Many years ago, I read an article by a first time mother and father. The mom described bonding to her baby immediately. The dad, on the other hand, did not feel the same attachment as his wife. He didn’t tell anyone about this for months because he was embarrassed about not immediately “falling in love” with his baby. He did everything he was supposed to in terms of supporting mom and baby, but he felt a bit like an outsider at the beginning of his son’s life.
Ever since I read that article, I have made a point of telling new fathers that it’s “normal” for moms to bond to babies before they do. My rationale for this is as follows:
- The baby was biologically connected to the mom for the entire pregnancy.
- Men typically grow up playing with action figures and balls instead of dolls.
- Adult men are less likely than women to interact with other people’s babies before they become parents themselves.
I find that most new fathers are relieved to hear this information. I often joke that this observation does not get them out of chores. I also reassure them that they will become deeply attached to their babies in time.
Having people visit during the first week at home is a mixed blessing. Doctors routinely encourage new mothers to breastfeed their baby 8 to 10 times a day. Immediately after giving this advice, they tell you to get lots of rest. If you do the math, you will quickly see that it’s impossible to feed babies that much and get much rest.
While it helps to have friends or relatives assist you in taking care of the baby, what begins as a 5-minute visit can easily stretch to an hour or more. As a result, loved ones can unintentionally prevent you from taking a catnap or just closing your eyes to rest.
I advise new parents to restrict or discourage visitors during their first week or two that a baby is at home. It’s terrific for people to bring food or do some shopping for you, but they shouldn’t stay for more than 30 minutes. In addition, it’s a good idea for fathers to tell friends and family about limited visiting hours so moms can concentrate on nursing.
I recommend that parents don’t worry about tummy time until babies are 4 weeks old. The reason for this is because it’s hard enough in the first month to feed, bathe and get babies to sleep without worrying about head contr
Once parents start tummy time, lots of questions come up. How long should it last? How many times a day should we do it? What should we do if our baby cries during tummy time?
No one has studied this scientifically, but I recommend doing tummy time 3 or 4 times a day for about 5 to 10 minutes per session. If your baby cries during tummy time, there are a few things that might help.
- Pull the baby’s elbows in towards the body. This stabilizes the shoulder area and may make it easier for the baby to lift her head.
- Lie on the floor with the baby so when she looks up, she sees your face.
- Put the baby on her dad’s chest while he’s leaning back at a 30 to 45 degree angle. This will make it easier for the baby to lift her head. This can also work on a mom’s chest unless the baby smells the breast and looks down instead of up.
- Babies may be more willing to do tummy time at certain points during the day. A good time to try it is shortly before a feeding when she’s alert, but not too hungry.
Some people recommend that parents ignore the whitish material that accumulates between the labia majora (outside vaginal lips) and labia minora (inside vaginal lips). I prefer that parents clean the area because otherwise poop can get mixed in with the discharge and irritate the baby’s skin.
However, cleaning this area often makes parents nervous. I recommend two things to make this easier. First, you don’t need to remove all of the goo at one time. Second, clean the area by gently wiping with a cotton washcloth in a downward direction. (I prefer washcloths to cotton balls because they have better traction.) Third, if you clean the area with each diaper change, less goo will accumulate and the whole process becomes simpler.
The medical name for a baby’s soft spot is called the anterior fontanel. This is an opening between the bones of the skull that allows the cranium to grow. The fontanel is covered with a very tough membrane so you will not hurt it when you wash your baby’s hair. Although doctors would never recommend poking the fontanel, you can scrub it gently with a hairbrush like the rest of your baby’s scalp.
After a baby is born, hospital nurses take armpit temperatures. They do this for two reasons. First, they want to be sure a baby’s temperature doesn’t drop as she adjusts to being outside the uterus. Second, because the nurses take temperatures multiple times per day, they do it in a way that is quicker and less disruptive for the baby.
Once you take your baby home, you should take rectal temperatures if you’re concerned that the baby is sick or has a fever. The reason for this is because rectal temperatures are the most accurate way to check for fever, and a doctor’s diagnostic approach to fever is based on rectal temperatures. Pediatricians define fever in the first three months as a rectal temperature of 100.4 degrees or higher.
It’s much easier to take rectal temperatures on newborns than older infants. There are different ways to do this, but I prefer having a baby lying across my legs with her bottom facing up. I separate her buttocks with one hand and gently insert a lubricated digital thermometer with the other. I insert the tip about ½ inch and hold the thermometer in place with two fingers of the same hand I used to separate the baby’s buttocks. That way I don’t have to worry that the device will poke the baby if she wiggles or moves.
In the past, babies rarely got funny shaped heads because they slept on their tummies. When we started putting babies to sleep on their backs 20 years ago, unusual head shapes started to be noticed. The pictures above show three types of head shapes: symmetrical, plagiocephaly (flat on one side) and brachycephaly (flat along the back).
A baby’s head will take on an unusual shape if he spends more time sleeping with his head in one direction. This occurs because more pressure is applied to one area and the head “molds” the corresponding location. In most cases, this represents a temporary finding that will resolve over time.
When pediatricians examine babies with unusual head shapes, we look for two problems. This first is a common condition called congenital muscular torticollis. If a baby has torticollis, the neck muscles that bend and rotate the head are tighter on one side causing the baby to spend more time turned in one direction when asleep. It many cases, it will also be noticed when the baby is awake. Over time, this will deform the shape of the skull. Torticollis is treated with physical therapy or watchful waiting depending on its severity.
The second is a rare condition called craniosynostosis. In this situation, one of the skull bones is not growing properly because it is “stuck” to the opposing bone, causing a misshapen head. If there is a question whether your baby has this condition, he will be x-rayed or referred to a pediatric specialist (neurosurgeon or plastic surgeon) for a thorough evaluation.
For the past 10 years or so, companies have sprung up to “fix” plagiocephaly and other asymmetric head shapes. A handful of studies have been published showing that this is not necessary. If your baby’s head is flat on the side or back because of positional forces, the problem will usually resolve by 2 to 3 years of age. The head may not look perfect, but a corrective helmet won’t make it look any better.
Now that babies sleep on their backs, it’s important for them to get tummy time throughout the day to help strengthen the muscles in their arms, neck, shoulders and back. I usually recommend that parents start tummy time when babies are 4 weeks of age. You could do this sooner, but I figure parents have enough things to worry about in the first month without putting tummy time on their list.
There is no “right way” to do tummy time, but it makes sense to do it when babies are alert. First, put the baby tummy down on a firm surface like a couch, bed or the floor. If possible, lie down next to the baby, which will encourage her to look up and see your face. If the baby is fussy, you can help support her upper body by pulling her elbows in to her sides. If you smile and talk to your baby, she will be more likely to work her muscles to make tummy time a success. If your baby is still fussy, try putting her on a slant to make it easier to look up. The best way to accomplish this is to put her on her father’s chest while he is lying at a 30-degree angle.
Do tummy time for 5 to 15 minutes a handful of times during the day and evening. Obviously, how long tummy time lasts will depend on your baby’s interest. Never leave the baby alone in this position, even for a second, or she may roll over and hurt herself. Likewise, make sure you are alert because we don’t want babies to fall asleep during tummy time because that is a SIDS risk just like sleeping on their tummies at night.
When a newborn’s penis is circumcised, the head of the penis (glans) will be red and wet looking for 3 to 5 days. During the healing process, it’s common for the glans to develop small yellow patches. These areas are part of the healing process and do not mean the baby has an infected circumcision. (If you’ve ever had a cut inside your mouth, you’ll recall that it heals with a whitish or yellow patch rather than a tradition scab. The same thing happens to a circumcised penis.)
I’ve been practicing pediatrics for over 30 years, and I have never seen an infected circumcision. If this were to occur, the redness would extend from the glans to the shaft and then towards the baby’s body. If you see this, call your doctor right away.
In my last blog, I mentioned that 6 muscles control the movement of each eye. This is a lot for a newborn’s brain to coordinate. As a result, it’s common for a newborn’s eyes to “wander” in the first few months of life. In most cases, the eyes move inward instead of outward. They are also more likely to wander when a baby is tired.
If the family history is positive for strabismus (lazy eye), the baby’s eyes are constantly out of balance or the baby’s eyes wander after 6 months of age, she should see a pediatric ophthalmologist. Keep in mind that eyes are supposed to converge (come together) if someone is looking at an object close up.
Like all referrals, it’s best not to schedule the appointment during the baby’s nap time because she’s more likely to cooperate with the exam is she isn’t tired.
Newborn babies will look at their parents right after birth, but their eyes can’t do more than “fix” on objects for a few weeks. Between 1 and 2 months of age, babies will begin to follow objects during quiet, alert periods. It’s important to realize that this is still a difficult task. There are six muscles that control each eye, and they must work in unison for a baby to follow an object through space.
The best way to get your baby to follow is to put your smiling face 12 to 18 inches in front of her face. Then, move your head slowly in one direction or the other. Most babies will be able to follow you for an arc of about 30 to 45 degrees. After that, their eyes may stop or wander a bit.
For over 20 years, pediatricians in the United States have recommended that infants sleep on their backs. One of the questions that parents frequently ask is what they should do if their baby starts rolling over before 6 months of age.
Although babies occasionally roll over in the first few months, determined rolling isn’t learned until 4 months or later. If a baby rolls over at night, most doctors (this one included) don’t recommend putting the baby on her back again. This reason for this is simple. If you turn the baby on her back, she will invariably roll to her stomach again. If you do this repeatedly throughout the night, no one will get a good night’s sleep, which could lead to other dangers, i.e., car accidents.
So while I would still recommend putting your baby to sleep on her back, I would leave her alone if she rolls to her stomach.
Parents often have questions about the things they see in their baby’s mouths. Here are the most common findings you may notice.
- Epstein’s Pearls. These are white spots on the roof of a baby’s mouth. They are usually the size of a sesame seeds. They disappear in a month or two.
- Bahn’s Nodules. These are white spots on the top or sides of a baby’s gums. They are bigger than Epstein’s Pearls, and parents sometimes mistake them for teeth. They disappear by 6 months.
- White or irregular gums. Some babies have smooth gums. Others have tiny ridges. The sides of a baby’s gums sometimes look white instead of pink. These are all normal findings.
- White coating on the tongue. Most parents are aware that newborns can get a yeast infection called thrush. However, if all you see is a thin, white coating on your baby’s tongue, it’s most likely from breast milk or formula. With thrush, you usually see cheesy-looking material on the inside of the cheeks and lips and on the roof of the baby’s mouth.
- Tongue-tie. This is hard for parents to see, but most have heard about it. The bottom of the tongue attaches to the floor of the mouth with a thin band of tissue called the lingual frenulum. In some cases, the frenulum is tight, thick or attaches near the tip of the tongue. If this happens, it may be harder for your baby to nurse properly. Doctors and nurses routinely check for this at newborn visits. In some cases, the baby will be referred to an oral surgeon or an ENT doctor to “clip” the frenulum.
When I see boys for routine physicals, I always check their testicles for lumps or swelling. The most common problem I find in the first year of life is something called a hydrocele. A hydrocele is a collection of fluid around the testicle.
Hydroceles have an interesting history. Although a baby’s gender is decided at the moment of conception, both sexes develop along the same path until the third month of pregnancy. At that point, a group of cells in the lower abdomen develop into ovaries in females or testicles in males. If the baby is a girl, the ovaries are in the correct anatomic position. If the baby is a boy, the testicles need to descend into the scrotum. This process takes about six months. As the testicles move downward, they pass through the inguinal canal before reaching their proper position in the scrotum.
After the testicle enters the scrotum, the inguinal canal is supposed to fuse thereby separating the abdominal cavity from the scrotum. In some cases, this doesn’t happen and a small amount of fluid travels into the scrotum. Most of the time, this occurs before birth and the hydrocele will be detected at the baby’s first examination. In some cases, fluid moves into the scrotum after birth, in which case the hydrocele won’t be found until the baby is older. Most turn up between 1 and 4 months of age.
Hydroceles are not dangerous and usually resolve before a child’s first birthday. If they persist beyond a year, there’s a possibility the child also has an inguinal hernia. In this case, he should see a pediatric urologist or a general pediatric surgeon.
At the time of birth, a baby’s umbilical cord has a shiny, off-white color. Over the next few days, the cord will dry out and turn a dark brown or black color. As this happens, the cord will shrink and often looks like a scab on the baby’s abdomen. In the past, the umbilical stump was coated with a blue dye after birth and parents were told to clean the area with rubbing alcohol at every diaper change. These recommendations were discontinued because they were found to increase the time it took for the cord to fall off. Nowadays, parents don’t need to do anything special other than keeping the stump from becoming irritated by the baby’s diaper and avoiding baths until the cord falls off.
A few things may happen that worry parents during the 7 to 10 days that it takes for the cord to fall off.
- The base of the cord may develop a gooey, greenish-yellow appearance. This is normal and not a cause for concern.
- The cord may smell bad. The reason the cord falls off is because it no longer has a blood supply, and the baby’s immune system is rejecting the dead tissue. If the stump became infected, the skin around the belly button would become red and swollen. If you think your baby’s umbilical stump is infected, you should see the doctor promptly.
- The cord may bleed a little before or after it falls off. If this happens, you can gently clean the excess blood with a cotton swab.
- A red, fleshy lump may appear after the cord falls off. This is called an umbilical granuloma. It’s not serious, but doctors treat the area with silver nitrate to make the lump fall off.
Many childrearing books tell you not to use soap on a baby’s face. One of the reasons for this is because soap may irritate a newborn’s sensitive facial skin. Another is that a newborn’s skin is slightly acidic, which helps prevent infection. Soap can reduce the natural acidity of a newborn’s skin.
The problem with not using soap on a baby’s face is that some of them will be more prone to newborn acne and other rashes because of dead skin, saliva and regurgitated milk that accumulates on their face. The answer to this problem is to wash the baby’s face with a ph-neutral soap substitute like Cetaphil Gentle Skin Cleanser. Using Cetaphil with a washcloth helps remove dead skin, etc. without harming the baby’s skin.
It’s common for people to use baby powder after showering to keep dry, especially during the warmer months. Similarly, parents often use baby powder on their baby’s bottoms after diaper changes. I disagree with the latter use for two reasons. First, I’m not convinced it does any good. Although baby powder may absorb perspiration on an adult, it’s hard for powder to contend with the volume of urine a baby produces in between diaper changes. More importantly, baby powder can be dangerous. A number of reports have been published in medical journals where an older infant had grabbed a container of baby powder while he was lying on his back during a diaper change. Because baby powder containers look like bottles, these infants held the bottles up to their mouths and inadvertently aspirated the powder into their tracheas.
Swaddling is a time-honored method to help babies calm down. It helps fussy babies relax during wakeful periods and makes it easier for most newborns to sleep.
Infants respond to swaddling for two reasons:
- Newborns have a number in innate reflexes, including the Moro (or startle) Reflex. If a newborn is jostled or surprised by a noise or physical movement, he will typically extend his arms outward and then rapidly flex them in front of his body. A Moro response can be triggered by an infant’s own movements or by actions coming from his surroundings. Either way, the reflex may cause the infant to wake up or start to cry. Swaddling inhibits the Moro Reflex.
- Before birth, infants are in the confined space of the uterus. While it is important to be able to move their arms and legs after birth, research has shown that newborns calm down if they are held with their arms against their bodies. This can be accomplished by a reassuring hug or by swaddling them in a blanket.
Like all aspects of parenting, it is important to strike a balance with your baby. It is important for your baby to experience different types of physical interactions. This includes hugs, kisses, skin-to-skin contact, gentle rocking, and massage, etc. So while swaddling can be a real “life saver” when a baby is fussy it is best used when the child is sleeping or for brief periods (around 20 to 30 minutes) while awake.
Two aspects of swaddling are important for you to consider:
- The best way to swaddle babies is by keeping their arms at their sides. The reason for this is because most babies will “break out” of the swaddle if their arms are positioned in front of their chest. There are a number of commercial blankets to make this easier to do.
- The goal of swaddling a baby is to restrain his arms. The swaddle should not restrict the baby’s legs because it is important for him to be able to flex his knees and hips at all times. The reason this is important is because infants can develop a hip problem (developmental dysplasia of the hip) if their hips are restrained in an extended (straight) position.
Most doctors recommend that parents stop swaddling babies by about four months. At this age, the newborn reflexes that can interfere with a baby’s sleep have disappeared and many babies are starting to roll (and trying to break out of a swaddle). This is also the time when a baby will more actively interact with his surroundings. He will grab objects and explore them with his mouth. He may use a pacifier or suck his thumb for self-soothing purposes.
It’s very common for newborns to become jaundiced by the second or third day of life. Jaundice is a medical condition that presents with yellowing of the skin or sclera (whites of the eyes). It is due to a build up of bilirubin in the baby’s system.
Bilirubin is a breakdown product of red blood cells. Red blood cells live for three months after which the body breaks them down. Tens of thousands of red blood cells are destroyed and remade every day. Part of the breakdown process involves the release of bilirubin into the circulation. Before birth, a baby’s mother helps clear bilirubin from his blood. (Bilrubin is removed from the body by the liver.) Once the baby is born, he has to take over this process himself. Like many things, a newborn’s ability to process bilirubin is immature. As a result, bilirubin builds up in the circulation and can be seen in the baby’s skin.
Bilirubin is not dangerous to newborns unless it gets very high. The hospital staff follows standard protocols to make sure bilirubin levels stay in the safe range. In the past, this was done by visually checking the baby’s skin color. Nowadays, the bilirubin is checked every eight hours by placing a bilirubin meter on the baby’s forehead. If the reading is higher than expected for the baby’s age, the nurse will order a blood test to confirm the reading.
Most of the time, nothing needs to be done to treat a baby’s bilirubin. If the level continues to rise, the doctor may do additional blood tests, supplement the baby with formula or treat the bilirubin with something called phototherapy. This involves exposing the baby’s skin to ultraviolet light that increases bilirubin breakdown.
Because parents are commonly discharged when their newborn is 48 and 72 hours old, jaundice may not be noticed during your time in the hospital. When you have your first post-hospital visit, the doctor will carefully assess the baby’s skin to make sure he hasn’t gotten jaundiced since his discharge from the nursery. If necessary, additional blood tests and recommendations will be made at that time.
It is important for you to know that jaundice in the immediate newborn period is different from jaundice at any other time in a child’s life. If you notice that your one to 2-month-old baby is jaundiced, you should promptly call your doctor for an appointment.
Infants have two types of sucking: nutritional and non-nutritional. The former is something they do when they are hungry. The latter is something they do to soothe themselves. When babies reach five or six months of age, they are developmentally able to suck their thumbs. Prior to that, they are unable to reliably get their thumbs in their mouths. This is why pacifiers were invented.
If a baby has a big sucking need, it can be difficult for parents to satisfy his non-nutritional sucking needs with the breast or bottle alone. However, lots of babies spit out their pacifiers leading parents to think the baby doesn’t want it. This is not usually the case. Babies do not suck like we do. When a baby nurses or takes a bottle, his jaw moves up and down and his tongue moves back and forth to get milk. We call this the sucking (extrusion) reflex. Babies do the same thing when they suck on a pacifier, only in this case they inadvertently push the pacifier out of their mouths when sucking on it. In time, babies learn how to hold the pacifier in place with their lips, but in the beginning parents need to do this for them. If a baby truly doesn’t want his pacifier, he will turn his head or arch his neck to reject it.