INTRODUCTION TO THE HEALTHY NEWBORN

Initial Behavior

v Baby’s first cry

The fetal ejection reflex expels fluid or the physician will suction the baby’s mouth and nose to remove mucus from the throat as the head emerges; after this the infant will begin active respiration after the chest emerges. If the newborn does not cry spontaneously she/he may need stimulation, e.g., stroking of the back or a gentle patting of the buttocks. Neonates also frequently cry during routine newborn procedures that are new experiences for them, such as: clamping the cord, applying ointment to the eyes, bathing, being diapered and dressed.

v Vision and reaction to light

Newborns are able to see a distance of 8 to 12 inches at birth. Some babies have a temporary cross-eyed appearance as the muscles supporting the cornea are not developed. The newborn’s eyes don’t focus perfectly, but many will try. The baby will squint, blink or frown when there is a bright light, such as a camera flash. Their eyes can follow a slowly moving brightly lit object.

v Hearing and reaction to sound

Newborn infants recognize their mother’s voice at birth and their father’s shortly thereafter. They orient to sound and are often aware they have returned to familiar surroundings when arriving home from the hospital. The newborn will startle when he/she hears loud noises occurring nearby.

v Breathing, Coughing, Sneezing

Irregular and noisy or wet breathing is often common in the newborn. There can be husky wet sounds in the chest; coughing will help to bring up mucus. Babies will sometimes gasp or pant, even hold their breath, especially if crying. In deep sleep the breath is slow and regular, the baby’s body is very still. Many newborns sneeze frequently, this is very common and a way to clear the upper respiratory tract, do not take this as a sign your baby is chilled.

v Reflexes

Newborns are run by many reflexes; involuntary movements that fulfill specific functions. Rooting, sucking and swallowing reflexes are present in term babies. The grasp reflex is very strong as the fingers cling to what is put in the hand. This is especially pronounced in the premature infant. The arms and legs will grasp, seeking to cling. The tonic neck reflex helps to develop the neck muscles so that baby can hold his/her head erect. The arms and legs will flail wildly in circles in a classic moro (startle) reflex. This is often experienced when the newborn is put down or feels unsupported.

v Feeding and Nourishment

Full-term babies have little need for initial nourishment; they are born with a layer of “brown-fat” that provides enough caloric support until mother’s milk comes-in. However, colostrum the “first milk” is full of nutrients and immunities for baby. Baby needs to suckle at the breast often to receive this colostrum and stay adequately hydrated and also to provide the stimulation required to begin the milk production process. This teaches the baby to suck, swallow and breathe and get ready for the fluid milk that is on its way. Caution should be used in assessing the amount of fluid formula feeding the bottlefed baby should receive during this time. A certain amount of weight loss is expected as baby dries out and passes meconium, the “first stool”. Breastfed babies should re-gain to their birth weight by 2 weeks, formula babies sooner.

"Better" Baby Basics ^TM

with

Demaris Rae Bruce

INTRODUCTION TO THE HEALTHY NEWBORN

Initial Appearance

v Baby’s head

The newborn head is out of proportion to the rest of the body and needs to be supported when held until the baby develops head control of his/her own. The soft-spots or fontanelles should be avoided when handling baby. The pulse is often visible through the fontanelles. The neonate’s head is likely to be molded from passage through the birth canal, especially if the second stage was long. This means the bones of the skull have over-lapped. This is normal and necessary, and will go back very quickly. The nose may be flattened and the eyes puffy or appear swollen. This can be from the pressure of birth and possibly the eye prophylactic used. Newborn eyes are usually blue-gray and begin to change color after 6 months. Any hair is usually black in the beginning. The ears may be floppy or bent due to the position of the baby in the uterus. This also resolves with time.

v The body

The skin is wrinkled and loose if baby weighs in at 6 to 7 pounds or less, and is smooth and firm on a baby weighing more than 8 or 9 pounds. The baby might be covered in vernix, a waterproof protectant on the skin that is more evident on a younger baby. Lanugo is a fine, white hair on the face, ears, back and shoulders which usually disappears with time. Neonates are often blue in color, then purplish pink, then quite red and finally baby pink. The hands and feet may appear bluish and feel cold; this is more a matter of circulation than temperature. The skin will dry out and scale or peel, especially at the creases. This is normal and is baby’s very first exfoliation treatment. No moisturizers, please, until this phase in finished, this layer of skin just needs to slough off.

v The limbs

The legs may be bowed and the feet may turn in different ways. The limbs flail about in seemingly random movement.

v Body functioning

The newborn infants temperature regulating mechanism is not well developed, so care must be taken to keep baby from being over-dressed or chilled. Newborns do not sweat and therefore cannot cool off easily the way adults do, therefore it is important that parents do not over-bundle baby and that they regulate the baby’s body temperature for him/her. Newborns require only ONE layer of clothing more than adults do in the same environment to be safe and comfortable. This includes any blankets or swaddles.

v Sleep

Neonates are usually very active for the first 2-3 hours after birth if the mother did not receive drugs in labor and are very interested in interaction with mom and dad. Then they fall asleep and are very sleepy for the next several days. In this period they are often very sleepy at the breast, jiggling her/his body gently will arouse him/her to resume feeding without upsetting. In the first 2-3 weeks, many babies have their “days and nights mixed-up”; this is due to mom’s activity level during the days while pregnant. It takes a few weeks for baby to work this out. You can help by maintaining a distinct daytime and nighttime atmosphere in your home. Don’t discourage normal daytime sounds, such as putting out a sign to not use the doorbell. Try not to turn the lights on or speak out loudly at night during feedings. Turn off the TV and the lights in your room when you go to bed if this is where baby will spend any of her nighttime hours. Most babies will need a minimum of two night feedings in the beginning. Babies weighing 11 to 12 pounds or more, and 6 to 8 weeks old can often “sleep through the night” which really means a period of 5 to 6 hours or a little more.

"Better" Baby Basics ^TM

with

Demaris Rae Bruce

INTRODUCTION TO THE HEALTHY NEWBORN

Newborn Care

v Stimulation

Newborn babies need to be held, touched, comforted, provided with skin-to-skin contact with mom and dad, and to hear the sounds of the mother’s and father’s voices. They often need help in quieting, there are many techniques for soothing a crying baby, but most babies respond to motion, to bundling, to rocking, patting and swaying. Infant massage is another good technique. Babies should be given the opportunity to experience the prone position when awake, in order to develop and maintain the neck muscles holding up the head.

v Feeding

Infants should be fed “on-demand” to ensure that baby is thriving at the breast and providing for an adequate milk supply. Newborn stomachs have the capacity of about 1 ounce, babies will rouse and wake when the stomach empties and be ready for another feeding. Healthy babies should nurse every 2 – 3 hours, or a total of 8 to 12 feedings per 24 hour period. As the mother’s milk becomes more fluid, the capacity of the stomach increases and baby can take more at a feeding, and go longer in between.

v Crying

Sometimes babies are very fussy at the end of the day or around dinnertime. Parents must respond to their crying infant and not worry about spoiling a baby in the first 3 months. A crying baby needs attention from it’s parents or other caregiver. Newborns cry to communicate their needs, not to manipulate their parents. Crying as a hunger cue is really the last resort and is usually more about frustration that hunger.

v Bowel movements

The baby’s intestinal tract is lined with meconium, a sticky, tar-like substance that is the newborn’s first stool. Meconium is actually dried amniotic fluid that the baby swallows in utero. This provides internal packaging and protection. Because colustrum, (the mother’s first milk) contains a natural laxative, breastfed babies will excrete this meconium more rapidly than the bottlefed infant. One of the reasons that newborns are expected to lose weight is because of the elimination of this first stool. Meconium is often followed by a bit of mucus, as the stool’s appearance transforms from black/brown or green what is referred to as “transitional stool”. Transitional stool refers to the combination stool in between the meconium and breastmilk stool. Transitional stool is loose and unformed, still rather dark, but not yet the mustard color of breastmilk stool, which has a very characteristic appearance in all babies. It is quite often a bright yellow, and has the consistency of scrambled eggs. It is thin, loose and unformed, compared to the pasty and bulky stool of the formula fed baby. Any green color would indicate bile, this is not unusual and is not considered dangerous. While formula may cause an unpleasant odor in the stool of a healthy baby, breastmilk stool has been described as sweet smelling, and any foul or offensive odor may indicate illness in the nursing infant. Babies may appear to grunt and strain with the elimination, many parents worry that this is painful or that their baby is constipated. Often this is just the inner workings of a newly started digestive system. Constipation is considered highly unusual in breastfed babies. Bowel movements can be frequent, often occurring as baby rouses from sleep or during a feeding. It is not unusual for babies to have many bowel movements one day, and none the next or even longer. Baby’s digestion is not yet regular and parents should not be terribly concerned once the baby has started stooling and the integrity of the intestinal/rectal system has been confirmed. Some diarrhea may occur with teething and the eruption of a tooth, this is considered normal and is probably due to excess drooling.