Babies are awesome! But you probably have some questions…
Common baby questions:
Yes! Breastfeeding is not the panacea that some people make it out to be, but it is the best thing for your baby if you are able to do it. Breastfeeding is associated with fewer newborn infections, better maternal-infant bonding, lower cost, and greater convenience. There are only a very few reasons why a mother should not attempt to breastfeed (HIV is the most common one), and the vast majority of women who attempt to breastfeed will be successful. That being said, we acknowledge that sometimes it can be a difficult feat and some babies have a hard time with it. Talk to your doctor if you’re struggling, find a good lactation consultant, and be persistent. If at first you don’t succeed, try again! It can take babies and moms a while to get used to the process. Also, the old saying “breast is best” may be true, but the rest of that saying is “but follow with the bottle.” If in the beginning you are not producing milk or only producing a small amount and baby is still visibly hungry after the breast, give them the bottle. But at the next feed start with the breast again! The truth is, fed is best and whatever is needed to help your baby grow is what you should do. If you have tried breastfeeding, done the consultations, worked with the baby and tried the tips and tricks but it still isn’t working, that’s okay! Your baby and you will be okay and it is okay to turn to bottle feeding primarily. You tried your best and you should never feel bad about that. Sometimes it just doesn’t work out. Yes! You should definitely immunize your baby. There are a few very specific conditions when a baby shouldn’t get immunizations, and if that’s the case, your pediatrician will let you know. That is rarely the case, however, so immunize your baby. Thousands of studies have examined the safety of giving multiple vaccines at once with the overwhelming conclusion that it is safe and does not “overwhelm” a baby’s immune system. On-time vaccinating also ensures that babies have adequate protection against diseases as early as possible. Practically speaking, giving more than one vaccine at a time minimizes office visits, simplifies parents’ lives, spares babies extra visits for pokes, and saves you from multiple trips in the waiting room where others may be sick! For more in-depth information online, see healthychildren.org, vaccine safety section. Most importantly, ask your baby’s pediatrician if you have questions! A lot! Newborns sleep up to 17 hours a day. Eventually this will be in longer sessions, but sleep cycles are not regular until about six months, so expect “naps” of one to two hours which gradually lengthen as the baby becomes more regulated. By the end of the first year, most children will sleep 11-15 hours a night. Generally, breastfed babies eat every two to three hours, and babies taking formula eat every three to four hours. For the first several months, babies shouldn’t go much longer than four hours without eating, since they don’t have enough stored sugar to “fast” longer than that. Little ones tend to show you they’re full by turning away, becoming distracted from feeding, or simply falling asleep. If the baby is still fussing or smacking her lips at the end of a bottle or breast, she’s probably still hungry. Babies getting enough to eat will generally have one wet diaper for each day of life up to a week of age, then will level off at six to seven wet diapers and (on average) three to four dirty diapers each day. The doctor will measure the baby’s weight at each check-up; appropriate weight gain (typically 20-30 grams per day for newborns) is another good indication that the baby is getting enough to eat. Honestly, don’t worry about it too much! Just keep it clean and dry – so if the baby needs a bath while the cord is still attached, sponge-bathe rather than submerge the baby. Another trick is to fold down the top of the diaper before fastening; this keeps the cord from being irritated and helps keep it dry. If the cord becomes dirty, just use soap and warm water to clean it; no need to use alcohol or other agents. If you notice any discharge from the cord (particularly if it smells bad), bleeding more than a few drops, or if the baby cries when you touch or move the cord, let the doctor know. Cords usually fall off by several weeks of life; if it’s still present at eight weeks or so, bring it to your pediatrician’s attention. Pretty much whenever they get stinky! As long as you clean the diaper area well during diaper changes, babies only need baths a few times a week on average. Bathing too often can lead to dry skin, so pat the skin dry and make liberal use of hypoallergenic, fragrance-free lotion after baths. The safest sleep environment for a baby can be remembered by “ABC” – Alone, on their Back, and in a Crib. To elaborate, this means babies are safest in a flat crib (or similarly firm sleeping surface) with only a fitted sheet – no pillows, stuffed animals, crib bumpers, fluffy blankets, extra humans, etc. A wearable blanket, sleep sack, or thin blanket swaddled around the baby is okay. We’re still unsure exactly what makes SIDS (sudden infant death syndrome) occur, but the best research we have suggests the best way to keep a baby safe is to place her on her back during sleep until her first birthday. This should be on a firm sleep surface, free of any loose or soft objects (including blankets, stuffed animals, pillows, crib bumpers, etc.), and ideally in the parents’ room until the baby is at least six months old. Avoid placing babies to sleep on couches, armchairs, or other soft surfaces. If you are holding a baby and start to fall asleep yourself, it’s safest to put the baby down in a safe place, ideally as soon as you feel sleepy but definitely as soon as you wake up. Research also suggests that breastfeeding babies until six months as well as pacifier use during sleep can help reduce SIDS risk. Maternal smoking is an independent risk factor for SIDS in infants. No recommendations can be made for bedside or in-bed sleepers, and bed-sharing is NOT recommended for any infant. Early on, it’s not unusual for babies to be awake as much at night as they are during the day; they often don’t start to sleep in longer spurts through the night until one month or so. So until then, time and patience! Afterwards, if the baby is having trouble with night-day reversal, it can help to have more “active” sleep during the day – not worrying if there’s background noise, lights on, etc. At night, the goal should be for very calming interactions – dark room, minimal noise, low-volume speech. Most babies are getting two-thirds of their daily sleep at night by three months. Circumcision practices vary widely due to different cultural and religious expectations that exist. Medical groups around the world that discuss circumcision acknowledge the same facts surrounding circumcision, but they highlight some aspects for and against circumcision differently to either encourage, discourage, or remain neutral about the practice. Some facts are more relevant in other countries than in the United States; for example, the local rate of HIV infection will make circumcision more or less valuable. Here we will list evidence-based statements surrounding circumcision in a neutral manner and allow you to draw your own conclusions. Known risks of circumcision include: bleeding, infection, need for repeat surgery, meatal stenosis, and partial loss of penis. There is no quality evidence that circumcision reduces sexual pleasure. Newborns, of course, cannot directly consent to receiving circumcision, though this is true of many things and parents ultimately have a duty and right to make decisions on behalf of their children that involve their health or safety. A lot of the claims of benefit and harm regarding circumcision are exaggerated. Most men in the world are not circumcised. The CDC states that in 2010 in the U.S., 58.3% of men were circumcised, and in first world countries, we don’t really see significant health differences. Obviously, you may have a religious preference for circumcision. Discuss these issues with your doctor for and make a decision you feel is best for you and your son. First of all, a few normal things: some swelling is expected and there may be small amounts of blood on the first few diapers. If it’s more than about the size of a quarter, let your pediatrician know. It’s also very normal for a yellowish layer to form over the glans – this is known as granulation tissue and is part of the healing process. The best thing to do in the first few days is lube, lube, lube! Use liberal amounts of petroleum jelly (Vaseline) or a water-based lubricant (i.e., K-Y) over the circumcision with every diaper change to prevent friction. Gauze may be used over the tip of the penis for the first day or two, but make sure not to wrap gauze all the way around the penis itself as this could become constrictive with any additional swelling that develops. If the penis becomes soiled, clean gently with soap and water; anything more (alcohol wipes, etc.) is generally too harsh and drying. The glans typically heals fully in 7-10 days. The good thing is, there are a lot of birthmarks and rashes that babies get, and only a small amount of those are scary! Milia and neonatal acne are commonly seen on baby’s face and will improve on their own. A splotchy red rash may be erythema toxicum neonatorum (baby acne) in the first few days of life, or may be a heat rash if the baby was a little over-bundled. Importantly, a blistering rash (i.e., fluid-filled bubbles) might be a number of normal or benign conditions but also could be a sign of infection you should have checked out by a doctor. If you made sure all of their needs are met (clean diaper, fed, attempted a nap), you might check the temperature to make sure the baby doesn’t have a fever. You can also check to make sure the baby doesn’t have any hair or string caught around small body parts (fingers, toes, or penis; these are called “hair tourniquets”). If you’ve done all of this and haven’t found anything out of the ordinary, try swaddling the baby, rocking her or walking with her, offering a pacifier or her thumb/finger to suck, or turning on soothing sounds (soft music or white noise, like a fan). If you’ve tried all of these things and she is still upset, it is okay to put the baby in a safe place and take a break, especially if you feel yourself getting frustrated. Give it ten to fifteen minutes (or longer if you still feel upset), then try soothing measures again. If crying persists no matter what you do, it might be time to call the doctor’s office. Jaundice causes the skin to appear more yellow, usually starting in the face then spreading to the chest, abdomen, and limbs. It can also cause the whites of the eyes to appear yellow. If the baby is appearing more yellow than her last check-up, you notice that her belly, arms, or legs are yellow, or if her eyes are yellow, talk to her pediatrician, especially if she is acting more fussy, eating less, or harder to wake up. Totally, especially in the first few weeks. Depending on if the baby is breast or bottle fed, stools can be greenish-yellow to brown or tan in color, and loose and seedy to peanut butter consistency. Colors poop should NOT be are black, with visible blood, or white and chalk-like. If they are, talk to your baby’s doctor! There are several types of twins. The type of twin pregnancy depend on whether it results from one egg or two, and if one egg, depending on when the embryo splits. Twins that result from one fertilized egg are called monozygotic twins and twins from two fertilized eggs are called dizygotic twins. All dizygotic twins have two placentas; this is called dichorionic. They also have two internal compartments (amniotic sacs) which is called diamniotic. They are also called fraternal twins. Monozygotic twins that split very early will also be dichorionic-diamniotic but they will be identical since they came from the same embryo. However, if they split a bit later, they may have only one placenta; this is called monochorionic. Monochorionic twins can also be diamniotic with a dividing membrane between the two fetuses but they can also have no dividing membrane; this is called monoamniotic. All types of twin pregnancies are at an increased risk for essentially every complication of pregnancy, including preterm birth, gestational diabetes, hypertensive disorders of pregnancy such as gestational hypertension or preeclampsia, and of course more aches and pains and all of the other joys of pregnancy. Monochorionic pregnancies, however, have some special risks including a risk for twin-to-twin transfusion syndrome (TETS) for monochorionic-diamniotic twins and a risk of cord entanglement for monochorionic-monoamniotic twins. Because of this, monochorionic twins are much higher risk than dichorionic twins and require significantly more testing. Most twin pregnancies can still be delivered vaginally as long as the first twin is head down. The one important exception to this is monochorionic-monoamniotic twins; because of cord entanglement, these pregnancies need to be delivered by Cesarean delivery.
