WCC RESOURCE CENTER
Your New Baby
Whether by birth or adoption, the delivery of your infant will be a long-anticipated and emotion-filled experience. After your baby is born, the hospital will automatically notify us (if you designated us as your baby's pediatric office when you were admitted to the hospital). One of our pediatricians will examine your baby within 24 hours of delivery, and one of our pediatric nurse practitioners (or again a physician) will examine your baby again shortly before you go home. At these exams we will discuss some of the common transitions babies make in the first few days of life, and what to expect upon going home, including feedings, elimination, sleeping, visitors, and signs of problems. If your baby is born at a hospital other than the ones we attend, we will meet your baby at the two-week visit (or sooner if needed).
*** Remember to add your new baby to your insurance and your insurance card as soon as possible to avoid a lapse in coverage. Call the insurance directly (the number is on the back of your card) or contact your Human Resources Department (if insurance is employee chosen).
After Discharge From the Hospital
We typically recommend that all babies have their first clinic visit at 3-5 days of age to assess feeding progress, weight loss, jaundice, and other issues that can come up shortly after hospital discharge. This is a hospital follow-up visit, not a well-visit, which means you could be charged a co-pay or office visit (check with your insurance company for your specific benefits). Your baby's first "well" visit ("check-up") will be at age 2 weeks. We'll plot your baby's growth on the growth curves, discuss upcoming developmental milestones, safety, feeding, etc.
Life will be full of changes, learning experiences, surprises, and "firsts," for both babies and parents. Listed below are some of the most common newborn health and care issues that come up in the first few weeks at home. While most babies are healthy, please call us if you feel you have a problem.
Weight loss occurs in almost all newborns during the first week of life as they rid themselves of excess fluids. A 5-10% loss is considered normal, and babies are usually back to birth weight by the two-week visit. After that, most babies gain ½ to 1 ounce a day for several months.
Sleep will vary considerably. Some babies sleep 20 or more hours a day and waken only for a feeding. Others are awake every hour or so, including through the night! It is recommended that all infants be placed on their backs for sleep. Some sleeping babies gasp, snort, groan and occasionally even pause their breathing while they sleep. It's all normal.
Jaundice is a yellow discoloration of the skin caused by the build-up of "bilirubin" in the blood and fat tissues. Bilirubin is the normal result of the breakdown of red blood cells (we all have bilirubin in our bodies). Because there is so much bilirubin produced in the first few days of life (from the birth, bruising, etc.), sometimes it temporarily accumulates in the skin until the liver can break it up and help the body eliminate it. The most common time babies develop jaundice is 2-5 days after delivery. This is rarely a problem, but if you notice your baby becoming quite yellow (or "orange") and lethargic, contact us at the office. The best way to prevent jaundice is frequent feedings (every 2-3 hours) to help your baby have more stools (which is one way the body excretes bilirubin). Mild jaundice can be helped by exposing a baby to window sunlight.
Newborn rash or "Erythema Toxicum" is a common rash seen in the first week or two of life. It is a widely scattered rash that consists of red raised spots with whitish centers (resembling "flea bites"). The rash has no symptoms, and no one knows why babies get it, but it usually goes away on its own by the time a baby is two weeks old.
Infantile (neonatal) acne is another type of skin rash that usually shows up when a baby is two to six weeks old and is due to the stimulation of the body's oil glands by maternal hormones during the pregnancy. This appears as pink raised "pimples" and can develop anywhere on the body, but most commonly on the face, chest and upper back. Some babies get only a few pimples, while others get covered from head to toe. No treatment is needed nor recommended unless the pimples begin to look infected (increasing redness or fluid-filled pustules). Infant acne does not indicate the future presence nor severity of adolescent acne.
Infant breast enlargement is normal regardless of gender and is caused by pregnancy-related hormones. Sometimes a thin white discharge may be present at the nipple. Observation is all that is needed and this should clear within a few weeks.
Infant female bloody spotting, or "pseudomenstruation" is the name of the blood tinged vaginal discharge caused by maternal estrogen's effect on a baby girl's vagina and uterus. It is totally normal, and may occur on and off for the first month.
Hiccoughs, sneezing, chin quivering, sudden jerking movements and random eye crossing are all normal newborn behaviors and do not mean something is wrong. A newborn's nervous system is very immature and is not used to having to coordinate all those new reflexes.
Umbilical cord care usually involves observation alone. Some people still prefer to clean the base of the cord 1-2 times a day with rubbing alcohol, but avoid cleaning too frequently, as this can irritate the skin and delay cord separation. A little bleeding a few days before and after the cord falls off is normal.
Dry skin is normal and varies in all newborns. Some get just a little patchy dryness, while others have peeling, flaky, cracked skin all over their bodies. With the exception of extreme cases, lotions are usually not needed nor are they helpful. The dryness will resolve into smooth "baby" skin at about the same time the oil glands mature and erupt (age 2-6 weeks).
Circumcision remains a subject of controversy and opinion. There is no overwhelming evidence that supports whether a child should or should not be circumcised, so the decision is left to the parents. If the decision is to circumcise, take care of the freshly circumcised penis by gently washing away debris with warm water. Follow with an application of petroleum jelly and a fresh gauze pad (to prevent the diaper from sticking to the healing site) until there is no more drainage on the gauze pads. Most circumcisions are healed and well-protected within 2-3 days.
If the decision is to remain uncircumcised, the care of the foreskin consists of gently removing accumulated secretions with a soft cloth during bath time. It is not necessary to vigorously retract the foreskin during infancy; it will gradually separate over time and eventually become fully retractable. When this occurs, your son can be taught to clean this area on his own.
Bathing is initially done with a washcloth or sponge and the baby laying on a towel. When the cord falls off and there is no more drainage from the cord area, bathing your baby is a small tub or sink is fine (remember to put a non-slip pad or washcloth on the bottom of the tub for safety). Most babies need only 1-2 baths a week, as parents clean the dirty areas frequently anyway (around the mouth, nose, neck, and diaper area). Avoid soap on the face, and use it sparingly on the scalp and body (unscented mild soaps are the least irritating and drying). Healthy ears are self-cleaning, and cotton-swabs are never recommended. Baby powder is also not recommended because of the risk of inhalation of the talc and subsequent lung irritation.
Room temperature should be determined by what is comfortable for you (68-72 degrees is average), and we advise dressing your baby appropriate for the conditions. For example, if you like your house on the cooler side, an extra undershirt for baby is a good idea. Resist the urge to overbundle. If you take your baby outside (even if only from the house to the car), protect her from the elements (wind, cold, heat, sun, rain, blowing dirt/sand) with a lightweight blanket over her infant carrier.
Visitors and outings really need to be limited in your baby's first few weeks of life. This is very difficult for most parents, as the adrenaline is pumping and you are so excited to show your baby to the world. But, having too many visitors to your house or taking your baby to someone else's house is surprisingly exhausting, for parents and babies. Plus, this immediate and often uncontrolled exposure to illness (illness that we adults consider mild and routine) can be serious to a newborn. Remember (and remind visitors) to wash your hands frequently, and always before touching or picking up your baby.
Crying is a baby's way of communicating, and does not necessarily mean that the baby is angry. All babies cry, some much more than others. Eventually you will get to know your own baby's cries and be able to distinguish between the "feed me," "change me," "dress me," "hold me," and "leave me alone" cries. Each baby has a separate personality and temperament, which is often what determines how a baby will respond to changes or stimulation. Some babies are very mellow and barely squeak when really hungry. Other babies go into a full cry when their arms accidentally sneak out of the blanket a little. If you feel that your baby is crying inconsolably for more than an hour or two, or longer than you feel comfortable with, please call us. Familiarize yourself with Shaken Baby Syndrome and know who you would call for help if you needed a break from your baby's crying.
Pacifiers and thumbs are topics sure to stimulate intense conversation with friends and relatives! In general, all babies need to suck to console themselves; they have no other way to calm down. To deprive a baby of this natural sucking need will deprive him or her of a natural reflex and will likely lead to fussiness. Some babies are very "oral," while others really only suck when feeding. There are certainly advantages and disadvantages of both the pacifier and thumb for these oral babies. Early on, babies usually cannot hold anything in the mouth without help (the pacifier pops right out, or the thumb gets yanked away when the baby startles). If the baby is breastfeeding, and is having a hard time getting the hang of it, pacifiers and bottles are not recommended until the nursing improves. When the sucking strength improves, the thumb is handy because it's always there (especially in the middle of the night). But, pacifiers can eventually be thrown away. Once teeth start coming in, both the pacifier and to a greater extent the thumbsucking can cause displacement of the teeth and an increase to the arch (roof) of the mouth.