Care of Your Newborn
Newborn babies sleep a lot, usually waking every two to four hours for feeding. By four months of age, most babies sleep through the night, although some infants begin much sooner. Although you may have heard that starting solid foods will cause a baby to sleep all night long, there is no evidence to support this. Even after sleeping continuously, your baby may begin to wake once again during the night. This is a normal developmental phase, and a typical pattern of nighttime sleeping will soon return. Remember that babies must be placed on their backs for sleep to reduce the risk of SIDS (Sudden Infant Death Syndrome).
Hiccups, Sneezing, and Congestion
Hiccups and sneezing are normal reflexes for all babies. Sneezing helps keep airways clear and does not necessarily indicate a cold or allergies. While nasal congestion is common, call the office if your child has labored breathing, fever, or decreased feeding. To relieve discomfort of nasal congestion, use saline nasal drops and a bulb syringe or nasal aspirator to suction out the mucus. Put a few saline drops in one nostril with a medicine dropper. Wait a few seconds and then suction with the syringe. Repeat this procedure with the other nostril. Do not treat both nostrils at the same time as your child will have difficulty breathing. Please use commercial preparations of non-medicated nasal saline drops, such as Little Noses Non-Medicated Saline Drops.
Breast Swelling and Vaginal Discharge
Baby girls often have slight vaginal discharge and bleeding after birth. Both girls and boys frequently have breast swelling. Although these conditions may persist for several weeks, they are not a cause for concern.
The frequency and character of bowel movements vary widely. Bowel movements may occur as often as after each feeding or less frequently, such as once every three days. The stools of breast-fed babies tend to be loose and seedy, while formula-fed babies generally have more solid stools. Stool color ranges from yellow to dark green. Although babies strain and become red in the face even with normal bowel movements, hard or pellet-like stools may indicate constipation. As long as your baby seems happy, is eating as usual, and has no signs of illness, don’t worry about minor changes in the stools.
During the first four to six weeks, a baby’s skin often has rashes, which are usually on the face in the form of small discrete lesions or pimples that may appear and disappear. Newborn acne is a common rash on the face, neck, and upper chest that typically clears up in six to eight weeks. Wash the area with mild, unscented soap once or twice daily. Do not apply oils, lotions, or creams, which only worsen the condition. Please call the office if the rash is severe or widespread on your baby’s body.
All babies cry as their way of saying, “I’m hungry, I’m thirsty, I’m wet, I want to be hugged, I’m bored.” In time, you will learn to distinguish the different cries. If you check the baby and all is well, don’t worry. Infants cannot be spoiled, so feel free to pick up your crying baby. Pacifiers often calm infants and have been shown to decrease the risk of SIDS. The pacifier can easily be discontinued at four to six months of age.
Excessive irritability in a young infant is sometimes a condition known as colic. The baby usually cries, turns red, and pulls the knees up toward the chest. The crying typically increases in the evening hours, between 4 and 8 PM. Colicky babies may pass gas or need to be burped more often than other infants. Most of the time there is no cure for colic other than patience and passage of time. The symptoms subside by three to four months of age. If your infant experiences colic, try to make the baby as comfortable as possible. Suggestions include turning the baby on the stomach, stroking the back, swaddling in a blanket, rocking, cuddling, taking a ride in a carriage/stroller or car, and giving a warm bath. For additional information about swaddling and colic, visit http://www.happiestbaby.com.
The Umbilical Cord
The umbilical cord stump usually falls off by itself in one to four weeks. Keep the area clean and dry. Oozing and slight bleeding commonly occur before and after the cord stump falls off. It should dry out in one to two days.
Many babies have dry skin following birth. Since frequent baths increase dryness, bathe your infant every other day using a baby bath product or mild, unscented soap, such as Dove. Do not immerse the baby in a tub until the cord stump has fallen off and healed. Sponge baths are advised until that time, avoiding the cord area. Wash your baby’s hair with soap or baby shampoo two to three times per week. Lotions or creams are not routinely necessary. Peeling of the skin on the hands and feet is normal and usually subsides after three to four weeks.
The penis requires no special care, unless it is circumcised. After circumcision, generously apply petroleum jelly to the penis for one to two weeks. For baby girls, separate the labia and gently cleanse with a wet piece of cotton, wiping only from front to back. Clean the vaginal area after bowel movements in the same manner.
The key to preventing diaper rash is keeping the skin dry. We recommend frequent diaper changes as soon as possible after urination or bowel movement. Clean the area with warm water using a washcloth, paper towel, or cotton ball and pat dry. Avoid commercial wipes during the first month. A small amount of petroleum jelly in the skin creases will help protect that area. If a rash develops, use petroleum jelly. While exposure to air is the best treatment for most rashes, call our office if you see no improvement.
Eyes, Ears, and Nose
Do not use cotton swabs to clean the nose or ear canals. If a yellow discharge is noted from the eye, wipe away with a washcloth and warm water. If the discharge persists or you observe redness or swelling, call our office.
Call the office immediately if your infant is younger than two months and has a rectal temperature higher than 100.5 degrees Fahrenheit. While fever generally indicates infection, it is actually therapeutic. The degree of fever is less significant than the associated symptoms. Fever alone will usually not harm your child. We advise treating fever only to make your child more comfortable. However, please call the office if you are concerned about your child’s condition.
The effective methods of controlling fever in children over two months include:
- Acetaminophen for infants given orally or as rectal suppositories every six hours as needed.
- Ibuprofen drops, given every six to eight hours as required to a child over six months old.
- Sponge baths using lukewarm water. Repeat as often as necessary. Do not use alcohol to bring down fevers, which may cause chills and discomfort.
- Dress your child in lightweight clothing. Overdressing may cause heat retention and even raise the fever.
You will notice that your baby develops a pattern of bowel movements. If this pattern changes, such as increased frequency or watery stools, take precautions because your child could become dehydrated. Signs of dehydration include failure to urinate, dry mouth, and/or listlessness. If you observe any of these symptoms or your child is less than six months old, call the office immediately. Continue feeding breast milk or formula as well as regular food because proteins, carbohydrates, and fats help the intestines heal. It is important to replace the fluids that your child loses in the stools. If diarrhea continues repeatedly despite these measures, call the office.
Vomiting associated with a fever may indicate viral gastroenteritis (commonly called stomach flu) or more serious infection. If your child is vomiting, has a fever, and appears ill, or is younger than six months, call the office immediately. If there is little change from normal behavior and no fever, take steps to prevent dehydration. During the first day, stop giving your child milk. Clear liquids, such as an electrolyte solution (Pedialyte or other brands), should be given in small amounts of one to two ounces every half hour. After 12–24 hours, add soft foods to the diet if liquids are tolerated. Call the office if vomiting persists for more than 24 hours.
Your child’s first teeth usually appear between three months and one year. The bottom teeth generally erupt first, although order varies. Some children have no problems with teething while others become irritable and fussy. They may not eat as well as usual while the teeth are breaking through the gums. A runny nose and loose bowel movements are sometimes reported. Fever over 101 degrees Fahrenheit is not a typical symptom of teething. To relieve your child’s discomfort, you may rub the gums with an ice cube wrapped in a washcloth. You can also give your infant a hard teething ring to chew. If teething pain wakes your baby at night, you may give the appropriate dose of acetaminophen, or ibuprofen in babies over six months of age.
A car safety seat is required by law for all infants and children under the age of eight. A baby who is held in your lap has no protection from sudden stops. Install all new car seats in the vehicle’s back seat, preferably in the center when possible, and rear-facing until two years old. It is NJ law to keep chilren backward facing until age 2 due to statistics that demonstrate that it is five times safer to have a child under 2 facing backward rather than forward. Front seats are to be used only for children over 12 years old or if the vehicle has no rear seat. Never place a car seat in the front seat if you have front airbags. Children should be in 5-point harness restraints in a car seat until they are at least 4 years old AND 40 pounds, before considering changing to a booster seat. Booster seats should then be used until the child is BOTH at least 57 inches tall AND at least 8 years old.
Car Seat Resources
Click here for up to date recommendations and product listings from the American Academy of Pediatrics and enter search term "car safety seats families".
For New Jersey Child Passenger Safety Laws visit, http://www.nj.gov/oag/hts/childs.
The Morris County Division of Transportation has carseat inspection stations in our area -- a free service sponsored by Northern NJ Safe Kids/Safe Communities. For FREE local car seat inspection stations, visit http://www.preventionworks-nj.org/car-seat-inspection.php
Out of Doors
You may take your baby outside for short periods of time in pleasant weather when you feel well enough to venture outdoors. Avoid prolonged exposure to direct sun and wind. During the first two months, keep away from crowds, such as in shopping malls and supermarkets, as well as young children.
Dress your baby as you would dress yourself, according to the temperature. Do not overdress your baby on warm days. A hat is advisable when it’s sunny to protect the skin.
Room temperature should be comfortable, but not too warm. A temperature of 68–72 degrees Fahrenheit is ideal. If the temperature is lower, dress your baby appropriately.