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The Informed Parent

Typical Newborn Questions

by Louis P. Theriot, M.D., F.A.A.P.
Published on Oct. 17, 2005
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For most new parents the first doctor visit after leaving the nursery is a particularly exciting one. There are a number of questions that have come up, and it is a good time to reassure mom and dad that they are doing a great job. It is also a good time to dispel, or put to rest, any myths that have been promulgated by some well-intending distant relative.

Over the years I have observed that there are a number of questions about a normal newborn that come up time and again...it is almost predictable. It might be of value to address some of these questions in the form of an article.

Weight Gain

One of the most pressing concerns, especially for breast feeding moms, is "How can I be sure that my baby is getting enough to eat?" This is where the weight of the newborn is invaluable. One must remember that babies can normally lose up to 10 percent of their birth weight in the first few days of life. This weight loss is physiologic and normal. It has nothing to do with how well the baby is eating or how adequate mom's milk supply is, or isn't.

The peak weight loss occurs around day four of life. It occurs in bottle-fed as well as breast-fed babies. The baby's weight then turns the corner and is gained back. As a rule, babies should be back to birth weight around day 10-to-14 of life.

After babies have regained their birth weight a good measure of gain is around one ounce or 30 grams a day. As an example, a baby weights 7 pounds 2 ounces at birth and comes in for a visit at day 12 of life weighing 7 pounds 4 ounces. This baby is doing just fine. That is because if one assumes the baby was back to birth weight by day 10 of life (7 pounds 2 ounces) and then gained one ounce a day thereafter, at day 12 the baby should be 2 ounces over birth weight. This is exactly where the baby is.

Bowel Habits

An area that causes much angst and concern is the baby's bowel habits. If one checks out the pediatric literature they will find that the normal bowel habits for a newborn are extremely variable. It can be normal for a baby to have a bowel movement every time he eats, or it can be equally normal for a newborn to have one bowel movement every 5-6 days.

What is important is the consistency of the stool. As long as the stool is a mustardy yellow, seedy, and semi-liquid, it is normal. It may even be explosive and still be very normal. If a baby has a stool every three days, as long as the stool is soft and not hard rabbit pellets, it is NOT constipation.

Babies have a certain reflex whereby each time they eat and fill their stomachs, by reflex, the colon works. So it is not uncommon for a breast-feeding mom to tell you that whenever she feeds her baby, she doesn't make it to the opposite breast before hearing a loud and explosive stool. This may even be heard by dad who is in an adjacent room reading the sports page. Rest assured, this may very well be completely normal.

Umbilical Stump

The remnant of the umbilical cord often proves to be anxiety provoking for some family members. The umbilical stump typically falls off in one-to-three weeks. Before it falls off it may become dry, hard and shriveled. It can get pulled and tugged by the shirt or diaper, which may cause dry blood to be caked around the base. This is not a problem and the dried blood can be cleaned with a little rubbing alcohol on a cotton ball.

The stump may, however, seem moist and wet. There could even be an accumulation of pus around the base accompanied by a foul odor. This too is normal and does not indicate an infection. Simply clean the pus with a cotton ball and alcohol. The pus is there because once the umbilical cord is cut the body regards the stump as a foreign body. Naturally white blood cells are sent to the area to help expel the remaining stump. One should be concerned if the baby has a fever and the surrounding abdominal area is red and inflamed. Certainly if there are any questions about how the umbilical area appears, one should call the doctor immediately.

Sneezing

Sneezing and hiccupping are normal occurrences in the life of a newborn that tend to cause a lot of concern. Rest assured that these are normal reflexes that will resolve with time. Sneezing is an involuntary action that babies have to insure that the nasal passages remain patent. It is an important protective reflex. Babies are obligate nose breathers for the first two-to-three months of life. This means that they almost exclusively breathe through their noses rather than their mouths. When dried mucus, lint or dust gets in the nose the sneezing reflex is stimulated and causes the baby to let out a forceful sneeze to clear the nasal passages. That is why a baby can be resting comfortably in mom's arms, happy as a clam, and suddenly let out several loud sneezes. It doesn't signal that the baby is coming down with a cold.

Hiccups

Hiccups are caused by spasms of the diaphragm. When babies eat and fill their stomachs, the stomach presses upon the diaphragm. By reflex it will spasm, thus causing the hiccups. That is the reason when infants are nearly full and nodding off to sleep, they will begin to hiccup. This is not a problem nor does it cause any distress. Quite frankly, it tends to bother parents more than it does the baby.

Of interest, the same reflex occurs while fetuses are carried in utero. The fetuses are constantly drinking the amniotic fluid and filling their stomachs. This is what triggers the hiccups that many expectant mothers experience.

Dry Skin

Finally, the peely, seemingly cracked skin that newborns get is also normal and requires no treatment whatsoever. Remember that the fetus has been swimming in amniotic fluid for the better part of nine months. It is natural for the outer layer of skin to slough off in the first few weeks after birth. It is particularly common for the skin around the wrists and ankles to appear dry, leathery and even cracked. The skin may peel and flake away.

For babies that are post-mature, over 40 weeks gestation, this may be quite noticeable. The dryness may even appear on the trunk and abdomen. When you feel the area, however, it is soft and NOT dry. Although the tendency is to want to apply a lotion or lubricant, this is not at all necessary. In fact, lotions may clog the pores and cause the baby to get a prickly heat rash as a result.




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