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The Informed Parent

Coming Home With The New Baby

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jul. 14, 2008

Few moments in life are as magical and momentous as bringing the new baby home from the hospital. All of the anticipation and preparation during the long pregnancy have come to fruition. It is now time to put the knowledge you learned in baby classes and breastfeeding classes to work.

It doesn’t take long to realize that newborns have little quirks that are NOT in the standard books. These are not dramatic or worrisome peculiarities. But they are just curious enough to keep new parents wondering if there might be a problem…and they are certain to worry grandparents to death. Let’s look at some of these normal newborn facts.

All newborns lose weight in the first few days of life. It is very normal for a newborn to lose up to 10 percent of their birth weight. Babies typically lose a little weight each day for the first three-to-five days. Thereafter the weight stays the same for a day or so. Then they turn the corner and gain the weight back. Babies should be back to their birth weight by day 10-to-12. This is normal and physiologic, and is seen in both breast-fed and formula-fed babies. It can be quite concerning for a first time mom who is trying to successfully breast-feed. It is the job of the pediatrician to reassure and support this mom. This often requires periodic weight checks to prove that the baby is gaining appropriate weight and that the breast-feeding is truly a success. 

Most umbilical cord stumps fall off between one-to-three weeks of life. If the cord remains clean and dry, nothing really needs to be done to it. If it has a goopy discharge or becomes caked with dried blood, this can be cleaned with alcohol on a cotton ball. Sometimes the discharge can look like pus and can even be foul smelling. Rarely is this a problem or a sign of a true infection. Once the umbilical cord is clamped and cut in the delivery room the baby’s body now recognizes the umbilical stump as a foreign body. It will send white blood cells to the area to help expel the cord stump. That is why there might be actual “pus” around the cord. This is a normal and expected reaction of the body, and should not worry new parents.

One of the most disconcerting areas for parents and grandparents is the stooling patterns of babies and children. If one looks in the medical books you will find that newborns can NORMALLY have anywhere from one bowel movement every time they feed to one bowel movement every five-to-six days. It is extremely variable. Probably the most important fact is that the stool is soft and without any blood. The normal breast-fed stool is described as mustardy yellow, with seed-like curds. These can often be explosive. Some babies have what is called a gastro-colic reflex. Whenever they eat and fill the stomach the colon is stimulated to work. This triggers a bowel movement. Some breast-feeding moms will tell you that they don’t make it to the opposite breast before their baby turns beet red in the face, strains and fills the diaper with a large explosive stool. This is very normal, just as it is very normal for the newborn that has one soft yellow stool every five days.

Newborns are quite amazing creatures that have a number of protective reflexes built in to insure their safety. One such reflex is the sneezing response. This is one that is certain to drive grandparents crazy. Most newborns are obligate nose breathers, which means that they almost exclusively breathe through their noses and not their mouths. They transition to mouth breathers by two months of age. Since they nose breathe, they have a protective reflex that insures that the nasal passages remain clear and open, and this is sneezing. If a newborn’s nose gets plugged with dry mucus, lint or dust, they will sneeze to clear the nose. That is why a newborn may be comfortably sleeping in mom‘s arms. Then, all of a sudden, out comes two or three sneezes. This is rarely the sign of the baby coming down with a cold, or getting sick.

Another newborn reflex that causes undue concern for parents and grandparents is hiccups. When a newborn eats and fills the stomach the dome of the stomach can press up on the diaphragm. This can stimulate a nerve that serves the diaphragm. When this nerve is stimulated it triggers the diaphragm to spasm, thus causing the hiccups. Hiccups are nothing more than spasms of the diaphragm. They are not dangerous or in any way a problem for a new baby. Many a new mom will complain that her newborn eats like a little champ. But just when the baby is about finished, just ready to nod off to sleep, he or she will start to hiccup, and is wide-eyed and awake. This is NOT a problem. If anything, it is a sign that her baby’s tummy is nice and full.

The newborn baby is an amazing creature. Just take a few moments to carefully look at a newborn. Study the facial features; watch them breathe, look at their little fingers and toes. They look so helpless, yet they are so resilient and strong. While all babies are unique and individual, they do share certain traits and idiosyncrasies that can be concerning to new parents, even though they are completely normal. It is the responsibility of the pediatrician to put the parents’ minds at ease and to allay any fears that they might have. I constantly remind my patients that there is no such thing as a “dumb” question when it comes to the health of their child!

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