It’s such a privilege to be able to provide pediatric care to newborn babies. The first few weeks of parenthood with a new baby are so beautiful… and hard… and magical… and stressful. Easing parents’ concerns and helping them provide everything their new baby needs is one of my favorite aspects of the work I do.
Unfortunately, babies don’t come with an instruction manual, but there are certain universal facts about newborn babies that hold true across the board. Having a pediatrician as a partner in the care of your new baby is so important to make sure that everything is going as expected. You can have the peace of mind that if things are not going as expected, your pediatrician will help you take the right next steps to ensure your baby can thrive. If you’re an expectant parent, a new parent, or you know someone who is, I hope these “fun facts” about newborn babies are informative and helpful.
Your first visit with a pediatric provider should be within the first 3-5 days after birth. If you have your baby in the hospital, then a pediatrician will examine him or her within the first 24 hours of life and then will let you know when you should have baby’s first visit (usually at 5-7 days old, or sooner if there are any concerns). If you have your baby at home or at a birth center, then you’ll want to schedule baby’s first visit for as soon as possible.
All babies need to feed AT LEAST every 3 hours. And every 1-2 hours can be perfectly normal. It’s not healthy for babies to go longer than 3 hours between feeds for a couple of reasons. Babies need to feed 8-10 times a day so they can gain weight (see the next few points). In addition, they can’t regulate their blood sugar like we can, so if they sleep too long, they may have a dangerous drop in their blood sugar, making it hard for them to wake on their own to feed. For these reasons, I always advise parents to set an alarm for every 3 hours, day and night, for the first several weeks of life.
All babies lose weight at first. Breastfed babies tend to lose more weight than bottle-fed babies, and that’s natural and expected. Up to 10% weight loss is normal. More than 10% weight loss is concerning.
All babies should be back to birth weight by 2 weeks old. Even breast fed babies are expected to be gaining weight and surpassing their birth weight by 2 weeks old. We understand that it can take some time for milk to fully come in, and for moms and babies to get the hang of this whole breastfeeding thing. That’s why getting back to birth weight isn’t expected until 2 weeks of age. Of course, if baby gets there sooner, that’s awesome!
If a baby loses more than 10% of birth weight, or has not returned to birth weight by 2 weeks old, your pediatrician will want to follow the baby very closely. And that’s okay. This will include frequent weight checks, and may include recommendations such as:
- A lactation visit ASAP.
- Pumping and offering expressed breast milk in a bottle or syringe to be able to quantify baby’s intake.
- Giving at least X ounces every X hours (based on baby’s weight)
- If the volume of pumped milk is not enough for adequate weight gain, formula may be recommended as a temporary addition to breastfeeding/breastmilk until milk supply catches up to the baby’s needs. This way the baby can gain weight, get stronger, and will be able to breastfeed exclusively more successfully. This is one of the only situations in which I would recommend formula to a breastfeeding baby.
All breastfeeding moms can benefit from a lactation consultant visit, even if things are going great. I’m so proud to work at an office where a lactation visit is part of the Newborn Membership.
Breast is Best, but Fed is Better. There are situations where moms are unable to exclusively breastfeed their babies. Maybe mom had a breast reduction and can’t produce enough milk. Maybe mom has an anatomical issue that makes breastfeeding more difficult, despite all the lactation support she gets. Maybe mom has recurrent mastitis or severe pain with feeding, making breastfeeding stressful for her and/or her baby. Maybe baby has a medical condition that makes breastmilk harmful to his or her health. Maybe baby is adopted, or biological mom isn’t in the picture, and donated breast milk isn’t available. Or maybe mom just doesn’t want to breastfeed. While breastmilk is the perfect food for almost all babies, breastfeeding exclusively is not perfect for every family. And that’s okay. I support fed babies who are loved, growing, and thriving. And if breastfeeding exclusively is working for mom and baby, then I 100% support them with everything I have.
What’s considered a “normal” number of wet (urine) diapers per day changes depending on how old the baby is. Typically, we expect 1 wet diaper in the first 24 hours, 2 on day 2, 3 on day 3, and so on until day 7 and beyond. After a week of life, babies should be having 8-10 wet diapers per day.
All babies cry. Day and night. They are brand new to this world and have no idea what day and night mean. They also don’t know why it’s cold and dry and why everything sounds so different. They cry because they’re hungry. They cry because they wet their diaper. They cry because they need to poop. They cry because they want to be held or rocked or snuggled. They cry because it’s a cool new thing they can do. Sometimes you can’t figure out what to do to help them stop crying. Usually you can. Feed them; change them; hold them; rock them; sing to them; give them something to suck on (see next point); take turns doing all of the above.
All babies like to suck. On their thumbs, fists, your finger, mom’s nipple, or a pacifier. This doesn’t always mean they’re hungry, but sometimes it does.
Any fever in the first month of life is considered a medical emergency. Fever is a temperature of 100.4 or higher. It doesn’t necessarily mean something is terribly wrong, but it does mean you need to take your baby to an emergency room (preferably a Pediatric Emergency Department if available) to be evaluated. While most of the time the source of the fever ends up being something benign like a cold, it could also be a urinary infection, pneumonia, sepsis or even meningitis. The only way to know is to have a trained physician evaluate the baby and do the necessary tests.
Because fever in the first month of life is considered a medical emergency, I generally recommend that parents limit visitors and outings in that first month. It’s perfectly okay to ask your friend not to visit with her sick toddler. If grandpa has a cough, it’s okay to ask him not to hold and kiss the baby. It’s okay to decline attending the big family gathering with your newborn. Protect your baby from those exposures so you can do your best to avoid that ER trip for fever.
All babies can spit up, and that’s totally normal as long as the amount is small and it’s milky-colored. Vomiting large amounts after every feed, or vomiting blood or bile (forest-green color) are never normal and require medical attention.
Baby poop changes color. It starts off dark brown-black (meconium), then after 2-3 days it turns greenish (transitional stool), and finally around 3-5 days old it becomes mustard-yellow and seedy (breastfed baby stool). That said, baby poop can be almost any color and we’ll consider it normal UNLESS it’s red (bloody), white or very pale (acholic), or black (melena – not including the first 2-3 days of meconium which is black and that’s okay). If your baby’s stool is any of those 3 colors, bring it up right away with your pediatrician.
Baby poop should be soft or liquid-consistency. If it’s hard or comes out like pebbles, talk to your pediatrician.
Breastfed baby poop can be 10 times a day, or once a week, or anything in between. As long as baby is feeding well, not vomiting, belly is soft, and stools are soft/liquid consistency (see previous point), your baby’s poop is normal.
All babies have gas. So do you. You’re just more polite about it.
All babies make faces when they are pooping. So do you. You just do it in private.
(I hope those last two made you laugh. They were funny in my head!)
Being a newborn parent can be nerve-racking in many ways, but relying on your new 6th sense as a parent, and enlisting the help of your family, friends and your pediatrician will make the first couple of weeks as smooth as possible!
|Dr. Jamilet Alegria, M.D., joined the CentreSpring MD team of providers in the fall of 2016 after spending years as a Pediatric Hospitalist at both CHOC Children’s in Orange County and at the Pomona Valley Hospital Medical Center Inpatient Pediatrics Unit in Southern California.|
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