New Baby Care

Postpartum Panic Prevention

New Baby Care

Congratulations on your new baby! Even though some baby books will state that they are “manuals”, babies don’t actually come with them! There are some great books out there you can use as reference guides and as you learn more about your baby you will grow to recognize changes. We are there to help you in the early days at postpartum home visits and then at our clinic check-ups. We can answer your questions and help you as you transition into becoming parents.

	Normal
Behavior	Deep sleep, light sleep, drowsy, quiet alert, active alert, crying Sleeps about 16 hrs/day, 2-3 hrs at a time
Feeding	Every 2-4 hrs: 8-12 times per day Usually, at least 20 minutes is advised Cluster feeding, followed by longer interval
Elimination	Until milk comes in: One wet diaper for every day postpartum (e.g. day 2, two wet diapers); meconium stools. After milk comes in: 6-8 wet diapers/day; liquid yellow, green or brown stools, with curds Bottlefeeding: 6-8 wet diapers; poops are more formed, smelly and fewer
Skin color	Acrocyanosis (blue feet and hands) on first day May mottle with cold, crying Vernix and lanugo may be present Milia (white spots) Baby “acne” Birthmarks may appear within first week Mild jaundice after 24hrs
Respiratory patterns	Rate 30-60/min Obligate nose breathers May be irregular or periodic Apnea up to 20 seconds
Weight gain/loss	Loss of 5-8% considered average Regained birth weight by 14-21 days Average weight gain of ½ – 2 oz per week after milk in
Temperature	3 to 37.5

Temperature

Between 36.3 to 37.5C is normal. If the baby’s temperature is over 37.5, take off a layer of clothing and re-check in 30 minutes.

If the temperature is less than 36.3, place the baby skin-to-skin with you and cover both of you, or wrap the baby in a blanket warmed in the dryer, and re-check in 30 minutes.

Respirations

Irregular, shallow breathing is normal for a newborn. They will even stop breathing for up to 20 seconds at a time. Normal ranges are 40-70 per minute for the first 24 hours, and 30-60 thereafter.

Babies make all kinds of faces and noises, most of which are endearing and normal. They may blow bubbles or cough up mucous for the first few days. If you see flaring nostrils, grunting with each expiration, or the baby’s chest pulls in sharply between the ribs when s/he breathes: these are signs that the baby is having to work hard to breathe and should be reported to your midwife.

Color

Regardless of ethnicity, all newborns are pink. It is not uncommon for the baby’s hands and feet to be blue during the first day. If it happens after the first day it may mean that s/he is cold.

Skin care

Sponge baths or tub baths are okay, although not necessary, right from birth. Research has shown that babies who are not bathed for the first 2-3 days find the breast easier which makes breastfeeding more successful. When you do start bathing, it may be easiest for mom (or anyone) to get in the tub, then have someone hand her the baby.

• Use water to clean eyes and face
• Use mild soap to wash hair and body
• Use non-petroleum-based oil or lotion (olive oil works well) daily for dry or peeling baby, or if the environment is very dry

Babies’ is influenced for several weeks by the maternal hormones passed through the placenta. This can caused small red “acne”  which usually is on the face or trunk, and disappears quickly.

Cord care

The cord usually falls off within the first few days or weeks.

• Keep the cord dry and clean, placing the diaper, diaper wrap and plastic pants below the cord
• If desired, clean the cord daily, or when it is soiled, with warm water, then let it dry thoroughly. This will delay the cord falling, since it washes off the necrotizing bacteria, but will cut down on odor (for the same reason).

Problems to report include a large halo of redness around the cord area (some redness is normal due to irritation from diapers, etc), or excessive bleeding when the cord falls off (enough that it stains the blanket the baby is lying on).

Elimination

Healthy, term babies are built to lose some weight after birth before the milk comes in. This allows them time to take in the highly concentrated antibodies in the mother’s colostrum before they get the higher volume and hydration of breastmilk. Sometimes they get dehydrated enough that their urine forms crystals. These are called urate crystals and are pinky orange. More common in boys, they are often mistaken for blood in the diaper.

Problems to report

Temperature >37.5C

Temperature <36.3

Skin color changes to pale, grey or bluish

Difficulty breathing: nasal flaring, grunting, retraction of sternum

Apnea >20 seconds

Lethargic or difficult to arouse

Extremely irritable

Excessive, high-pitched crying

Blisters, boils, pustules or other unusual rash

Red halo or bleeding cord area

Urate crystals after first 48 hrs

Jaundice that appears in first 24 hours, extends into extremities, or rapidly increases

If circumcised: if there is discharge or the penis becomes increasingly red or swollen