Babies Don't Come with Instructions
Pediatrician Dr. Eric Street of Children's Clinic in Tupelo shares valuable information for new parents about jaundice, crying, coughing, respiratory issues, sleepiness and other common conditions among newborns.
Most babies will have jaundice to some degree. Jaundice is caused by the baby’s immature liver not being able to breakdown the byproducts of the red blood cells that are normally disposed of after babies are born. You will see a bit of a yellowish tinge to baby’s skin.
Typically, it will start in the whites of the eyes and then move down from the face, chest and abdomen and sometimes on the arms and legs as well. In most cases this is a mild, temporary condition that will pass on its own, but if levels get too high, they can cause problems—even brain damage if the levels are too high for too long.
We can monitor bilirubin levels with a skin probe, which is nice because we don’t have to stick the baby every time for a blood test. If jaundice becomes an issue, we can put the baby under special lights. Bilirubin levels usually peak after three to five days, so we typically see babies back within a day or two after discharge to check.
It is common for a baby’s hands and feet to be blue soon after delivery and last for several weeks. If it’s mainly the hands and feet that are blue, this is considered normal—especially if hands or feet become cool. Typically, the face and around the mouth should not be blue unless very temporarily while baby is fussy or crying. If blueness around the face or lips persists, or if it’s associated with breathing or feeding difficulty, it may be a sign of heart or lung issues that need to be evaluated very quickly.
At birth babies’ lungs are full of amniotic fluid, so we may see respiratory distress along with faster/harder breathing, but we expect those issues to resolve very quickly. Past that first few hours, baby should be stable with mom in her room. If you notice baby showing these signs of difficulty breathing, alert your caregiver:
- Ribs sucking in
- Breathing hard or fast (more than 60 times per minute—which is much faster than our typical adult respiration respiratory rate)
- Grunting sounds, especially when baby breaths out
- Flaring of the nostrils
- Persistent blue discoloration around the face and mouth
Being born can be tough for babies as well as for moms. Very commonly we’ll see bumps, bruises and scrapes on babies, especially on the head. Broken collarbones will occur sometimes, especially in large babies or if delivery was difficult. This will heal on its own without much intervention. As the bone heals, you’ll feel or see a little knot usually in the middle part of the collarbone—that is a good sign. Babies can have arm weakness from nerves in the neck becoming stretched during delivery. This should heal within several weeks, but we will want to monitor.
Sometimes it is difficult to figure out why your baby is crying. It may just be that baby is fussy, so holding the baby, talking to him, singing or swaddling may help. As time goes on, you will be better able to figure out what his cries indicate. If baby cries an unusually loud, shrieking cry, or in a pattern that’s different than normal, or if you have any concerns that something that may be out of the ordinary, call your pediatrician.
Babies’ abdominal muscles are not as strong, so typically after a meal their bellies will look more distended. If distention is associated with vomiting or pain, check with your pediatrician, especially if you note constipation or gas.
Poop and Pee
At first your baby should have a wet diaper for every day of age. On Day 1 we expect to see at least one wet diaper for baby, two on Day 2 and so on. The first bowel movements are meconium, a thick, tarry, dark stool. We expect to see that first dirty diaper at least within the first 24 to 48 hours. As baby eats, stool transitions to more normal consistency—it should never be hard or little balls, nor bloody. Breastfed babies may have a more liquid-type stool than formula fed babies, which is normal. Frequency may vary—some babies have a bowel movement once every day or two, while some poop almost every time they eat.
A mild cough, sneeze or hiccup is very normal for newborns. At first, baby may take a little bit of time to adjust to the speed of feeding, especially if breastfeeding and mom has a fast letdown. However, if baby consistently coughs, gags or has other problems feeding (with breast milk or bottle), it could be a sign of aspiration or milk going down into the lungs and should be investigated.
Lethargy and Sleepiness
Newborn babies are very sleepy. A newborn should not typically sleep more than four hours at a time without waking up to feed—after that, I would recommend waking up baby to feed. As baby gets older, we expect those stretches of sleep to get longer. If feedings seem difficult for the baby, especially if baby sweats or seems to have breathing problems, or is always sleepy, consult your pediatrician.
Babies should always sleep on their back. Babies should sleep in their own bed with no loose blankets or anything that could get around the face. If your baby likes to be snuggly swaddled, that is fine. Avoid exposure to smoke. We don’t want babies to get too warm either – your baby should be fine with no more than one layer additional to what you are comfortable wearing in that environment.
If your baby has a temperature of 101.4 degrees or higher, see a doctor immediately. Because babies don’t have a strong immune system and haven’t received some vaccines to protect against severe childhood illnesses, we need to investigate any kind of fever. Also, it could worsen very quickly if there is an infection. We recommend a standard thermometer used under his arm or rectally. Ear thermometers are not recommended for babies as they may not be as accurate.
As pediatricians, we want the best for children. If you have any concerns, please call your child’s doctor.