Bringing Home Your Newborn
Congratulations! Your new baby is here, and after a few days in the hospital you are ready to go home. The first few days of life are often a whirlwind of activity and confusion for parents. By the time you arrive home many parents are a little shell-shocked. And honestly, no matter how many parenting books or blogs you have read to prepare, it can be a little scary to bring your newborn home. No doctors, no nurses, no lactation consultants…just you and your baby.
But don’t worry! You’ve got this. And this post is here to help, by discussing the most common questions and concerns I hear from new parents.
Eating
The American Academy of Pediatrics recommends exclusive breastfeeding for babies. Babies will instinctively root at a breast within a very short time after birth. Unfortunately, it can take a few days for true breastmilk to be fully produced by mother’s body, especially in first-time moms. Placing the baby at the breast every couple of hours will help stimulate milk production. Nearly all infants lose weight in the first week of life while waiting for milk to come in fully. Pediatricians monitor this closely, and will advise supplementation with formula if weight loss percentages become too high.
If you choose to feed your baby formula, it is likely that he or she will not lose much weight, since the milk supply is already there. Watch your baby for cues on hunger and satiety – if he or she is actively looking around and still rooting or sucking after finishing a bottle, give a little more. If your baby immediately spits up after finishing a bottle, it may have been too much.
Diapers
Monitoring wet and soiled diapers can be an excellent way to determine if your new baby is hydrated and getting enough milk. At first, bowel movements will be very dark and sticky, like tar. This should slowly transition to typical newborn bowel movements that are loose and seedy. If your new infant does not have a bowel movement for more than 12 hours call and speak with your Pediatrician. An easy guideline for urination for the first week of life is to expect one wet diaper per number of days old – for example, if your infant is four days old, you should expect to see at least four wet diapers that day. Again, if you are concerned that your baby is not producing enough wet diapers, call your Pediatrician.
Jaundice
Jaundice is the term for the yellow tint to a baby’s skin that is caused by a build up of the chemical bilirubin. This occurs in newborns for a variety of reasons, mostly because it takes the newborn liver a few days to start actively removing bilirubin from the blood. Certain risk factors can increase the bilirubin levels as well, including prematurity, blood type mis-match between mother and baby, bruising as result of birth, exclusive breastfeeding, certain blood disorders, and East Asian race.
Bilirubin levels are checked before newborns leave the hospital. If the levels are too high, infants are treated with UV light to help bring the levels back down. If your infant’s level is in a high-risk zone, you will be given instructions on how quickly to follow up. You can help your baby by exposing him or her to a small amounts (5min) of sunlight and making sure he or she is well hydrated. If you notice the yellow tint to your baby’s skin becoming brighter or if it is covering more of his or her body, call your Pediatrician.
Crying
Newborn infants cry. A LOT. They cry when they are hungry, when they are sleepy, when they need to be changed, when they are startled by noises, when they are overstimulated. If you have checked all of the things that may be bothering your baby, it is best to simply hold him or her for comfort. It is impossible to spoil a newborn; often what they need most is your comforting touch. If you feel your newborn is crying excessively and will not be comforted no matter what you do, reach out to your Pediatrician.
Spitting up
Nearly all babies will spit up. There is a small ring of muscle between the stomach and the esophagus (the tube that takes food from the mouth to the stomach) that is supposed to be tight and keep food in the stomach. However, in infants this is often loose. Then, we feed them liquids and we lay them down…and up comes the milk! Try keeping your infant upright after feeding to help with this. Small amounts of spit up are fine, even if they are frequent. Large volumes or projectile (think: hitting the wall behind you) are not ok. Call your Pediatrician if this is happening with your baby.
Sleeping
Newborn infants sleep most of the day. They wake up to eat, wake when they need to be changed, and briefly interact with parents before going back to sleep again. In the beginning you will want to wake your baby up at least every three hours to feed him or her. This will help prevent excessive weight loss or dehydration.
Safe sleeping is one of the most important considerations for newborns. Establishing safe sleep practices can be difficult in the beginning as newborns adjust to the wide open world, but it is one of the most important things you can do. Please refer to my prior blog post regarding safe sleep for infants: https://www.astheygrow.blog/back-to-sleep-reduce-the-risk-of-sids-suffocation/
Environmental temperatures
Infants are not born with much fat on their bodies to provide insulation. Make sure your infant is dressed appropriately for the weather – not bundled too much in the heat but with layers in the cold. Check your thermostat to makes sure it is not too cold in the house – remember, we do not want to wrap infants in blankets other than a swaddle while sleeping. A purple or blue discoloration of hands and feet does not necessarily mean your newborn is cold. This is a normal phenomenon seen in infants as their circulation regulates.
Skin
Newborn skin is very dry. It will likely peel in the first few weeks. In general, you do not need to treat this dryness or peeling with anything – lotions tend to make the peeling process last longer. If you notice any cracking of skin, especially in the wrist and ankle creases, you can use petroleum jelly to protect the skin and allow it to heal. Once the peeling process has finished, you can begin to use fragrance-free lotions as desired.
Umbilical cord
The stump of the umbilical cord usually falls off within the first two weeks. Until it does, be gentle with the area. Make sure it does not catch on diapers or clothing. Keep the area dry – do not immerse your baby in water until the area is completely healed. Use sponge baths to clean your infant during this time. Allow the umbilical stump to fall off on its own. Do not pull on it. Have your baby seen by a doctor right away if the skin around the area turns red or swollen, or if there is persistent drainage from the stump.
Final thoughts
Bringing your new baby home is both exciting and scary. Trust yourself, take deep breaths, and ask for help when you need it. At times you will be tired and frustrated, but being a part of helping your new infant explore the world is worth every minute.
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