Congratulations! You have both become proud parents! After months of anxious waiting during your pregnancy, labor and delivery topped by a tiresome hospital stay… you now have a wonderful bundle of joy to love and cherish. Now comes…?
Many questions that you never thought about, start creeping up. Endless sleepless nights along with emotional and physical fatigue make your journey seemingly formidable.
As a pediatrician and parent, I know what you are feeling. I have put together some information that will help you get started in the best possible way with your newborn baby.
Fortunately for us parents, babies come with a limited number of needs. Although you may feel clumsy and feel incredibly tired, this job does not have to be difficult. All babies need is simply to be clothed, fed, changed and loved. They communicate by crying and it is then our responsibility to decipher what they mean, mostly by trial and error. They respond almost immediately when we have interpreted their cry correctly. Like Dr. Spock once said, use your good common sense and you will do well.
Take Care of Yourself
The amount of time that we as parents dedicate to our babies is surprising. It can be very stressful especially if your baby is colicky or if your spouse's participation is limited. The first couple of months or so you will chronically feel sleep-deprived. Working mothers will sometimes find themselves socially isolated after the baby arrives. These feelings can be at their worst one to two months later when the novelty of the experience has worn off. What to do? Trade off with your spouse or close relative. Get away for a few hours, get in contact with a reliable babysitter and maybe even make a date with your spouse. Other suggestions are to get some exercise; mingle with friends, maybe with other new parents, and go for strolls or trips to the park, etc. You can travel with your baby. Between one and nine months of is the ideal age for a trip to visit friends or relatives and show off the baby.
Bathing Baby
Keeping your baby clean can become tideous. They will spit up quite a few time during the day and can smell of formula. Sponge bathing your baby doesn't have to be hard. Do it in a warm area of you home two to three times per week. Soap is not necessary but may be used (any baby made product of your choice, preferably perfume free). Shampoo with a baby shampoo. Keep the cord dry and apply alcohol to it to aid drying after sponge bath. Do not submerge your baby in a tub of water until aftere the cord has fallen and completely healed.
Feeding
Breast Feeding
You should nurse your baby on demand, about every two to three hours. Avoid nursing more often than every hour, but don't allow your baby to go without a feeding for more than five hours. You should wake your baby at five hours during the first week if he doesn't wake on his own. Feed an average of 5-20 minutes per breast on the first day gradually increase the time to a maximum of 20 minutes per side by the fourth day. Depending on how vigorous your baby is, he may require only five minutes and others twenty minutes to empty each breast. Try to empty each breast at every feeding. Milk “comes in” around the third to fourth day after delivery. Some woman experience engorgement, which is hard, sore, and full breasts. Burping the baby between each breast will help him feel more comfortable and avoid gassiness. If your baby is falling asleep during feeding, you can stimulate him by undressing him, rubbing the bottom of his feet, back or abdomen. This will hopefully keep him awake so he completes his feeding and lets you rest for the next feeding. If the baby is sucking well at the above intervals, acting satisfied after feeding, wetting the diaper over three times a day and having several daily stools, rest assured that he is getting enough milk. Breast-fed babies normally lose some of their body weight during the first week of life and then should be back to birth weight by two weeks.
It is not necessary to supplement with formula when breastfeeding, unless the baby is sucking poorly or acts unsatisfied after nursing. It is a natural instinct for the baby to continue sucking after nursing or acts hungry. If your breasts are empty and you feel your baby has had enough to eat then, use a pacifier. You've got enough to do with feeding and caring for the baby, for him to continue to want to use YOU as a pacifier. It is normal for your baby to have a need to suck more than they can satisfy by nursing alone. Breast-fed babies don't need supplemental vitamins but you should continue your prenatal vitamins and calcium supplements, follow a healthy diet, get plenty of rest and drink lots of fluids. Always check with the doctor before taking any medication (other than Tylenol) while breast-feeding. Do not consume alcohol while breastfeeding. When you are nursing your baby it is often helpful to introduce a bottle at 2-3 weeks of age, and also continue bottle feeding a few times a week. This is so the baby knows how to feed off a bottle in the future. This will allow dads to be involved and not feel left out!
Breastfeeding is a learning process for mom as well as for the baby. Some babies learn to nurse with much more ease. For others it can be difficult to master, and in about fifteen percent breast-feeding won't be successful. The nurses are a useful resource in coaching you on the many “tricks” of breastfeeding. If nursing doesn't work out for you and your baby, do not to take it personally; instead, acknowledge the disappointment and move on. The baby's health and well-being is more important for you. The most important goal is to have a good mothering experience, and if that means bottle-feeding, so be it. Your body has been through many changes the last forty weeks, therefore your hormones are wreaking havoc with your emotions and these disappointments may seem devastating. If you are feeling frustrated or sad — notify us.
Bottle Feeding
Commercial formulas come in three types: Cow's milk – most commonly used (Enfamil - Lipil & Similac Advanced with iron), soy (ProSobee, Isomil) and protein hydrolysates (Nutramigen, Alimentum). The most commonly used formula is cow's milk based. In some cases there may be a strong family history of milk intolerance, then we will usually recommend a protein hydrolysate or soy formula. Signs of formula intolerance can include vomiting, diarrhea, bloody stools or colic.
Formulas come in three different formulations: Ready-To-Feed mixture (open the can and pour no need to add water). Concentrated formula requires you to dilute half-and-half with water. Powdered formula requires mixing two ounces of water per every scoop of powder. You will decide which formula works best for you; you can make a day's supply of bottles at one time – refrigerate them and use them as you go. Be consistent so that in the middle of the night when you are half asleep you won't make a mistake in mixing the formula. It is no longer necessary to sterilize the water or bottles in most middle-class communities. Boiling bottles and nipples about once a week is suffice. Use the dishwasher or hot water to clean them after each daily use. After a feeding, do not save any remaining formula in the bottle. Formula should be given at room temperature. Heating the milk in the microwave is not recommended because they heat unevenly and can burn the baby's mouth.
Nipples will vary in size, shape and color. You may find yourself trying different kinds of nipples until you choose the nipple that works best for your baby. If you notice your baby sucks hard and chokes, he may need a lower-flow nipple. If your baby takes over 30 minutes to feed he may do better with a higher flow. If your baby is very gassy, try a collapsible plastic inner-type bottle. It is recommended that you periodically check the nipple opening for size, especially if the baby is fussy with feedings.
On average infants will take 2 ounces every 2-3 hours or 2 ounces per pound of body weight in a day. Most babies feed approximately every 2-4 hours. As a rule of thumb after 2 months of age, a baby should take 24-32 oz. per day. No more than 40 oz. per day.
Additional feeding information
Infants usually set their own feeding schedule by 1-2 months of age. If your baby is fussy and it has been more then 2 hours since his last feeding, feed him. By 3-4 months of age most formula fed infants will give up middle of the night feeds. It is generally recommended to not start solid food until 4-6 months of age. Do not add rice cereal to the formula in a bottle, unfortunately this does not make babies sleep through the night. Most babies will begin to sleep through the night around 4 months of age and most will do it on their own.
Don't forget to burp your baby about halfway through a feeding, hold your baby up to your shoulder or prop him up on your knee in a sitting position, always remember to support their back and head. Gently pat his back for approximately one to three minutes or until you hear him burp. Hold your baby close during feedings, if you peer into his eyes he will be able to see you, these are good time to allow for parent bonding. Wet burps or spitting after feeding is common and almost always expected. Hiccups are common, and even occasional mild choking occurs normally. Repetitive forceful vomiting, green vomit with blood or choking and turning blue could be signs of serious problems – call the doctor.
Caring for the Genital Area
Boys: If recently circumcised, gently sponge wash the penis with a wet washcloth (do not use baby wipes) and apply a generous amount of Vaseline on a gauze pad with each diaper change for about a week. Normally during the healing process the circumcision site looks sore and red for a couple of days, then a yellow and sticky film forms for one to two days, lastly a dry yellow scab forms. Bleeding should be very minimal and the circumcision site should not hurt (even though it looks sore). Healing should be complete by the end of a week. If the baby is uncircumcised there is nothing special to do until about four to five years of age when boys should be taught to retract the foreskin with every bath.
Girls: It's important to part the labia with each change and wipe off debris using a wet washcloth or baby wipe. Newborn girls normally have some white discharge for several days and occasionally a small amount of blood for a day or two during the first week.
How should I dress my baby?
It is a very natural tendency for parents to want to dress the baby too warmly. We sometimes get a lot of unsolicited advice from other experienced moms who say a baby will “catch a cold”. As a rule of thumb, dress the baby as you would yourself— if you are comfortable in short sleeves, do the same with baby. At night or when sleeping use a thin cotton receiving blanket. Be sure that the baby is not in direct line with cooling or heating vents.
Diapers
What is best, cloth or disposable? From a health perspective there is little difference between cloth and disposable diapers. Cloth diapers are much more favorable to the environment, while disposable diapers are more convenient. Cost is very similar. Babies in disposable diapers do not need anything applied to their buttocks on a routine basis. Baby powder and cornstarch should not be used on the baby. They can inhale it and can cause serious respiratory problems.
Mixed Feelings
Bringing a new life into the world is not like buying a new television set, they don't come with instructions. It is normal to feel anxious, clumsy or unsure the first few days when baby is home. Be patient! It won't be too long before you and the baby will figure the whole thing out. Try to relax and enjoy the slow pace of the early days. Don't be surprised to find that not a whole lot of things are getting done around the house. Your primary job is taking care of yourself and the baby. Allow your husband, visiting relatives and friends to help with household chores. Schedule your friends' visits and calls so you can nap. If grandparents' or relatives' help or advice is interfering rather than helping, find a way to politely say “thanks,” but follow your instincts and our advice.
Emergencies
We highly recommend that all parents take a CPR course through their local hospital, fire department or local Red Cross. Know the location of the nearest emergency room, and keep the following important numbers ready by the phone: Pediatrician, Poison Control Center, Pharmacy. Also, instruct your babysitters about them.
Immunizations
Immunizations have saved the lives of an endless amount of children and have rendered previously feared diseases nearly extinct. Unfortunately, there is a lot of incorrect information available online or simply word of mouth that immunizations are unnecessary or even harmful. Nothing could be further from the truth, they are safe and effective. While there may be “reactions” to certain vaccinations, these are usually very minor. If you have any question or concerns about immunizing your child, please discuss these with us. Routine childhood immunizations begin in the hospital with Hepatitis B vaccine. This vaccine is very safe and effectively prevents a viral disease that destroys the liver and can ultimately cause death. Other vaccines will begin at the 2 month well child visit. You will be provided with verbal and written information about vaccines as well as their benefits and potential reactions. You will be given the opportunity to ask questions at that time, prior to your providing consent.
