Newborn Infant (Neonate)

A newborn infant, or neonate, is a child under 28 days of age.

Some physical conditions are common during the first few weeks after birth. Contact the office if you have any concerns.

Diaper Rash

Diaper rash can be caused by leaving a wet or dirty diaper on too long. A common mistake made with disposable diapers is that, because they are so absorbent, parents tend to keep them on for longer periods of time. This may cause irritation that eventually causes the rash. Changing diapers often, washing the diaper area with soap and warm water at each change, and drying their bottom completely before replacing a new diaper can help reduce the risk of diaper rash.

If a rash develops, allow the diaper area to be exposed to the air as much as possible. Be sure to place several folded cloth diapers under the baby and loosely cover the penis of your son to help prevent messes. Also zinc oxide or diaper rash cream on the irritated areas after washing will be helpful. If the diaper rash is persisting, spreading, or developing blisters, call your doctor because your baby may have a yeast or bacterial infection that will need a special cream or medicine.

Jaundice

All babies are born with temporarily immature liver function, a situation that corrects itself in about a week. In the meantime, about 60% of all full term babies and 80% of all premature babies, develop a yellowish tint to their skin called jaundice. This usually appears about the second or third day of life and reaches a peak about the third or fourth day, before fading away by the sixth or seventh day.

This "physiological jaundice" is a sign that the blood contains an excess of bilirubin, a chemical formed during the normal breakdown of old red blood cells. Everyone's blood contains small amounts of bilirubin, but newborns tend to have higher levels because they have extra trouble processing the additional bilirubin that exists.

As bilirubin levels rise above normal, the jaundice will appear first on the face, then on the chest and abdomen, and finally on the legs. Typically, after worsening for a few days the jaundice will subside without treatment. If the bilirubin level is extremely high and does not decline, there's a risk of damage to the nervous system. Your doctor will order blood tests to determine the cause and may recommend treatment with phototherapy. In this procedure the baby is placed under fluorescent-type lights for a day or two until the liver matures enough to handle the bilirubin load. For milder cases, these lights are available as a blanket that wraps around the baby. Normal daylight has a similar effect, but is not intense enough to help. Direct sunlight is not more effective, and should be avoided because of the danger of sunburn.

Breast milk sometimes interferes with the liver's ability to process bilirubin, so breastfeeding may prolong jaundice in some newborns. When that happens, we may recommend that you consider halting breastfeeding briefly (no more than 48 hours) to help decrease the bilirubin levels. This approach will be taken only when absolutely necessary since the baby's frequent sucking at the breast during these first few days is crucial to stimulate the mother's milk supply.

Spitting

Spitting usually occurs in all babies at one time or another; some babies are destined to spit after almost every feeding no matter what, other babies respond dramatically to simple alterations in feeding technique.

This can be helped in a few ways:

1. Burping carefully during and after feedings (as noted in the Feeding Section).

2. Gentle handling of your baby.

3. Holding the bottle at an angle so that the nipple is filled with milk, not air.

4. Avoid feeding while your infant is lying down.

5. Place the baby in an upright position immediately after feeding for 10-20 minutes.

6. If bottle-feeding, make sure the hole in the nipple is the proper size (only a few drops should come out when you turn the bottle upside down, and then they should stop).

7. Do not overfeed your baby. Remember that she only needs 2-4 ounces at a time.

If weight gain is good and the baby does not vomit forcefully, there is no cause for concern.

Hiccups

Babies often develop these harmless episodes after feeding during the first two months. Occasionally a pacifier will help as will just calming the baby.

Crying

Newborns express themselves in many ways. The most common is through crying. Pay close attention to your baby's different cries and you'll soon be able to tell what his cries are trying to tell you; does he want to be fed, diapered, or just held and loved. Almost all babies have fussy periods throughout the day, even though there is nothing he needs or wants. It is thought that this helps babies get rid of excess energy and is not a sign of colic (which we will discuss later). When this happens, it can be very frustrating for a new mom and the whole family. It is OK to have those feelings as long as you know how to act on them. If you get really upset with your baby because of crying and feel you can't handle the situation at the moment, have someone watch him for a few minutes, or leave him in his crib so you can get five minutes of peace outside. And no matter how impatient or angry you feel, do not shake your baby. This can cause blindness, brain damage, or death. Also remember, your baby is not crying because he doesn't like you. No mother can quiet her child ALL the time. Just be realistic and know where your breaking point is.

Gas Pains

More than half of all newborns suffer from gas in the first two months of life. Infants will become fussy and cry after feedings, sometimes seeming to get better with the passing of gas. If this becomes a persistent problem, the passage of gas might be enhanced and the gas pains relieved with an over-the-counter medication called Mylicon Drops. Infants' Mylicon Drops break down baby's gas bubbles in minutes. The drops are safe for babies of all ages. Warm pressure on the abdomen in the form of the baby being layed across mother's lap may be helpful too.

Colic

About one fifth of babies develop colic, usually between the second and fourth weeks. Colic is more than fussiness; the baby is crying, inconsolable, sometimes screaming, drawing his legs up and straightening them back out, awake when everyone else is asleep, red-faced, constantly hungry but never satisfied. This usually occurs in the late afternoon or early evening and goes on for hours despite all efforts of the parents to stop it. This pattern reproduces itself daily but usually colic clears up before three months of age, even in the worst cases. To someone who has never been associated with colic before, it can be frightening at first and then very frustrating. No one thing is the single cause of colic in every baby; after hundreds of years of baffling medical science, colic is still largely a mystery. Parents usually are comforted to know, however, that their colicky baby is not in physical pain. Colicky babies are usually big feeders and grow in accordance.

If you are convinced that your baby has colic, try these strategies to manage fussy periods:

1. If nursing, cut out caffeine, onions, beans, broccoli, cabbage, and any other irritating foods. If bottle feeding, you may try a formula that has no cow's milk (at the instruction of your doctor).
2. Hold your baby, stomach down, across your knees and rub his back.
3. Rock your baby.
4. Gently stroke his head or pat his back or chest.
5. Sing or talk to your child.
6. Play soft music.
7. Walk with him in your arms, or push him in a carriage or stroller.
8. Put him in his car seat and take him for a car ride.
9. Try rhythmic noise and vibration (like the TV on a channel that doesn't come in, running the vacuum in the next room, blowing the hair dryer near, but not on, the baby, or sitting on top of the washing machine). Do not leave baby unattended!
10. Swaddle your baby. Wrap him snugly into a bundle with a blanket. To do this, spread your blanket, with his head at one corner. Wrap the left corner over his body and tuck it under him. Then bring up the bottom corner over his feet and wrap the right corner around him. His arms will be bent naturally and tucked in the blanket. This leaves only his head and neck exposed and will give him a sense of security.

If all else fails, simply leave your baby alone for a while to see if he'll go to sleep. Don't allow your frustration to build into anger or panic. A couple of minutes of quiet on the front porch can do wonders for your patience and if you can have someone else watch the baby for an hour or two, it can really help you keep a positive attitude.

If you notice that your baby's cry sounds different (like shrieks of pain) or if it persists for an unusual length of time despite all your efforts, call your pediatrician for advice and consider taking her temperature.

Breathing Patterns

Finally, it is important to address a newborn baby's breathing patterns. Many times you may notice periods of irregular breathing with gasps, sighs, etc. He may stop breathing for a few seconds and then take several deep or rapid breaths to make up for the lapse. Listen and relax, this is normal. If you notice any blue color change or limpness associated with these spells, or if the pause in breathing lasts longer than 15 seconds, call your doctor.

Signs of Illness

The newborn is protected from many infections during the first four to six months of life because of immunity passed on from the mother to the infant during pregnancy. Infants are still NOT PROTECTED from many other infections, including the common cold, influenza, chickenpox, and strep throat, so it is important not to expose them to too many people, to children, or to crowds during the first month or two, especially during the wintertime.

Fever

Your baby's normal temperature will vary with his age, his activity, and the time of day. Babies tend to have higher temperatures than older children, and everyone's temperature is highest between late afternoon and early evening, and lowest between midnight and early morning. A rectal temperature of 100 degrees Fahrenheit (37.8 degrees Celsius) or less is considered normal.

By itself, fever is not an illness. In fact, usually it is a positive sign that the body is fighting infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria. However, fever can make you baby uncomfortable. It increases his need for fluids and makes his heart rate and breathing faster.

If your infant is two months or younger and has a rectal temperature of 100.4 degrees Fahrenheit (38.1 degrees Celsius) or higher, call us immediately. This is an absolute necessity. The doctor will need to examine the baby to rule out any serious infection or disease.

If your older infant (3-12 months) has a fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher, call the office for advice. Your decision to call the pediatrician for older children will depend upon behavior and associated symptoms or persistent fever.

The American Academy of Pediatrics recommends parents stop using all mercury-containing devices, including thermometers. Although the amount of mercury in a single thermometer is usually insufficient to produce significant exposure when ingested, if the thermometer breaks, the mercury can be inhaled, causing toxicity. For this reason, the AAP recommends switching to digital thermometers.

To take a rectal temperature:

- Clean the end with soap and water or alcohol, or use plastic covers.

- Put a small amount of KY jelly or Vaseline on the end.

- Place your baby belly-down on a firm surface or across your lap or lay him on his back with his legs bent.

- Press one hand firmly against his back or belly (he will squirm, so get in a good position to hold him well).

- Turn on the switch.

- With your other hand, insert the lubricated tip into the baby's bottom ½-1 inch only. Hold in place until it beeps and then read.

Home treatment of fever may include fever reducing medications. These so-call antipyretic agents include acetaminophen and ibuprofen. Both of these drugs appear to be equally effective at reducing fever. Ibuprofen use is approved for children six months of age and older; however, ibuprofen should never be given to babies who are dehydrated or vomiting continuously.

Ideally, the dose of acetaminophen should be based on a baby's weight, not his age. The dose of ibuprofen should be based on baseline temperature and weight, not his age. However, the dosages listed on the labels of acetaminophen bottles (which are usually calculated by age) are generally safe and effective unless your baby is unusually light or heavy for his age.

Be sure to read and follow the instructions on the manufacture's label when using any medication. Following the instructions is important to ensure that your baby receives the proper dosages. Acetaminophen may be contained in other over-the-counter medications, such as cold preparations. Read all medication labels to ensure your baby is not receiving multiple doses of the same medicine.