Prenatal/Newborn

Newborn care is an area of pediatrics that focuses on ensuring that babies under three months old are getting the nutrition they need and developing properly. If you have a newborn or are expecting in the coming months, take a moment to learn more about what is required when caring for a newborn. Good newborn care includes scheduling regular checkups with a pediatrician during those first few months of the child’s life.

Newborn Care Appointment Milestones

If you're unsure of when you should bring your newborn in for a checkup with your pediatrician, here are a few of the most important milestones to keep in mind:

• The first doctor’s appointment should be within a few days of returning from the hospital after the child’s birth.

• The second appointment should be about one week after the first.

• The third doctor’s appointment for a newborn should be at the age of one month.

The purpose of these checkups, also called well-baby visits, is to chart the baby’s growth, check for concerns that may have developed after leaving the hospital, and ensure that the baby is getting plenty of good nutrition.

Weight and Growth in the Newborn

When your baby was born, his or her birth weight included excess body fluid, which he or she lost during their first few days. Most babies lose about one-tenth of their birth weight during the first five days, then regain it over the next five, so that by about day ten they usually are back to their original birth weight. Most babies grow very rapidly after regaining their birth weight, especially during growth spurts, which occur around seven to ten days and again between three and six weeks. The average newborn gains weight at a rate of 2⁄3 of an ounce (20–30 grams) per day and by one month weighs about ten pounds (4.5 kg). He or she grows between 1 1⁄2 and 2 inches (4.5 to 5 cm) during this first month. Boys tend to weigh slightly more than girls (by less than 1 pound, or approximately 350 grams). They also tend to be slightly longer than girls at this age (by about 1⁄2 inch, or 1.25 cm).

During these first weeks, your baby’s body gradually will straighten from the tightly curled position he or she held inside the uterus during the final months of pregnancy. He or she will begin to stretch their arms and legs and may arch their back from time to time. His or her legs and feet may continue to rotate inward, giving him or her a bowlegged look. This condition usually will correct itself gradually over the first year of life.

Head Growth and Shape in the Newborn

Your pediatrician will pay particular attention to your child’s head growth because it reflects the growth of their brain. The bones in your baby's skull are still growing together, and the skull is growing faster during the first four months than at any other time in their life. The average newborn’s head circumference measures about 13 3⁄4 inches (35 cm), growing to about 15 inches (38 cm) by one month. Because boys tend to be slightly larger than girls, their heads are larger, though the average difference is less than 1⁄2 inch (1 cm).

If your baby was born vaginally and his or her skull appeared misshapen at birth, it will usually resume its normal shape after a few days. Any bruising of the scalp or swelling of the eyelids that occurred during birth will be gone by the end of the first week or two. Any red spots in the eyes will disappear in about three weeks.

Skin and Hair Conditions in the Newborn

You may discover that the fine hair that covered your child’s head when he or she was born soon begins falling out. If your baby rubs the back of their head on their sleep surface, he or she may develop a temporary bald spot there, even if the rest of his or her hair remains. This loss is not medically significant. The bare spots will be covered with new hair in a few months.

Another normal development is baby acne—pimples that break out on the face, usually during the fourth or fifth week of life. They are thought to be due to stimulation of oil glands in the skin by hormones passed across the placenta during pregnancy. This condition may be made worse if the baby lies in sheets laundered in harsh detergents or soiled by milk that he or she has to spit up. If your baby does have baby acne, place a soft, clean receiving blanket under his or her head while the baby is awake and wash baby's face gently once a day with a mild baby soap to remove milk or detergent residue.

Your newborn's skin also may look blotchy, ranging in color from pink to blue. His or her hands and feet, in particular, may be colder and bluer than the rest of their body. The blood vessels leading to these areas are more sensitive to temperature changes and tend to shrink in response to cold. As a result, less blood gets to the exposed skin, causing it to look pale or bluish. If you move his or her arms and legs, however, you should notice that they quickly turn pink again.

Temperature in a Newborn

Your baby’s internal “thermostat,” which causes him or her to sweat when he or she is too hot or shiver when he or she is too cold, won’t be working properly for some time. Also, in these early weeks, the baby will lack the insulating layer of fat that will protect him or her from sudden temperature shifts later on. For these reasons, it’s important for you to dress baby properly—warmly in cool weather and lightly when it’s hot. A general rule of thumb is to dress baby in one more layer of clothing than *you *would wear in the same weather conditions. Don’t automatically bundle baby up just because he or she is a baby.

If your baby feels warmer to you or has symptoms of being sick, it is important to check your newborn's temperature. The most accurate way to measure a baby's temperature at home is rectally. You can place a small amount of Vaseline or Aquaphor on the thermometer tip and place in baby's bottom about 1-1.5 inches deep. Any temperature greater than 100.4 degrees Fahrenheit is considered a fever in a baby less than 8 weeks old and is an emergency. If your baby has a fever, call our office immediately.

Umbilical Cord Care in Newborn

Between ten days and three weeks after birth, the stump from the umbilical cord should have dried and fallen off, leaving behind a clean, well-healed area. Occasionally a raw spot is left after the stump is gone. It may even ooze a little blood-tinged fluid. Just keep it dry and clean (using a cotton ball dipped in rubbing alcohol) and it will heal by itself. If it is not completely healed and dry in two weeks, call our office.

Breastfeeding: What You Should Know

Breastfeeding is the act of feeding a baby directly from a mother's breasts. Babies are born with a reflex that enables them to suck instinctively, which in turn stimulates the ducts inside the mother's breast to release milk. Pregnant women begin producing colostrum just before having their babies. This thick, nutrient-rich liquid will gradually turn to breast milk over the days following childbirth. If breastfeeding is not physically possible for the mother or the baby, the milk can be extracted using hand or electric pumping machines.

Benefits of Breastfeeding

It is widely accepted that breastfeeding, also called nursing, is the best option for both mother and baby. Organizations like the World Health Organization recommend six months of exclusive breastfeeding. While infant formula is designed to replicate the basic nutrients found in breast milk, certain natural components cannot be duplicated. Breast milk contains the exact balance of nutrients that a growing baby needs; it is easily digested and provides the infant with necessary antibodies that help to fight off infections and chronic diseases. Nursing a newborn also triggers the mother's body to burn calories and shrink the uterus after birth, allowing the mother to return to her pre-pregnancy weight more easily. It has also been shown to be beneficial in preventing cancer and diabetes in both the mother and child.

For many women and children, breastfeeding is a positive experience, but there can also be difficulties with an infant's "latching" technique or the production of milk. Lactation coaches at hospitals and outside support groups exist to help nursing mothers achieve breastfeeding successfully and comfortably.

We understand many women may be apprehensive or unsure at first about breastfeeding vs. bottle-feeding their baby. It’s normal to have many questions related to breastfeeding. Dr. Johnson is here to support you in whichever decision you choose.