Your Newborn Baby—What’s Normal?

    Parents’ Guide to the Newborn

Keep your caregiver informed of any concerns about your baby.
Phone number of dr., public health nurse, midwife, or other provider Name_______________________Phone_____________________

Your baby’s breathing

Noises such as snuffles, grunts, wheezes, etc are not a concern by themselves. Babies can be noisy breathers. They have small amounts of mucous in their airways from the birth process and they are adjusting to air breathing. It is normal for the breathing to be irregular—sometimes rapid and then followed by slow, deep breathing. When your baby cries vigorously, he/she will become redder in the face and take deep, gasping breaths. This is normal.

Concerns about breathing to notify your caregiver about are:

1. Chest retractions–if your baby draws the chest wall in noticeably when breathing and you can see the outline of the breast bone with every breath.

2. Prolonged rapid breathing–the rate of breathing in a healthy calm newborn should be about 30 to 40 breaths per minute. If the baby is doing a panting breathing when calm (60 or more breaths per minute) for more than 15 minutes, have your caregiver check.

3. If your baby seems to have worrisome breathing and blueness around the mouth, call your caregiver.

FEEDING Within 8 hours of birth, the baby should be waking to feed every two hours and latching on to the breast well. Demanding to be fed is a very good sign of health in a newborn. Your baby needs only what is in the breast, do not feed water. If baby seems lethargic and doesn’t wake to feed for 4 hours, call your caregiver immediately. This behavior might mean the baby has a serious infection.

COLOUR A small amount of blueness and coolness in the extremities (hands and feet) is normal. Some mottling of the chest and tummy is normal. Many parents are alarmed by the baby’s whole body going dark red like a strawberry, this is a normal result of changing blood circulation in the newborn. Generalized blue or gray colouring (rare) would be alarming.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

TEMPERATURE Only take your baby’s temperature under the armpit. Digital thermometers can be purchased for about $12 at the pharmacy. If the temperature falls below 36.1 degrees Celsius (97 F) or goes above 37.2 degrees Celsius (99F), look to see if you have bundled the baby too warmly or if the baby needs more covering. Adjust the baby’s garments and recheck the temperature in 15 minutes. Call your caretaker if abnormal temperatures persist. The usual rule of thumb for baby covering is to look at what the adults are wearing and then add one more layer for the baby. The baby being skin to skin with the mother is a good way to help the baby have a normal temperature and breathing rate.

URINE The baby may only have one wet diaper per day for the first two days. Once the breast milk is in, the baby should have at least 6 very soaked diapers in 24 hours. Urine should be colourless. Some babies have crystals in their urine (orange staining that looks like face makeup) and this is not a concern in the first 3 days. After the third day, that orange staining can be a sign that the baby is dehydrated. Increase the time at the breast and advise your caregiver. Little girls may have a spot of blood in their diaper which is their first menstrual blood, this is normal. By the fourth day, the baby should have at least 6 very wet diapers per day (the diaper will feel heavy in your hand).

BOWEL MOVEMENTS In the first 24 hours of life, the baby will pass meconium (blackish, tarry stools). Next, the stools will be brownish, greenish and quite soft. Once the milk is fully in (around day 3 of life) the baby’s stools are the colour and consistency of yellow mustard. The baby should have two poops the size of a loonie (silver dollar) as a minimum every day. A well fed baby usually has much more than the minimum.

UMBILICAL CORD Fold diapers down away from the drying umbilical stump. The cord will be dry and blackened within 24 hours and the clamp can be removed. The stump usually rots off by 5 to 10 days after the birth. Don’t put peroxide or alcohol on the cord. It heals best if left alone. Because it is rotting flesh, there is usually a foul odor when it is ready to fall off and it can be quite goo-ey looking. If there is redness on the abdominal skin surrounding the belly button area, notify your caregiver.

EYES The policy in hospitals is to treat the baby’s eyes with an antibiotic cream called “Erythromicin”. If you do not want your baby to receive this antibiotic, let your caretaker know in advance and sign a waiver. Newborns can have plugged tear ducts which cause discharge to accumulate in their eyes. Bring any discharge concerns to the attention of your caregiver.

INTACT PENIS Keeping your son’s penis intact is now the recommended policy of physicians’ groups. There is no special cleaning that needs to be done. Simply bathe your baby in a warm bath and leave the foreskin alone. The foreskin is attached to the glans in babies (much like the fingernail is attached to the finger) and the separation process may take years to complete. Only the boy should retract his own foreskin, this should not be done by parents or medical professionals. For more info on caring for your intact son, there is a handy free brochure at this link http://www.nocirc.org/publish/pamphlet4.html

JAUNDICE Yellowing of the skin of the newborn in the first 24 hours of life is unusual and should be called to the attention of your caregiver.
After Day 2, some yellowing is normal. Usually the face and chest are the most yellow places on the body. The baby may be sleepier than normal with jaundice and you may have to wake the baby to feed every two hours. It’s important that the baby remains well hydrated in order to get rid of the yellow cells from the body. Let your caregiver know if you are having trouble waking/feeding the baby or if the yellowness extends out to the hands and feet.

Slightly jaundiced newborn

Slightly jaundiced newborn

Gloria Lemay, Vancouver, BC
March 2016

BABIES BORN IN THE CHRISTMAS SEASON–KEEP THEM HEALTHY

It’s a special thing to have a baby in North America at Christmas time. Photos of the new baby under the tree with the gifts, extra time off from work, a time of holiness joy and good cheer, . . . you would think it would be the ideal time to give birth. Unfortunately, many little newborns end up in hospital at this time due to the timing of their arrival.

No Finer Gift

No Finer Gift

Photo credit http://www.gracemogadamphotography.com/2015/05/08/newton-newborn-photography-william/

1. This is sugar time. The chocolate, cookies and candies are everywhere you look and sugar undermines the immune systems of the family members leading to colds and flu.
2. Staying up late. Parties given by neighbours, school, church, etc., tend to go late and the older kids in the family are affected and can get sick at this time by the late nights AND THE SUGAR.
3. The pregnant parent is either nesting in with the new baby or is hugely pregnant and doesn’t want to go to events, so the other parent takes the bigger kids and doesn’t pay close enough attention to the sugar or the late hours.
4. The children at school tend to be getting coughs, colds, flu and they spread it to the siblings of the new baby. Those older siblings sneezing or coughing on the new baby leads to trouble.
5. Christmas travel. A lot of pressure can be put on the family of a new baby to drive 100 miles (or more) for Christmas day family dinners. No matter how much the family thinks this is a good idea, IT IS NOT. The newborn should be kept warm and cozy at home because those long car trips are exhausting, no matter how much planning happens in advance. The nursing parent has to take care of her breasts/breast milk supply. All this is best done at home.
If the breast feeding gets thrown off at this season of the year, it can result in the newborn baby failing to thrive and/or the nursing parent getting mastitis, sore cracked nipples or a diminished production of milk.

What can you do to make sure that your new baby stays out of the hospital during this season?

1. Screen all visitors by asking them “Are you sure you are completely well? We don’t want any bugs around the new baby.”
2. Buy lots of grapefruit, kiwi fruit and oranges and make them the whole family’s dessert through this time. Keep a big bowl of this healthy Vitamin C-packed fruit out and visible. Keep stocking it up. Don’t bring sugar-y foods into the house.
3. If you have older kids in school, pay close attention to their diet and sleep. Keep them healthy. Both parents need to be responsible and communicate with each other about this.
4. Both parents need to watch their own health. Stay away from alcohol, take your vitamins, keep your schedule calm, have afternoon naps, avoid annoying people, etc.
4. Take a year off from the hype and pretend you’re in a stable with cattle lowing. In the big scheme of things, you’ll be glad you did. Have a really peaceful Christmas giving thanks for the miracle of your very own healthy newborn Christ child.Christmas warmth

CHEAT SHEET FOR PARTNERS –Breast feeding support

CHEAT SHEET FOR PARTNERS

    Breastfeeding Support

This is a brief list of ways to make a big difference for the woman who is breast feeding. Do one, some, or all, everything matters.

1. When the breast comes out, you run to get a big glass of something for her to drink. (Trust me, the minute the baby latches on, her throat will go dry).
2. Find (or buy) a low foot stool for her. (Rubbermaid makes a good one and Ikea has a cheap, functional one). Putting her feet on a stool brings baby up to the breast so she doesn’t have to hunch forward.
3. Watch her shoulders, if they are hunched forward, she’s not relaxed. Find some soft pillows to bring baby up higher or support her arms. She’ll forget about this so you keep on top of it.
4. Tell her what you authentically appreciate about her feeding the baby. E.g. Thank you for all you do to make our baby healthy. You look so beautiful when you’re feeding the baby., etc etc.
5. Put a snack beside her, she needs extra calories to produce milk. A plate of sliced apples, toast with almond butter, cheese and crackers, etc.
6. While she’s feeding, scan the environment she’s looking at. When she’s sitting, you’re moving. Empty the trash, clear the clutter, mop the dust bunnies, water the plants.
7. Give her a shoulder massage.
The partner being an active participant in the breast feeding support can strengthen the family. Please add your ideas in the comments section.

A partner who actively works to make the breast feeding go smoothly is a treasure.

A partner who actively works to make the breast feeding go smoothly is a treasure.


Gloria Lemay, Vancouver BC Canada

6 Point Recipe for Making New Parenthood as Difficult as Possible

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

1. Start with giving the birthing woman antibiotics in high doses so that the baby develops candida (thrush) and colic. Then mix in a lot of stitches, either to repair the perineum or the lower belly/uterus.

2. Separate the mother and newborn. Make the mother walk a long distance (with her stitched body) to be able to see/feed her newborn.

3. Teach her that the best (and only) way to feed her baby is to sit upright in a chair

4. Discourage sleeping together as a family. Don’t let her know that lying down to nurse will enable her (and her partner) to get much more sleep.

5. Tell her that the baby is not getting enough milk and don’t give her the tools to increase her supply.

6. Scare her into thinking that her instincts about caring for her baby are not to be trusted and that she should listen to professionals for all things to do with her baby’s health.

Opthalmia Neonatorum

Oh dear!  The Food and Drug Administration in the U.S. has issued a bulletin saying that there is a shortage of the small erythromicin tubes for newborn babies. (see below)  Hospitals are wondering how to break up larger tubes into small doses for infants.  I guess they didn’t get http://wisewomanwayofbirth.com/ways-to-save-millions-of-tax-dollars-in-obstetrics/ my blog post of February 21, 2009, where I clearly told the U.S. government:

2. End eye ointment treatment of newborns.  Britain and Australia do not put antibiotics in the eyes of newborns who don’t need it.  If a baby gets an infection, they treat it.  Who makes all the money from this unnecessary tribal rite?  Curious minds want to know.  When nurses, midwives and doctors continue these practises they line the pockets of the pharmaceutical companies at the detriment of babies.

Perhaps the gigantic drug company payout of $2.3 billion in damages this past week is actually affecting their money making cartel?  Who knows what’s going on but maybe a few babies will benefit by not receiving unnecessary antibiotics.  Just think, those lucky babies will get a clear look at the world instead of the murky, oily one that we give to most babies born in North America.

Gloria

FDA statement 9/2/09:
http://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM180747.pdf
 

Erythromycin Ophthalmic Ointment Shortage
 

FDA was recently made aware of a shortage of Erythromycin Ophthalmic
Ointment due to a change in manufacturers.  Fera Pharmaceuticals recently
acquired the rights to the product and they are actively working to make
Erythromycin Ophthalmic Ointment available. Bausch and Lomb also
manufactures Erythromycin Ophthalmic Ointment and they are working to
increase production during this period of drug shortage. We anticipate
shortages of both the 1 gram and 3.5 gram tubes.

Erythromycin Ophthalmic Ointment is approved for prophylaxis of ophthalmia neonatorum due to gonorrhoeae or C. trachomatis and is the only product approved for this indication currently commercially available in the United States.
Erythromycin Ophthalmic Ointment is also approved for the treatment of
superficial ocular infections involving the conjunctiva and/or cornea
caused by organisms susceptible to erythromycin. Other products are also
approved for the treatment of these types of infections.
 What is FDA doing to address the shortage of Erythromycin Ophthalmic
Ointment?
 
FDA is working with manufacturers to increase production of erythromycin
ophthalmic ointment.
FDA has worked with the manufacturer to facilitate distribution of
available product to hospitals for neonatal prophylaxis use.
 
What can healthcare providers do?
 
While Erythromycin Ophthalmic Ointment is also approved for the
treatment of superficial ocular infections involving the conjunctiva
and/or cornea caused by organisms susceptible to erythromycin, health
care providers are asked to consider alternative drugs for this
indication during this time of shortage to maximize the availability of
Erythromycin Ophthalmic Ointment for prophylaxis of ophthalmia
neonatorum. (end of Bulletin)


The eyes have it
Added on April 14, 2015 Someone’s listening. The Canadian Society of Pediatrics has recommended against this treatment of babies’ eyes. http://www.cps.ca/en/documents/position/ophthalmia-neonatorum Quote from the policy:

Applying medication to the eyes of newborns may result in mild eye irritation and has been perceived by some parents as interfering with mother-infant bonding. Physicians caring for newborns should advocate for rescinding mandatory ocular prophylaxis laws. More effective means of preventing ophthalmia neonatorum include screening all pregnant women for gonorrhea and chlamydia infection, and treatment and follow-up of those found to be infected. Mothers who were not screened should be tested at delivery. Infants of mothers with untreated gonococcal infection at delivery should receive ceftriaxone. Infants exposed to chlamydia at delivery should be followed closely for signs of infection.