You’ll be bombarded with parenting advice from friends, relatives, books, Google, Facebook and TV. When overwhelmed with information, while also sleep deprived, it will be difficult to sort out what advice is accurate and relevant. The pediatricians, physician assistants, nurse practioners and clinical staff at Lincoln Pediatric Group are here to help you navigate this parenting job you signed up for! You are your child’s advocate, so ask questions! We already know what many of your questions will be, so the answers are provided below.
Parents often say they wish their new baby came with a manual. Well here it is!
Below you’ll find more information about each of these topics:
- Baby Hygiene
- What the heck? Can this be normal?
- Cry, Eat, Poop, Sleep, Repeat
- Preparing Ready-to-Fee, Concentrated, or Powder Formula
- A Few Other Things
Baby Hygiene
The Bath
A responsible caregiver should be present whenever your child is in or near water.
Bathe your baby every 2-3 days. Too much time in the water can dry out the skin.
Place a folded towel on the bottom of the tub and add 2-3 inches of warm water. Lay your baby on the towel in the water, supporting her head with one hand. Keep the water level below the ears. Clean the outer ear with a Q-tip, but never push it in the ear canal. Wash the face first and progress to the toes. Use fragrance free soap and gentle shampoo. Protect the eyes. It’s OK if the ears, umbilical cord or circumcision get splashed with a bit of water. Just dry it off when you’re done.
Lotions are not necessary, but you can apply unscented cream to dry and cracked skin, which is common around the wrists and ankles. Lotions interfere with natural body oils. And, if your baby gets a common newborn rash, it might be difficult to know if it was due to the lotion. A newborn’s skin commonly “flakes” in the first few days. Exfoliate these areas with a soft wash cloth.
Do not use powders, as the “poof” of powder might be inhaled and powders can cause friction in skin folds.
Baby Manicures
Cleaning the Girl Parts
If you see poop in the vaginal entrance, gently wipe it out with a baby wipe or use Cetaphil Gentle Skin Cleanser on a cotton ball. Wash and dry from front to back. It isn’t necessary to remove mucous.
Cleaning the Boy Parts
If your son is not circumcised, no special care of the penis is needed. The foreskin will retract over time.
Plastibell Circumcision: A round piece of plastic will remain attached to the end of the penis for 5-7 days and will then fall off. The foreskin comes off with the plastic. Let us know if the skin becomes very red and swollen.
Gomco Circumcision: The foreskin was surgically removed, with no sutures or plastic in place. Redness, swelling and yellowish tissue on the penis is expected for several days. Infection is rare. Squeeze soapy water followed by clear water over the area to clean it. Do not retract the foreskin during healing. Paint the inside of the diaper with Vaseline or apply it to the raw skin to prevent the sores from sticking to the diaper. Call if you think the penis is unusually red or swollen.
Diaper Rash Prevention
Urine is acidic, like the skin, so you probably don’t need to use a baby wipe while changing a diaper that’s only wet. Just dab it and air dry before replacing the diaper.
If the buttocks get raw, it’s likely due friction from frequent wiping, no matter how careful you are. Wipe away most of the poop, and then finish cleaning by putting Cetaphil Gentle Skin Cleanser on a cotton pad. This cleanser is slippery, so you can wipe down all the nooks and crannies (including the vaginal area when needed) without friction. DO NOT RINSE IT OFF WITH WATER. Apply a thick layer of cheap Vaseline or your choice of ointment.
Call for advice if a rash won’t go away by doing all of this, especially if it looks pimply. This could represent a yeast rash.
Click here to read an article with detailed instructions for diaper rash care.
Umbilical Cord Smells Bad
The cord typically detaches by 1-2 weeks of age. Some bleeding, scabbing or weeping is common.
Keep the cord dry by folding the diaper UNDER below the cord, so moisture doesn’t wick up onto the cord.
Do not put a bandage over the umbilicus. It is important for air to dry it out to avoid infection.
If you lift the drying cord, you might see brown “goo” where the cord stump meets the skin. This can smell horrible, because it is decaying tissue (not infection). To alleviate the smell, use a damp cotton swab to wipe away the goo. Keep the area dry. Call for advice if there is persistent or recurrent drainage.
Goopy Eyes
It is common to see clear, white, yellow or even greenish mucous in the corners of the eye lids. This happens when the tear ducts (drainage system) are blocked or are too small to drain excess tears. Until the drainage system improves, goopy eyes may be a recurrent problem.
Use your breastmilk to dissolve and wipe away the crusting. Breastmilk antibodies prevent infection.
Otherwise, clean the eyes with a cotton ball dampened with water.
Call for advice if the eyes are mattered shut upon most awakenings, or if the eyelids are red or swollen.
What The Heck? Can This Be Normal?
My baby has breasts!
The belly button sticks out so far!
If you google umbilical hernia, you might read about a loop of bowel slipping through the hole and getting strangulated within in the hernia. This is exceedingly rare. Call if your baby cries excessively while the hernia is unusually large, hard and red.
What's with all the sneezing?
Options for nose drops include your breast milk, over-the-counter saline/salt water nose drops, or make your own drops. Every few hours as needed, lay your baby on her back and put 3-4 drops in each nostril. Wait a few seconds and then suction it back out, hopefully with snot. While suctioning one nostril, occlude the other nostril with your finger, to “seal” the system and create better suction.
Home-made salt water drops: ¼ teaspoon salt in 1 cup of water. Discard after 4 hours
Avoid second-hand smoke as this irritates small airways.
Cool mist or ultrasonic humidifiers help moisturize the air, especially during the winter months when our heaters dry out the air.
Call if the nasal congestion doesn’t improve by trying these things, or if you think your baby might be catching a cold, especially if other family members are ill.
Click here to view a video that demonstrates how one person can suction the nose.
My baby hiccups all the time!
Your baby’s neurologic system is immature, which you witness every time the startle reflex makes your baby jump. There are also “jumpy” nerves alongside the esophagus, thus causing hiccups after eating, burping and spit ups. As your baby matures, the startle reflex and the hiccups will go away.
My baby breathes really weird sometimes!
On occasion, your baby might also make a high pitched or honking noise when breathing IN. The tissue in the back of some newborns’ nose and throat is “floppy,” and thus collapses as the baby inhales.
Call if your baby ever turns dusky, blue or pale and limp; if her calm breathing rate is more than 1 breath per second; if she seems to need to push the air out when she exhales.
My baby is REALLY gassy!
Cry, Eat, Poop, Sleep...Repeat.
During the first year of life, things are forever changing. At times you will feel like things are under control, and “you got this.” Then it all falls apart and you feel like you’ve failed, again. Rest assured, this is normal, and there’s a very logical reason for it!
In one short year, your baby goes from being completely helpless to mobile and communicative. What was working 3 weeks ago may no longer work now! Each new stage of development requires that you and your baby readjust your routine, while maintaining some basic daily consistencies.
Temperament
Crying and Colic
You can’t spoil a young infant. Babies that are held more cry less. They need lots of attention while awake. Talk to your baby in reassuring tones and be as calm as possible.
Colic is inconsolable crying that lasts for 3 or more hours, usually in the early evening. The typical time is around 3 weeks to 3 months of age. It can be very frustrating and is thought to be from over-stimulation and difficulty “changing states” from sleep to awake to sleep. It is likely also related to temperament. Colicky babies are healthy and grow well.
Over the years, we’ve become better at teasing out a few medical conditions which might be contributing to at least some of the fussiness. Call us if you need help with an excessively fussy baby. Hopefully we can find a reason and develop a management plan. Perhaps your baby has heart burn, food sensitivities, excess foremilk in a breastfed baby, or other conditions. We will at least give you strategies to calm your fussy baby. Sometimes it’s just a matter of knowing that you’re doing all you can to help your baby, realizing your baby is OK, and knowing she will grow out of this stage!
Self-Quieting
If your baby is bottle fed, it’s OK to put her in the bassinet for a bit to see if she will settle to sleep on her own, since you know that she drank a certain amount of milk. She can sense your anxiety, so remain calm! If fussing escalates to full on crying, tend to her.
If your baby breastfeeds well and stays asleep after burping, lay her in the bassinet. Don’t leave her to self-quiet until weight checks have proven adequate weight gain. Fussiness means hunger until proven otherwise. After nursing, you don’t know how much milk she drank, so restlessness and other hunger cues should prompt further feeding. When your milk supply is known to be adequate and a feeding pattern has resulted in adequate weight gain, self-quieting is OK. Click here to learn more about how to know if your baby is not getting enough.
Swaddling will help your baby self-quiet, as it subdues the startle reflex, which is present in the first 3 months or so. Stop swaddling when your baby attempts to roll over. Don’t swaddle too tight, and don’t swaddle while nursing.
Sleep please.
Also, understand that normal sleep cycles cause big people to wake up several times each night. We have learned to relax and go back to sleep, without eating or rocking. Babies can learn to do this also, but generally not until after about 4-6 months old. That discussion will be for a later time. We are now discussing newborns!
The more calories your baby consumes during the daytime, the fewer calories she’ll need during the night. So, in the first few days, before your baby gains weight, wake her to nurse at least every 3 hours, start to start, around the clock, PLUS on demand. Once she gains 1 ounce per day, you can allow one 5 hour stretch of sleep at night (if she will). Once your baby is back to birth weight (by around 2 weeks), gaining 1 ounce per day, and self-waking for most daytime feedings, don’t wake her at night.
After the first few weeks, realize that your baby’s tummy can still hold only enough milk to keep her sleeping for about 3-5 hours, but a bit longer if you’re really lucky. It’s normal for an exclusively breastfed baby to nurse in the night, even at 6 months old. Try to make this easier by getting a good feeding in around 11p – 12mn to avoid having to get up between midnight and 5am. If she awakens before 5am and a recent weight check proves that she’s gaining well, you can let her whimper briefly during a night awakening and see if she’ll fall back to sleep. If the crying escalates, proceed with nursing.
Click here to view a video about night time with your breastfed baby.
The temperature in your baby’s room should be around 70 degrees. As a general rule, she should be covered in clothing or wraps such that she is covered in one more layer than you are comfortable in. If she gets fussy, check for sweating at the hairline at the back of her neck. Readjust the room temperature or remove covers accordingly.
Safe Sleep and Preventing Sudden Unexplained Infant Death (SUID)
So Much Talk About Poop
Spitting Up and Vomiting
Spitting up is effortless and usually happens with a burp. Small amounts dribble over the chin but it’s common for the spit up to fill your cupped hand. Almost all spitters gain weight well. Call us if your baby is excessively fussy, arches her back (heartburn), or has scary choking spells. Click here t o view a video about reflux.
Vomiting happens with forceful retching, when the stomach muscles contract to expel the stomach contents. It might happen after over-feeding or with excessive handling after a feeding. If it happens repeatedly, we want to know. Call us if it happens more and more frequently and forcefully over the course of a day or two. Keep track of wet diapers.
BREASTFEEDING
Breastfeeding is the preferred feeding method for at least the first year, as there are many benefits for both you and your baby. There is an entire section of this website devoted to breastfeeding. The materials are written by our physician lactation specialist who does private consultations with new mothers and babies whenever needed. Just ask!
Click here to access breastfeeding articles and videos.
Feed Infant Formula, Not Grocery Store Milk
Sometimes breastfeeding doesn’t work out, for various reasons. If that is the case for you, commercial formula is the appropriate food for your baby through the first year. If you are breastfeeding successfully but a bit short on milk supply, despite your best efforts to increase your supply, it is very common to give supplemental formula to make sure your baby is content and gains weight.
Regular milk from the grocery section is not appropriate to feed your baby while under 1 year old. Your newborn’s kidneys cannot handle the concentrated proteins and minerals found in regular milk. It is also difficult to digest and can irritate the gut lining and cause bleeding. There is too little iron in grocery store milk, which can result in iron deficiency anemia.
Don’t feed your baby fresh cow’s milk because it isn’t pasteurized.
Goat’s milk is not appropriate because it lacks adequate vitamin D, B12, iron and folate. It is sometimes promoted as easier to digest, but it can result in severe anemia if supplemental vitamins are not provided also.
All formula sold in the USA is fortified with iron, vitamins and minerals in an appropriate balance. If breastmilk is not available, use commercial infant formula through 1 year of age.
Typical Volumes of Milk Intake
Click here to read more about expected volumes of milk intake.
Types of Infant Formula
There are so many brands of formula! Each company has similar “lines” of formula (described below). Infant formulas made in the USA are likely of equally quality, but one baby might digest one formula better than another, for no apparent reason! If the formula you choose is working, don’t change it without a good reason.
Cow's-milk-based formula is the go-to basic formula which is used most often.
- Protein: cow’s milk. This protein is treated so it is easier to digest.
- Carbohydrate: lactose (milk sugar)
- Fat: vegetable oils or animal fats. These fats replace the butterfat, as they are easier for babies to digest.
- Protein: soy protein (instead of cow’s milk protein)
- Carbohydrate: sugar (sucrose) or corn syrup (instead of lactose)
Soy formulas today contain a good source of protein, but it’s not as good as cow's milk protein formulas (which isn’t as good as human milk). Some strict vegetarian parents choose to use soy formula because it contains no animal products. Babies absorb calcium and other minerals less efficiently from soy formulas. Thus, soy formula is recommended only when medically necessary. Soy formula is rarely recommended for milk sensitivity or allergy, because half of babies sensitive to cow’s milk are also sensitive to soy.
Specialized formulas (hypoallergenic/elemental/hydrolyzed)
- Protein: extensively broken down (pre-digested) proteins
- Carbohydrates: sugar (sucrose) or corn syrup
Premature formulas are available, which have a higher caloric concentration and more vitamins and minerals. Use them only as directed by your physician.
Preparing Ready-to-Feed, Concentrated, or Powder Formula
You can buy 2oz ready-to-feed bottles, large containers of ready-to-feed formula, large containers of concentrated formula, and powder formula. Instructions on the container will tell you how to prepare the formula by mixing it with water, and how long you can store it.
Powder formula is the least expensive and most commonly used. One scoop of powder is mixed in 2 ounces of water. It is easiest and most accurate to put the water in the bottle first, and then add the powder to get the right concentration. Too little water can result in diarrhea and dehydration. Too much water results in too few calories being consumed.
City water can be used directly from the tap (luke warm). Chlorination of the water supply removes bacterial spores, so it doesn’t require boiling. If you are unsure of your water’s quality, boil the water for approximately 1 minute before mixing it with the formula, or consider buying jugs of bottled water.
Wash all feeding supplies in the dishwasher or in hot soapy tap water. Rinse well and air dry upside down.
Newborns probably prefer their milk at around room temperature. As they get older, don’t waste too much time warming it if they will drink it cold just as well. To take the chill off, place the container in warm water and rotate it frequently, or place the container in a pan of water at low heat on the stove. Shake a few drops on the inside of your wrist to make sure it’s not too hot for your baby.
DO NOT USE A MICROWAVE! A “hot spot” might develop and scald your baby's mouth or the bottle can explode.
A Few Other Things
New Baby on Display
You may have a toddler living in your house, and they love to spread germs! Kids love foam hand sanitizer! Consider using finger or glove puppets on their hands.
Screen visitors for illness, especially during cold and flu season. Keep cold sores away from the baby all together. Beware – a fever over 100.4 rectally in a baby under 1 month old will most likely end up in the hospital. It is too difficult to know if the fever is from exposure to a cold virus or from a serious infection from the birth process.
Speaking of Illness
Call us immediately if your baby’s temperature is over 100.4 degrees rectally in the first 2 months of life.
Sibling Adjustments
Pick out some special books prior to delivery and keep them in a special place. Whenever you sit down to feed the baby, bring the books out. Give siblings little jobs to help with the baby and then praise them for doing so. “Catch them being good” to teach them good behavior by praising them whenever they do something good, like touching the baby gently.
Kids want your attention, whether it’s positive or negative. If scolding them for bad behavior is the only attention they get, then they’ll misbehave more to get your attention. If you praise them and give more attention for good behavior, they’ll learn what good behavior is and perform it more often. Touches and hugs are the best positive attention to give.
Time-out removes attention. When your child is naughty, instruct a time-out. Don't reason with them or over-explain things – kids under 7 typically can’t rationalize. Simply state what they did wrong and order a time-out. If they get NO attention for bad behavior, over time the bad behavior should decrease.
A good rule of thumb: Give 10 time-ins for every 1 time-out.
Kay Anderson, MD, IBCLC. 6/23