp easily; others do not.  It is not essential that the baby burp if he is comfortable and happy.  To burp the baby, hold him up on your towel-covered shoulder and gently pat his back.  You may also sit him on your lap with one hand under his chin for support and the other gently patting his back while you rock him.  If he eats too fast, remove the nipple after every 1-2 minutes and burp him.  When offering a bottle to the baby, make sure the bottle is tipped up so that the milk covers the entire nipple while he is sucking.  This will prevent the entrance of air into the stomach and the discomfort that it may cause.  Bottles with plastic bag inserts may result in less air being swallowed.

4.  Spitting

All babies will spit mouthfuls of food from time to time and occasionally vomit most of a meal.  If this is a persistent problem, please call us. If the baby is gaining weight you need not worry.  Spitting may persist for several months, but it should improve when the baby is spending more time sitting and standing.  Keeping an infant sitting upright and not passing her around after feedings may lessen this problem.

5.  Hiccups

These are normal and often occur after feeding or burping.  They may last for 5-15 minutes or more.  You may be able to stop them by feeding a bit more or re-burping the baby.

6.  Crying

Crying is your baby’s means of communicating with you.  There are many reasons babies cry: hunger, thirst, discomfort, etc.  Babies also cry when they need to be held and cuddled. That is why your baby will often stop crying when you pick him up.  Do not feel that you are spoiling him by picking him up when he cries during the first 3 to 4 months.  His need to be close to you is just as important as his other physical needs.  On the other hand, there is no reason why your baby cannot be left to fuss for 10-15 minutes if you have checked him to be sure that there is nothing wrong.  Some babies cry just before sleeping as a tension outlet.  Your baby has different cries and you will soon learn to tell them apart.

7.  Bowel Habits

Each baby will establish her own bowel habits and they may not be what you expect. Breast-fed babies will often have frequent loose, seedy, yellow stools.  They may have one or two stools after each feeding! They almost never have constipation. Formula-fed babies’ stools are often darker and more formed.  Some babies can go a full week between bowel movements but as long as they are not so hard as to make the baby uncomfortable, no treatment is needed.

8.  Activity

Your baby may constantly be moving, so crib bumpers are often recommended.  Never leave your baby alone on the bed, changing table, etc. since one never knows when he might roll himself over and fall.  But do allow him room to move.  Do not dress or wrap him too tightly once he is active in his crib

9. “Belly Time”

Since babies are sleeping on their backs, and they often prefer to stay on their backs when awake, it is important to give them some “belly time” on a regular basis. A few times a day put the baby on his belly while you are with him. This encourages development of upper body strength and reduces flattening of the back of the skull. Begin this from the time you take the baby home from the nursery (otherwise he won’t like it!).

General Physical Characteristics of the Newborn

1.  Jaundice

Many babies have a yellow color (jaundice) to their skin starting on the second day of life. This usually begins to disappear in a few days. If it increases in intensity or persists, we should be notified. Most serious forms of jaundice will be diagnosed and treated prior to discharge from the nursery.

2.  Cradle Cap

A flaky white or yellow waxy scale may appear on the scalp soon after birth. This is usually due to immature oil glands, a temporary condition.  Cradle cap is also aggravated by the use of ointments and petroleum jelly.  One recommended treatment is to wash daily with baby shampoo and use a soft brush to remove some of the scale. It will usually disappear on its own over a period of time. Sometimes a medicated preparation such as Sebulex shampoo may be needed for the more stubborn cases, but unless the baby is uncomfortable it is usually not necessary to treat.

3.  Facial Rash

The most common facial rash is due to the baby rubbing her face on a wet surface.   It looks like a burned red area, such as one might see in chapping or sunburn.  To treat, try to avoid having the baby’s face come into prolonged contact with her own saliva.  Place a cloth diaper or pillowcase under the baby’s head and change it frequently to keep her face dry. Applying petroleum jelly or Aquaphor to the affected area (after you have dried it thoroughly) may also help.

Another type of rash is called milia.  This looks like many small pimples scattered over the face and is caused by unopened pores.  Treat simply by washing the face gently with warm water.  Do not try to squeeze the pimples.

There are several other facial rashes that commonly appear during infancy.  Most are not worrisome and resolve on their own, but do call us if you have any concerns.

4.  Eyes

Your child can distinguish lightness and darkness from birth.  His vision is best close-up (12-18 inches). He will enjoy looking at brightly-colored objects and smiling faces.

Yellow material may collect in the corner of your baby’s eyes until the tear ducts fully open. This usually happens between 6 weeks to 6 months or longer.  You can clean by wiping gently from the inner corner of the eye outward with clear water and cotton.   Discuss this with us at your baby’s first check-up, but do call us sooner if the white of the eye becomes red or the eyelids become swollen.

A red flame-like spot is seen on the white of the eye in some babies soon after birth. This is a broken blood vessel and is harmless; it will not affect vision. It may take some time to disappear but requires no treatment.
Your baby may occasionally appear to look cross-eyed during the first few months.   If this becomes more frequent with time or persists after 4-5 months please discuss it with us.

5.  Nose

Crusted nasal secretions are common in infants and can be removed safely with a damp washcloth.  Never use a Q-tip inserted into the nostril.  If the nose becomes stuffy you can usually help to clear it by placing 1-2 drops of saltwater nose drops (brand names are Ocean, Nasal, etc.)in one nostril at a time, waiting a few seconds, and then gently suctioning with a small bulb syringe (given to you in the nursery or available at most pharmacies).   A cool-mist vaporizer in the baby’s room may also be helpful (see section on colds).

6.  Ears

The outer ear may be cleaned with a damp washcloth. Never use a Q-tip to clean your child’s ear canal.  The wax in her ear serves an important function and will come out naturally on its own. Do not attempt to remove it yourself.  Nothing smaller than your elbow should ever be inserted into your child’s ear!!

7.  Mouth

A yeast infection (thrush) is quite common in the first few months of life.  It looks like milk curds on the inside of the cheeks, lips and gums.  If a Q-tip does not easily remove them this is probably thrush and you should have the baby seen by us for evaluation and treatment.

8.  Breasts

The newborn’s breasts may be enlarged (both boys and girls). This is due to the mother’s hormones and is a benign temporary condition. If the breasts are left alone the swelling will disappear more rapidly. If the breasts appear enlarged, but also red, warm or tender, please call us.

9.  Navel (Umbilicus)

It is important to keep the navel clean and dry. Bathing the area is now considered OK. You can gently clean around the stump with a Q-tip but alcohol is no longer recommended for routine care.  When diapering, try to keep the diaper folded below the navel to keep it drier and to prevent the diaper from rubbing against it. The umbilical cord stump should fall off after 1-3 weeks if kept clean and dry. Please contact us if you notice any abnormal redness, swelling, odor or pus around the healing navel.

10.  Genitals

Female: Wash the area with mild soap and rinse well with clear water, always wiping from front to back. A whitish discharge may be seen for the first few weeks and some spotting of blood may appear. These are due to release from the mother’s hormones and indicate that the baby has a normal genital tract.

Male: The circumcised penis should be washed gently with mild soap and water.  A thin layer of petroleum jelly may be placed over the healing area with each diaper change until it is no longer sore or raw-looking. Petroleum jelly should be purchased in a tube, rather than a jar, to keep it cleaner. The skin around the circumcision can be pulled back gently to prevent adhesions and for cleaning.  The uncircumcised foreskin should only be retracted very gently (as far as is comfortable) for cleaning. Vigorous retraction is not necessary and should not be attempted during the first few years.

11.  Skin

Do not be afraid to use mild soap (Dove, Neutrogena, etc.) and water.

The skin folds should be kept clean and dry, especially the armpits, neck and diaper areas. If there is no diaper rash and the baby is comfortable, routine diaper changes can be made when convenient.

If your baby does have a diaper rash, change him very frequently, washing the area each time with mild soap and water (not diaper wipes).  Let the area be exposed to the air for as much time as possible.   If the rash is red but dry, you may use a protective ointment such as A&D, Desitin, etc., but more severe rashes or any rash lasting more than 5 days should be discussed with us.

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