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Taking Care of Your Baby in the First Few Weeks

Skin to Skin: Comforting Your Baby

Holding your baby on your chest is the best place for your baby to adjust to the outside world. Babies held skin to skin cry less, are calmer, and stay warmer. Holding your baby near you this way also stimulates your breast milk production. This position is good for both breastfed and bottle-fed babies.

To cuddle your baby skin to skin, dress her only in a diaper and lay her belly-down directly on your chest with her face turned to either side. Place a blanket over both of you, making sure it does not cover your baby's face.

Babies can also cuddle skin to skin with mom in a side lying position. Lay with your lower arm extended forward, creating a protected space for your baby below your arm and near your breast for easy breastfeeding.

Snuggle your baby this way as often as possible, especially during the first weeks home from the hospital. Partners can also hold the baby skin to skin. This type of cuddling will help as your baby continues to learn to breastfeed.

It will also help your baby feel calm and gently ease her transition from the uterus to the outside world. Your newborn cannot be held too much. Research indicates that skin to skin contact enhances brain development in the newborn baby.

Jaundice

What it is
All babies are born with extra red blood cells. After birth, the extra red blood cells break down and release a substance called bilirubin in the baby's blood. When there is too much bilirubin in the blood, the baby becomes jaundiced and her skin looks yellow. Jaundice also causes your baby to be sleepy and she may not feed well. Your baby gets rid of bilirubin in her stools. When your baby is feeding well, she will have frequent stools that will remove bilirubin from her system.

Why it is important
It's very important to watch your baby for jaundice during the first week home. Most newborns become a little jaundiced — this is normal. However, some babies will have a higher level of jaundice that is more serious and requires monitoring or phototherapy treatment. Untreated jaundice that becomes too high may cause brain damage.

When a baby has jaundice, you will see it (yellowish color) first in the face and as it increases, you will see it on the baby's chest, tummy, and legs. You may also notice that the white area of your baby's eyes look yellow. Your nurse will do a skin test with a bilimeter to check your baby for jaundice before you go home after delivery. If it is elevated, the doctor will order a blood test. Once you go home, continue to watch your baby for jaundice. Pay attention to skin color changes, alertness, feeding, and stooling.

What to do
Hold your baby in natural light in front of a window and notice the color of her skin as you press down on her nose, chest, and thighs. Notice whether the skin looks yellow instead of creamy white under where you pressed. Look at your baby's eyes and check to see if the white area looks yellow.

Encourage your baby to eat often. Breast milk contains colostrum, which has a laxative effect. Frequent breastfeedings starting at birth will help your baby get rid of bilirubin in her stools. When your baby does not pass her meconium stools, the bilirubin can build up in her system causing the jaundice to increase.

Most jaundice typically goes away in one to two weeks; however, some babies will need phototherapy to treat the jaundice. If your baby's skin looks yellow, if she is sleepy and/or not feeding well (8 to 12 feedings per day) or stooling well (at least 2 to 4 stools per day), call your baby's doctor. He or she will do a blood test to measure the bilirubin level and decide if your baby needs phototherapy.

Sleep Positions

When you put your baby down to sleep, the safest position is on her back. Sudden infant death syndrome (SIDS) has declined more than 50 percent since babies started sleeping on their backs instead of their tummies.

Place your baby on her back on a firm, flat mattress in the crib. Dress your baby in an extra nighttime sleeper for warmth rather than covering her with loose blankets. Using a single swaddling blanket is OK.

Do not put pillows or toys in the baby's bed that could cover her face. Having a fan turned on in your baby's room may also be helpful in lowering the risk of SIDS for your baby.

The American Academy of Pediatrics recommends babies sleep in their own bed or a co-sleeper bed near you. If your baby does sleep with you, lay down in a side-lying position with your lower arm extended forward creating a protected area for your baby below your arm. Your arm will prevent you or your partner from rolling over onto your baby. Turn your baby onto her back and make sure no blankets cover the baby.

There shouldn't be any space between the bed and the wall or headboard that your baby could slip through.

It is important that you do not smoke, drink alcohol, or take other drugs because these activities are associated with a higher risk of injury for your baby while sleeping with you.

Tummy Time

Your baby should have "tummy time" every day. Place your baby on her tummy when she is awake and someone is watching her. Tummy time gives your baby the chance to lift and turn her head. This strengthens her neck and shoulder muscles so she can learn to hold her head and roll over. It also helps to prevent flat spots on the back of the baby's head.

Caring for the Umbilical Cord

Keep the umbilical cord clean and dry. Wash and dry the area daily. Try to keep the diaper folded below the cord.

Exposure to air will help dry the cord so it falls off faster. It is not necessary to clean the cord with alcohol.

The cord will fall off in one to three weeks. As the cord dries out, you may notice dry blood. This is normal. Clean the area and continue to keep it as dry as possible. Call your baby's doctor if the cord area bleeds or oozes for more than a few days after the cord comes off, if the skin around the cord is red, or if the cord has foul smelling drainage or pus around it.

Temperature

Its best to take your baby's temperature under the arm (axillary). Ear thermometers are not accurate until baby is 1 year old. Rectal temperatures are not recommended.

Pull your baby's clothing away from her arm and put the thermometer snug in her armpit. Hold the arm firmly down over the thermometer until is beeps.

• Normal newborn temperature: 97.5 - 99.0°F
• Fever is a temperature equal to or greater than 100.0° F

Newborn axillary temperatures may be different from one arm to the other. If the baby's temperature is not normal, check it on the other arm.

You can help your baby maintain a normal temperature by holding her skin to skin with mom or dad, or by adding or taking off clothing. Newborns typically should wear a T-shirt, socks, a gown and be wrapped in one blanket in a room at 70° F. If your baby is cold, put a hat on her. If your baby is warm, remove a layer.

If your baby's temperature is higher than 100.0° F, remove extra clothing and recheck in 30 minutes. If the temperature remains greater than 100.0° F, call your baby’s doctor.

Warning Signs During the First Two Weeks

Call your health care provider if you have any concerns about your baby or if your baby has any of these signs:

• Baby is feeding less than eight times per day.
• Baby does not have enough wet or dirty diapers according to the number of days old. (See the diaper chart in Feeding Your Baby.)
• Baby seems to struggle to breathe, makes grunting noises or flares her nostrils when breathing, or takes more than 60 breaths per minute.
• Baby's sleeping periods last more than 5 hours after the first day of life.
• Baby's skin color is bluish around the mouth, or skin color turns yellow.
• Baby is shaking or irritable and cannot be comforted, or is sleepy and difficult to wake.
• Baby's temperature is below 97.5° F or above 100.0° F in two separate readings taken 30 minutes apart after adjusting clothing and room temperature.
• Baby is vomiting forcefully and it projects several inches away from the baby. Don't confuse this with normal spitting up that happens when some milk dribbles out with burping.
• Umbilical cord has foul smelling drainage or pus around it.

You may notice a pinkish or rust colored stain in your baby's diaper. This is normal. It is caused by uric acid crystals that occur when the baby's urine is concentrated and indicates that it is important to feed your baby as often as possible. You do not need to call your provider for this.