Mom's Corner - About Your Baby After Childbirth

These are the topics we'll cover in this section:

Your Baby’s Sleep Patterns

Crying

Sibling Rivalry

Emergency First Aid

Vaccinations

Jaundice

Bathing Your Baby

Umbilical Cord Care

Thrush

Ear Infections

Spitting Up and Vomiting

Bowel Movements

Potty Training

Teething

Your Baby’s Sleep Patterns

Most parents want to know "How much should my baby sleep?" Or, "Is it okay for my baby to sleep so much?. . . so little?" Answers to these questions change over time, as you can see in the chart below, which shows the typical number of hours that a child sleeps in a 24-hour period. The blue areas represent nighttime sleep; the orange areas show naptimes during the day.

Generally, your new baby sleeps a total of about 16 hours out of 24. But, as you've noticed, she isn't able to sleep more than a few hours at a time. Your baby goes through about seven different asleep/awake cycles each day. These cycles are fairly even spaced over 24 hours.

By the time your baby is 6 months old, she will probably sleep a total of a little over 14 hours — about 11 hours at night. Your baby will most likely welcome a 1- to 2-hour nap both in the morning and in the afternoon.

Crying

Babies cry an average of 2½ to 3 hours a day during the first 7 weeks. The following sections explain more about this tearful "baby talk."

Facts About Crying

• A baby's first cry, which usually occurs in the delivery room, is the first breath of life. The initial cry helps the lungs and heart adapt to life outside the womb.
• Crying is usually how babies communicate they are cold or hot; tired or bored; hungry; wet or uncomfortable; overexcited or in pain or distress.
• The length of time a normal infant spends crying and fussing usually peaks at about 3 hours a day by 6 weeks, and slowly decreases to 1 or 2 hours daily by 12 weeks.
• Between 2 and 4 weeks, about 20 percent of babies develop a fussy crying, sometimes called colic. Colicky crying spells may occur at any time, but may become worse in the evening. These crying spells usually stop by 3 months.

Ongoing Crying

The reasons for ongoing crying are not always known, but may include:

• A way for your baby to relieve tension or release excess energy.
• Your baby may be very sensitive to his/her environment.
• Physical discomfort from how or what your baby eats.

When babies eat/drink breast milk or infant formula too quickly during feedings, they tend to get fussy or cranky. When you notice this discomfort, it's best to interrupt the feeding. The break will help slow the eating/drinking and reduce the amount of air your baby swallows. If you are giving an infant formula, check the flow of formula from the nipple to make sure it's not too fast or slow. Burp your baby after she drinks about 3 ounces (90 mL) of formula and at the end of the feeding.

It's also possible that the crying and fussing could be from sensitivity to the formula. If there is a concern about lactose (milk sugar) sensitivity, a lactose-free formula, such as Similac Sensitive Lactose-Free, may be recommended. If the problem is IgE-mediated cow's milk protein allergy, your baby's doctor may recommend a soy-based formula, such as Isomil.

Less commonly, some babies are sensitive to the protein in both milk- and soy-based formulas and may need a special formula, such as Alimentum. Always discuss with the doctor any baby-care concerns you have. Don't switch formulas without talking to the doctor or nurse.

Consoling Your Crying Little One

Babies tend to cry less overall if their cries are answered quickly. Give your baby attention and don't worry about spoiling her. Check to see if she is wet, cold, hot or hungry.

To calm your baby, try the following:

• Get face-to-face with her and talk or sing softly.
• Rock her in your arms or a rocking chair.
• Carry her in a front carrier as you move around.
• Try swaddling—wrap her snugly in a receiving blanket.
• Babies like rhythm and movement. Go for a car ride, and be sure to use an approved infant car seat, or walk with her in your arms or stroller.
• Burp her to release any gas bubbles.

If you're feeling impatient, try leaving your baby with someone you trust while you get away, even for just a short while. Never shake your baby, no matter how frustrated or angry you feel. Shaking an infant could cause blindness, brain injury, or death.

Be especially alert to a sudden onset of crying, unusual sounding cries, like piercing or shrieking or persistent crying that is not typical of your baby's crying patterns. In these instances, you should call your baby's doctor. You also need to call if crying is accompanied by diarrhea, vomiting or apparent pain or if you have any concerns regarding your baby's condition.

Sibling Rivalry

Sibling rivalry is a natural way for older kids to express their feelings about a new brother or sister. They may act out or express feelings of dislike for their new sibling, because they are unsure of their new status as "big brother" or "big sister."

There are some very simple ways to help older children not feel "left out" or "replaced."

Once baby arrives home, try:

• Giving the older children attention, especially if they seem upset or jealous of their new brother or sister.
• Praising your other children for everyday behavior that might otherwise be overlooked—like when they put their clothes away, feed themselves, draw a picture or discover something.
• Catch them being good!
• Involving the older ones as much as possible. Let them hand you diapers and help with baths, dressing and other routine baby-care tasks.
• Be sure they know you will have time to be alone with them, too.

Emergency First Aid

What to Do If a Baby May Have Been Poisoned

• Stay calm and act quickly. Prompt treatment reduces the risk of permanent harm.
• Immediately call the Poison Control Center or a doctor. (Learn this number and post it in a convenient place.) Or go to the hospital.
• Be prepared to give as much information as possible when calling for help: Who (your child's age and weight); What (The name of the substance, if known. Find the container if possible.); When; How Much.
• Follow the directions given. Do not take any action without instructions from the Center.

For a Baby Who Has Been Scalded or Burned

• If the injury is to an arm or leg, place it in cool water—or if the injury is to another part of the body, immediately apply a clean cloth dipped in cool water.
• Call the doctor or go to the hospital.
• Leave any blisters alone.
• Keep the area free of ointments, greases or powders. Cover the area loosely with a sterile gauze pad or clean material that won't stick to the burn until the doctor sees the baby

Warning Signs for a Baby Who Has Had a Head Injury

• Any loss of consciousness after an injury.
• Inability to move arms or legs.
• Drainage of blood or other fluid from the nose, mouth or ears.
• Vomiting that won't stop.
• Pupils of the eyes are uneven in size.
• Excessive or unusual sleepiness and/or lethargy or irritability.
• Cannot be awakened.
• Try to have the baby rest quietly, then call the doctor immediately or go to the hospital.

Vaccinations

Your baby should be immunized to protect her from serious childhood diseases. The Public Health Agency of Canada recommends a specific schedule of vaccines to be given throughout childhood. Please discuss them with your pediatrician and try to adhere to the schedule as much as possible. Keep track of what shots your baby has received. If one is missed at the recommended age, arrange with your baby's doctor or a community or public health clinic to have it made up as soon as possible.

Older children have immunization needs, too. If your baby has brothers or sisters, consult your doctor about their vaccinations.

Jaundice

Jaundice is a common and usually harmless condition in newborn infants. The word jaundice comes from a French word meaning "yellow." It describes the yellowish appearance of the whites of the eyes and skin of many newborn babies.

The most common kind of jaundice is called physiologic jaundice. It usually appears on the second or third day of life in healthy babies born after a full-term pregnancy. It often disappears within a week without treatment. It may occur in both breastfed and formula-fed babies.

In most babies, jaundice occurs because the liver and other organs are not yet fully mature and able to rid the body of bilirubin, the breakdown product of old red blood cells that causes the yellow coloring.

In rare cases, jaundice can become severe. This is called pathologic jaundice. With pathologic jaundice, treatment is required to prevent long-term neurologic problems.

If you notice a yellowing of your baby's eyes and skin, be sure to check with his health care professional. But remember:

• Jaundice in newborn babies is common.
• In the majority of instances, the condition is normal, harmless and temporary.

Bathing Your Baby

The Bathing Experience

Baths can be fun, but the first few will be learning experiences for both you and your baby. Be confident that soon you will both enjoy this ritual. This new experience, like other new experiences, will be more pleasant for both you and your baby if you talk softly, explaining what you're doing and why.

Don't worry about feeling silly using full sentences talking to a newborn. Babies can pick up language skills, and the more you talk to the baby now, the more likely he will enjoy being talked to or read to later. Sing if you feel like it, even if it's a little off-key.

What You'll Need

• Soft washcloth
• Two towels
• Disposable diapers or cloth diapers and pins
• Clean clothes
• Cotton balls
• Bar of mild soap or liquid baby soap
• Baby shampoo
• Tub with 2 inches (5 cm) of comfortably warm water and liner to keep the baby from slipping

For Safety's Sake

• Keep your water heater set lower than 120°F (48.8°C). Always test the bath water with your elbow. Serious burns can occur as a result of excessively hot water.
• Use a safe hold when moving your baby. Have your fingers under your baby's armpit, with your thumb around the shoulder. Your other hand supports your baby's bottom and legs.
• Stay with your baby every second during a bath and dressing.

Giving a Sponge or Tub Bath

First Steps of Both a Sponge Bath and a Tub Bath:

1. Choose a place that is safe, warm and free from drafts.
2. Use cotton dipped in cool water. Wipe around the eyes. Then, wipe the outside of the nose and ears.
3. Wipe the rest of the face with plain, warm water and a washcloth (no soap).

A Sponge Bath

Continue with the following steps:

1. Shampoo the head and squeeze water from the washcloth to rinse.
2. Wash the front of your baby with your free hand lathered with soap. Go from front to back between the legs. Rinse well with the wet washcloth.
3. Wash the back of your baby with your hand lathered with soap. Rinse well with the wet washcloth.

A Tub Bath

When the umbilical cord has dropped off and the navel and circumcised penis have healed, your baby will be ready for his first tub bath. After completing steps 1 and 2 above ("First Steps of Both a Sponge Bath and a Tub Bath"), continue with the following steps, and keep talking to your baby:

1. Hold your baby safely. Shampoo the head with your free hand and squeeze water from the washcloth to rinse.
2. Wash the front of your baby. Go from front to back between the legs. Rinse with the wet washcloth.
3. Wash the back of your baby with your free hand lathered with soap. Rinse well with the wet washcloth. If the first bath isn't great fun, later ones will be. Some newborns fuss and cry when undressed. If this happens with your baby, you can keep him calm if you undress and wash one area at a time. If the bath remains difficult, remember that you don't have to bathe the baby every day so long as his diaper area and face are kept clean.

Umbilical Cord Care

• Swab the umbilical cord (navel) each time you change your baby's diaper.
• Soak a cotton-tipped swab in rubbing alcohol.
• Clean the tip and base of the cord area. She may squirm because the alcohol is cool, but you're not hurting her.
• It can take several weeks for the cord stump to fall off.
• Continue the same care for a week after the cord stump falls off.

Except for the diaper area, which you will clean at each diaper change, your baby does not get very dirty. Until the umbilical stump has fallen off and the circumcision site (if one was done) is fully healed, only a sponge-bath is recommended. Daily bathing will dry his skin. Two or three baths each week are plenty.

Alert your doctor if the area around the cord becomes reddened or inflamed, if you see pus around the cord, or if your baby appears to be sensitive to touch around the site.

Thrush

Thrush is an infection caused by a fungus called Candida (CAN-dee-dah). Thrush begins as tiny flat white spots in the mouth. These spots come together and form "cheesy" white patches that may cover the tongue, the gums or sides and roof of the mouth. These spots are often mistaken for "milk patches." You will not be able to remove these patches with a soft cloth or a cotton-tipped swab. If there are very many of these patches, your child may have pain while sucking and will not drink as much as usual.

If your child has thrush, the doctor may prescribe an oral medicine used specifically for fungal infections.

Ear Infections

Ear infection (otitis media) is common in babies and children. Otitis media is an infection of the middle ear. Fluid may collect in the middle ear space and push against the eardrum, causing pain. Otitis media is often associated with upper respiratory infections such as colds or flu.

Symptoms of ear infections may include fever, pulling or rubbing the ear, irritability, loss of appetite, loss of hearing or vomiting. Call the doctor if your child shows symptoms of otitis media.

Since ear infections can be caused by bacteria, they are usually treated with antibiotics. Although your child may seem to be well within a day or two of taking the medication, the infection is still present. It is important to give the antibiotic for the entire treatment, unless otherwise advised by your doctor.

Spitting Up and Vomiting

Spit-Up

More than half of all babies spit up to some extent after they have been fed. Occasional spit-up is normal for both breastfed and formula-fed babies, possibly because their digestive systems are delicate and still developing.

What is it?

Spitting up is when some of the baby's stomach contents spill out of her mouth. This usually involves only small amounts of liquid—although it often seems like a lot. Spitting up generally occurs shortly after feedings, beginning in the first few weeks of life.

What causes it?

In most cases, spit-up is thought to be due to an immature muscle in the tube connecting the throat and stomach, which allows the stomach contents to back up into the mouth. This is often referred to as "GE reflux" (gastroesophageal reflux) and goes away as the baby matures and the muscle gets stronger.

What can I expect over time?

Most babies have stopped spitting up by the time they can sit up (when gravity can help keep things down). Occasionally, it continues until the baby can walk or beyond.

Is it serious?

Though occasional spit-up may be messy, it's usually not a cause for concern. Most babies gain weight well despite spit up. If an infant is frequently in distress, is not gaining weight as he should, or has other symptoms, your doctor may want to test for other medical problems.

What can I do about it?

Spit-up happens. If your baby spits up occasionally, here are several things you can do to help keep meals down:

Position your baby upright. Avoid feeding your baby when he is lying down and keep him upright for about 30 minutes after a feeding—in a front carrier, a back carrier, or in your arms. Avoid placing him in an infant seat, which can increase pressure on the abdomen. Avoid vigorous play and jostling after feeding your baby. Excess activity can aggravate an already delicate system. Control the amounts you are feeding. If baby gets an overly full stomach, it is more likely to overflow. Give more frequent, smaller meals to see if that helps. Burp your baby often and control the amount of air and liquid he takes in. If you are giving an infant formula, check the nipple-hole size. If the hole is too small (which may increase the gulping of air) or too large (and the formula flows too fast), baby may spit up more. Also, try to feed your baby before she is overly hungry. Gulping formula too fast may lead to spit-up problems.

Vomiting

Vomiting is different from spit-up. The word "vomit" refers to the stomach contents being ejected through the mouth with force. It usually is a cause of great distress for the baby. When vomiting occurs, it usually involves more than just a few mouthfuls.

Call your baby's doctor right away if you notice any of the following:

• Frequent, repeated vomiting
• Crying (with legs pulled up) that cannot be soothed
• Fever
• Blood in vomit
• Green vomit
• Can't keep fluids down
• Repeatedly refuses feedings
• Sign of dehydration:
  • Less frequent urination (fewer wet diapers)
  • Dry mouth
  • Few tears
  • Overly sleepy or overly fussy
  • Sunken eyes

 Do no hesitate to call your baby's doctor if you have any concerns regarding his/her condition.

Bowel Movements

Babies' bowel movements or stools vary considerably in color, consistency and frequency. What is normal for your baby may not be normal for someone else's. Breastfed babies' and some formula-fed babies' stools are typically loose and seedy. Babies fed formula will have stools ranging from loose to well-formed. Many babies naturally grunt and groan when they have a bowel movement. Unless your baby has a change to more frequent, watery stools, blood in the stools, very hard pellet-like stools or apparent pain with the passage of the stools, you don't need to be concerned about his bowel habits. Ask your baby's doctor or nurse for advice if you're worried about your baby's stools.

Constipation

Constipation in infants less than one year of age can be a source of concern for parents. Sometimes your baby is not really constipated, but must be given time to set his own schedule for having a bowel movement. Remember that some grunting and straining is normal. Generally, an infant's stool is soft and easily passed. Irregular bowel movements do not necessarily mean a baby is constipated.

In very rare cases, constipation may be caused by a lack of nerves or by structural problems in the lower large intestine. Your baby can be tested for these conditions if your doctor feels it is necessary.

Signs of Constipation

Infants who are constipated usually strain and show discomfort with the passage of a bowel movement. The stool may be formed like small, hard pebbles or wide and large. There may also be blood in or on the outside of the stool. Sometimes solid stool stays inside and liquid stool (like diarrhea) may pass out around it. Your child's abdomen (belly) can become swollen with gas, and cramping pain can result from constipation.

Treatment for Constipation

If your baby is old enough to eat strained foods, you may give him fruits and vegetables. If your baby is not eating jarred baby food yet, and your doctor approves, you may give him fruit juices (prune, pear, cherry or apple). If his stools become too loose, just give him less juice. If your baby is eating rice cereal, it may help to switch to oatmeal or barley cereal. Rice cereal can cause constipation.

Do not give your baby enemas, laxatives or suppositories unless you are directed to do so by your doctor.

Diarrhea Can Be Dangerous

The average baby has diarrhea three times in the first year. Infant diarrhea has many different causes. It can be serious if the baby loses a lot of fluid and becomes dehydrated.

During diarrhea, babies lose fluid and important minerals (known as electrolytes) from their bodies. Excessive fluid loss caused by diarrhea can lead quickly to a more serious condition called dehydration, especially if the baby is also vomiting. Severe dehydration may require the baby to be hospitalized to have fluid replaced. You can help prevent your baby from becoming dehydrated by keeping Pedialyte Oral Electrolyte Maintenance Solution on hand and giving it as soon as diarrhea starts. Make sure to follow the dosage chart indicated on the label to know the daily amount of Pedialyte recommended according to the weight of your baby.

Know the signs of diarrhea—more frequent, watery stools, often with a change in color and odor. Begin giving Pedialyte and follow your doctor's instructions for dealing with the diarrhea. Be sure to call your pediatrician or go to the hospital if your infant has persistent diarrhea or you note any of the following signs of dehydration:

• Less frequent urination (fewer wet diapers)
• Dry mouth
• Few tears
• Overly sleepy or overly fussy
• Sunken eyes

You may have heard that sports drinks, fruit juices, weak tea and soft drinks containing sugar are good to give your baby during diarrhea. But these liquids aren't best for your baby. They don't have enough sodium and the proper balance of electrolytes to replace what is lost during diarrhea. Most of these fluids also contain too much sugar. Too much sugar can draw water into the intestine and away from the rest of the body and make diarrhea worse.

The best fluid to give your baby is an electrolyte maintenance solution. Pedialyte, the #1 pediatrician-recommended brand, is a balanced mixture of water and minerals with an appropriate amount of carbohydrate (sugar) for babies and young children. Pedialyte is an ideal solution to help keep fluid and electrolyte balance normal during mild to moderate diarrhea and to help prevent dehydration. Don't give your infant common household beverages unless your pediatrician tells you to.

During and after diarrhea, your pediatrician will probably recommend that you continue breastfeeding or formula feeding. After an episode of diarrhea, a baby who is being fed infant formula may have trouble digesting the lactose. Your pediatrician may suggest that you feed your baby Similac Sensitive Lactose-Free or  Isomil for a while. These formulas don't contain lactose. Follow the advice of your baby’s pediatrician about feeding when your baby has diarrhea.

Do not give over-the-counter medications to stop diarrhea.

Diaper Rash

Occasionally, diaper rash is caused by a yeast infection and needs special treatment. Usually, though, it is caused by direct contact with wet or soiled diapers. The skin gets red, raw and bumpy. To prevent diaper rash:

• Change diapers as soon as they become wet or soiled.
• Wash the area with water at every diaper change.
• Wash girls from front to back.
• Let your baby's bottom air-dry whenever possible.
• Apply a thin layer of petroleum jelly before you put on another diaper.

With proper care, diaper rash usually clears up in 3 to 4 days. If the rash spreads or gets more irritated, blisters develop, or the skin breaks open, talk with your baby's doctor or nurse.

Potty Training

Most children aren't ready to begin potty training until after their second birthday. Until then, they don't have the necessary muscle control. It usually takes longer to master control of the bladder than the bowels, and boys usually take longer to master potty training than girls.

Teething

Your baby may get her first tooth—usually a lower middle one—anytime between the ages of 4 and 7 months. But don't worry if your baby doesn't show any teeth during this period. Once your baby begins teething, the gums around the new teeth will be swollen and tender. Teething may occasionally cause mild irritability.

If your baby's gums are sore, try any of the following to soothe the gums, keep teeth clean and prevent tooth decay:

• Wash your hands and gently rub or massage your baby's gums with one of your fingers. Don't use medications that you rub on the gums, because they will wash out of her mouth within minutes after they are applied. Pain relievers taken by mouth may help relieve the discomfort.
• Give her a cold teething ring or a cold, clean, wet washcloth. Do not freeze the teething ring as injury may occur.
• Offer a drink of cold water, or a chilled, pureed food she normally eats.
• Offer limited amounts of fruit juice in a cup. Don't put sweetened water, soft drinks, or cereal in her bottle.
• If you use food to soothe the tooth, be sure your baby is in a sitting position and supervised by an adult.
• Never let your baby fall asleep with a bottle, because some of the liquid may stay in his mouth and cause tooth decay. This condition is called nursing caries.
• Brush your baby's teeth with a child's soft toothbrush or wipe them with moist gauze at the end of the day.
• The right amount of fluoride at the right age is important for proper development of your baby's teeth. The Canadian Pediatric Society recommends beginning fluoride supplements at 6 month of age if the water you're using does not contain fluoride. Ask the doctor if supplements will be necessary.
• If your baby seems especially irritable or has a temperature over 101ºF (38^o C), check with the doctor. These symptoms are probably not caused by teething.