Common Concerns of New Parents

Most new mothers and fathers express some concern over their newborn’s appearance or the care involved with a new baby. If you are a first-time parent, you may feel unsure of yourself and wonder what to do with this little person. This section discusses those topics that new parents have many questions about.

Cord Care

The most common concern of new parents is how to care for the umbilical cord stump. If the umbilical cord was clamped at birth, the clamp is usually removed within 48 hours. If the cord was tied off, the tie will remain on the stump until the stump falls off. The stump will dry up and fall off in 1 to 2 weeks. Some pediatricians tell parents to give their babies only sponge baths until the cord falls off. Others allow tub baths right from birth, citing studies that show no increase in infection. Whether you give your baby tub baths or sponge baths, keep his cord dry between baths by folding the top of the diaper to a level below his navel and by wiping the cord with alcohol three to four times a day. If you notice a foul odor, redness, or discharge, notify your pediatrician. You might find some blood when the cord finally does fall off. This is normal.

Jaundice

Normal physiologic jaundice is a condition that affects 50 percent of all newborns. A fetus has a large number of red blood cells (RBCs) to carry oxygen to handle the stress of labor. After birth, the extra RBCs are not needed and begin to deteriorate. A product of this breakdown is bilirubin. Bilirubin is normally detoxified by the liver and excreted by the bowel. However, because a baby’s liver is immature and unable to handle the bilirubin, the excess may cause jaundice, which is marked by a yellow discoloration of the baby’s skin, mucous membranes, and whites of the eyes. Physiologic jaundice usually appears on the second or third day of life and disappears within a week. Your pediatrician may test your baby’s blood to determine the level of bilirubin. Treatment is usually not necessary, as jaundice is a normal condition found in newborns.

Certain factors such as delayed or poor feeding, first stool after 24 hours, Oriental race, maternal diabetes, bruising, use of Pitocin during labor, or polycythemia (high RBC count) can increase the chances of a full-term infant developing jaundice. Babies who begin nursing soon after birth or who room-in with their mothers, thereby enjoying frequent nursings of every 2 to 3 hours, are less likely to develop jaundice. Early breastfeeding stimulates the passage of meconium, which contains a high level of bilirubin. This decreases the reabsorption of the bilirubin through the intestinal wall. Also, the protein in the colostrum binds with the bilirubin, which can then be excreted with the bowel movements. Supplemental feedings of water have not been proven to decrease bilirubin levels and should be avoided. If your pediatrician encourages you to give your baby supplemental feedings, nurse more often. If your baby nurses poorly, you can pump your breasts and give him this additional breastmilk between feedings, preferably with an eye dropper to avoid nipple confusion.

A fiberoptic blanket can help correct jaundice without glaring bili-lights or separation of mother and baby.

Phototherapy is another formerly popular corrective therapy for normal physiologic jaundice that is no longer recommended for healthy term infants. Phototherapy uses light energy in the blue-to-white range to break down the bilirubin through the skin. While under “bili-lights,” an infant’s eyes must be protected to avoid damage. Because phototherapy can cause dehydration and results in the separation of the mother and baby, it should be avoided if the bilirubin level is not significantly elevated, is not pathologic (abnormal) in nature, or is observed in a baby who is otherwise healthy and vigorous.

Feeding the baby frequently and placing him in front of a sunny window are methods for helping the bilirubin level return to normal without the trauma of prolonged separation. In addition, many areas offer home phototherapy in the form of either bili-lights or a fiberoptic blanket that is wrapped around the baby. A home health nurse comes to the parents’ home to set up the equipment, perform the blood tests, and also provide reports to the pediatrician.

Some pediatricians encourage nursing mothers to eliminate several feedings if their baby’s bilirubin level is elevated. A high bilirubin level is not an indication to stop nursing or to give supplemental water or formula. Frequent nursings provide sufficient fluid. While some mothers’ milk contains a factor that tends to prolong jaundice, true breastmilk jaundice is rare. It does not appear until after the third day of life and may peak between the fifth and the fifteenth days.

Your pediatrician will observe your infant closely and may order blood tests to determine whether his jaundice is normal or pathologic in nature. Pathologic jaundice usually occurs within the first 24 hours after birth. It may be due to a blood-type or Rh-factor incompatibility. This type of jaundice is cause for more concern because a high bilirubin level can prompt irreversible brain damage. Preterm infants are also at greater risk. Treatment in these cases may include frequent feedings, phototherapy, or blood transfusion.

Circumcision

Circumcision is a surgical procedure in which the foreskin is removed from the head of the penis. Traditionally, in the United States, this procedure is performed within the first week of life, usually prior to discharge from the hospital. Experts at one time thought that removal of the foreskin promoted health and cleanliness, and prevented masturbation. However, some studies have claimed that circumcision is not necessary for good health or hygiene, and that it does not affect the desire to masturbate. One argument still used for routine circumcision is that it prevents cancer of the vagina or cervix in the female sex partners of these men, but little evidence exists to support this. The United States remains the only country that practices nonreligious circumcision almost routinely.

Unless you are sure your baby is a girl, you should decide before your due date whether you truly wish to have your son circumcised. In 1989, the American Academy of Pediatrics stated that newborn circumcision has potential medical benefits as well as risks. This was a modification of an earlier statement that routine circumcision has no medical benefit. The change was prompted by a task force that looked into the benefits and risks of circumcision. According to one study, uncircumcised male infants have an increased rate of urinary tract infections. The task force also took note that cancer of the penis almost always occurs in uncircumcised men, though this form of cancer is very rare and is also associated with poor hygiene and certain sexually transmitted diseases. In addition, the task force reported that circumcision can prevent phimosis (the inability to pull back the foreskin), paraphimosis (the inability to return the foreskin to its original position), and inflammation of the foreskin and head of the penis. These conditions usually occur after the normally tight foreskin is forcibly retracted. There is some evidence, however, that uncircumcised men have a greater incidence of sexually transmitted diseases, including HIV.

Circumcision is a surgical procedure and can result in bleeding or infection. Ask your pediatrician whether he uses an anesthetic for the surgery. Recent studies have verified that infants who receive local anesthesia for the procedure cry less and have lower amounts of stress hormones in their bloodstreams. Local anesthesia is usually given by injecting the nerves at the base of the penis. Because this method causes discomfort upon administration, physicians who do not use a local anesthetic argue that the pain from the injection is just as bad as the circumcision. Some physicians have started using a topical anesthetic instead of or prior to the injections. A recent study showed that the application of a lidocaine-prilocaine (EMLA) cream to the penis 60 to 80 minutes before circumcision decreases pain and has no adverse effects. This technique is pain-free. EMLA cream is currently approved for use on children over 1 month of age as a topical anesthetic prior to injections, blood work, IV starts, and minor surgery. The disadvantage is that the cream must be applied approximately 1 hour prior to the circumcision.

The decision of whether to circumcise a baby is a personal one and should be made by the parents in consultation with their pediatrician. Some couples decide to circumcise their sons for religious reasons. Other parents choose to have the surgery performed for cosmetic reasons or to keep their child from being different. However, the number of males not circumcised is increasing. Uncircumcised males are no longer so “different.” After examining both the benefits and risks, many parents today are deciding against routine circumcision.

If you are considering having your newborn son circumcised, check with your insurance company regarding coverage of the procedure. Some companies no longer pay for routine circumcision of newborns.

If you decide to have your son circumcised, delay the procedure for at least 24 hours to give him time to adjust to extrauterine life. A baby who is born preterm or who has any medical problems should not be immediately circumcised. The procedure should be performed only on healthy, stable infants. After the surgery, watch for bleeding, infection, and discomfort, and notify your pediatrician if they occur. Make sure you receive instructions on the proper home care, since this procedure can be done in different ways and each requires different postsurgical care. Placing your baby on his side or back may make him more comfortable. If the procedure was done using a Gomco or Mogan clamp, you should apply petroleum jelly to the head of the penis to prevent the diaper from sticking. When washing your baby, gently pull back the small remaining foreskin to prevent scar tissue from growing between the foreskin and the head. If a Plastibell was used, there will be a plastic ring on the penis that will fall off in 5 to 7 days. You do not need to use petroleum jelly with this type of circumcision.

Do not request a particular method of circumcision. Each physician performs the method he was trained in or the one with which he is most comfortable. Of the procedures in use today, one type does not give better results than another. It is more important to choose a doctor who performs this surgery frequently and is competent in the technique.

The uncircumcised penis requires no extra cleaning. Just wash, rinse, and dry it along with the rest of the baby’s bottom. Do not pull the foreskin back over the head of the penis. In a newborn, the foreskin is almost always attached to the head, and forcing it back may cause damage. It may be years, possibly even into puberty, before separation occurs. By 3 years of age, the foreskin can be retracted in up to 90 percent of uncircumcised boys. Forcibly retracting the foreskin can cause pain, bleeding, adhesions, and paraphimosis. Once the foreskin is fully retractable, you should pull it back gently to wash the penis and then replace it gently. Your son can learn to do this himself when he bathes.

Skin Care

Diaper rash is the result of the skin being irritated by urine and stools, the laundry products used on the diapers, or the chemicals used in the disposable diapers. Some babies break out in diaper rash while teething. Breastfed babies are less likely to develop diaper rash, for reasons that are not known. You can prevent diaper rash by changing your baby frequently and washing his bottom with warm water. If the baby has a bowel movement, use soap and water. Always make sure to dry the baby well, especially in the folds of his skin. Apply petroleum jelly or medicated ointment if you desire. If you use cloth diapers, avoid plastic pants. Exposing the irritated area to air is helpful, as is rinsing diapers twice to remove all traces of soap or changing your brand of disposables.

Avoid applying powder to your baby’s genitals. It can cake in the creases and irritate sensitive tissues, especially in girls. If you use talcum powder or cornstarch, first pour it in your hand and then apply it sparingly. If you shake powder onto the baby, he may breathe it into his lungs, which could cause irritation.

Baby oil or lotion that has a mineral oil base should not be used on infants. Mineral oil robs the skin of vitamins. A better choice is an unscented, edible nut or vegetable oil, such as almond, sunflower, or safflower oil.

Prickly heat is another type of rash that is common in babies. It usually occurs if the weather is warm or the baby is overdressed. Most new parents tend to overdress their infants. A baby should be dressed just like an adult or older child. If it is 90°F outside, you certainly do not need a sweater and neither does your baby. In addition, you should wash all baby clothes and bedding with special baby detergent before using them for the first time. This is to avoid rashes from allergy to strong detergent or to chemicals in new clothes or bedding. You should also use a softener that is diluted in the rinse water because the softener on dryer sheets is not rinsed out, is usually perfumed, and may cause a skin reaction in the baby.

Cradle cap appears as flakes, scales, or crusts on the baby’s scalp or behind his ears. Wash the area daily and brush it vigorously with a baby brush. You may want to apply baby oil to loosen the crusts prior to shampooing. Using oil and not washing it out would allow the scales to build up on the scalp. If necessary, ask your pediatrician to prescribe a special soap.

Bowel Movements

Your baby’s first bowel movements will be black, tarry, and sticky. They are called meconium and consist of the waste that was in the baby’s intestines while he was in utero. During the first 4 to 5 days, the baby’s stools will gradually change from tarry black to greenish brown to brownish yellow to greenish yellow. After the transitional period, they will become “milk stools.” If you bottlefeed your baby, his stools will be soft and yellow, and will have an offensive odor. If you breastfeed your baby, his stools will most likely be mushy, loose, and not offensive. The number of stools he has can vary from one to eight per day (a small amount with each diaper change). Or, after 1 to 2 months of age, he may have them as infrequently as one every several days or, if he is totally breastfed, even just one a week.

Constipation occurs when the stools are hard, dry, and difficult to pass. It is not related to the frequency of bowel movements. Infants who are totally breastfed and do not receive any supplements of formula or solids rarely become constipated. If you bottlefeed your baby and his constipation becomes severe, you may need to change his formula.

If your baby has diarrhea, he will need medical attention to prevent dehydration. Diarrhea is frequent stools that are watery, green in color, or foul smelling, or that contain mucus. Be prepared to tell your pediatrician the number, color, and consistency of the stools. Remember, the stools of a totally breastfed baby normally are loose and are not considered to be diarrhea unless other signs are present.

Spitting Up

Spitting up is common in the early weeks. The sphincter at the top of the baby’s stomach may be immature and, when you burp the baby after feeding him, some milk may escape along with the air. Be prepared by keeping an extra diaper handy. If you give your baby a bottle, hold him at a 45-degree angle while he feeds and burp him often. Try not to overfeed him, since this may cause him to vomit. If you nurse your baby and your let-down (release of milk) is forceful, the baby may choke and gulp air. Gently remove him from your breast until your let-down slows.

If you allow your baby to cry for too long before feeding him, he may gulp large amounts of air, which will cause him to spit up. After you feed your baby, make sure you burp him and place him on his right side to aid his digestion. As he matures, his sphincter will become stronger and he will stop spitting up.

If your baby frequently vomits forcefully either during or right after a feeding, inform your pediatrician.

Crying

Crying is a baby’s only way of expressing his needs. However, trying to cope with a crying newborn can be a very frustrating experience for new parents. Many babies have “fussy periods,” usually at the same time each day, commonly late in the afternoon when you are rushing to make dinner. In fact, so many babies become fussy at this time that in earlier days, mothers aptly named it “Grandma’s hour”—the time when Grandma could help by rocking and cuddling her grandchild. Do not let anyone convince you that “crying is good for the lungs.” A baby’s lungs do not need “exercise.” Try to approach your crying baby with as much calmness as possible, since he can sense your tension and may become even more irritable.

Is he hungry? If your baby is crying and has not eaten for 2 or more hours, he may be hungry. If the baby is breastfed, he may be trying to build up your milk supply with more frequent feedings. Even if he recently nursed, he may want to breastfeed some more just for comfort. After 3 weeks of age, you can also try giving him a pacifier if he enjoys it and needs more sucking. If you bottlefeed your baby, check the nipple of the bottle to make sure that the milk drips freely.

Is he uncomfortable? If the baby is crying but is not hungry, check him for a loose diaper pin, a soiled or wet diaper, or an irritating diaper condition such as diaper rash or a diaper that is too tight. Is he underdressed or overdressed? Is his clothing too tight or too rough? Is the room too hot or too cold? Any of these conditions can make a baby fussy.

Is he lonely? For 9 months, your baby was safe and snug within your warm body, listening to your heartbeat and other sounds. Then he was delivered and is now expected to be satisfied lying alone in a hard wooden crib. Your baby may just need to be cuddled and held close. You may find a front-pack baby carrier or sling to be of tremendous help. This way, you can make your baby happy by holding him close to you and still have your hands free to do other things.

A calm daddy can be very handy for soothing a crying baby.

Is he bored? Some babies need more interaction than others. Change the environment by taking your baby outside or just into another room. Take him on a tour of the house to see what interests him. Try to distract him with a mobile or show him bright objects. Talk or sing to him, or even read him a book. The book does not have to be a child’s. Read out loud any book or magazine article that interests you.

Has he been overstimulated? Too much handling by visitors or long periods of wakefulness can exhaust your baby. Try using motion of any kind—a stroller, car ride, baby swing, or walking—to help calm him down. If you are tense, have someone else hold him. Or, try removing all your baby’s clothes except for his diaper, laying him on your breast or your husband’s bare chest, and lightly massaging him. You can also take the baby into a warm bath. This accomplishes three things—quieting the baby, giving him a bath, and taking a bath yourself. Have someone available to take the baby out of the tub, or carefully place the baby into a towel on the floor while you get out. An infant may also be quieted by swaddling (being wrapped snugly in a blanket).

Surprisingly, the sound of a vacuum cleaner may be just the trick to quiet your little one. The constant hum or “white noise” seems to lull and relax some fussy babies. There are also tapes available that mimic the mother’s heartbeat or the sounds that the baby heard inside the womb. These may be used to quiet a young baby.

Hints for the New Father When the baby gets fussy:
  • Take over for your mate.
  • Take him for a walk while your mate cooks dinner or takes a break.
  • Take a bath with him.
  • Lay him skin-to-skin on your chest.
  • Talk or sing to your baby.
  • Turn on the vacuum cleaner. "White noise" often lulls fussy babies.
  • Check for a soiled or wet diaper.
  • Check if he is over- or underdressed.

Colic

Colic is identified as inconsolable crying for 2 to 3 hours a day, three or more times a week. Babies usually have colic at the same time each day. Even the experts disagree on the cause of colic. Some doctors state that it is characterized by abdominal cramps or spasms, often with some swelling or hardness of the abdomen. The baby may draw up his knees as he cries in pain and may also pass gas. A colicky baby may be milk intolerant and require change to a soy formula. If the infant is breastfed, the mother should cut out all dairy products from her diet to see if the colic improves. While colic is rare among breastfed babies, it is believed that the cow’s milk proteins can get through the breastmilk and cause colic in some infants.

Other doctors believe that colic is not a stomachache, but a response to being overstimulated by too much noise, bright lights, and activity. They suggest that providing the baby with a quiet, dimly lit environment, especially during feeding, may help. You may even want to place cotton in the baby’s ears while you are feeding him if the household is noisy.

Colic hold

Try to soothe a colicky baby by walking him slowly or by rocking him. Do not jiggle or bounce the baby on your knee. He may prefer to be held facing away from you, with your forearm across his belly. The colic hold may also provide relief. To do this, hold your baby by straddling his legs over your arm, supporting his head with your hand. Use your forearm to apply pressure against his upper abdomen and chest. Placing him over your knees with a warm towel under his tummy may also help. You can easily warm a towel by placing it in the dryer. You may also want to try moving his legs as if he were riding a bicycle. Do this gently with the baby on his back. This may help the baby to expel gas. Fortunately, colic usually disappears by 3 months of age.

Crying spells, especially when caused by colic, can make a parent angry and frustrated. If you have tried everything and the baby is still crying, place him in his crib, remove yourself from the room, and close the door.

Turn on the vacuum cleaner, put on earphones, take a shower, or go to another area of the house. Give yourself time to calm down so you can better take care of your infant. After 10 to 15 minutes, go back and try to soothe your baby. Never take your anger out on your infant.

Shaken baby syndrome and child abuse can result when a parent feels unable to handle the situation. If you are dealing with a colicky infant, do not feel guilty or responsible. Colic is not a result of poor parenting. Talking about it, accepting offers of help, or even laughing about it with your spouse may help you to get past this difficult time. Remember that the baby is not mad at you or doing it on purpose.

Sleeping

Newborns sleep from 12 to 20 hours per 24-hour day. The periods of sleep and wakefulness vary from baby to baby, depending upon individual sleep cycles and eating patterns. Some babies seem to be awake all the time. Most newborns wake up when they are hungry and fall asleep again when they are satisfied. This rhythm usually continues throughout the day, except for that possible late-afternoon fussy period. As a baby grows, his need for sleep lessens. At 9 months, most babies need only a morning and afternoon nap. By 12 to 15 months, they usually take just one nap. Remember, however, that each baby is an individual and establishes his own routine.

Some babies have problems falling asleep. They are not lulled to sleep by sucking and may fuss or cry for a few minutes. If your baby has trouble going to sleep, try rocking him or singing a lullaby to him. You will find that a comfortable rocking chair is a necessity. Do not give your baby any medication to help him sleep. Such drugs are not good for babies and may even be dangerous.

Most babies are very versatile and will sleep almost anywhere. Some sleep in cribs, others in bassinets, and still others in carriages or their parents’ beds. One place where a baby should not sleep, however, is in an adult waterbed. An infant can suffocate by sinking into the bed or rolling into the space between the mattress and the frame. You should also be cautious about placing your baby on soft bedding, pillows, sheepskins, and comforters. Infants lying on their stomachs on these surfaces can rebreathe the same pocket of air with decreasing levels of oxygen and can suffocate. In addition, do not place stuffed toys in the bed with your infant. If your infant’s face is close to the toy, the same problem can result. Otherwise, personal preferences should guide you in making the sleeping arrangements for your family.

Some people feel that allowing your older baby to sleep in bed with you or a sibling can help make him feel secure. Many adults do not like sleeping alone and understand why a baby feels comforted and sleeps better when in his parents’ bed. Your child will not become perverted by sleeping with you. In many cultures, the entire family sleeps together. Our progressive society is the only one that frowns on this custom. You should do what is comfortable for you and your baby. When your child is older, he may prefer sleeping in his own bed and may just return to your bed when he is sick or frightened. A dark, shadowy room can be quite scary to a young child with an active imagination.

In 1992, the American Academy of Pediatrics issued a statement on infants’ sleep positions. After reviewing studies from other countries, the Academy determined that the prone (on the stomach) position for sleep was linked to a higher incidence of sudden infant death syndrome (SIDS). SIDS is a medically unexplained death of a baby under 1 year of age. It is most common between 2 and 4 months of age, and during the winter months. About 80 percent of cases are in children less than 6 months old. The actual cause of SIDS is still unknown. Other factors, according to the statement, include overbundling of the infant, smoking, and not breastfeeding. In 1992, the Academy recommended that a baby be placed on his side or back to sleep. It said that no evidence exists that these positions increase the chance of a baby choking from vomiting. In 1996, the Academy altered its original recommendation to state that a baby should be placed only on his back (not on his side) until age 1 or until he can roll onto his back unaided. This is to prevent side-lying infants from rolling onto their abdomens. Since the Back to Sleep program was initiated in the United States, there has been a 30-percent decrease in the number of deaths attributed to SIDS. The SIDS Alliance, while supporting the Academy’s findings for normal infants, does not recommend sleeping on the back or side for premature infants or infants with gastroesophageal reflux or upper airway anomalies.

Babies’ Needs

You may be wondering if you are spoiling your new baby by giving him too much attention. Current authorities feel that it is impossible to spoil an infant. Babies need lots of love, warmth, tenderness, affection, and holding. These are very important for their security and development. If you compare a human baby to the offspring of other mammals, you will find that humans are born more immature and remain so for a much longer period of time. Most other mammals are able to walk very soon after birth. Ashley Montagu, a noted anthropologist, said that a human baby’s gestational period is only partly completed by the time he is born; the remainder is completed outside the womb. This is necessary because of the rapid brain development that occurs in human infants. If a human baby were not born until he was completely developed, he would not be able to fit through his mother’s pelvis. Therefore, the same way that he is carried within his mother’s body for 9 months, he needs to be carried and held until he is able to move around on his own, which is at least another 9 months, according to Montagu.

Your young baby is completely ego-centered. He wants his needs met immediately, and if they are not, he lets you know. He really does not plan to fuss or cry as soon as you start to make dinner or sit down to enjoy it, or at any other inopportune time.

Your infant’s needs include physical factors (such as food and warmth) and emotional factors (such as comfort and love). Babies who receive only physical care exhibit slower emotional and physical development than do babies who are given plenty of attention and love. Do not listen to people who tell you that you are spoiling your baby by holding and cuddling him a lot. If your baby stops crying when you pick him up, it is because he is happy to see you and needs to be held. Your baby will be tiny for such a short time—enjoy him and give him plenty of love. As he matures, he will cry less frequently and become less demanding because he will know that comfort is coming.

Bathing

Bathing your baby is one task that you do not need to do every day. After all, your new baby does not go out and play in the dirt! The only area on his body that you do need to wash daily is the diaper area. Make sure that you thoroughly clean his bottom with soap and water after each bowel movement to prevent diaper rash. If he just urinated, plain water is sufficient. Take care drying the area, especially the creases. If, during a feeding, milk drips into the creases of his neck, you will want to make sure that the area is clean and dry.

When your baby does need a bath, you can take him into the tub with you to combine the chore with fun. You can also use one of the many commercial tubs that have a special hammock in which to place the baby so that you can keep both your hands free. If you wish, you can even use a large sink, but wrap a cloth around the faucet to protect the baby from injury. By cradling the baby in the crook of your arm and holding his arm with your hand, you will have a free hand with which to wash him. Make sure you have all your supplies handy before you start. Never leave an infant alone in a bath, even for a second.

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