A friendly guide for your first weeks together.

During the hospital stay

Many things happen after a baby is born. After delivery, each baby is dried and placed under a warmer to warm the body and protect against getting cold. Fluid and mucus are suctioned from the mouth and throat. The baby is checked one minute after birth and again five minutes after birth to evaluate color, breathing, heart rate, muscle tone, and infant response. The baby is given a score on this assessment called an Apgar Score. Most healthy babies have an Apgar score between 7 and 10. Occasionally a baby will need oxygen to help them “pink up” and improve the Apgar score.

Soon after birth, a plastic clamp is placed on the umbilical cord near the belly button. The rest of the cord is removed. Name bands are placed around the baby’s wrist and ankle. A security device is placed on one of the name bands while your baby is in the hospital. Footprints are made on the birth sheet.

When the new baby appears well and is active, mother can hold and breastfeed her baby. This bonding helps mother and baby learn to know each other and will continue to take place as the baby grows.

After the baby has bonded with mom and dad, they will be weighed and measured. The infant is again placed under a warmer until the body temperature is normal. The baby will then receive their first bath.

It is recommended every infant receive an injection of vitamin K to help blood clot (a circumcision will not be performed without this injection). Eye ointment is put into the baby’s eyes to help prevent certain eye infections. If your baby is larger or smaller than average, a blood sample will be taken from the baby’s heel to evaluate the blood sugar. If it is low, your baby may need to be fed early.

Common features of newborns

Once you and your baby are home, away from the knowledge and reassurance of doctors and nurses, you will notice things about your baby that you may not have expected. Remember that no two babies are alike. Babies can be very different from each other and still be normal. Below are some of the more common features.

Head & scalp

The baby’s head will often be strangely shaped or molded due to pressure put on the head during delivery. Swelling of the head (caput) may occur from birth. These will go away and do not affect your baby’s brain. You may notice a soft spot, called a fontanel, where the skull bones don’t quite meet. A tough membrane covers the brain and provides ample protection, so a pat on the head or a brisk shampoo will not be harmful. This membrane usually closes by 15–18 months of age. Ridges can also be felt on the top of your baby’s head; both will disappear as your baby grows. Sometimes the baby’s head can be bumped hard during delivery causing a soft fluid-filled bruise called a cephalohematoma. This may last for several weeks before going away. It does not put pressure on the brain. If forceps were used during the birth, marks may be seen on the face or head.

Eyes

Swollen eyes can occur the first few days after birth. Sometimes a small blood vessel will break causing a red flat spot on the white of the eye. This does not affect vision and will disappear without treatment.

All babies are born with deep blue eyes. The final color will not be known until they are about 6 months old. Your baby is too young to focus their eyes and control their movement. They can usually see large objects and will be able to focus fully by about 4–6 weeks of age. A hazy look or occasionally crossed eyes are normal. Most babies see best between 8–12 inches away.

Ears

The skin behind the ears may become dry and cracked. Lubricating ointments (not baby lotion) may improve this. Many babies are born with hair in their ears; this will fall out after a few months. The shape of your child’s ears will change with growth.

Nose

Most babies have mucus in their nose and throat from time to time. During the first few months, your child will sneeze or cough often to help clear their nose of mucus, lint, or milk. As they get older they will be able to blow their nose.

Mouth

Small white bumps called Epstein’s pearls may be seen along the gums and roof of the mouth. This is not harmful to your baby and will disappear. Sucking blisters can form in babies who suck very strongly. This whitish blister can be seen in the middle of the lip and requires no treatment.

Skin

Newborns can have many skin changes or rashes due to their sensitive skin. Some common ones:

• Acrocyanosis — Your baby’s arms and legs may look blue the first day or two. When the blood vessels under the skin open up, your baby will be pink all over.
• Milia — All newborns have tiny white bumps on their face and forehead. This will soon go away.
• Newborn acne — Many babies develop tiny pimples on their face and forehead. Sometimes this can last for months but will go away without medicine. Washing the baby more will not help. Do not pick or pop, which can cause scarring.
• Dryness — Your baby may have cracked, peeling skin, especially around the arms and legs. This is normal and will go away as your baby gets older. Lubricating ointments (not baby lotion) may improve this.
• Bruises — Bruising may occur during delivery and should be gone in several days.
• Stork bites — Pink birthmarks may be found over the eyelids or around the back of the neck. These are common and will often fade until they are not noticeable.
• Color (jaundice) — Your baby’s skin may appear yellow-tinged. A yellow pigment in the blood, called bilirubin, can collect in the baby’s system causing this color. This is usually noticed in the first few days of life. As your baby gets older and has increased stools, the bilirubin will be removed and your baby’s skin color will return to normal, usually in a week or so. Please call our office if you see an increase, instead of decrease, in this yellow skin color. Occasionally a blood test may be done to monitor the bilirubin. If the level is too high, your baby may need light therapy.

Chest & breasts

The breasts of both boys and girls can be swollen and may take months to return to normal. This happens because of the hormones the baby receives from the mother during pregnancy. The breasts should not be squeezed or pushed hard. Sometimes a noticeable bump can be seen around the middle of the chest caused by the end of the breast bone (sternum). This is not a problem and will become less noticeable as your baby grows.

Navel care

Your baby will have their umbilical cord for as long as 4–6 weeks of age. This is how the baby received nourishment during pregnancy. The navel should be cleaned daily. Be sure to clean down in and around the cord. Follow with a dry cotton swab to be sure the navel is dry. Fold back the top of each diaper to expose the navel to air; this will aid healing and may cause the cord to fall off sooner. Cleaning the umbilical cord does not hurt your baby. A small amount of oozing and occasionally bleeding may occur as the cord heals. The cord may have an odor due to moisture; adequate cleaning and drying will diminish this. Normal navels are not all the same size or shape. If your baby’s navel protrudes outward there is no need for concern. Do call our office if you notice redness, swelling, or discharge around the cord.

Penis & circumcision

The circumcision may be sore for several days. When cleaning your baby, gently push back the foreskin and clean with warm water (no soap). A small amount of swelling or yellow discharge is not uncommon. Call the doctor if any significant swelling, unusual discharge, or bleeding is present. Apply A&D ointment or Vaseline to the penis with each diaper change to prevent sticking to the diaper.

Baby boys have extra fat around the genitals and the penis can look like it is hiding. As boys grow, this fat goes away and the penis will look more normal.

Vagina

Baby girls will often have thick, white mucus around the vaginal lips or labia. Occasionally a small amount of blood may be passed, which is called pseudomenses. These are both normal and will be gone soon. Clean your baby with plain water, gently separating the vaginal lips. Wipe from front to back.

Arms & legs

Babies are born with soft, pliable bones and joints. Many babies are bow-legged or have inturning of the feet, due to being folded up inside the mother before birth. As the leg muscles strengthen, the legs get straighter. Treatment in most cases involves exercising and stretching the feet. You may notice that your baby often quivers or shakes while sleeping or when excited. These quivers go away as your baby develops coordination.

Feeding

Mealtime can be an enjoyable experience for both parents and infant. When feeding your baby, hold them with head elevated in your arms and talk to them. Feeding time should be quiet and relaxed and a time to get to know your baby. The goodness of food as well as the loving contact are both very important for normal growth and development.

We recommend breastfeeding or formula for the first year of life. Your baby can be assured of getting the best possible nutrition through either the breast or bottle. The baby’s desire for milk will be made known in a loud and clear voice. If you prefer a routine, you can plan to feed the baby every 2–3 hours but remember your baby will need time to achieve this regularity. Be flexible. Consider half an hour or so on either side of your schedule as on time. After the bedtime feeding, allow the baby to sleep as long as they wish once the baby is back up to birthweight and your pediatrician has advised this is safe. It is generally better not to wake the baby for a feeding unless advised.

Breastfeeding

Pediatricians recommend breastfeeding for most babies. Breast milk has the best balance of nutrients for the baby; it is most easily digested by babies; and it contains factors from the mother that help young babies fight infections.

We are fortunate at RMH and Augusta to have breastfeeding specialists who will come to talk with you if you’ve decided to breastfeed. They will teach you basic techniques and can answer questions you may have, both while in the hospital or when you get home. The doctors are certainly available for your questions about feeding also. Dr. Hutton is also board certified in breastfeeding and lactation medicine if you have additional questions in the office.

Since breast milk is easily digested, many babies want to eat frequently. We do not recommend extra water or formula for most breastfed babies. The more the baby nurses, the more quickly mother’s milk will come in.

If for any reason you won’t be able to breastfeed the baby at certain times, you can pump your own milk and store it for up to 4–5 days in the refrigerator, or freeze it for months. This stored breast milk can then be given to the baby in any bottle.

Bottle feeding

Any of the FDA-approved formulas will provide your baby with the nutrients necessary for normal growth and development. You and your doctor will decide which one is best for your baby. The amount of formula your baby eats will vary; a baby’s appetite changes from one meal to another. Don’t force the baby to finish the bottle if they seem satisfied and don’t want more. Most babies will eat for about 15 to 20 minutes. Never prop your baby’s bottle. Babies who have been overfed will cry and suck as if they are still hungry and may have increased spitting.

Well water used to make formula should be boiled for 3 minutes for the first 3 months of life. Treated (town) water does not need to be boiled. Avoid microwaving formula because of burns from uneven heating; the bottle may feel cooler than the milk inside. Wash bottles in hot soapy water using bottle and nipple brushes; rinse and drain thoroughly. Bottle feeding beyond 12 months of age is discouraged, as this can be associated with decaying teeth, being overweight, and an unbalanced diet.

Solid foods

Babies will not sleep better or have less gas if they are started on solid foods. Most pediatricians recommend that solids be started at about four to six months of age. We will discuss feeding at each of your child’s well-baby checkups.

Burping & hiccups

When your baby drinks, they will swallow some air, which may cause an upset stomach or spitting. Burp at least once during the feeding and again at the end. Several positions can be used: place the baby over your shoulder and pat between the shoulders, sit the baby upright on your lap, or lay the baby face down on your lap rubbing or patting the back. Often, a small amount of milk comes up with the burp. Hiccups are also frequent and result from air swallowed during feeding.

Water, vitamins & fluoride

Breast milk or formula supply your baby’s water needs. No additional water supplement is necessary. Do not add any type of sweetener such as sugar, NutraSweet, juice, or honey to your baby’s formula or breast milk. Honey should not be given to any child under 12 months of age.

Breastfed babies receive needed vitamins through mother’s breast milk, plus a vitamin D supplement. If your baby is bottle fed, the formula contains all the vitamins your baby needs. Once your baby has teeth, we can start to coat them with topical fluoride at checkups, particularly if you have well water or do not have fluoride in your water source. We do not typically recommend oral fluoride supplements.

Stools & urination

Stools vary in number from one baby to another. Some babies may have a stool with each feeding while others may go once every 2–3 days. Breastfed babies usually have looser, more frequent, yellow stools. Most babies will grunt and strain while trying to have a bowel movement; this does not mean your baby is constipated. A constipated baby will have hard, pellet-like stools. Diarrhea means watery stools that are more frequent than usual. Diarrhea often makes the diaper area red and sore — be sure to change your baby’s diaper as soon as possible after each stool, and clean and dry the area well before putting on another diaper.

Frequent wet diapers indicate your baby is getting enough to eat. Your baby should have at least 4–6 wet diapers each day by 1 week of age.

Daily care

Bathing

When you take your baby home from the hospital, the umbilical cord may not be off. Keep the baby clean with a sponge bath until the circumcision is healed. It is OK to submerge the baby with the cord still attached, as newer studies show no increased risk of infection. Follow common sense in getting the baby clean and protecting them against becoming too hot or too cold. Wash the baby’s face with plain water, no soap, using a soft cloth. The eyes, ears, nose, and throat need little or no attention. If the baby’s eyes have a small amount of drainage, they may be gently wiped with a warm washcloth or cotton ball. You may clean around the ears and nose with a moist cotton swab — do not stick anything in them. The rest of your baby’s body may be washed using a mild fragrance-free soap. Be sure to wash well in the creases and to rinse the soap off. Wash your baby’s head being careful to keep soap out of eyes. After the bath, dry carefully, wiping off creases and folds. Infants do not necessarily need daily soapy baths; this can dry the skin, especially in winter.

Crying

Crying is your baby’s way of communicating. Babies cry because they are hungry, wet, thirsty, too hot, too cold, or just plain bored. Crying does not always mean “feed me.” As your baby grows, you will learn to recognize what your baby wants by the type of cry.

Pacifiers

Most babies need to suck and a pacifier may be helpful in infancy. This natural need diminishes between 7–8 months of age but pacifiers are not harmful until several years of age. Do not dip pacifiers into tea, coffee, or soda for flavoring. Please do not put your baby’s pacifier in your mouth to “clean” it.

Clothing

Your baby’s clothes should be light, loose, and simple. Dress your baby according to the temperature. Heat rash or sweating means the baby is overdressed, even in winter. As a general guide, the baby should wear the same amount of clothing in which the parents are comfortable.

Diapers

If you use cloth diapers, they should be placed in a diaper pail filled with soapy water until you are ready to wash. Use Ivory Snow or Dreft. Strong detergents may cause or aggravate diaper rash. Your baby’s diaper should be changed immediately after dirtying to help prevent diaper rash.

Fresh air & sunshine

Fresh air and sunshine are very good for everyone. If the weather is mild and pleasant, a baby can go outdoors. On warm, sunny days, try to keep the baby shaded. You can also protect your baby’s sensitive skin with light clothing and use sunscreen made for children when they are over 2 months of age. Do not take the baby out when it is cold, windy, or blustery unless absolutely necessary.

Car seats

Infant car seats are required by law in all 50 states. Babies should ride in rear-facing seats until they weigh 30 pounds and are 2 years of age. Children should use a car safety seat until at least 6 years of age. Booster seats are required until at least 8 years of age. Children and infants should ride in the back seat if your vehicle is equipped with front seat airbags. We strongly urge you to put your child in an approved safety seat each time you go for a drive, starting with the baby’s ride home from the hospital. Remember, one of the most dangerous places for your baby while traveling in the car is in your lap or arms.

Sleep & safety

Sleep habits will be different from one baby to another. Laying your baby on their back to sleep reduces the incidence of SIDS (sudden infant death syndrome). They should not be placed on their stomach or side to sleep. It is not necessary to keep unusually quiet around your baby. Carry out your usual routine without regard to the baby’s sleep. Soon the baby will realize that sleep is sounder at night when the house is quiet, and the nights and days will no longer be mixed up.

Inspect your baby’s bed for safety. Crib slats should be spaced no greater than 2½ inches and there should be no other place where your baby’s head might get trapped. We do not recommend bumper pads, stuffed animals, or comforters with the baby. The mattress should be firm and flat and have a waterproof pad to protect against moisture. Pillows are dangerous and should be avoided.

Illness & when to call

Your baby may occasionally sound congested or stuffy. Salt water nose drops and a warm steam vaporizer may be used. Switch to a cool mist humidifier when your baby becomes active to prevent the possibility of a burn. Do not give your baby any over-the-counter medicines without first consulting your doctor.

We recommend taking your baby’s temperature rectally when concerned about a fever. Use a blunt-tipped thermometer. Coat the end with petroleum jelly. Place your child on their stomach, gently insert the thermometer about one inch into the rectum while holding your baby’s lower back to keep them from moving. Keep the thermometer in place 1½ to 2 minutes. An average rectal temperature is 99.6°F.

Well-baby visits

During the first year of life, your baby will be growing and developing rapidly. Regular check-ups are important to ensure that your child is developing normally. During these visits a complete examination is performed. We will talk with you about diet, growth and development, behavior, safety issues, and any other questions or concerns you may have. We encourage you to write down questions and bring them with you.

Visit schedule

Below is a list of times your baby will need to be seen for check-ups:

• 7–14 days
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 2 years
• 2½ years
• 3 years

Your child should have a yearly check-up beginning at 3 years of age.

Vaccines

Additional special vaccines, such as the RSV vaccine, may be indicated, especially if your child has special health problems such as chronic lung or heart disease or sickle cell anemia. We recommend Flu vaccines for all children 6 months of age and older. A tetanus booster is recommended at least every 10 years; if your child receives a dirty cut or puncture wound and has not had a tetanus shot within 5 years, it should be repeated.

For moms & dads

For moms

Everything seems topsy-turvy, nobody seems to care, your partner seems thoughtless and you feel clumsy and depressed. These feelings are normal and a result of waiting nine months anticipating the birth of your baby. Don’t try to do it all from the start. Rest when the baby rests, drink extra liquids, and eat a good diet. Don’t worry about housework — if you must clean, clean only one room a day. Many people have help from family and friends to lessen this overwhelming task.

For dads

Dads can help with all aspects of childcare, even changing diapers and feeding the baby. Dads can also help by running errands. Call home when leaving work and check whether there are grocery needs, etc. you could pick up on your way home. Childcare is a full-time job and can be a chore for both mom and dad. Be patient and helpful to each other as you adjust to the changes brought about by a new baby.

Visitors & advice

Your friends and relatives are willing and anxious to give advice to new mothers. Usually this advice is good but can sometimes be inconsistent and confusing. Use your judgment; if you have questions, do not hesitate to call or message us during regular office hours.

Many people will come to visit and may ask to hold the baby. Hand washing helps prevent the spread of infection. Anyone wishing to hold the baby should first wash their hands. Anyone with colds, sore throats, or other illnesses should not handle the baby. Smoking should be discouraged around your baby; cigarette smoke causes an increase in illness, especially respiratory infections and earaches.

Travel

Many parents make travel plans with their new child to visit relatives that live a distance away. Make sure your child is warm and comfortable. Stop every so often so you and your baby can stretch. Never leave the baby alone in the car at any time, for any reason. Always stop for feedings.

Pets

Pets can become jealous of a new baby just like brothers or sisters. Keep your baby away from animals even if that animal has always been gentle and calm.