Here are items 6 – 10 of the top 10 concerns at the newborn visit. Please see part one of this blog post for items 1-5.
6. Sleeping: Sleep is a topic that parents and pediatricians talk about for 18+ years but with regard to newborns, I have a few specific comments. Newborns can sleep 18-22 hours per day waking to eat every 2-3 hours then going right back to sleep. They will start to have more awake and alert periods about 2 weeks of age. They are also nocturnal. This means mean they will sleep more during the day and be awake more at night similar to when they were in-utero and mother’s daytime activities lulled them to sleep. The circadian rhythms that help them differentiate between day and night become more active after several weeks and things do get better. In the meantime, offer lots of environmental cues to the newborn. During the day, exposure her to increased stimulation such as talking and singing, normal daytime light/sunlight and routine daytime noises. At nighttime, keep it all business. The sleeping space should be dark and you should tend to the newborn’s basic needs while being mindful to not over stimulate. Lastly, the safest place for a newborn to sleep is in the parents’ room in her own separate sleeping space on her back.
7. Stooling issues: I very commonly get concerns during this time period about stooling that include questions about frequency, consistency, infant straining and grunting and stool color. I always tell parents that normal newborn stools (especially an exclusively breastfed infant) are what you and I think are diarrhea. Breastfed infants can have 8-10 yellowish liquid stools a day. This is nature’s way of letting you know the infant is getting enough given you cannot quantify what the infant is taking right from the breast. Rest assured, lots of poop usually means lots of breastmilk ingested. Formula fed newborns still have loose stools but at a frequency of about 2-3 times per day. Just to add more confusion to this challenging time, some newborns can have bowel movements once every 7-10 days which can also be normal. To help reassure, I again revert back to the infant’s comfort level. If they are content after eating, happy in between bowel movements, eating well, passing gas and not vomiting (spitting up is OK – see below) then there is no need to panic. I recommend you continue frequent feedings and contact the pediatrician during regular business hours to discuss concerns.
8. Spitting up: Pediatricians have the term “happy spitter”. This is an infant that effortlessly turns his head to expel a mouthful (or two) or milk without much drama during or afterward. This can happen with every feed. During the first few weeks of life, as the infant’s stomach size stretches out (from about the size of a grape to the size of a ping pong ball), spitting up usually lessens. Be careful about offering too large a volume of milk to a newborn infant given this small size of the stomach. An adequate volume during the first few days of life is about 15-30 ml per feed. This can gradually be increased depending on how full the infant seems and amount of spitting up. As long as there is no perceived discomfort with spitting up and the newborn is content and appears to gaining weight *, continue frequent feedings and monitor closely. (*With adequate weight gain in early life, the newborns tummy appears large and distended. It is usually a sharp contrast between the tiny hips and often a source of concern for families when they change their newborns diaper. Use this sign as affirmation that your infant is thriving).
9. Bowed legs: This is an easy one…..normal in the newborn period due to cramped quarters and being folded in half x 9 months. The legs will straighten with time.
10. Finger nails: The nails are paper thin and almost seem to be connected to the tips of the fingers until they begin to harden at about 2 weeks of life. Given this, it is difficult to clip them with a nail clipper early on. I recommend using a file or simply covering the hands with newborns mittens or layette gowns.
This blog is by no way a comprehensive discussion of all 10 topics but more of a quick reference guide to hopefully help in the stressful first few days home from the hospital or between the first few pediatrician visits. I encourage families to use their family/friends support systems and trust their guts with regard to their newborns care. Look at your newborn, he or she will let you know if they are comfortable or not. And try not to second guess yourself. After years of practicing pediatrics, I have come to realize that despite often lacking confidence, parents, new and old, can instinctively tell when something is amiss with their child. Trust yourself and enjoy your baby and this amazing one of a kind experience.