Neonatal care

Why is my baby crying? Why should I breast feed? Why is my baby still crying? Why are my breasts hurting? When will my baby sleep through the night? Why does my baby want feeds so often? Why is the baby passing stool so often? Answering questions like these is the purpose of this hand book on newborn care.

General information:

The first month of life is called the newborn period. Your newborn needs your love, attention and care as she adjusts to the world around her. Babies have their own special personalities, so no two newborn are alike. There is no one "right way" to raise your baby. You can help your baby grow up happy, healthy and confident. Learning what your baby likes and dislikes and caring for her and showing your baby that you love her, is what is most essential.

What to expect when you see your baby for the first time:

Remember that when your get to see your baby for the first time, there may be some features that may make you panic.

Skin

Newborn are normally coated with thick, pasty white material, called vernix caseosa made up of fetus’ skin secretions and shed skin cells to protect the fetal skin while in the womb. It usually peels off after a few days. Mottling of the skin is common when baby is exposed to cold. The newborn has fine, soft hair present on the face, shoulder, and back called Lanugo hair, which will disappear in a few weeks. Several harmless rashes may also appear in newborn, but will go away after several weeks with normal skin care.

Eyes

Most infants open their eyes few minutes after birth and what they can see best are black and white. Visual focusing and fixation is attained at 3 to 4 months of age.

Chest

Your baby’s chest is still thin so you may observe her chest move with each heartbeat. This is normal. Whether your baby is a girl or a boy, he or she can have breast engorgement and secretion. This is due to the female hormone estrogen that is passed from the mother to the foetus and is normal.

Genitalia

The sexual organs of male and female may appear large and swollen due to exposure to maternal hormones. Some female infants will have vaginal mucus or blood tinged discharge for few days, but this isn’t a cause for concern.

Physical Growth & Development

Your newborn baby may look wrinkled and chubby when she is born. Your baby will lose about 10% of her birth weight in water loss during the first 3 to 5 days. But, she will regain this weight by the time she is 7 to 10 days old and gain about 30 grams during her first month. Your baby will have a growth spurt when she is about 3 to 6 weeks old.

Your baby's skull may have become misshaped, bruised, or swollen if she was born through the vagina. But, it will return to a normal rounded shape within a couple of weeks. Any bruises or swelling also goes away in a few weeks.

Your baby has 2 soft spots on her head. The soft spot at the back of the head closes at about 6 months. The larger one found towards the front of the head closes at around 12 to 18 months

Rooting and sucking reflexes make your baby turn her head toward your hand if you stroke her cheeks or mouth. These reflexes help your baby find the nipple at feeding times. The rooting reflex starts to disappear by 4 months. By this time, your baby knows how to move her head and mouth to eat.

The grasp reflex is when the palms of your baby's hand closes when you stroke them. The hand grasp turns into purposeful grasping when your baby is about 5 to 6 months old.

The eye blinking reflex happens if your baby sees bright lights or an object moves toward her very fast.

Movement: It is normal for your baby to curl up in a "fetal" position during her first couple of days of life. Your baby's posture straightens as she grows and develops. Make sure you support your baby's head when changing her position as she is unable to hold her head up by herself.

Fine motor movements are when your baby can control his fingers purposefully. Your newborn can bring his hands toward his mouth and suck on his fingers.

Daily Living Activities: Your newborn sleeps about 16 to 20 hours a day and will awaken for feeds. Breast feeding has to be on demand. You can tell if your newborn is getting enough milk if there are 6 to 8 wet diapers a day.

Language and Intellectual Development: Your newborn communicates (lets you know what she needs and feels) by her facial expressions and body movements. She cries to let you know that she is stressed, uncomfortable or just wants your attention. You will soon be able to hear the difference in your baby's crying. You will be able to tell whether she is hungry, in pain, afraid, uncomfortable, bored or upset. It is important to react quickly and consistently (the same way each time) to your baby's different cries. This tells your baby that you care and understand her.

Your newborn is very sensitive to light, so make sure it isn't too bright or too dark. She is able to look at something held about 8 to 12 inches away from her. Your newborn would rather look at black and white pictures or high contrast patterns, like stripes or simple faces. But, mostly your baby likes to look at a human face rather than pictures or toys.

Your newborn is also very sensitive to sound. Your baby likes your voice most because it is the one she heard from before she was born. Your baby will be able to identify you by your voice by the time she is one month old. Your baby prefers to be spoken to in a soft, comforting way. Loud noise may startle your baby or make her cry.

Family and Social Relationships: Your newborn baby does not understand that she is a person by herself and that you are a separate person. The most important people in your newborn's life are you, her parents. She depends on you for love, to take care of all her needs, safety and play. Your newborn will learn to trust and feel like she "belongs" when you love and care for her. Make sure your older children are allowed to be a part of your newborn's activities and care.

Personality and Emotional Development:

Your baby's personality and emotions start to show as you care for and play with your baby. You are telling your baby that her thoughts and feelings are important when you react to your child's cries. Do not worry about spoiling your baby by giving her too much attention. You give your baby a feeling of safety and trust when you quickly and consistently comfort your baby when "demanded."

Colic is when your baby cries and cannot be calmed down. She stretches her legs and pulls them toward her stomach. Colic usually starts between the 2nd and 4th week of life and stops around the end of the 3rd month.

Some ways to deal with colic

  • Try snuggling your baby and rock the baby or walk and move in a rhythmic slow motion 
  • Gently rub your baby's back while putting your baby's tummy down across your knees or arms. 
  • It is important to remember that your baby is not trying to make you angry or upset. 
  • Never take out your anger on your baby. Shaking your baby can cause brain damage or death. 

Safety of the newborn

  • Your baby should have a physical exam by a pediatrician before leaving the hospital. 
  • Take your baby to see a pediatrician for routine medical checkups and vaccination 
  • Put your baby on her back for sleeping 
  • Handle your baby with gentle, slow movements. Speak in a soft, quiet, soothing way 
  • To prevent choking, do not attach pacifiers or other objects to the crib or body with a string or cord 
  • Keep small objects away from your baby. This includes toys or stuffed animals that have small breakaway parts 
  • Babies can suffocate if they play with plastic bags. Never leave plastic bags or wrappings where your baby can reach them 
  • Always keep your baby in a smoke-free area. Do not allow people to smoke around your baby 
  • To prevent burns, do not hold your baby when smoking, drinking hot liquids or when cooking. Your baby skin is also very sensitiveto the sun. Keep your baby out of direct sunlight to prevent sunburn 
  • Your baby is not able to control her own temperature so she can get very cold or very hot easily. Make sure she is dressed correctly in both cold and warm weather 
  • Never leave your baby alone up high like on a changing table, couch, chair or the bed. Always keep a hand on your baby and never walk away when your baby is at a high place 
  • Never leave your baby alone at home or yard or in the car. 

Feeding and Burping Your Baby

It is recommended that babies be fed on demand — whenever they seem hungry. Your baby may cue you by crying, putting fingers in her mouth or making sucking noises.

A newborn baby needs to be fed every 2 to 3 hours. If you are breastfeeding, give your baby the chance to nurse about 10–15 minutes at each breast. If you are formula-feeding, your baby will most likely take about 2–3 ounces (60–90 milliliters) at each feed. Babies often swallow air during feeds, which can make them fussy. You can prevent this by burping your baby frequently. Try burping your baby every 2 to 3 ounces (60–90 milliliters) if you bottle-feed and each time you switch breasts if you breastfeed.

The following are burping strategies:

  • Hold your baby upright with his or her head on your shoulder. Support your baby's head and back while gently patting the back with your other hand. 
  • Sit your baby on your lap. Support your baby's chest and head with one hand by cradling your baby's chin in the palm of your hand and resting the heel of your hand on your baby's chest (be careful to grip your baby's chin - not throat). Use the other hand to gently pat your baby's back. 
  • Lay your baby face-down on your lap. Support your baby's head, making sure it's higher than her chest and gently pat or rub her back spitting up.

Sleeping Basics

As a new parent, you may be surprised to learn that your newborn, who seems to need you every minute of the day, actually sleeps about 16 hours or more! Newborns typically sleep for periods of 3–4 hours. Don't expect yours to sleep through the night — the digestive system of babies is so small that they need nourishment every few hours and should be awakened if they haven't been fed for 5 hours (or more frequently if your doctor is concerned about weight gain).

Many babies sleep through the night (between 6–8 hours) at 3 months of age, but if yours doesn't, it's not a cause for concern. Like adults, babies must develop their own sleep patterns and cycles, so if your newborn is gaining weight and appears healthy, don't despair if she hasn't slept through the night at 3 months.

It's important to place babies on their backs to sleep to reduce the risk of sudden infant death syndrome (SIDS). In addition, remove all fluffy bedding, quilts, sheepskins, stuffed animals, and pillows from the crib to ensure that your baby doesn't get tangled in them or suffocate. Also be sure to alternate the position of your baby's head from night to night (first right, then left and so on) to prevent the development of a flat spot on one side of the head.

Warning or "Alarm Signs" of Potentially Serious Problems - When to Seek Immediate Medical Attention

When a new born baby is unwell, there are often warning signs. If your baby has any of the following symptoms, seek medical attention right away:

  • doesn't pass a greenish-black stool within 36 hours after birth 
  • vomits forcefully or more frequently than usual (more than just spitting up) 
  • refuses feeds for more than 6 to 8 hours 
  • has a fever before 6 weeks of age 
  • has a persistent cough
  • is excessively or uncharacteristically fussy or irritable 
  • is unusually lethargic or sleepy 
  • has color changes in the lips or face 
  • has bad diarrhea or unusually frequent and very watery stools 
  • appears dehydrated 
  • or has any other unusual symptoms 

In case of emergency 

They don’t happen every day but accidents do happen. Be prepared by keeping a list of emergency phone numbers in your mobile or by the phone. 

Baby safety measures at home 

  • Sturdy furniture to prevent toppling over 
  • Wipe up spills on the floor as soon as possible. You could slip on them while carrying your baby or a small child could slip and fall over. 
  • Lay anti-skid mats under your rugs and floor coverings or roll them away. 

Your Baby's Checkup Schedule:

Pediatric well-baby visits are a critical part of childhood care.

  • Assesses the infant or young child's growth and development 
  • Recognize problems early and supply appropriate intervention 
  • Immunizations 
  • Educate the parents on baby care 
  • Provide treatment for existing problems. 

The well-baby examination is an ideal time to discuss concerns or questions with your pediatrician. This may include special questions you have about immunizations, nutrition, growth and development, accident prevention and family related concerns. If you have important questions, it is a good idea to write them down before going for your well-baby visit - you will save time and won't forget any of the questions you wanted to discuss.

 

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