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Newborns 101

Updated: Aug 18, 2021

You're finally home with your newborn... Here's what you need to know!




Feeding

Newborns need to be fed frequently as their stomachs are not large enough to accommodate large volumes of milk each time. We recommend that you feed your baby at least every 2-3 hours during the day and at least every 3-4 hours during the night. Your baby may want to feed even more frequently than these intervals, which is okay. The feedings will start to space out as your baby becomes older.


Weight loss

Keep in mind if you are breastfeeding that your milk supply will not be fully established until at least 3-4 days after delivery, a bit faster in women who have nursed before and a bit later for those who deliver by C-section. Prior to that, small volumes of colostrum (thick, cream-like discharge from breasts) are present and often sufficient for most babies during those first few days. All babies will lose up to 10% from their birth weight during the first week of life. If your baby seems to be losing more weight than expected, your pediatrician may temporarily recommend supplementing with formula until your milk supply comes in. Lactation consultants are available and can be very helpful in establishing good techniques and habits for both babies and moms. Once your baby has regained his birth weight, your pediatrician will recommend allowing the baby to sleep longer without feeding during the night.


Breastfeeding vs. Formula

While we strongly encourage breastfeeding your baby up to age 12 months if possible, some women may choose formula feeding for a variety of reasons. Some women also find that their body doesn't produce sufficient milk no matter their efforts or lose their supply eventually and depend on formula supplementation. Luckily we live in a time and place where many good options are available for formula. Please speak to your pediatrician on choosing the right formula for your baby.


Sleep

Newborns sleep A LOT. You may feel that they spend very few hours in a day completely awake. Your baby may need to sleep every 1.5-2 hours. Sleep durations can be variable, ranging from short "cat naps" of 20 minutes up to 2-3 hours stretches. It will take several months for your baby's sleep pattern to become more predictable and for the small periods of sleep to consolidate into longer chunks.

Most newborns unfortunately have their days and nights reversed - completely knocked out during the day and wide awake during the night. This pattern can be distressing to already fatigued parents but rest reassured that it is only temporary. Most babies normalize their circadian rhythm by 4-6 weeks of age and will start to be more alert during the day and sleep longer stretches at night starting around that time. So in the meantime, you may temporarily need to become nocturnal to match your baby's schedule. Rest when your baby is resting as you never know what kind of night you will have tonight!


Diaper changes


Your baby is already producing urine inside the womb but usually will not pass stool until during or following delivery. During the first week of your newborn's life, you will likely notice more stool than urine. The number of urine diapers will typically equal the number of days old your baby is (ex. on day 1, we expect at least 1 urine diaper, on day 2, at least 2 urine diapers, etc). Once your baby reaches a week, the number of urine diapers will range from 6-8 per day. More is always welcome as this signals that your baby is being well hydrated. Less than that amount, however, is concerning that your baby is not getting as much milk or feeding as well as we expect him to.


While urine diapers reflect your baby's overall hydration status, stools are less reliable as the frequency naturally varies among babies. Some babies have a bowel movement with (or even during) every feeding while others will have one every 1-2 weeks! Your baby's first several bowel movements will be very dark, tarry, and sticky and is called meconium. The stool will typically transition to a very loose consistency within the first 4-5 days and the color change to green and then to yellow or brownish stool. Yellow, green, brown stool are usually normal. If you every observe red or black in the stool, that usually indicates blood and you should notify your pediatrician.



It's common for parents to observe an orange-pink color in their baby's urine diaper during the first 3-4 days. This is not blood but likely urate crystals (below left) which can precipitate into the diaper when your baby is a bit dehydrated (which most babies are during those first few days of life). It's not painful or an indication of any internal damage and will resolve with increased milk intake.


Some parents of girls will notice a bloody discharge near the vaginal opening or in the diaper (below right) during the first week of life. This is essentially a "mini-period" that your daughter is having due to withdrawal of her mother's hormones from her body. This does NOT mean that your daughter is entering puberty (those days will come soon enough!) and will resolve within the first week. If the bleeding persists beyond a week, please let your pediatrician know.



Rashes

Newborn skin is very sensitive and very reactive to external triggers such as temperature changes, heat, and dryness. Many develop rashes that are harmless and transient. Here are the most common ones you will likely see:


Erythema toxicum

Small yellowish pimple on a red base scattered on the body. Comes and goes and usually resolves within the first 2 weeks of life.



Milia

Tiny "white heads" on the tips of the nose or chin that resolve within the first few weeks of life.



Mottling

Marbling of skin, especially when exposed to cooler temperature. More commonly observed in fair-skinned babies and will improve with age. Does NOT signal that your baby is uncomfortably cold!



Languo

Excess hair on unexpected body parts (ex. ears, shoulders, back). Don't worry, it will all shed within the first few weeks of life.



Peeling skin

Shedding of the outer skin after delivery, most notable on hands and feet but can also be on the trunk. Can take up to 4 weeks to resolve. Moisturizing can help but will not expedite this natural process.



Neonatal acne

Typically will start to appear around week 2-3 with small red bumps mostly on the face although the neck, chest, and backs can also be affected. Moisturizing helps to calm down the inflammation and will resolve within 3-4 months.



Cradle cap (seborrheic dermatitis)

Commonly referred to as "baby dandruff," this will start to appear around week 2-3 as well. Can range from light scalp flaking to greasy, scab-like crusts on the scalp, eyebrows, and ears. Gentle scrubbing with a washcloth or baby toothbrush and moisturizing afterwards can help manage it. Will resolve by 3-4 months of age.



Umbilical cord

The umbilical cord will initially appear very gelatinous but quickly shrivel down to a hard, plastic-like stump. It will dry and fall off within 1-3 weeks after delivery. We recommend that you try to keep the area as dry as possible until it has healed completely - not because it's dangerous but because getting it wet repeatedly will prolong the drying period. If you do get it wet (or your baby pees on it!), don't panic - just pat it dry and move on! Small amounts of foul-smelling discharge and/or bleeding from the area is normal, especially when it's getting ready to fall off or shortly after it has fallen off.



Head Molding

Some babies will appear to have swelling over one side of his head (occasionally on both sides). This usually results from his position inside the birth canal causing localized swelling of the scalp. It will resolve within a few days to a couple of weeks and no intervention is needed.





Behavior

Some normal newborn behaviors may appear strange to new parents. Most are due to the baby's immature nervous system causing more dramatic reactions to external stimulation. They will resolve within the first few months of life.


  • Trembling/quivering lips, chin, arms, legs

  • Flailing of arms and legs while crying

  • Episodes of irregular and hard breathing/panting

  • Easy startle (even during sleep)

  • Hiccups that last for several minutes

  • Frequent sneezing

  • Eye crossing or drifting out (should resolve within 3 months of life)



When to call your pediatrician

Fever of 100.4 degrees F (38 degrees C) or higher

  • Rectal temperature is the more accurate measure of the body's core temperature

  • If the temperature is borderline, try unwrapping your baby a bit as overbundlng is the most common reason for babies being too warm. Recheck the temperature within 10 minutes. If it has decreased within that time, you can back off on a layer or two. If the temperature is holding steady or increasing, contact your pediatrician.

Persistent rapid, hard breathing

  • As above, intermittent, short periods of fast or hard breathing is normal but if your baby is breathing heavily all the time, then that is worrisome.

Persistent poor feeding

  • This can indicate that your baby is either too sick or weak to feed properly.

< 6 wet diapers (urine) within 24 hour

  • As mentioned above, urine diapers are indirect measures of your baby's hydration status. If your baby is not urinating enough, then it can indicate that he is too sick or weak to feed properly to make sufficient urine.

  • In rare cases, persistently low urine diapers may indicate a problem with his kidneys.

Hard, pellet-like stool and/or blood in stool and/or painful bowel movements

  • Turning red in the face and straining is normal but crying and screaming while passing stool is not.

  • Stool consistency should be no firmer than peanut butter.

Red (blood), dark red/black (old blood), or white/gray stool

  • Blood in stool may indicate an anal tear, intestinal infection, blockage, or inflammation induced by exposure to certain proteins in the breast milk or formula.

  • Persistent white/gray stool may represent possible liver disease. occasionally, you may observe small cottage-cheese like chunks of white mixed in with normal colored stool. That is partially undigested milk and is normal.

Persistent forceful or projectile vomiting after each feed

  • Spit-ups that dribble down or occasional forceful vomiting is normal but if your baby starts to vomit forcefully after each feeing, it can indicate a blockage of his GI system.

Redness and/or swelling surrounding the belly button and/or increasing discharge or bleeding from the area

  • Intermittent discharge and bleeding is common especially around the time it starts to detach or right after.

  • Rarely, the belly button area can become infected and may require antibiotics.

Worsening jaundice (yellowish coloration of the skin and whites of the eyes)

  • Most babies will have mild jaundice that resolve within the first 2 weeks of life. If the jaundice continues to worsen beyond the first 3 days or recurs after improving, it can indicate possible dehydration, milk protein jaundice, or rarely liver disease.






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