Doctors’ Notes

Newborn Normals

Congratulations on your new baby! This is such an exciting time for you and your family!

If this is your first child, you may have many questions about how to care for your newborn, what to expect, and when to call the doctor. This note will give you some guidance on your new adventure.

Belly Button

The umbilical cord will typically fall off between 1-3 weeks of age. There’s no need for special care other than keeping the area dry.

We recommend sponge baths (don’t immerse the baby into water) until after the cord falls off. As the umbilical cord begins to separate and fall off, the skin underneath may bleed slightly or be gooey.

If bleeding is excessive, if there is pus and/or a lot of drainage (soaking the clothes several times), or the skin surrounding the umbilical cord starts to become red or tender to touch, please call us in the office.

Circumcision

There may be some slight bleeding, redness, or a yellowish coating at the circumcision site. This yellowish coating is normal healing tissue, and there is no need to try to remove it or wipe it off. You may apply Vaseline to the circumcision at every diaper change until the site is no longer bright red (usually 5-7 days, but may take longer).

If your baby boy is not circumcised, then clean the penis as you would any other area. Do not pull back the foreskin.

Breasts & Vagina

There may be some enlargement of the newborn breast tissue — in both girls and boys. Some baby’s breast tissue may even express milk. This is normal and is due to hormones from pregnancy. If your baby experiences this, it will decrease with time.

Baby girls may have vaginal discharge in their diaper. This may range from white to red, as they withdraw from their mother’s pregnancy hormones. This is all normal and will decrease with time.

Eyes

Babies may have crossed eyes occasionally during the first few months of life, as their eye muscles become more mature. If one eye is consistently crossed, please let us know at your next Well Visit.

Skin

Most newborns develop dry, peeling skin. They’re almost like a snake who needs to shed a layer of skin. There is typically no need to use creams or lotions, unless areas are cracked or bleeding (which can occur on the hands and feet). If this does occur, you can use Vaseline or A&D ointment to protect these areas until they heal.

Newborns also may develop several normal rashes. For more information, see Terri Bailey’s Note on Newborn Skin.

Hydration

Your baby should have 1 wet diaper for every day of life until they’re 6 days old. (For example: if they’re 3 days old, we expect 3 wets in a 24-hour period.) Once they’re 6 days old, babies should have 6-8 wet diapers per day.

Gas & Stool

Babies will pass gas, and may appear to have difficulty stooling. These are all normal experiences, and typically require no treatment.

Stools begin as thick, black, and tar-like (called meconium), and will transition to a brown, green, or even yellow color, and may appear to have seeds within them. A baby may have a stool after every feeding, or he/she may go several days without stooling. They may strain to pass a stool, because ultiple muscles need to learn to work together for a baby to pass gas or stool. For more information, see Jonette McClelland’s Note on Poop.

A baby will at times try to push stool or gas through — they may turn red, grunt, or hold their breath — while the other muscles are not squeezing or relaxing together in a way that will allow the stool or gas to pass. This is ok, and part of the gut learning how to function more efficiently. As long as the stool that does finally pass is soft, this is considered normal, and is part of your baby’s body learning how to pass stool. However, if the stool is in the shape of hard balls or rocks, your baby may be constipated. For more information, see Dr. Maddalena’s Note on Constipation in Infants.

Occasionally, babies may have a streak of blood on their stool if there is a small cut or sore on the anus. If you notice this, Vaseline or A&D ointment on the affected area may help. If the bleeding persists, or there is blood mixed in the stool, please call us in the office.

Spit Up

Babies spit up. This may happen after every feed or even in between feeds. This is a normal experience, and typically requires no treatment, as long as the baby is gaining weight well. If there is anything red or green in the spit up, or if the spit up is so frequent that the baby is having fewer wet diapers, please call us in the office.

Hiccups

Hiccups bother parents much more than they bother babies. This is a normal occurrence, and requires no treatment.

Sneezing/Stuffy Nose

Babies will sneeze and may have noisy breathing or a stuffy nose. The nasal passages are very small, and a small amount of mucus can make your baby’s breathing sound very loud. Sneezing may help your baby clear these passages. If your baby is congested, you may use saline drops and a nasal suction before feedings and bedtime. You may also use a cool-mist humidifier in the baby’s room during sleep times.

Breathing

Babies may have irregular breathing, and may even pause in their breathing for up to 10 seconds (time it – it’s a REALLY long time!). As long as there is no color change in the baby’s skin, this is considered normal. It even has a name: “periodic breathing of the newborn.”

Sleep

It’s normal for infants to wake to feed every 1-3 hours throughout the day and night. Most infants do not sleep for more than 6 hours at night until about 4 months of age (it’s ok — you’ll get there!).

It’s also normal for a newborn to be a “night-owl.” When the baby was in the womb, Mom’s activity during the day provided a lot of rocking motion which would lull the baby to sleep. At night, however, when Mom would rest, the baby often would have more active periods. This will continue for a while once the baby is in the outside world. One strategy you can use to help babies when they have their “days and nights mixed up” is to make the middle of the night feedings/changing as quiet and boring as possible. Turn on only the amount of light needed, and save the talking, cuddling, and playing for daytime hours. This will help the baby to transition to being more active during the day and more restful at night.

To reduce the risk of SIDS (Sudden Infant Death Syndrome), place your baby to sleep on his/her back on a firm surface without other items (blankets, pillows, stuffed animals, bumper pads, etc) in the area. Use a fitted sheet on the mattress. You may use a swaddle blanket if the baby is under 3 months old and the swaddle is snug. Don’t place your baby to sleep in your bed, on the couch, or on other soft surfaces.

To avoid your baby developing a flat head (called “plagiocephaly”), you can rotate which side of the crib/bassinet your baby’s head is facing. Your baby will look all around, but most often will look towards the most interesting thing in the room — YOU! Rotating will allow the baby to have pressure ofdifferent sides of the head on different days.

For more information on sleep in infants, see Dr. Wolynn’s Note on Infant Sleep and his Note on Naps.

Crying

Babies cry. Some of them cry a lot.

During their first several months of life, babies have very few ways of communicating their wants and needs, so they cry. They cry when they’re wet, when they’re dirty, when they’re hungry, bored, lonely, tired, cold, hot…. just to name a few!

They don’t have the ability to self-soothe in the first 3 months of life, so they may need your help to calm down. It’s ok to pick up your baby when she cries, especially in the first 3 months. You will not spoil you baby by doing this.

It can seem frustrating at times, but having a mental checklist may help you troubleshoot the crying:

Is the baby wet/dirty? Change the diaper.

Is the baby hungry? Feed the baby, but (if you’re bottlefeeding) try not to overfeed your baby during this time.

Does the baby want to suck? Offer a clean finger or pacifier.

Is the baby bored, or wanting to be held? Pick up the baby; walk around; sing, talk, or read to the baby.

Is the baby tired? Swaddle the baby and place them in their crib/bassinet, turn off the lights, and put on soft music or white noise (static on the radio, hairdryer, vaccum, etc).

Another way to soothe an infant may be to do skin-to-skin time with a parent or other trusted adult, or to place baby in a carrier (making sure the baby’s head is turned to the side with chin up, to ensure an open airway).

Babies may also respond the 5 S’s — a technique taught by Dr. Harvey Karp in The Happiest Baby on the Block:

Swaddle (with a blanket)

Suck (use a pacifier)

Side (hold baby up in a side position)

Swing (stand and gently swing baby back andforth)

Soothe (make loud sushing noises).

For more information, see Dr. Steven’s Note on Crying and Dr. Wolynn’s Note on Soothing Infants.

Signs of Illness

Fever – Rectal temperature of 100.4°F or higher. Take a temperature if the baby is very fussy, very sleepy, or feels warm to you. If there is a fever, and your baby has not yet received their 2-month vaccines, call us immediately or go to an emergency room.

Unusual irritability

Unusual sleepiness (can’t wake to feed more than 2 feedings in a row)

Vomits repeatedly (not just spitting up) orrefuses food several times in a row

Dehydration (fewer than 6 wet diapers per day after 6 days of life)

If you notice any of these symptoms in your baby, or are otherwise concerned, please call the Kids Plus office or go to an emergency room.

This note covers a whole lot of “Newborn Normals” and common questions, but we’re always happy to answer any questions you have. Ask them on our Facebook page or the Patient Portal, or call us in the office anytime. That’s why we’re here!

Dr. Jennifer Zarit is a former Kids Plus provider.