Newborn care

To help you as you bring your newborn home from the hospital, learn about the issues most often of concern to new parents.


Appearance
Your baby's head
You may notice that your baby's head has an unusual shape. Don't be alarmed. This often occurs when a baby passes through the birth canal and is called "molding." Your baby's head should return to a normal shape after a few days to a week.

The soft spot (fontanelle) is a diamond-shaped area on the top front of your baby's head that allows for rapid brain growth during infancy. The soft spot normally closes by age 18 months. It's covered by a thick fibrous layer and is safe to touch.

Your baby may also have what doctors refer to as a cephalohematoma (head bruise). This is a collection of blood on the outer surface of the skull from the birth process. It's usually limited to one side of the head. It appears in the first days after birth and may not resolve completely until the baby is 2 to 3 months old.

Your baby's hair
Your baby may have lots or little scalp hair at birth. Most newborn hair is dark in color. This hair is temporary and begins to shed after about a month. The permanent hair typically appears by 6 months and may be an entirely different color from the newborn hair.

Fine downy hair may cover the back and shoulders of some infants (more common in premature infants). This is called lanugo and usually wears off from normal friction within two to four weeks.

Your baby's eyes
A newborn's eyes may be blue, green, gray or brown at birth, but it will take about six months for true eye color develop. Your baby's eyelids may look puffy or swollen. This may be related to the delivery or the eyedrops your baby received after delivery. The puffiness typically resolves after about three days. You may also notice a small red area on the white of your infant's eye. This is called a subconjunctival hemorrhage. Small blood vessels may have ruptured during delivery, but the blood should reabsorb after about a week. Call your baby's doctor if the redness grows or your baby develops other symptoms.

Your baby's face
Some of your baby's facial features may appear misshapen, such as ears that stick out or have a fold. After a few weeks, the cartilage should become firm and give the ears a normal shape. Due to positioning in a "crowded" uterus, your infant's nose may appear flattened or pushed to the side. This should correct itself after about a week.

Your baby's skin
Because newborns have immature circulatory systems, you may notice color changes in your baby's skin. The changes may be different from left to right or top to bottom.

Your infant's hands and feet may be a bluish shade (this should only be present about 24 hours). Some babies look mottled or splotchy when crying. For apparently healthy, responsive babies with no known medical conditions, these color changes normally don't indicate a problem. If you think your baby is in distress or the color changes are associated with other symptoms, contact your baby's doctor or seek medical attention.

Your baby's genitalia
Female hormones that cross the placenta may cause newborn girls to have a swollen vagina. The swelling usually disappears within two to four weeks. Newborn girls may also have a clear, white, pink-tinged or bloody vaginal discharge during the first week, also due to female hormones that cross the placenta. Once this normal discharge stops, it should not recur until puberty.

Newborn males may have fluid in the scrotum from the birth process. This is called a hydrocele. It's painless and will disappear over time. If there is a scrotal swelling that frequently changes size, a hernia may also be present. You should discuss this with your baby's doctor. If your son is not circumcised, he may have a tight foreskin that doesn't allow you to see the head of the penis. Do not try to retract the foreskin. Your son will still be able to urinate, and the foreskin will eventually retract and loosen by itself over time.

Both newborn boys and girls may have enlarged breast tissue, which may even secrete a small amount of milk. This is caused by the mother's hormones passing through the baby's system and rarely lasts more than a week.


Reflexes
Newborns typically have immature nervous systems. For the first two to three months of life, your newborn may display certain reflexes, such as a trembling chin or quivering lower lip. Your baby may also tremble while crying or stiffen for a moment if there is a sudden movement or noise (this is called the startle or Moro reflex).

Bowel movements
Your baby's first bowel movements may be tarry or greenish-black. This is due to meconium bile and other products that were in your baby's intestines before birth. After the meconium passes, your baby's bowel movements may be "seedy" and dark green or yellow. They may also be loose or sound explosive, especially if you're breastfeeding. Breastfed babies typically have formed stools once they're weaned. Bottle-fed babies often begin to have more formed stools after a few days.
During the first month of life, your newborn may have four to six bowel movements a day. Later, your baby may only have one bowel movement a day or even every other day. As with adults, the number of normal bowel movements varies. Call your baby's doctor if your baby seems ill or irritable, cries excessively, runs a fever, or has frequent liquid stools that are foul-smelling or contain mucus or blood.

Many babies strain with each bowel movement because the muscles needed for defecation aren't developed yet. This will change as your baby grows. Signs of constipation in an infant include straining accompanied by small, pellet-like stools that appear to cause pain or contain small streaks of blood. If your baby seems to be constipated, call your baby's doctor for advice.


Fluid intake
Newborns eat around the clock with varied intervals between feedings. A newborn should be fed at least every four hours in the first weeks of life to prevent low blood sugar levels. As your baby grows, he or she will be able to go longer between feedings.
Newborns usually start with 1 ounce per feeding, but by seven days they can often take 3 ounces. By five or six months, most babies reach their maximum of 8 ounces per feeding. To estimate the ounces of breast milk or formula your baby is likely to need at each feeding after the first week, divide your baby's weight (in pounds) in half.

If you're nursing, you can't measure the amount of milk your baby drinks. Instead, pay attention to your baby's diapers. Properly fed babies have at least six to eight wet diapers and two stools each day during the first month of life. They are also alert and content.

During the first days or weeks, contact your baby's doctor if:

Your infant has less than six wet diapers and two stools a day.
The diaper is dark yellow or has a foul odor.
Your infant has other symptoms that concern you.
Your infant is eating poorly.

Spitting up
Spitting up can be caused by an immature digestive system, swallowing too much air during feeding, or eating too much. Most babies spit up a small amount at least once in a while. Others spit up after each feeding. Many babies stop spitting up when they learn to sit upright, at about 6 months of age. Some babies spit up until age 1.
Here are some tips to help you decrease how often your baby spits up:

Don't feed a crying baby. This will limit the amount of air your baby swallows.

Hold your baby as upright as possible during each feeding.

Burp your baby after every couple of ounces, or at least halfway through the feeding.

If you're bottle-feeding, make sure the nipple is the right size. Keep the bottle tilted so the nipple fills completely with formula, not air.

Let your baby sit quietly in an upright position after eating (in an infant seat or stroller, for example). This gives your baby time to digest the food. Right after a feeding, avoid bouncing your baby or passing your baby from person to person.

While your baby sleeps, keep his or her head higher than the stomach by elevating the head of the crib. Also, make sure you place your baby to sleep on his or her back.
Normal episodes of spitting up should not be concerning. Call your baby's doctor if:

Spitting up appears to be affecting your infant's weight gain or growth.
Spitting up causes prolonged gagging or coughing.
The spit up is extremely forceful (projectile vomiting).
The spit up is brown or green.

Crying
Crying is the only way babies have to communicate their needs. Babies cry when they're wet, cold, hot or hungry. Some babies cry when they're overstimulated or settling themselves to sleep. Some crying episodes don't seem to be related to anything. For unknown reasons, newborns often have daily crying spells that last from 15 minutes to an hour. Many babies outgrow these crying episodes by about 3 months of age.
Here are some tips to help you soothe your baby and limit the length or number of crying spells.

Rock your baby in your arms or an infant swing. (Be sure your baby has good neck strength before using a swing. This strength is usually not present until about 6 weeks of age.)
Walk with your baby in a sling or in your arms.
Sometimes, taking your baby for a ride in a stroller or a car can do the trick.
Some babies feel more secure when they're snugly wrapped or swaddled in a light blanket, such as a receiving blanket.
Others are calmed by rhythmic sounds, such as a fan. Tapes or CDs of wind or wave sounds may also help.
Newborns are often comforted by the warmth of skin-to-skin contact. Lay your baby tummy-to-tummy against you, and gently pat or rub your baby's back.
Most crying episodes are normal. Call your baby's doctor if your baby has a sustained episode of crying, appears ill or in distress, or is difficult to console, especially if such crying isn't typical for your baby.


Sleeping patterns
Newborns normally sleep about 16 hours a day. Between meals, your baby may sleep for three to four hours straight. Newborns have a lot of active sleep with dreaming and movement, so your baby may seem restless or make noises while asleep. You may hear your baby wake up periodically throughout the night. When left alone, your baby may settle down and return to sleep. Your newborn may need your attention during periods of active crying.
To help your baby learn the difference between day and night, keep night feedings quiet. This will also help your baby settle back to sleep after eating. As infants get older, they're awake for longer periods of time during the day. Also, at night, your baby won't need to wake up as often to eat. Establishing a bedtime routine -- such as singing a song, nursing or offering a bottle -- may help settle your baby to sleep.

Call your baby's doctor if your baby begins to sleep much more than normal and is difficult to wake, seems more restless and irritable, or has other troublesome symptoms.


Sleeping positions
Recent studies have shown an increased incidence of sudden infant death syndrome (SIDS) in babies who sleep on their stomachs. As a result, the American Academy of Pediatrics and the National Institutes of Health recommend that healthy babies sleep on their backs. There is no evidence that healthy babies risk vomiting and inhaling the vomit while sleeping on their backs. Talk to your baby's doctor about the best sleeping position for your infant, especially if your baby has a medical condition that may affect the decision. To further decrease the risk of SIDS, your baby should sleep on a firm mattress without soft, fluffy or loose bedding or stuffed toys. Don't let your baby get too warm and avoid any exposure to cigarette smoke.