Newborn Concerns

Congratulations on the birth of your baby!

Please visit us within 1-3 days of discharge from the hospital. The first set of vaccines will begin at 2 months of age. We will discuss the vaccine schedule as well as their safety and efficacy during our first few visits.

Fever in a Newborn
A fever in a newborn (and up until 2-3 months of age) is considered an emergency. You should check your baby’s temperature whenever they feel warm or are acting sick in any way. Acting sick would mean too much crying (although some crying is very normal), lethargy (not as responsive), repetitive vomiting, breathing harder, or not eating/drinking/latching as well. At this age, the temperature must be checked with a rectal thermometer, and a worrisome fever is 100.4 or above (or 38.0 Celsius). If such fever occurs, please contact us immediately.

Breathing in the Newborn
The breathing rate of the newborn is not only faster than ours, but it varies. We breathe at a rate of 12-16 times a minute and you can’t see our efforts of breathing. On the other hand, a baby can breathe up to 50 times a minute, and the actual rate can vary a great deal. Your baby can take some very rapid panting breaths and then slow down, and even take a break for a few seconds and not breathe at all!

But if you ever see your baby breathing very fast, and they are uncomfortable or working too hard to catch their breath, this is a true emergency and they must go to the emergency room immediately.

Most newborns will have normal spit-up, also called reflux. It only becomes a problem if he/she fails to gain weight, or seems to be in pain because of it. Then, you may see your baby arch their back and cry during feeding, and cry excessively overall. Please, let us know if your baby seems uncomfortable, has a cough, or vomits forcefully.

Nasal Congestion
Congestion and sneezing is totally normal in the newborn period. If your baby is eating well (quickly, and without unlatching from breast or bottle), the congestion is not significant, even though it may seem that their nose is completely stuffed up and you hear them snoring. You can use normal saline nasal drops (over the counter) and then suction the mucous with a bulb syringe before feeds. You can use a humidifier or stand with your baby in the bathroom with the steam shower running. A frequent cough should be checked by the doctor.

There are many normal rashes in the newborn period. A baby’s skin is also very sensitive, easily irritated, and often gets dry and flaky. You can use a hypoallergenic cream such as Johnson and Johnson’s or Aveeno, or it will get better on its own in most cases. If you are concerned about a progressing rash, bring your baby back to see us.

Your baby needs to sleep on their back. Sudden Infant Death Syndrome, or SIDS, is much more likely if a baby sleeps on their stomach. Sleeping propped at a slight angle on the sides is very common –but flat on the back is still our recommendation. Other ways of decreasing the risk of SIDS is to avoid any cigarette smoke exposure, not overheat the baby, and use a pacifier (once the latch has been established if breastfeeding).

Your baby won’t establish their sleep pattern for a while, so try to hang in there! Sleep training, and any hope of sleeping through the night really comes between 3 and 6 months, so every time your newborn baby wakes up you should go to them and feed them. They won’t get spoiled in these first three months!

Breastfeeding is the best source of nutrition for your baby, so try to power through the initial obstacles of latching difficulties and sore nipples –it will get better in a few weeks. We can answer a lot of questions about breastfeeding as pediatricians, but it is a very worthwhile experience to see a lactation consultant. You can also call or attend a local La Leche League meeting for free advice and support.

Formula is really a great source of nutrition as well –so don’t feel guilty if breastfeeding doesn’t work out for you. We don’t prefer one brand over another, and recommend starting with a standard cow milk-based formula. Soy formulas and others are sometimes needed, but we don’t recommend starting with those.

Most babies will lose some weight, but we don’t want them to lose too much (certainly not more than 10 percent of their birth weight), so make sure you come back for the first check-up within 1 or 2 days after discharge. Monitor their wet diapers. A baby needs to have at least 1 wet diaper in the first 24 hours of life, at least 2 in the second 24 hours and so forth until 1 week of age. At that point, he/she should have about 6-8 wet diapers. The number of bowel movements may vary. Please let us know quickly if you think the baby is not having enough wet or dirty diapers.

Do not give any straight water unless your baby has true hard stool and even then give a maximum of two ounces a day. You can start cereal and other pureed foods at 4-6 months, but not before. When you do start cereal it should be with a bowl and spoon.

A healthy baby’s liver is temporarily immature, which often causes the skin to turn yellow. This condition is called jaundice. Please bring your baby in if they seem jaundiced, and we will decide whether or not to check a blood test to monitor the jaundice level.

Germs, Visitors, and Going Outside
Although there are germs and sick people outside, the most common way that your newborn is going to catch those germs is if people cough on or touch your baby. So as long as you prevent them from touching or coming too close to the baby, you can and should take your newborn baby for a walk (they often sleep so much better outside!).

If you are going to have visitors over, make sure they are not sick AND wash their hands thoroughly. Young children almost always have a cough or runny nose, so the little ones should stay away from your baby.