By Tanya Remer Altmann, MD, FAAP
It’s 2 am. Your first night home from the hospital. The baby is crying and you’re exhausted. Is she hungry, wet, tired…aaahhh! You’ve read all the must-have parenting books. You thought you were prepared. But nothing can ever completely prepare you for the crazy but exciting ride ahead. All parents have questions (lots of them!) the first few days at home with their newborn and here are some of the answers to get you started.
1. Why should I breastfeed my baby? Is it going to hurt?
Breastmilk is best! Mother’s milk provides immunity against bacteria and viruses, is easy for your baby to digest, is less expensive and requires no prep time. It is demanding because of the large time commitment required, but the benefits are well documented. Studies show that breastfed babies have fewer ear, respiratory tract, and diarrheal infections. They are also at lower risk for many childhood diseases. Breastfeeding also benefits mom by decreasing your risk of cancer and helping you get back to your prepregnancy shape.
Persistent pain during breastfeeding is not normal. Although breastfeeding is natural, it’s not always easy at first. It’s ok to ask for help from your pediatrician or lactation specialist. Improper latch on and vigorous or prolonged sucking can be painful and may lead to sore, cracked nipples. In the beginning, brief pain can occur while your infant latches on. Count to 10 and if the pain continues, remove the baby and reattach him so that the baby’s mouth covers as much of the areola (the dark brown area around your nipple) as possible. If the pain occurs during a feeding, switching breasts may help. If a burning or stabbing pain is experienced later in breastfeeding, call your physician because you might have an infection that needs treatment.
Most of your milk comes down in the first 5-10 minutes, so after 15-20 minutes on one side, take your baby off. You are not a pacifier! Prolonged sucking can dry out your nipples and cause soreness. Allow your nipples to air-dry after you feed your baby or shower. Then apply a lanolin cream. Wear a cotton bra or loose fitting top and remove plastic liners from your bra. Continue breastfeeding! Your baby will appreciate you for sticking it out through any discomfort.
2.Which type of formula is best for my baby?
If you can’t breastfeed or choose not to, there are many good infant formulas that will provide your baby with all the nutrients he needs to grow and develop normally. Whichever brand you choose, always use formula with added iron—important for blood and brain development. DHA and ARA are Long Chain Fatty Acids that also play an important role in your baby’s growth and development. Prebiotics and Probiotics, also now added to some infant formulas, may help a baby’s immune system. Talk to your Pediatrician about the types and which she recommends for your baby.
3.How do I know if my baby is gaining enough weight?
Babies normally lose up to 10% of their birth weight in the first few days after they are born. Then they start gaining weight and by two weeks should be back at birth weight. Your pediatrician will see your baby frequently after birth to make sure the weight gain is appropriate. After that, babies usually gain ½ to 1 ounce a day. Most babies double their birth weight by six months and triple it by one year.
4.How do can I tell if my baby is hungry? How do I know if she is getting enough to eat?
During the first two weeks of life breastfed babies should feed 8-12 times a day, about 10 to 15 minutes on each breast. Formula fed babies should feed 6-10 times a day. Don’t wait until your baby is crying and upset to feed. This is actually a late sign of hunger and it may be harder to feed the baby if both of you are frustrated. Look for earlier, more subtle clues such as stirring from sleep, putting the fist in the mouth, turning the head if the cheek is stroked lightly, or sucking movements with the mouth. During the first few days it is best to feed your baby every 2 to 4 hours, even if you have to wake them up.
To tell if your baby is getting enough in, take a look (literally) at what comes out. The first two days your baby may only have a couple of wet and dirty diapers. The next few days he should have at least three of each. For the next few weeks, your baby should have at least 6 wet and 3 dirty diapers a day (although often they will have a dirty diaper after every feed). If your baby is having less, please call your pediatrician. Don’t forget that many times a diaper has both urine and stool mixed together.
5. How do I know if my baby’s spit up is normal or worrisome?
All babies spit up—sometimes after every feed. There are two common causes: overfeeding and reflux. Reflux happens because the valve at the bottom of the esophagus (feeding tube) where it connects to the stomach is weak or relaxed. This allows the food to easily come back up. The valve tightens as the baby grows and the reflux usually resolves by about 1 year of age. As long as your baby is gaining weight and the spit up doesn’t bother him we usually don’t treat it medically. Things that do help are giving smaller, more frequent feeds as well as holding your baby upright for 15 to 20 minutes after a feed. Call your pediatrician if you notice blood in the spit up, greenish color, increase in frequency and intensity of the spit up, projectile or forceful spit up or if the baby’s belly looks swollen or feels hard.
6. My baby is yellow. My mom says it is jaundice. What does that mean?
Your mom is right. Jaundice occurs when babies have extra bilirubin in their system. Bilirubin is produced by the breakdown of red blood cells. This is often normal in newborns. The more your baby feeds and poops, the more bilirubin he will get rid off and the yellow in the skin will begin to resolve. You should let your pediatrician know if your baby begins to look yellow so the bilirubin level can be checked (a simple blood test). Depending on the results your pediatrician will advise on treatment.
7.What color should his poop be?
You may think that poop should be brown, but babies produce a wide variety of colors! During the first 24 hours of life, it is thick, sticky, and brownish-black in color (meconium). After the first few days of life, the stools of breastfed babies lighten in color from black to brown to green to yellow and change consistency from sticky to seedy to cottage cheese like to looser. Formula fed babies usually have firmer stools that are light brown in color.
8. What are the best creams for diaper rash?
The cream you choose depends on the type of diaper rash your baby has. In the first week of life the rash is usually due to irritation from wetness. Barrier creams with Zinc Oxide are best, but even a thin layer of Vaseline works well on newborns. If your baby has a yeast rash (bright reddish pink and raised, often with little bumps surrounding) you will need a special medicine (prescription or over-the-counter). Let your doctor check the rash and let you know which type of cream you need.
9. What’s the best way to help my baby sleep through the night?
In the beginning your baby should wake up to feed about every 3 hours. To help her learn the difference between day and night, keep night feedings as calm and quiet as possible. As she gets older (around 3 or 4 months) you can start teaching her how to fall asleep on her own. Start by putting her down when she is awake. She will find her own method of soothing herself to get to sleep. If you always rock or feed her to sleep when she wakes up in the middle of the night she’ll need you to put her back to sleep. Around 4 months of age she no longer need to eat in the middle of the night, so don’t pick her up, hug her or feed her every time she cries. Don’t forget—your baby should always be put to bed on her back!
10.How do I know if my baby is sick? Should I take his temperature every day?
There is no need to randomly check your baby’s temperature. He can’t tell you that he’s not feeling well, but he will show you by changing his normal behavior. If he feels very warm, is not eating well, or is acting irritable or overly sleepy you should use a thermometer to check for a fever. Call your doctor immediately if your newborn has a fever—temperature of 100.4 degrees Fahrenheit or 38 degrees Celsius or higher. Other signs to call your doctor for include rapid breathing, a decreased number of wet diapers, vomiting, sweating while feeding, or blueness around the mouth or skin. Babies are more susceptible to serious infections that can progress rapidly so it is very important to call your doctor right away if you notice anything unusual. Trust your instincts.