Taking Care of Baby and Mom (Part One: Baby)

BWS - 11

The days and weeks following the birth of a precious little one are a whirlwind for new parents. There’s so much to learn and so many new rhythms to discover as they welcome this tiny life into their home. Mom and Dad find themselves with a heightened awareness, eager to ensure that everything unfolds just as the books and charts suggest it should. Yet, for most first-time parents, the true challenge is uncovering what “normal” truly means for their unique baby.

In these pages, we hope to offer you the gentle guidance you need during this tender time of adjustment. We’ve divided this journey into two parts: first, this blog post explores the developmental milestones healthcare professionals will look for as your newborn grows, and in our next post, we will address the physical and emotional changes a mother might experience in the postpartum period. The more you understand the changes ahead, the more prepared you’ll feel to embrace the magic of this new chapter.

Apgar Score

You have probably heard other parents talk about their baby’s Apgar Score, but you may not fully understand what it means or how it is used to assess a newborn’s health. The test was designed and perfected in 1952 by Dr. Virginia Apgar, who used it to determine how birthing anesthesia affected newborns. Eventually, her test became the normative tool to help doctors determine babies' health status at birth. The test measures five critical areas of newborn vitality within the first minute after birth and five minutes later. Each point is given a value, and the sum total provides the score. A score of 7-10 is considered normal and indicates a baby in good condition. A score of 4-6 indicates a baby who probably needs respiratory assistance, and a score of 0-3 indicates the need for lifesaving intervention.

Newborn Basics

All newborns have similar needs, characteristics, and reflexes that are considered normal and are all part of what makes us human. Discovering your baby's uniqueness is more than a pastime; it is a necessity of true nurturing and begins with becoming familiar with a baby’s physical characteristics. What do you need to know?

Characteristics of a Newborn

Head:

• Measures 25 percent of the baby’s body size.

• Average circumference is 13-14 inches.

• Neck muscles are weak, so baby’s head needs support at all times.

Fontanels:

Areas of the skull (soft spots) that are not yet joined but are held together by membrane tissue. (The soft spot is where the skull is not fully formed, allowing room for the brain’s tremendous growth during the first year, when over 50 percent of your baby’s total head growth occurs.)

Anterior fontanel (on top of the head)—closes at approximately 18 months of age.

Posterior fontanel (at the back of the head)—closes at approximately three months of age.   

Hair:

Some babies are born with a full head of hair; others have no hair at all.

It is not uncommon for babies to lose some or all of their hair within weeks after birth. 

Milia:  

Little white bumps resembling pimples on the baby’s forehead, nose, and cheeks.

Nearly 50 percent of newborns have the condition of Milia. It is not contagious, and most cases disappear within the first month of life; although in rare cases it could last up to three months. There is no treatment for this condition, except time.

Exact cause is not known, but Milia may develop when tiny skin flakes become trapped in small pockets near the surface of the skin. Do not attempt to remove. Contact baby’s doctor.

Eyes:

Color: Caucasian babies are usually born with blue eyes with their permanent eye color becoming evident between six months to one year of age. Babies of African and Asian descent are usually born with brown eyes and the color does not change.

Newborns are born cross-eyed because of immature eye muscles. If your baby’s eyes continue to wander after three months of age, contact your pediatrician.

By six months, a baby’s eyes should be focusing together. If they are not, ask your baby’s pediatrician to refer you to an ophthalmologist.

There may be swelling or discharge from your baby’s eyes because of the antibiotics applied at birth.

The tear ducts begin to produce tears around the second or third week of life.

Sensory: Vision

Newborns possess full visual capacity in terms of eye mechanics, but the brain center controlling vision is not yet fully developed. This is why babies are born nearsighted, meaning objects far away appear blurry. It is estimated that infants are able to see objects about 8-14 inches away.

At birth, babies see bright and contrasting colors. Their full color vision is not developed until approximately three or four months of age, when they can determine hues and light shades.

Sensory: Hearing

A baby can hear fairly well, but not perfectly, right after birth. A Newborn Infant Hearing Screening Test is common practice and usually performed prior to a baby’s hospital discharge. Ask your pediatrician if it is part of his or her discharge protocol.

Infants tend to regard loud noises as disturbing and soft sounds as soothing.

Sensory: Taste and Smell

Both are well-developed at birth. Researchers have found that many babies are able to differentiate between their mother’s milk and the milk from another woman.

Skin:

“Lanugo,” or fine, downy hair, is sometimes present on a baby’s body at birth. This is seen more frequently in premature infants and normally disappears within a few days or weeks on its own.

Dry, scaly skin. Is sometimes associated with peeling and is seen two-three weeks following delivery, and in babies born after 40 weeks of gestation.

Ruddy Skin. The newborn’s skin often has a ruddy hue, and for the first few days the hands and feet can have a bluish tint. As the baby’s circulation improves, his skin color will become more consistent.

Rash. A rash may develop if the baby is overdressed or wearing clothing made of an irritating fabric. About half of all newborns display a harmless rash of little red bumps that disappear on their own, usually within a week. If you have any concerns, contact your baby’s healthcare provider.

Birthmarks. There are a variety of classifications of birthmarks (such as “strawberry,” port-wine stains, and salmon patches) and moles that may appear at birth on newborns.   

Breathing:

Newborn breathing rate: 30-60 breaths per minute. It is normal for breathing to be irregular and shallow. Some babies may be noisy breathers at night.

Hiccups are normal, and many mothers know when their baby is having a bout during pregnancy. When the baby’s diaphragm matures, the frequent hiccups disappear.

Extremities:

A baby’s arms and legs are disproportionately short for his body. It is also normal for the arms to be bent and held close to the chest with his little hands in a fist.

Baby’s legs are positioned similarly to that assumed in utero, and it is normal for most newborns to appear bow-legged.

Nails are usually long at birth, soft and pliable. It is important to trim them weekly to prevent the baby from scratching his face. As babies grow and become more alert and aware of their surroundings, nail trimming becomes more of a challenge. The safest and easiest way to trim a baby’s nails is when he is sleeping or right after his bath, when he is relaxed and his nails are slightly softer. Newborn baby clippers are available at your local drug store. (Do not use adult clippers on your baby.)

Reflexes:

Certain reflexes are present at birth, most of which are vital for survival. They are also strong indicators of the vitality and health of the central nervous system and are often tested at the various well-baby checks. As the baby matures, it is normal for some reflexes to disappear and others to change. It is important for parents to have a basic understanding of how reflexes work, because they indicate how well their baby is doing and help pediatricians evaluate normal brain and neurologic activity. While there are about 90 named reflexes, here are the 10 most common: Sucking, Swallowing, Rooting, Gagging, Coughing, Grasping, Stepping, “Babinski,” “Tonic Neck,” and “Moro reflexes.”

Sucking reflex: This reflex was active in the womb and is very strong at birth, since it is required for feeding. Usually any stimulation of the baby’s lips will elicit a sucking response. Babies often suck on their thumbs, fingers, or fists.

Swallowing reflex: This reflex is also present before birth, as babies will swallow and then excrete amniotic fluid in utero.

Gagging reflex: Prevents choking.

Rooting reflex: This is when your baby turns his head in response to stimuli to receive food.

Coughing reflex: This helps clear the air passages of mucus.

Grasping reflex: If you place your finger inside the palm of your baby’s hand, he will grasp it—often with enough strength to allow the baby’s upper body to rise up.

Stepping reflex: If the baby is held up under the arms in a standing position, his little legs will make walking motions.

Babinski reflex: Many years ago, Dr. Joseph Babinski discovered that when he firmly stroke the sole of a baby’s foot, the big toe turns up and the toes fan out. This reflex may continue up to two years of age. (If it continues after that, it may be a sign of some nerve damage.)

Tonic Neck reflex: This reflex, also called the Fencing reflex, happens when your baby turns his head to one side: his leg and arm on the same side will extend, while the opposite limbs bend. It is connected to your baby’s ability to crawl on his hands and knees, which has other neurologic implications, and is one of the reasons Tummy Time for a young baby is so important.

Moro reflex: This happens when your baby is startled: his arms thrust out as if to embrace you and his legs straighten and stiffen. The Moro reflex is present in all newborns and usually remains until four to five months of age. Its absence at birth can indicate a problem.

Caring For A Newborn

The following are routine baby-care practices that will become part of Mom and Dad’s day.

Umbilical Cord Care: Shortly after birth, the umbilical cord is clamped and cut, leaving an inch-or-so stump that is saturated with a drying agent. Over the next several days the stump will turn black, and it usually falls off between the first or second week of life. Here are guidelines for umbilical cord care.

Keep the stump dry. Parents were once instructed to swab the stump with rubbing alcohol after every diaper change. Researchers now say this might kill bacteria that can help the cord dry and separate. Instead, expose the stump to air to help dry out the base. To prevent the diaper from covering the stump, fold the front flap of the diaper away from Baby’s stomach so the stump remains exposed.

There normally is an unpleasant odor associated with the drying of the stump, but an excessively foul odor may indicate an infection. If you notice this problem, contact your healthcare provider.

Call your pediatrician if there is excessive bleeding from the cord stump, pus-like drainage, or redness and swelling around the cord junction site.

Until the cord stump falls off, avoid clothing that is binding around the waist.

Do not immerse your baby in water for a bath until the stump has fallen off.

Never attempt to remove the stump. It must fall off naturally.

Diapering: Diapering may seem intimidating the first few days, but it is a skill soon mastered. Parents can choose between cloth and disposable diapers.

When Your Baby Develops a Diaper Rash

Most rashes occur because a baby’s skin is sensitive and becomes irritated by a wet or messy diaper. If your baby has a diaper rash, change wet diapers frequently and as soon as possible after bowel movements.

• Clean the affected diaper area with warm water only (no wipes on a newborn, but you can use them later).

• Over-the-counter creams or powders specifically prepared for this purpose and applied on dry skin will usually clear up a mild rash.

• If a rash is present, leave your baby un-diapered and exposed to air for 30-minute periods when possible.

If your baby is receiving antibiotics, you may notice a diaper rash suddenly appearing. That does not mean your baby is allergic to the antibiotic; rather, it probably is a natural response to the change in the content and pH of his stool, which causes irritation to the skin. Do not stop the antibiotic unless advised by the pediatrician to do so.

Call the pediatrician if:

• The rash continues or worsens for three days or longer.

• The skin is bleeding or has blistered areas.

• The area of the rash is swollen.

In these situations, over-the-counter creams and ointments will not help. Prescription medications will probably be necessary.

Bathing (See Bathtime Safety - Blog Post 6)

During the first couple of weeks stay mindful not to immerse Baby in a sink or tub until the cord stump has fallen off, usually between 10-14 days. Until then, sponge bathing is all that is needed. Here are some guidelines to follow.

Circumcision Care

Circumcision is almost as old as history itself. The practice was historically (though not exclusively) a Jewish rite. Today, medical experts and studies affirm that there are modest benefits to circumcision, although not all agree on the necessity of it. Evidence suggests that circumcision may decrease the risk of urinary tract infection and that it virtually eliminates the possibility of cancer of the penis. Circumcision for infants is not a traumatizing experience; it is a minor surgery. The discomfort felt will be no more rooted in his memory than being pricked in the heel during his PKU blood test (a phenylketonuria test, which verifies that your newborn baby has an important enzyme). A circumcision normally heals within four to seven days and needs routine cleaning during diaper changes:

Clean with a soft cloth and water; do not rub.

Apply a coat of Vaseline over the area of exposed tissue and cover with a gauze square. This protects the area from wetness and bacteria.

Replace at each diaper change until area is healed.

Call the pediatrician if there is excessive bleeding from the surgical site or if there is excessive swelling, redness, the presence of pus or drainage, or a foul odor.

Jaundice in Newborns

Jaundice is not a disease but a temporary condition characterized by a yellow tinge to the skin and eyes. The yellow comes from bilirubin (a bile pigment) in the blood and is usually easily controlled. If the condition appears more pronounced after the second day, frequent blood tests are taken and conservative treatment initiated.

Babies with moderately raised levels of bilirubin are sometimes treated with special fluorescent lights that help break down the yellow pigment. Additional fluid intake may also be part of the recommended treatment. In this case, your pediatrician may recommend other liquid supplements, although exclusive breastfeeding is usually the best way to correct this condition, even feeding as often as every 2 hours. Because bilirubin is eliminated in the stool, make sure your baby is having regular stools. A newborn with jaundice will tend to be sleepier than normal, so be sure to wake him for a feeding at least every 2½ to 3 hours.

Sick Baby Care

While a sick baby can foster insecurity in the parents, they gain a new appreciation for the medical professionals that serve their baby during this time. It is normal for a baby to be sick as many as seven to nine times within the first year. Prevention is the best care so do what you can to provide your baby with a clean, safe environment and a routine that provides regular sleep, play, and feeding. If you observe any of the following symptoms, however, call your pediatrician:

Rectal temperature over 100.4° F (38° C)

Excessive vomiting or green vomit.

Diarrhea, defined as three or more stools (watery or foul smelling) beyond what is normal for the baby and that continues for more than 48 hours.

Constipation, defined as stools that are hard and dry or no stools for 48 hours. Remember that breastfed babies over a month old may have only one to two stools per week because breastmilk is nearly 100% digested. This is why it is important to know what is normal for your baby.

Yellowish coloring of the skin and the whites of the baby’s eyes.

Baby is showing symptoms of dehydration. Similar to adults, babies become dehydrated when they do not receive enough liquids, but unlike adults, they cannot ask for or get a drink by themselves. In the first few weeks, babies may show signs of dehydration due to a breastfeeding problem. The warning signs include:

• Lack of wet or dirty diapers

• Dry tongue and mouth

• Lethargic or difficult to wake for feedings

• Weak suck or latching-on problems

• Feeding less than eight times in 24 hours

• Losing weight

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