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The Informed Parent

Normal For Newborns

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jan. 12, 2004

Mr. and Mrs. King brought their three-week-old infant into the office because they were worried. Their son was having numerous stools a day; practically a bowel movement every time he ate. They were afraid that he might be dehydrated.

Mrs. Lewis came to the office with her twenty-one day-old daughter. It seemed that she had not had a bowel movement for four days and the baby strained each time she had a stool. Mrs. Lewis brought her to the office because she was constipated.

Both babies were completely healthy, normal and thriving newborns. Some babies have what is called a “gastro-colic reflex”. Every time they eat and fill the stomach the colon works by reflex and they are able to pass a stool. It is common for breast-feeding moms to report that every time they feed their baby the newborn strains and passes a stool even before being offered the second breast. Or, the baby may not pass a stool, but mom can hear the intestines “churning away”. This is very normal as long as the baby has a stool that is regular in consistency and color. The typical breast-fed stool is mustard yellow, liquidy, with little seeds or curds mixed within. There should never by ANY blood.

The other end of the spectrum for newborns is to have a stool once every four-to-five days. Again, the stool should be of typical color and consistency. The baby may strain hard, with red cheeks puffed out like Dizzy Gillespie blowing his horn. As long as the stool is normal, it is not a problem. Think about it. These little babies are lying flat on their backs, with relatively weak abdominal musculature trying to have a bowel movement. Of course it is an ordeal for them. Older children and adults are afforded the luxury of sitting on a toilet, with both feet firmly planted on the ground. They are able to fully use their abdominal muscles to bear down and strain effectively.

Mr. and Mrs. Moore and both sets of grandparents brought two-week-old Stacy to the office fearing that she was catching a cold. It seemed that she had constantly been sneezing. Also, her nose was terribly congested, so much so that they said she sounded like a little piglet. The nurse took her temperature and there was no fever. Her examination was very normal. She was a beautiful, content newborn in no distress eating at mom’s breast. “Wouldn’t you know it,” her grandmother said in an incredulous voice. “It’s like when you take your car to the mechanic, the noise stops!”

Stacy was a perfectly normal baby who did NOT have a cold. I explained to the family that newborns have a sneezing reflex that is normal and protective. Babies are obligate nose-breathers for the first several months of life. This means that they exclusively breathe through their nostrils. This reflex is built in to insure that the passages remain open. Dried mucus, lint or dust may stimulate this reflex which makes the baby sneeze a few times in a row. The infant may be sitting quietly in your arms, and suddenly erupt with these sneezes. This is completely normal.

Since babies nose-breathe they are susceptible to what is referred to as the “low humidity syndrome”. When the room is kept too warm, and the air is dry nasal passages dry up as well. Thus, when the baby breathes in snorty, congested sound can be heard, even in another room. This does not put the baby at any risk. It is easily remedied by running a cool mist humidifier and keeping the thermostat set at 68 degrees. One of Stacy’s grandmothers made a confession. Since she thought the baby was getting a cold, she made sure the house was kept nice and toasty by setting the temperature at 74 degrees. That’s when the congestion started.

I also mentioned to the family that if Stacy did have a cold, she would not have been so perfectly normal as she was in the office. After all she had been snorty, congested and sneezing just an hour before at home. They were relieved and pleased. As they were leaving Stacy’s grandfather stuck his head back in the room and said, “I tried to tell them that the house was too darn hot but...” He was stopped in mid-sentence by his wife, who warned him in a stern voice, “Don’t even go there!”

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