Childbirth Center St. Louis

My Newborn Help & Tips

Newborn Care : The First 6 Weeks

Courtesy of   childrens

Once you arrive home with your baby, it’s normal to feel a little bit overwhelmed. But just because you are no longer surrounded by nurses and hospital services, doesn’t mean that you’re alone. We encourage you to call us when you have questions, and to take advantage of our Mom’s MoBap Morning support group and other infant care services.

In addition, the following guide, developed by our partners at St. Louis Children’s Hospital, covers many topics that come up with new parents in the first six weeks. You may always, of course, call us or consult your pediatrician for advice more customized to your situation.


Browse topics (topic will expand on page):

 

Proper bathing and skin care for your newborn:

A newborn's skin is soft and delicate. Proper skin care and bathing can help maintain the health and texture of the baby's skin while providing a pleasant experience for both of you.

Contrary to popular thought, most babies do not need a bath every single day. With all the diaper changes and wiping of mouth and nose after feedings, most babies may only need to be bathed two or three times a week or every other day.

Baths can be given any time of day. Bathing before a feeding often works well. Many parents prefer to bathe their baby in the evening, as part of the bedtime ritual. This works well especially if bath time is relaxing and soothing for the baby.

Sponge baths are required at first. Bathing in a tub of water should wait until the baby's umbilical cord falls off, and a baby boy's circumcision heals, to prevent infection.

What equipment is needed for bathing newborns? 

  • thick towels or a sponge-type bath cushion
  • soft washcloths
  • basin or clean sink
  • cotton balls
  • baby shampoo and baby soap (non-irritating)
  • hooded baby towel
  • clean diaper and clothing

How to give a sponge bath:

  • Make sure the room is warm, without drafts, about (75° F).
  • Gather all equipment and supplies in advance.
  • Add warm water to a clean sink or basin (warm to the inside of your wrist or between 90 and 100° F.).
  • Place baby on a bath cushion or thick towels on a surface that is waist high.
  • Keep the baby covered with a towel or blanket.
  • NEVER take your hands off the baby, even for a moment. If you have forgotten something, wrap up the baby in a towel and take him/her with you.
  • Start with the baby's face - use one moistened, clean cotton ball to wipe each eye, starting at the bridge of the nose then wiping out to the corner of the eye.
  • Wash the rest of the baby's face with a soft, moist washcloth without soap.
  • Clean the outside folds of the ears with a soft washcloth. DO NOT insert a cotton swab into the baby's ear canal because of the risk of damage to the ear drum.
  • Add a small amount of baby soap to the water or washcloth and gently bathe the rest of the baby from the neck down. Uncover only one area at a time. Rinse with a clean washcloth or a small cup of water. Be sure to avoid getting the umbilical cord wet.
  • Wash the baby's head last with a shampoo on a washcloth. Rinse, being careful not to let water run over the baby's face. Holding the baby firmly with your arm under his/her back and your wrist and hand supporting his/her neck, you can use a high faucet to rinse the hair.
  • Scrubbing is not necessary, but most babies enjoy their arms and legs being massaged with gentle strokes during a bath.
  • Wrap the baby in a hooded bath towel and cuddle your clean baby close.
  • Follow cord care instructions given by your baby's physician.
  • Use a soft baby brush to comb out your baby's hair. DO NOT use a hair dryer on hot to dry a baby's hair because of the risk of burns.
  • Expect your baby to cry the first few times you bathe him/her. Usually, this is just because a bath is a new experience. However, be sure to check that the water is not too warm or cold or that soap has not gotten in your baby's eyes if your baby suddenly starts crying during a bath.

How to give your newborn a tub bath:

Once your baby's umbilical cord has fallen off and the stump is healed, and after a boy's circumcision has healed, you can give your baby a tub bath. This can be a pleasurable experience for you and your baby. However, some babies may not like to be bathed, especially the first few times. Talk softly or sing and try some bath toys if your baby protests.

What equipment is needed for a tub bath?

  • baby bathtub (preferably with a bottom drain plug)
  • nonslip mat or pad
  • bath thermometer (these often have "safe" bath temperature ranges marked on them)

When bathing your baby in a tub:

  • Clear the counter or table top of breakable objects and electrical appliances to prevent injury.
  • Fill the tub with warm water, using a bath thermometer.
  • Follow the same general bathing instructions for a sponge bath.
  • NEVER take your hands off your baby, or walk away, even for a moment.
  • Be sure to clean the bathtub after each use.

Providing proper skin care for your newborn:

A baby's soft and delicate skin needs special care. Generally it is best to use products made especially for babies, but your baby's physician can advise you about other products. Products for adults may be too harsh for a baby and may contain irritants or allergens. Many parents like to use lotions for the sweet baby smell. However, unless the baby's skin is dry, lotions really are not needed. Powders should be avoided, unless they are recommended by your baby's physician. When using any powder, put the powder in your hand and then apply it to the baby's skin. Shaking powder into the air releases dust and talc which can make it hard for the baby to breathe.

Many babies have rashes and bumps that are normal. Some rashes may be a sign of a problem or infection. Diaper rash can be irritating to the baby and needs to be treated. If you have concerns about a rash, or your baby is uncomfortable or has a fever, call your baby's physician.

Laundry detergents may cause irritation to a baby's delicate skin. Even if you use a detergent marketed for baby laundry, it is a good idea to rinse the laundry an extra time to remove residues.


 

The umbilical cord is the baby's lifeline to the mother during pregnancy. However, it is no longer needed once the baby is born. Within a few minutes after birth, the cord is clamped and cut close to the navel. The clamp helps stop bleeding from the three blood vessels in the umbilical cord - two arteries and one vein. A medication is sometimes applied to the cord as part of a baby's first care. This may be a purple dye or another type of antiseptic.

By the time the baby goes home from the hospital, the cord is beginning to dry and wither. The clamp can be removed when the cord is completely dry. The cord falls off by itself in about two to three weeks. Because the umbilical cord may be a place for infection to enter the baby's body, it is important to care for it properly.

How to take care of your baby's umbilical cord:

Your baby's physician will give you instructions on how to care for your baby's umbilical cord, which include keeping it dry and exposed to the air.

Keep the cord on the outside of the baby's diaper. Some newborn-size diapers have special cut-outs for the cord area, but you can also fold down the top edge of the diaper. Call your baby's physician if there is:

  • bleeding from the end of the cord or the area near the skin.
  • pus (a yellow or white discharge).
  • swelling or redness around the navel.
  • signs that the navel area is painful to your baby.

There may be a small amount of blood after the cord falls off, but this should stop quickly. Never try to pull the cord off. Parents are often concerned about a baby's navel being an "innie" or an "outie." There is no way to predict this or make the navel look one way or another. Contrary to popular traditions, taping a coin or other flat object over the navel does not help. It is common in some babies for there to be a small protrusion of the baby's abdomen around the navel, especially when the baby cries. This is part of the baby's development and usually goes away on its own.

Some babies may have a weakness in the abdominal muscles called an umbilical hernia. This can be checked by your baby's physician to see if treatment is necessary.


 

How to provide care after a circumcision:

Circumcisions performed by a qualified physician rarely have complications. Problems that occur are usually not serious. The most common complications are bleeding and infection. Proper care after circumcision helps reduce the chances of problems.

Your baby's physician will give you specific instructions on the care of the circumcision. It is important that you keep the area clean. After the procedure:

  • There may be a gauze dressing with petroleum jelly or an antibiotic cream. This may be removed at the first diaper change. Your baby's physician may recommend applying a new dressing.
  • The head of the penis may be very raw and red looking.
  • There may be a small amount of blood at first or yellow-colored drainage later. These are part of normal healing.
  • Your baby may have some discomfort with diaper changes the first few days.
  • Keep the penis clean with soap and water.
  • Circumcisions usually heal within one to two weeks.

Your baby may be fussy after circumcision. Cuddling him close and breastfeeding can help comfort him. Most boys do not require special care of the penis after the circumcision is healed.

How to provide care to the uncircumcised penis:

A newborn boy normally has foreskin tightly fitted over the head of the penis. As long as the baby is able to pass urine through the opening, this is not a problem. It is not necessary to clean inside the foreskin, only the outside, as part of a normal bath.

As the baby grows, the foreskin becomes looser and is able to be retracted (moved back). This may take many weeks or months. Do not retract the foreskin on your baby boy. Your baby's physician will check this as part of your baby's checkups and will show you how to retract the foreskin. This allows cleansing of the area. As a boy grows, he should be taught how to retract the foreskin and clean himself. The foreskin should never be retracted forcibly. Do not allow the foreskin to stay retracted for long periods as this may shut off the blood supply causing pain and possible injury.


 

How to diaper your baby:

New parents often feel awkward trying to diaper a squirming baby. It can be frustrating not knowing how to hold the baby or where to place the diaper the first few times. However, it does not take long to get comfortable changing a diaper, and most parents get plenty of practice.

Here are some tips to help you diaper your baby comfortably and correctly:

  • Use a changing table or pad placed waist high. This prevents bending and back strain.
  • Have all diapers, wipes, and other items right above or below the table. Never leave a baby unattended, even for a brief moment.
  • Have a washable or disposable mat on the changing table to lay the baby down on.
  • Place your baby on the table with his/her head to the right or left. Most parents find one direction easier than the other.
  • Open a clean diaper and set it aside.
  • Undo the tabs or pins of the dirty diaper. Hold the baby's legs in one hand and pull the front of the diaper down with the other hand.
  • If there is bowel movement in the diaper, use the front of the diaper to wipe most of the mess toward the back of the diaper. Never wipe from back to front as this may lead to urinary tract infection.
  • With the dirty diaper pressed flat under the baby, use a wipe to gently cleanse the baby's diaper area. Be sure to work from front to back.
  • Lift the baby's legs and slide the dirty diaper out and set it away from the baby.
  • Place the back of the clean diaper under the baby and pull the front up between the baby's legs.
  • Secure the adhesive tabs or carefully pin the diaper corners snugly together. You should be able to place at least two fingers between the diaper and the baby's abdomen.
  • Place the dirty diaper in a container near the changing table to save steps. A lid that opens with a foot pedal is a plus. (It is a good idea to dump solid bowel movements in the toilet before placing the diaper in the can. This helps decrease the odor and helps the environment.)

While this sounds very technical, it does not take long to change a diaper once you have done it several times. Some special tips to remember when changing a diaper include:

  • Keep a boy baby's penis covered at all times. A free stream of urine can go through the air over the changing table and onto the floor, or into your face.
  • With messy bowel movements, hold the baby's legs carefully to prevent feet from kicking into the diaper.
  • Some diaper changes may require clothing changes if the diaper has leaked. A bath may also be needed if there is bowel movement on the baby's back or legs.
  • Try talking or singing during diaper changes as a distraction. Older babies can hold a special toy reserved for diaper time.
  • Diaper sizes and shapes vary among manufacturers. Your baby may fit a certain brand for many months, then suddenly start leaking. Try a different brand if the one you are using is not working.

Yeast diaper rash:

Some diaper rashes are caused by a yeast called Candida Albicans, which often causes problems when a baby already has a diaper rash, is on antibiotics, or has thrush. This rash appears bright red and raw, covers large areas, and is surrounded by red spots. Call your baby's physician for a special cream to treat this rash, and follow the guidelines above. With proper treatment these rashes usually improve in two to three days.

Call your baby's physician if:

  • any big blisters or sores (more than one inch across) develop
  • the rash has not improved in three days
  • the rash becomes solid, bright red, raw, or bleeds
  • pimples, blisters, boils, sores, or crusts develop
  • the rash interferes with sleep
  • the rash spreads beyond the diaper area
  • your child starts acting very sick or has an unexplained fever

Caring for diaper rash:

Most babies will get a diaper rash at some time. Their bottoms are in frequent contact with moisture, bacteria, and ammonia, and there is rubbing from the diaper. Babies and toddlers are at risk as long as they are wearing diapers. Rashes are much easier to prevent than to cure. Many rashes can be treated by the following:

  • change diapers frequently
    The most important thing is to keep the area dry and clean. Check the diapers often, every hour if your baby has a rash, and change them as needed. Check at least once during the night.
  • gentle cleaning
    Frequent and vigorous washing with soap can strip the baby's tender skin of the natural protective barrier. Wash gently but thoroughly, including the skin folds. Do not use diaper wipes if your child has a rash, as they can burn and increase the irritation. You can sit the baby in a basin or tub of lukewarm water for several minutes with each diaper change. This helps clean and may also be comforting. You can also pour warm water from a pitcher or use a squirt bottle. Do not use any soap unless there is very sticky stool, then a very mild soap is okay; wash gently and rinse well. Baby oil on a cotton ball can also be used.
  • pat dry or leave diapers off for a while
    Let the skin air dry, or pat very gently with a very soft cloth or paper towel. A hairdryer set on cool can also be used. Leave the skin open to the air as much as possible. Fasten diapers loosely and do not use airtight rubber pants. If you use disposable diapers, it can help to punch holes in them to let air in.
  • skin protection
    Petroleum jelly (Vaseline®) provides a good protective coating, even on sore, reddened skin, and is easily cleaned. A number of other ointments are available commercially; see what works for your baby and what your baby's physician recommends.

    Be very careful with all powders; be sure the baby does not breathe them in. Do not use talcum powder because of the risk of pneumonia. Cornstarch reduces friction and may prevent future rashes.

Preventing diaper rash:

Changing the diaper immediately and good cleaning are the best things you can do. Diaper rashes occur equally with cloth diapers and disposables diapers. Some children will get a rash from certain brands of disposable diapers, or from sensitivity to some soaps used in cloth diapers. If you use cloth diapers, bleach them by adding Clorox®, Borax®, or Purex® to the wash. Be sure to rinse the diaper thoroughly.

Urine:

Babies wet their diapers with urine several times a day. The number of wet diapers is a helpful sign of how much fluid the baby is taking in. Although it is sometimes hard to tell when a disposable diaper is wet, generally, a baby should have at least seven wet diapers each day. Fewer wet diapers can mean the baby may not be taking in enough fluid.

Normally, a baby's urine is clear and yellow-tinged. Changes in the odor and color may indicate a problem. Dark yellow or even pinkish color urine may mean the baby is not getting enough fluid.

Call your baby's physician if you have concerns about how often or how much your baby is wetting diapers.

Bowel movements:

The first bowel movement of a newborn is called meconium. This is a sticky, greenish-black substance that forms in the intestines during fetal development. The baby may have several meconium bowel movements before this substance is completely gone from the baby's system. The next bowel movements are seedy-looking and are greenish-yellow. Breastfed babies usually have frequent bowel movements, sometimes with every feeding, and even some in-between. These bowel movements are often loose, yellow, and seedy. Formula-fed babies have thicker bowel movements that are more beige in color.

Occasionally, babies become constipated. This rarely happens in breastfed babies. Firm or formed stools, that occur only once a day or less than once a day, may mean a baby is constipated. A baby may strain or fuss with constipation.

Very runny or watery bowel movements, especially if there is distinct change, may mean the baby has diarrhea. You should contact your baby's physician if this occurs.

Talk with your baby's physician about your baby's bowel movements and their frequency and appearance.


 

Parents often dream of what their new baby may look like, thinking about a pink, round, chubby-cheeked and gurgling wonder. It may be surprising for many parents to see their newborn the first time - wet and red, with a long head, and screaming - nothing at all like they had imagined.

Newborns have many variations in normal appearance - from color to the shape of the head. Some of these differences are just temporary, part of the physical adjustments a baby goes through. Others, such as birthmarks, may be permanent. Understanding the normal appearance of newborns can help you know that your baby is healthy. Some of the normal variations in newborns include the following, and are explained below:

  • color
    A baby's skin coloring can vary greatly, depending on the baby's age, race or ethnic group, temperature, and whether or not the baby is crying. Skin color in babies often changes with both the environment and health.

    When a baby is first born, the skin is a dark red to purple color. As the baby begins to breathe air, the color changes to red. This redness normally begins to fade in the first day. A baby's hands and feet may stay bluish in color for several days. This is a normal response to a baby's immature blood circulation. Blue coloring of other parts of the body, however, is not normal.

    Some newborns develop a yellow coloring called jaundice. This may be a normal response as the body rids excess red blood cells. However, it may indicate a more serious condition, especially if the yellow color appears in the first day and worsens. Jaundice can often be seen by gently pressing on the baby's forehead or chest and watching the color return. Laboratory tests may be needed to assess jaundice.
     
  • molding
    Cranial molding is the elongation of the shape of a baby's head. It occurs when the movable bones of the baby's head overlap to help the baby pass through the mother's birth canal. Normal shape usually returns by the end of the first week.
     
  • vernix
    This is a white, greasy, cheese-like substance that covers the skin of many babies at birth. It is formed by secretions from the baby's oil glands and protects the baby's skin in the amniotic fluid during pregnancy. Vernix may not be present in babies who are born postterm (after 41 weeks of pregnancy). It does not need to be removed and usually absorbs into the skin.
     
  • lanugo
    This is soft, downy hair on a baby's body, especially on the shoulders, back, forehead, and cheeks. It is more noticeable in premature babies, but is not usually seen in babies born very late in pregnancy.
     
  • milia
    Milia are tiny, white, hard spots that look like pimples on a newborn's nose. They may also appear on the chin and forehead. Milia form from oil glands and disappear on their own. When these occur in a baby's mouth and gums, they are called Epstein pearls.
     
  • stork bites
    These are small pink or red patches often found on a baby's eyelids, between the eyes, upper lip, and back of the neck. The name comes from the marks on the back of the neck where, as the myth goes, a stork may have picked up the baby. They are caused by a concentration of immature blood vessels and may be the most visible when the baby is crying. Most of these fade and disappear completely.
     
  • mongolian spots
    Mongolian spots are blue or purple-colored splotches on the baby's lower back and buttocks. Over 80 percent of African-American, Asian, and Indian babies have Mongolian spots, but they occur in dark-skinned babies of all races. The spots are caused by a concentration of pigmented cells. They usually disappear in the first four years of life.
     
  • erythema toxicum
    Erythema toxicum is a red rash on newborns that is often described as "flea bites." The rash is common on the chest and back, but may be found all over. About half of all babies develop this condition in the first few days of life. It is less common in premature babies. The cause is unknown but it is not dangerous. Erythema toxicum does not require any treatment and disappears by itself in a few days.
     
  • acne neonatorum "baby acne"
    About one-fifth of newborns develop pimples in the first month. These usually appear on the cheeks and forehead. It is thought that maternal hormones cause these, and they usually disappear within a few months. Do not try to break open or squeeze the pimples, as this can lead to infection.
     
  • strawberry hemangioma
    This is a bright or dark red, raised or swollen, bumpy area that looks like a strawberry. Hemangiomas are formed by a concentration of tiny, immature blood vessels. Most of these occur on the head. They may not appear at birth, but often develop in the first two months. Strawberry hemangiomas are more common in premature babies and in girls. These birthmarks often grow in size for several months, and then gradually begin to fade. Nearly all strawberry hemangiomas completely disappear by nine years of age.
     
  • port wine stains
    A port wine stain is a flat, pink, red, or purple colored birthmark. These are caused by a concentration of dilated tiny blood vessels called capillaries. They usually occur on the head or neck. They may be small, or they may cover large areas of the body. Port wine stains do not change color when gently pressed and do not disappear over time. They may become darker and may bleed when the child is older or as an adult. Port wine stains on the face may be associated with more serious problems. Skin-colored cosmetics may be used to cover small port wine stains. The most effective way of treating port wine stains is with a special type of laser. This is done when the baby is older by a plastic surgery specialist.
     
  • newborn breast swelling
    Breast enlargement may occur in newborn boys and girls around the third day of life. In the first week, a milky substance, sometimes called "witch's milk," may leak from the nipples. This is related to the mother's hormones and goes away within a few days to weeks. Do not massage or squeeze the breasts or nipples, as this may cause an infection in the breast.
     
  • swollen genitals/discharge
    A newborn's genitals may appear different depending on the gestational age (the number of weeks of pregnancy). Premature baby girls may have a very prominent clitoris and inner labia. A baby born closer to full-term has larger outer labia. Girls may have a small amount of whitish discharge or blood-tinged mucus from the vagina in the first few weeks. This is a normal occurrence related to the mother's hormones.

    Premature boys may have a smooth, flat scrotum with undescended testicles. Boys born later in pregnancy have ridges in the scrotum with descended testicles.

 
Sleeping

What are the sleep patterns of a newborn?

The average newborn sleeps much of the day and night, waking only for feedings every few hours. It is often hard for new parents to know how long and how often a newborn should sleep. Unfortunately, there is no set schedule at first and many newborns have their days and nights confused - they think they are supposed to be awake at night and sleep in the daytime.

Generally, newborns sleep about eight to nine hours in the daytime and about eight hours at night. Most babies do not begin sleeping through the night (six to eight hours) without waking until about three months of age, or until they weigh 12 to 13 pounds. Newborns and young infants have a small stomach and must wake every few hours to eat. In most cases, your baby will awaken and be ready to eat about every three to four hours. It is not necessary to wake a baby for feedings unless you have been advised to do so by your baby's physician. However, do not let a newborn sleep longer than five hours at a time in the first five to six weeks. Some premature babies need more frequent feedings and must be awakened to eat.

Watch for changes in your baby's sleep pattern. If your baby has been sleeping consistently, and suddenly is waking, there may be a problem such as an ear infection. Some sleep disturbances are simply due to changes in development or because of overstimulation.

Never put a baby to bed with a bottle propped for feeding. This is a dangerous practice that can lead to ear infections and choking.

What are the sleep states of a newborn?

Babies, like adults, have various stages and depths of sleep. Depending on the stage, the baby may actively move or lie very still. Infant sleep patterns begin forming during the last months of pregnancy - active sleep first, then quiet sleep by about the eighth month. There are two types of sleep:

  • REM (rapid eye movement sleep)
    This is a light sleep when dreams occur and the eyes move rapidly back and forth. Although babies spend about 16 hours each day sleeping, about half of this is in REM sleep. Older children and adults sleep fewer hours and spend much less time in REM sleep.
  • Non-REM sleep:
    Non-REM has 4 stages:
    • Stage 1 - drowsiness - eyes droop, may open and close, dozing
    • Stage 2 - light sleep - the baby moves and may startle or jump with sounds
    • Stage 3 - deep sleep - the baby is quiet and does not move
    • Stage 4 - very deep sleep - the baby is quiet and does not move

A baby enters stage 1 at the beginning of the sleep cycle, then moves into stage 2, then 3, then 4, then back to 3, then 2, then to REM. These cycles may occur several times during sleep. Babies may awaken as they pass from deep sleep to light sleep and may have difficulty going back to sleep in the first few months.

What are the different alert phases of a newborn?

Babies also have differences in how alert they are during the time they are awake. When a newborn awakens at the end of the sleep cycles, there is typically a quiet alert phase. This is a time when the baby is very still, but awake and taking in the environment. During the quiet alert time, babies may look or stare at objects, and respond to sounds and motion. This phase usually progresses to the active alert phase in which the baby is attentive to sounds and sights, but moves actively. After this phase is a crying phase. The baby's body moves erratically, and he/she may cry loudly. Babies can easily be overstimulated during the crying phase. It is usually best to find a way of calming the baby and the environment. Holding a baby close or swaddling (wrapping snugly in a blanket) may help calm a crying baby.

It is usually best to feed babies before they reach the crying phase. During the crying phase, they can be so upset that they may refuse the breast or bottle. In newborns, crying is a late sign of hunger.

Helping your baby sleep:

Babies may not be able to establish their own sleeping and waking patterns, especially in going to sleep. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on his/her own, and providing the right environment for comfortable and safe sleep.

What are the signs of sleep readiness?

Your baby may show signs of being ready for sleep when you see the following signs:

  • rubbing eyes
  • yawning
  • looking away
  • fussing

How can you help your baby fall asleep?

Although it is surprising, not all babies know how to put themselves to sleep. When it is time for bed, many parents want to rock or breastfeed a baby to help him/her fall asleep. Establishing a routine like this at bedtime is a good idea. However, be sure that the baby does not fall asleep in your arms. This may become a pattern and the baby may begin to expect to be in your arms in order to fall asleep. When the baby briefly awakens during a sleep cycle, he/she may not be able to go back to sleep on his own.

Most experts recommend allowing a baby to become sleepy in your arms, then placing him/her in the bed while still awake. This way the baby learns how to go to sleep on his own. Playing soft music while your baby is getting sleepy is also a good way to help establish a bedtime routine.

What sleeping positions are best for a newborn?

For many years in the United States, babies have been put to bed on their stomachs. In most other countries, babies sleep on their backs. Research has found a link between sudden infant death syndrome (SIDS) and babies who sleep on their stomachs (in the prone position).

Experts now agree that putting a baby to sleep on his/her back is the safest position. Side-sleeping may also be used, but this also has a higher risk than back sleeping. Other reports have found soft surfaces, loose bedding, and overheating with too many blankets also increase the risk for SIDS. When infants are put to sleep on their stomachs and they also sleep on soft bedding, the risk for SIDS is even higher. Smoking by the mother is also a major risk for SIDS, as are poor prenatal care and prematurity. Since the American Academy of Pediatrics (AAP) made the "back-to-sleep" recommendation in 1992, the SIDS rate has dropped more than 40 percent.

Back sleeping also appears to be safer for other reasons. There is no evidence that babies are more likely to vomit or spit up while sleeping on their back. In fact, choking may be more likely in the prone position.

A task force of The US Consumer Product Safety Commission (CPSC), the American Academy of Pediatrics (AAP), and the National Institute of Child Health and Human Development (NICHD), offer the following recommendations for infant bedding:

  • Place your baby on his/her back on a firm, tight-fitting mattress in a crib that meets current safety standards.
  • Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib.
  • Consider using a sleeper as an alternative to blankets with no other covering.
  • If using a blanket, put your baby with his/her feet at the foot of the crib. Tuck a thin blanket around the crib mattress, only as far as the baby's chest.
  • Make sure your baby's head remains uncovered during sleep.
  • Do not place your baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.

According to the task force report, bed sharing or co-sleeping may be hazardous for babies in certain conditions. The report advises the following:

  • Parents should consider placing the infant's crib near their bed for more convenient breastfeeding and parent contact for the first six months.
  • Infants can be brought into the parents' bed for feedings and comforting, but should be returned to their own crib for sleep.
  • Adults other than the parents, children, or other siblings should not share a bed with an infant.
  • Parents who choose to bed share with their infant should not smoke or use substances such as drugs or alcohol that may impair their ability to awaken.

To prevent overheating, the report recommends that the infant should be lightly clothed for sleep and the room temperature kept comfortable for a lightly clothed adult. Avoid over bundling and check the baby's skin to make sure it is not hot to the touch.

Additional research has found that infants should not be put to sleep on a sofa, alone or with another person, as this practice increases the risk for SIDS.

While babies should sleep on their backs, other positions can be used during the time babies are awake. Babies can be placed on their stomachs while awake to help develop muscles and eyes and to help prevent flattened areas on the back of the head.


 
Crying

What are the crying patterns of a newborn?

The first cries of a newborn baby are often music to the ears of parents. However, over the next weeks and months this "music" can become grating and painful. This is especially true when all attempts fail to stop the crying.

Surprisingly, crying does not produce tears until after the first month or two. Crying is the way babies communicate. They cry because of hunger, discomfort, frustration, fatigue, and even loneliness. Sometimes, cries can easily be answered with food, or a diaper change. Other times, it can be a mystery and crying stops as quickly as it begins.

You will soon learn differences in cries, from a cry of "I'm hungry" to "I've been overstimulated." It is important to respond to your baby's cries. Contrary to old wives' tales, young babies cannot be spoiled by being picked up when crying. Being held is reassuring and comforting when a baby cannot express him/herself any other way.

Some techniques to help console a crying baby include the following:

  • Take care of physical problems first - hunger, diaper change, need to burp.
  • Walk with baby in a sling or in a stroller.
  • Rock your baby in a rhythmic, gentle motion.
  • Try a baby swing or rocking cradle.
  • Gently pat or stroke on the back or chest.
  • Try swaddling the baby.
  • Go for a ride in the car.
  • Turn on some white noise (such as a washing machine or vacuum cleaner).

No matter how frustrated you may become, NEVER SHAKE A BABY. This can cause severe injury to the baby's fragile brain. If you become angry or frustrated, allow someone else to take over for a while. If you are alone, put the baby down in a safe place, such as the crib, and go to another room for a few moments. This will give you time to collect yourself. Then you can return to your baby and try a different tactic to comfort your baby.


 
Colic

Colic is a problem that affects some babies during the first three to four months of life. It can be very stressful and frustrating to parents. Physicians have defined colic as prolonged or excessive crying in an infant who is otherwise well. The crying can be very loud and can last for several hours a day. Colic often starts by 3 weeks of age, is at its worst around 6 weeks, and gradually gets better by about 3 months of age. It is not clear what causes colic. Some of the reasons babies may have colic include the following:

    • Adjusting to one another
      Colic may relate to the adjustments that a new baby and his/her parents have to make to each other. Babies obviously cannot talk. Until they learn to talk, one way they communicate with adults is by crying. Parents have to learn to interpret the reasons their baby is crying, and then determine what to do to make the baby happy. Is the baby hungry? Wet? Cold? Hot? Tired? Bored? A baby will cry for these reasons as well as for other problems, and parents must try to determine what is causing their baby stress, often by trial and error. New parents, especially, may have trouble reading their baby's cues and responding appropriately. The baby may continue to cry simply because his/her needs have not yet been met.
        
    • Temperament and adjusting to the world
      Newborns must also make adjustments to the world they are living in. Not all babies have the same temperament. Some adjust to lights, loud noises, and all the other stimulation around them with no trouble, while others are not able to adapt as easily. Just like adults, some babies are easy-going, and some are impatient. Crying may be one way for a baby to vent feelings as he or she is getting adjusted to the world.

      Babies have been noted to cry for specific lengths of time every day, as they are getting used to the world and as their parents are learning to interpret their needs.
       
    • Oversensitive to gas
      Another possible reason for excessive crying in babies might be that they are oversensitive to gas in the intestine. The normal amount of gas that is produced as food is digested may be more uncomfortable for some babies than others. If a baby with colic seems to pass more gas than other babies do, it is probably due to swallowing more air while crying for prolonged periods of time. 
       
    • Milk allergy
      It is rare for colic to be caused by a true milk allergy. However, some babies may be more sensitive to cow's milk based formulas. Your baby's physician may recommend changing formulas to a soy-based rather than cow's milk based formula to see if this helps relieve the symptoms of colic. 

Dealing with colic:

Learning how to interpret your baby's cry can be helpful in dealing with colic. It does take some time for parents and babies to become accustomed to each other. Remember, babies will cry for a certain length of time every day under normal circumstances.

Other suggestions include the following:

  • Make sure your baby is not hungry, but do not force feed if he/she is not interested in the bottle or breast.
  • Change your baby's position. Sit him/her up if lying down. Let your baby face forward if you are carrying or holding him/her facing your chest. Babies like to see different views of the world.
  • Give your baby interesting things to look at: different shapes, colors, textures, and sizes. Talk to your baby. Sing softly to your baby.
  • Rock your baby.
  • Walk your baby.
  • Place your baby in an infant swing on a slow setting.
  • Let your baby lay on his/her belly on your lap or on the bed, and rub his/her back. Never leave your baby unattended on a bed, sofa, or other soft surface.
  • Go for a ride in the car. The motion of the car often soothes babies.
  • Try using something in your child's room that makes a repetitive sound, like a wind-up alarm clock or heartbeat audio tape.
  • Hold and cuddle your baby. Babies cannot be spoiled by too much attention. However, they can have problems later in life if they are ignored and their needs are not met as infants.

Let an adult family member or friend (or a responsible babysitter) care for your baby from time to time so that you can take a break. Taking care of yourself and lowering your stress level may help your baby as well.


 

Your doctor will welcome any kind of call in which you have concerns about your newborn. There are times, however, when a more urgent call is necessary. St. Louis Children’s Hospital recommends you call your doctor right away if your baby is experiencing:


 

Adults have a tightly controlled thermostat to help regulate their body temperature. When cold, an adult shivers, helping to raise the temperature of the body. Sweating occurs when an adult is overheated, to allow for cooling. These mechanisms, on the other hand, are not completely developed in newborns. In addition, newborns lack the insulating fat layer that older babies and children develop.

Because a newborn's temperature regulation system is immature, fever may or may not occur with infection or illness. However, fever in babies can be due to other causes which may be even more serious. Call your baby's physician immediately if your baby younger than 3 months old has a rectal temperature of 100.4° F or higher.

Fever in newborns may be due to:

  • infection
    Fever is a normal response to infection in adults, but only about half of newborns with an infection have fever. Some, especially premature babies, may have a lowered body temperature with infection or other signs such as a change in behavior, feeding, or color.
     
  • overheating
    While it is important to keep a baby from becoming chilled, a baby can also become overheated with many layers of clothing and blankets. This can occur at home, near heaters, or near heat vents. It can also occur when a baby is over bundled in a heated car. Avoid placing a baby in direct sunlight, even through a window. Never leave a baby in a hot car even for a minute. The temperature can rise quickly and cause heat stroke and death.

    An overheated baby may have a hot, red, or flushed face, and may be restless. To prevent overheating, keep rooms at a normal temperature, about 72º F to 75° F, and dress your baby just like you and others in the room.
     
  • low fluid intake or dehydration
    Some babies may not take in enough fluids which causes a rise in body temperature. This may happen around the second or third day after birth. If fluids are not replaced with increased feedings, dehydration (excessive loss of body water) can develop and cause serious complications. Intravenous (IV) fluids may be needed to treat dehydration.  

 
A change in behavior may be one of the first signs of illness in a newborn. Although a baby's activity level, appetite, and cries normally vary from day to day, even hour to hour, a distinct change in any of these areas may signal illness.

Generally, if your baby is alert and active when awake, is feeding well, and can be comforted when crying, occasional differences in these areas are normal. Consult your baby's physician if you have concerns about your baby's behavior. Some behavior changes may indicate an illness is present including the following:

listlessness or lethargy
Lethargic or listless babies appear to have little or no energy, are drowsy or sluggish, and may sleep longer than usual. They may be hard to wake for feedings and even when awake, are not alert or attentive to sounds and visual stimulation. Sometimes, this can develop slowly and a parent may not notice the gradual change. Lethargy may be a sign of infection or other conditions such as low blood glucose (sugar). Consult your baby's physician if your baby's becomes lethargic or has a change in activity level. 


 
  • poor feeding
    Feeding problems may include difficulty with a baby's suck at the breast or bottle, lack of hunger, problems with spitting up, and weight loss.
    • Feeding difficulties due to a sucking problem may show up when a baby starts out at birth with a strong, vigorous suck and gradually become less effective at feedings over time, or when a baby starts out with a weak suck and does not eat effectively. This is especially common if he/she was born prematurely. Babies with a weak suck may not pull strongly or have a good latch while breastfeeding. The mother may not hear the baby swallowing or gulping during feedings. A mother's breasts may not feel full right before a feeding or she may not notice her breasts getting softer (emptying) after a feeding. Bottle-fed babies with a weak suck may need the bottle nipple "worked" or pumped to stimulate a suck. Feedings with either breastfed or bottle-fed babies with a weak suck may take a very long time, often more than 45 minutes.
       
    • After the first day or so, most newborns are ready to eat every three to four hours and show signs of hunger by sucking on fingers or a hand, crying, and making rooting motions. A sick baby may refuse feedings. A baby who sleeps continuously and shows little interest in feeding may be ill.
       
    • Spitting up and dribbling milk with burps or after feedings is fairly common in newborns. This is because the sphincter muscle between the stomach and the esophagus (the tube from the mouth to stomach) is weak and immature. However, forceful or projectile vomiting, or spitting up large amounts of milk after most feedings, can indicate a problem. In formula-fed babies, vomiting may occur after overfeeding, or because of an intolerance to formula. In breastfed or formula-fed babies, a physical condition that prevents normal digestion may cause vomiting. Discolored or green-tinged vomit may mean the baby has an intestinal obstruction.
       
    • Weight loss up to about 10 percent of birthweight is normal in the first two to three days after birth. However, the baby should have gained back to his/her birthweight by 10 or 11 days old. Signs a baby is not gaining weight may include a thin, drawn face, loose skin, and decreased number of wet or soiled diapers. Most physicians want to see a newborn in the office at the end of the first week to check his/her weight. Lack of weight gain or continued weight loss in a young baby may be a sign of illness or other conditions and needs to be treated.

      Feeding problems can be a sign of other conditions and may lead to serious illness if untreated. Consult your baby's physician if your baby has any difficulties taking or digesting feedings.
  • persistent crying or irritability
    All babies cry - this is their only way of communicating their needs to you. Babies also develop different types of cries for different needs - including hunger, sleepiness, loneliness, in need of a diaper change, and pain. At first, parents may not know how to interpret cries, but they usually can console a baby by meeting those needs. However, a baby who is continuously fretful and fussy, or cries for long periods, may be ill. Also, a baby may be very irritable if he/she is hurting. Colic, a common intestinal problem, can cause babies to cry inconsolably. Jitteriness or trembling may also be signs of illness.

    Examine your baby carefully to make sure there is not a physical problem - such as clothing pinching the baby, or a diaper pin sticking the baby. There may be a thread or even a hair tightly wound on a finger or toe. Look at the baby's abdomen for signs of swelling. Consult your baby's physician promptly if your baby is crying for longer than usual or has other signs of illness. 

 

What might skin color changes indicate in a newborn?

The color of a baby's skin can often help identify possible problems in another area of the body. It is important for you to detect and notify your baby's physician if the following skin color changes should occur:

  • increasing yellow color
    Over half of all newborns develop some amount of jaundice, a yellow coloring in their skin, during the first week. This is usually a temporary condition, but may be a more serious sign of another illness. Jaundice is caused by the breakdown of red blood cells. As the old cells are broken down, hemoglobin is changed into bilirubin and removed by the liver. The build-up of bilirubin in the blood is called hyperbilirubinemia. Because bilirubin has a pigment, or coloring, it causes a yellowing of the baby's skin and tissues. As liver function matures, the jaundice goes away. A premature infant is more likely to develop jaundice. The yellow tint to the skin can often be seen by gently pressing on the baby's forehead or chest and watching the color return. There are several types of jaundice:
    • physiologic jaundice
      Physiologic jaundice occurs as a "normal" response to the baby's limited ability to excrete bilirubin in the first days of life.
    • breast milk jaundice
      About 2 percent of breastfed babies develop jaundice after the first week. Some develop breast milk jaundice in the first week due to low calorie intake or dehydration.
    • jaundice from hemolysis
      Jaundice may occur with the breakdown of red blood cells due to hemolytic disease of the newborn (Rh disease), having too many red blood cells, or bleeding.
    • jaundice related to inadequate liver function
      Jaundice may be related to inadequate liver function due to infection or other factors.

Treatment for jaundice depends on many factors, including the cause and the severity of the jaundice. Treatment often includes using special lights called phototherapy. Babies with severe jaundice may need hospitalization and blood transfusions.

Babies with jaundice may have feeding problems and be irritable or listless. Call your baby's physician if your baby has any of these signs.

  • blue color that does not go away
    When a baby is first born, the skin is a dark red to purple color. As the baby begins to breathe air, the color changes to red. This redness normally begins to fade in the first day. A baby's hands and feet may stay bluish in color for several days. This is a normal response to a newborn's immature blood circulation.

Blue coloring of other parts of the body is not normal. Occasionally, a baby's face or lips and mouth may turn purplish with very intense crying. However, this should turn back pink when the baby stops crying. If the baby's color does not turn pink again, or there is an overall blue tinge to the baby, this may signal a problem. The blue coloring is called cyanosis and is often seen in babies with a heart defect, because the heart cannot pump the oxygenated blood to the rest of the body. Breathing difficulties may also cause cyanosis. Consult your baby's pediatrician immediately if your baby has any blue coloring. 


 

What might breathing problems indicate in a newborn?

Babies breathe much faster than older children and adults. A newborn's normal breathing rate is about 40 times each minute. This may slow to 20 to 40 times per minute when the baby is sleeping. The pattern of breathing in a baby may also be different. A baby may breathe fast several times, then have a brief rest for less than 10 seconds, than breathe again. This is often called periodic breathing and is a normal occurrence. Babies normally use their diaphragm (the large muscle below the lungs) for breathing.

Changes in a baby's breathing rate or pattern, using other muscles and parts of the chest to breathe, or changes in color may mean the baby is having respiratory distress and needs immediate medical attention.

Signs of respiratory problems may include, but are not limited to, the following:

  • rapid or irregular breathing
    Rapid breathing is more than 60 breaths each minute. A baby who is overheated or upset and crying may breathe rapidly, but the rate should slow when the baby is no longer too hot or crying. Continuously rapid breathing is a sign of a problem. Breathing that stops longer than 10 seconds, called apnea, can be a serious problem.
  • flaring nostrils
    A baby who is having trouble taking in enough air will have nostrils that widen with each inhaled breath.
  • retracting
    Another sign of difficulty taking in air is retracting, when the baby is pulling the chest in at the ribs, below the breastbone, or above the collarbones.
  • grunting
    This is a sound made by a baby who is having difficulty breathing. The baby grunts to try to keep air in the lungs to help build up the oxygen level. Another sound may be a moan or sigh when exhaling.
  • blue color
    Cyanosis, a generalized blue coloring, can be a sign the baby is not getting enough oxygen. This is often seen in babies with heart defects, as well as respiratory problems.
  • coughing
    Occasionally, coughing or choking may occur when a baby takes in milk too quickly with feedings. Persistent coughing or choking may indicate a breathing problem, or a problem with digestion that should be examined by your baby's physician.

For any sign of respiratory problems, you should consult your baby's physician immediately. 


 

What might gastrointestinal problems indicate in a newborn?

A newborn's ability to eat and digest food is essential to growth and development. Most babies are able to take feedings with normal absorption of the milk followed by normal bowel movements. Difficulty in any of these areas can be a temporary adjustment or a sign of a more serious problem. The following symptoms may indicate the baby is having gastrointestinal problems: 

  • Vomiting:
    Spitting up and dribbling milk with burps or after feedings is fairly common in newborns. This is because the sphincter muscle between the stomach and the esophagus (the tube from the mouth to stomach) is weak and immature.

    However, forceful or projectile vomiting, or spitting up large amounts of milk after most feedings, can indicate a problem. In formula-fed babies, vomiting may occur after overfeeding, or because of an intolerance to formula. In breastfed or formula-fed babies, a physical condition that prevents normal digestion may cause vomiting. Discolored or green-tinged vomit may mean the baby has an intestinal obstruction. Consult your baby's physician immediately if your baby is vomiting frequently, or forcefully, or has any other signs of distress.
      
  • Reflux:
    Some babies may constantly spit up all or most of every feeding, or gag and choke during feedings. This may be caused by reflux. Reflux occurs when stomach contents back up into the esophagus (the tube that connects the mouth to the stomach). The esophagus can become raw and irritated by the stomach contents. When the stomach contents back up into the esophagus, they may be vomited and aspirated (breathed) into the lungs. You may also be able to hear and feel "rattling" in the chest and back. Tips that may help babies with reflux include:
    • Play with, bathe, and/or change diapers before feeding.
    • Be sure diaper is loose.
    • Feed smaller amounts but feed more often.
    • Feed slowly, holding your baby upright.
    • Burp your baby often during the feedings.
    • Handle your baby gently after the feeding.
    • Place your baby on his/her side, or as instructed by your baby's physician.
    • Raise the head of the bed.

Consult your baby's physician if he/she is fussier, the vomiting seems worse, or your baby has problems breathing during or after feedings, choking spells, or refuses feedings. 

  • Diarrhea:
    The first bowel movement of a newborn is called meconium. This is a sticky, greenish-black substance that forms in the intestines during fetal development. The baby may have several meconium bowel movements before this substance is completely gone from the baby's system. After the first few days normal bowel movements are yellow and formed in formula-fed babies and may occur once or twice a day, sometimes more often. Breastfed babies have soft, seedy, yellow-green bowel movements several times a day, as often as every few hours with feedings.

    Babies with diarrhea have watery, very loose bowel movements that occur very frequently. A baby may or may not have signs of cramping with the diarrhea. Watery bowel movements and diarrhea in a newborn can quickly lead to severe dehydration and should be treated immediately. Consult your baby's physician if there is a change in your baby's bowel movements or your baby develops diarrhea.
      
  • Colic:
    Colic is a problem that affects some babies during the first three to four months of life. It can be very stressful and frustrating to parents. Physicians have defined colic as prolonged or excessive crying in an infant who is otherwise well. The crying can be very loud and can last for several hours a day. Colic often starts by 3 weeks of age, is at its worst around 6 weeks, and gradually gets better by about 3 months of age. It is not clear what causes colic. Some of the reasons babies may have colic include the following: 
      
    • Adjusting to one another
      Colic may relate to the adjustments that a new baby and his/her parents have to make to each other. Babies obviously cannot talk. Until they learn to talk, one way they communicate with adults is by crying. Parents have to learn to interpret the reasons their baby is crying, and then determine what to do to make the baby happy. Is the baby hungry? Wet? Cold? Hot? Tired? Bored? A baby will cry for these reasons as well as for other problems, and parents must try to determine what is causing their baby stress, often by trial and error. New parents, especially, may have trouble reading their baby's cues and responding appropriately. The baby may continue to cry simply because his/her needs have not yet been met.
        
    • Temperament and adjusting to the world
      Newborns must also make adjustments to the world they are living in. Not all babies have the same temperament. Some adjust to lights, loud noises, and all the other stimulation around them with no trouble, while others are not able to adapt as easily. Just like adults, some babies are easy-going, and some are impatient. Crying may be one way for a baby to vent feelings as he or she is getting adjusted to the world.

      Babies have been noted to cry for specific lengths of time every day, as they are getting used to the world and as their parents are learning to interpret their needs.
        
    • Oversensitive to gas
      Another possible reason for excessive crying in babies might be that they are oversensitive to gas in the intestine. The normal amount of gas that is produced as food is digested may be more uncomfortable for some babies than others. If a baby with colic seems to pass more gas than other babies do, it is probably due to swallowing more air while crying for prolonged periods of time. 

Milk Allergy
It is rare for colic to be caused by a true milk allergy. However, some babies may be more sensitive to cow's milk based formulas. Your baby's physician may recommend changing formulas to a soy-based rather than cow's milk based formula to see if this helps relieve the symptoms of colic.