THE FIRST FOUR WEEKS
JAUNDICE: It is normal for the skin of most healthy newborns to become a little yellow in color starting on the second or third day of life. Occasionally the yellowness or jaundice becomes too extreme and needs to be treated. If your baby appears more yellow after discharge from the hospital, please call our office.
POSITIONING YOUR BABY: Always have your baby sleep on a firm, flat surface. Never leave your baby sleeping on a pillow, waterbed, sheepskin or fluffy comforter. We recommend that you position your baby on his or her back when you are leaving your baby to sleep. This has been shown to decrease the incidence of SIDS (Sudden Infant Death Syndrome). When you are playing with your baby you may use the tummy position.
BREASTFEEDING: We fully endorse breastmilk as the optimal infant food. Allow your baby to breastfeed quite frequently at first to stimulate your milk production. This may be as often as every 1 ½ to 2 hours. Your baby will receive your nutritious colostrum for the first 2 - 3 days until your true milk comes in. Please use the log from the hospital to track when your baby nurses, urinates and stools. This is a helpful way to assess breastfeeding progress. By four weeks of age you may be nursing every 3 to 4 hours. We encourage you to read about breastfeeding, search the links, and ask our nurses and doctors any questions, especially if you are having difficulty. Your breastmilk is the only source of nutrition that your baby will need for at least four months, and we recommend that you breastfeed for a year or longer. Most medicines that you may need to take will not adversely affect the baby. Ask us if you have any questions.
FORMULA FEEDING: Start your baby on formula with iron. Pleas note that infant formulas come as a concentrated liquid or powder that need to be diluted with water, or as “ready to feed.” Follow the instructions carefully. Nipples and bottles should be kept very clean but do not need to be sterilized. Warm the formula in a pan of hot water or by holding the bottle under the hot water tap. Always shake the bottle well after warming and test a few drops before offering it to your baby. We discourage the use of microwave ovens for warming the bottle because it is too easy to burn your baby’s mouth. Smaller, younger babies may desire to eat as often as every two hours, while larger or older babies may go four hours between feedings. Formula is the only source of nutrition that your child will need for at least the first four months. We recommend that you use formula (not regular milk) for the entire first year. Always hold your baby when feeding and do not prop the bottle. Feeding time is an important time for you and the baby to be close.
WATER: Your baby receives plenty of water from either breastmilk or formula, so you do not have to offer extra water.
VITAMINS: We recommend infant vitamins for breastfed infants starting at 2 weeks of age. TriViSol drops can be purchased at most pharmacies and supermarkets. Formula fed babies receive vitamin supplementation in the formula, so they do not need added vitamins.
BURPING: Try to burp your baby between breasts or after every 1 - 2 ounces of formula. If the baby does not burp within 1 - 2 minutes return to feeding. It is not always necessary to interrupt a baby who is feeding comfortably at the breast or at the bottle. Spitting up, or wet burps, are very common and not a concern.
VOMITING: Any healthy baby will occasionally vomit a large amount of a feeding. Occasional vomiting is not worrisome but let us know if your baby vomits repeatedly. Following vomiting, allow your baby’s stomach to settle by waiting about a half hour before attempting to refeed.
SNEEZING: Most babies have nasal mucus and will sneeze it out. This does not mean that your baby has a cold. If your baby sounds like his nose is stuffy, you may try some saline nose drops and a suction bulb to clear his nostrils.
ILLNESS: How do you know if your newborn is ill? If any of the following occurs call the office to report your findings:
1. Decreased interest in feedings
2. Fever (rectal temperature over 100.4 degrees)
3. Poor color (pale, blue, or any change from usual color)
4. Very sleepy
5. Very fussy
6. Persistent vomiting
7. Frequent, watery stools
If you sense, for whatever reason, that your newborn is ill, call and tell us your concern.
BOWELS: Stools vary tremendously. They may be green and wet, change to yellow and seedy, and eventually become more brown and formed. Your baby may have a bowel movement with every feeding at first. Soon the bowel movements will decrease to 2 - 3 per day. Nursing infants will sometimes only have one bowel movement a week. As long as the stool is soft, the baby is not constipated. Many babies fuss or strain when having a bowel movement. This does not necessarily mean that something is wrong.
BATHING: You may immerse your baby in water to bathe, as you have been shown in the hospital. Some parents feel more comfortable with sponge baths at first. Either method is fine. Your baby does not need a bath every day. Use mild soap. A thick moisturizer such as Eucerin creme or even Vaseline is useful for dry skin. If your baby’s scalp becomes scaly, a mild baby shampoo followed by soft brushing or fine combing can help. You do not need to clean your baby’s ears with anything other than a washcloth. Do not put cotton swabs in the ear canal.
NAVEL: The navel does not require extra care. Gently clean it during baths. Keep it dry by folding the diaper below the cord. Usually the cord falls off when the baby is between one and three weeks old. Call the office if you notice a very foul odor or skin redness extending progressively further away from the cord.
EYES: If your baby’s eyes have excessive tears or a cloudy discharge, cleanse them with water and a washcloth. If the discharge is yellow for more than a few days or if the eyes become red or puffy please call us for advice.
BOYS: If your baby has not been circumcised there is no need to try to retract the foreskin during bathing. The foreskin may not fully retract for many years. If your baby is circumcised, continue to apply Vaseline on a small gauze pad until the circumcision is healed, which may take a week. Once healed, push back the remaining foreskin during bathing for thorough cleaning and to prevent the skin from re-adhering.
GIRLS: You may notice some bloody or white mucus discharge from the vagina in the first week or two. This is normal and related to hormones that pass from mother to baby. When bathing your baby girl, spread the labial folds and cleanse gently from front to back.
BREASTS: Both male and female babies may develop firm swelling of their breasts. This is a normal finding and it is important that you not attempt to squeeze the breasts. The swelling will gradually resolve on its own. Call us if the breasts appear red, warm or tender.
RASHES: Cleaning your baby’s diaper area thoroughly with soapy water or wipes and frequent diaper changes will usually prevent diaper rash. Should your baby develop a diaper rash try any diaper ointment such as Desitin or A&D, along with more frequent diaper changes, to heal the rash. We do not recommend powdering the baby’s bottom as it is possible for the baby to breathe in the powder. If you have difficulty healing a rash after trying for more than a week please call us.
Your newborn may have small red blotches that look like flea bites scattered on the body. This is a common rash and will gradually disappear after the first week or two. Your baby also may have milia, which are tiny white spots on the nose and cheeks. These are plugged pores which will also gradually resolve without treatment.
CLOTHING AND ROOM TEMPERATURE: Dress your baby so that your baby’s skin is not too cool or too warm. Hands and feet are usually cool so feel the chest and back. The general tendency is to overdress the baby. If you find your baby sweating, then dress more lightly. In cool weather, remember that your baby can lose a lot of body heat by having an exposed head. The temperature of your baby’s room should be around 68-70. Remember to avoid cold drafts. Going outside for fresh air can start at about one week during the summer and three weeks during the winter.
ENVIRONMENT: Do not allow your baby to be exposed to smoke. No one should smoke in your home or vehicle. We know that cigarette smoke irritates your child’s lungs and causes many illnesses. Avoid large groups of people and sick people during the first six weeks. Hand-washing is necessary for anyone handling the baby. Never leave your baby unsupervised with a young brother or sister - their actions can be very unpredictable.
CAR SEATS: Your newborn should be in a rear-facing car seat, in the back seat of your car. Never hold the baby in your arms when the car is moving. Be sure the car seat is fastened securely according to the instructions. If you would like your car seat checked by a certified car seat technician, call the Rutland Regional Ambulance Service at 773-1746 to make an appointment.
BABY BLUES: As hormones change after the baby is born, mom may notice mood swings often called “baby blues.” Mom may experience feelings of anger, irritability, sadness and frustration. This is normal, but should pass in a week or two. If these feelings last longer you should contact a health professional or counselor. Ignoring signs of true depression can be dangerous.