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The Informed Parent

The Newborn Visit

by Louis P. Theriot, M.D., F.A.A.P.
Published on Dec. 12, 2000

Mr. And Mrs. X brought 12-day-old Cole to the office for his first visit after leaving the hospital. Mrs. X. had an uncomplicated vaginal delivery, and Cole was a healthy, strapping baby boy with a birth weight of 7 pounds 10 ounces. He did well during his two- day stay in the nursery, and then went home with Mom. His weight at the time of discharge was 7 pounds 2 ounces. This concerned Mom, as she was eager to breast-feed. We discussed the fact that all babies lose weight in the first few days of life. In fact, it is acceptable for babies to lose up to 10% of their birth weight by around day four-to-five. What is important is that they re-gain their birth weight by around day 10-to-12.

Both parents were excited and proud of their new son. I congratulated them again as I sat in my chair to begin the visit. Mom seemed a bit unsettled, or actually worried, and passed little Cole over to Dad while pulling out a shopping list of questions.

She took a deep breath and tried to gain her composure. With a quivering voice she stated, “I think I’m going to have to stop breast-feeding…or at least supplement him. I just know that Cole is not getting enough milk from me.” She was obviously upset, so I interrupted before she could go on.

“Before you go any further let’s just see exactly how much Cole weights. He will tell us if he is not getting enough to eat.” Sure enough, at twelve days of life, Cole was a whopping 8 pounds 1 ounce…7 ounces above birth weight. “This is outstanding weight gain,” I announced. “This proves that the breast feeding is a big success, and there is absolutely NO need to supplement from a nutritional standpoint!”

It was like a huge weight had been lifted from Mom. Her face lit up and she beamed as she let out a nervous giggle. What truly broke the ice was when Dad pronounced, “I told you that everything was OK.” Mrs. X flashed him an incredulous look and started in, “You what? You were more of a basket case than I was. You made me a nervous wreck. You…never mind!” Then Dad laughed and confessed that he was only kidding.

Having established that Cole was doing just fine and the breast-feeding was going well, we moved on to Mrs. X’s questions. First on her list was the fact that Cole sneezed all the time, and one of Cole’s grandmothers was sure that he had a cold. I explained to Mom that sneezing is a normal reflex that ALL newborns have. In fact, it is a very important protective reflex. Babies are “obligate nose breathers” until around two months of age, which means that they predominately breath through the nose. They have a sensitive reflex built in to insure that the tiny nasal passages stay open. As a result, when they get dried mucus in the nose, or if dust or lint get in, this reflex is stimulated and they sneeze. I went on to explain further that if Cole did have a cold, he would have a runny nose, increased mucus production and congestion, and possibly a fever--just like when Mom or Dad get a cold. Cole certainly did not have any of these other symptoms, and it made good sense to them.

Last on Mom’s list was hiccups. Before Mom could even finish her question I said, “Let me guess. Cole gets the hiccups every time he eats, just about at the end of the feeding.” They looked at each other and said, “Exactly!” I told them that this, too, was a normal reflex in most newborns. In fact, I went even further and suggested that these probably bothered the parents MORE than it did Cole, and they agreed. When babies eat and fill their stomachs, this presses up against and stimulates the diaphragm, which then spasms. All hiccups are spasms of the diaphragm. I assured them that this was NOT a problem, and that they would gradually disappear within the next few weeks.

At the end of the visit, Mom pulled out her list of questions once again. I watched her eyes go up and down the list a couple of times. With a sigh of relief she said, “Well, I guess that’s it. We’re doing all right, huh?” Just then Dad started to say, “I TOLD you…”, and then stopped. Enough said.

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