This page contains some of the information parents most often ask us about. For additional information about what to expect from your newborn, we recommend the following website:
Breastfed infants will need extra vitamin D beginning around 6-8 weeks old. This can be given as Tri-Vi-Sol or Poly-Vi-Sol, which can be purchased over the counter. The dose is 1.0 ml per day.
An easy and safe way to give the vitamins is to place an empty nipple in the infant’s mouth. Drop the liquid inside the nipple; your baby will suck it down at his/her own rate. Or you can nurse your baby immediately after giving the liquid through the dropper.
Formula fed infants should not need a vitamin.
Sleeping-Milestones and Behavior
The newborn’s sleep pattern is very variable. Some will sleep up to 20 or 22 hours per day. Others may only sleep 10 or 12 hours. The important thing to remember is that both patterns are perfectly normal.
Since sleep, or more often lack of sleep, are of major concern to new parents, here are some helpful hints.
An infant is usually ready for sleep after feeding. After burping and a quick diaper check, lay the baby down to sleep. This is not the time for play or stimulation. Try to put the baby down while he or she is still awake. It is important for the newborn to become accustomed to falling asleep in his own crib. Videotaped studies of infants who “sleep through the night” reveal that no baby really sleeps through the night. Each infant is up two to three times, gurgles, coos and goes back to sleep. However, if an infant becomes accustomed to falling asleep in the parents’ arms, then upon awakening he or she will expect those arms to be there, and will cry until they arrive. Putting the infant down still awake will insure the development of good sleeping habits at an early age.
Recent studies have shown that the infant’s sleeping position may also be critical and reducing the risk of Sudden Infant Death Syndrome (S.I.D.S.) or “crib death” which strikes 1 in 2000 newborns. Contrary to popular belief, placing a newborn to sleep on his back may actually reduce the risk of S.I.D.S. by 50%. We therefore recommend that all infants sleep on their back and not on their stomachs or sides. The fear over infants choking on “spit up” during sleep has been shown not to be a significant concern since it may occur in only 1 of 20,000 newborns (one tenth the risk of SIDS).
The “Gerber” baby does not exist in real life. The birth process temporarily alters your baby’s features and to an extent distorts them. Fortunately, by 1 to 2 weeks of age your infant’s normal and beautiful features will emerge.
Your baby’s head may be molded (long and narrow) and he may look like a “cone head.” He may have lumps and bumps (caputs and cephalohematomas) all due to the passage through the birth canal. All these will ultimately and completely resolve. The soft spot or “anterior fontanelle” is a “diamond shaped” space between the skull bones. Its purpose is to allow for the rapid growth of the newborn’s brain. It normally closes by 8 to 18 months of life. Beneath the skin of the fontanelle lie three very strong, leathery layers that protect the brain. Routine handling, such as scrubbing, shampooing, combing or brushing will not hurt the soft spot.
- Swollen eyelids – The eyes may be puffy because of pressure on the face during delivery.
- Redness in the white of the eye – A flame-shaped hemorrhage on the white of the eye (sclera) is not uncommon. It’s harmless and due to birth trauma. The blood is reabsorbed in 2 to 3 weeks.
- Eye color – The eyes are usually blue, green, gray or brown, or variations of these colors. The permanent color of the eye is often uncertain until your baby is six months of age.
- Blocked tear duct – If your baby’s eye is continually watery, he or she may have a blocked tear duct. This means that the channel that normally carries the tears from the eye to the nose is blocked. It is a common condition, and more than 90% of blocked tear ducts open up by the time the child is 6 months. The problem is easily handled with a combination of eye massage and drops.
A baby’s nose is soft cartilage, not bone. It may be flattened or pushed to one side during birth, but will return to normal by 1 to 2 weeks of age.
- Sucking callus (or blister) – A sucking callus occurs in the center of the upper lip from the constant friction at this point during bottle or breast-feeding. It will disappear when your child begins cup feedings. A sucking callus on the thumb or wrist may also develop.
- Tongue-tie – The normal tongue in newborns has a short tight band that connects it to the floor of the mouth. This band normally stretches with time, movement, and growth. Babies with symptoms from tongue-tie are extremely rare.
This is very common in both male and female infants due to exposure to female hormones during the pregnancy and breast-feeding. The swelling may easily last for 4 to 6 months or longer. Occasionally even a little bit of milk may be seen leaking from the nipples of even boy babies. This is also perfectly normal. Never squeeze an infant’s breasts because it may lead to infection.
- Swollen vaginal lips- These can be quite swollen in newborn girls because of the passage of female hormones across the placenta. The swelling will resolve in 2 to 4 weeks.
- Vaginal discharge – As the maternal hormones decline in the baby’s blood a clear or white discharge can flow from the vagina during the latter part of the first week of life. Occasionally the discharge will become pink or blood-tinged (false menstruation). This normal discharge should not recur once it stops.
- Hydrocele- The newborn scrotum can be filled with clear fluid. This painless collection of clear fluid is called a “hydrocele.” It is common in newborn males. A hydrocele may take 6 to 12 months to clear completely. It is harmless but can be rechecked during regular visits. If the swelling gets larger or persists past 1 year of age, a hernia may also be present and you should call our office during office hours for an appointment to have this evaluated.
- Tight foreskin- Most uncircumcised infant boys have a tight foreskin that doesn’t allow you to see the head of the penis. This is normal and the foreskin should not be forcibly retracted.
- Tibial torsion – The lower legs (tibia) normally curve in because of the cross-legged posture your baby was confined to while in the womb. Gravity will exert directional forces on the growth plates to remodel and straighten the bone as your baby stands, walks, jumps and runs.
- Feet turned in – As long as your child’s feet are flexible and can be easily moved to a normal position, they are normal. The direction of the feet will become more normal between 6 and 12 months of age.
- “Ingrown” toenails – Many newborns have soft nails that easily bend and curve. However, they are not truly ingrown because they don’t curve into the flesh.
- Scalp hair – Most hair at birth is dark. This hair is temporary and begins to be shed by one month of age. Some babies lose it gradually while the permanent hair is coming in; others lose it rapidly and temporarily become bald. The permanent hair will appear by 6 months.
- Body hair (lanugo) – Lanugo is the fine downy hair that is sometimes present on the back and shoulders. It is more common in premature infants. It is rubbed off with normal friction by 2 to 4 weeks.
- “Baby acne” – This consists of small, red bumps, beginning at 3 to 4 weeks of age and lasting until 4 to 6 months of age. One causative factor appears to be the transfer of maternal hormones just before birth. This combined with the skin’s increased oil production which was necessary to protect the baby from nine months of underwater life, produces the “acne.” No treatment is necessary. Baby oil will just make it worse. In severe cases, a mild drying agent such as soapy water is useful.
- Erythema toxicum – More than 50% of babies get a rash called erythema toxicum on the second or third day of life. The rash is composed of l/2 to 1 inch red blotches with a small white dot in the center. Their cause is unknown, but they always resolve themselves by I week of age or sooner.
- Mongolian spots-A mongolian spot is a bluish-gray, flat birthmark that is found in more than 90% of American Indian, Oriental, Hispanic and African American babies. They occur most commonly over the back and buttocks, although they can be present on any part of the body. Most fade away by 2 or 3 years of age, although a trace may persist into adult life.
- Stork bites (pink birthmarks) – Flat pink birthmarks (also called capillary hemangiomas) occur over the bridge of the nose, the eyelids, or the back of the neck in more than 50 % of newborns. The birthmarks on the bridge of the nose and eyelids clear completely by I to 2 years of age. Most birthmarks on the nape of the neck also clear, but those can persist into adult life.
Some findings in newborns that concern parents are not signs of illness. Most of these harmless reflexes are due to the normal, immature nervous system and will disappear in 2 or 3 months. These include:
- Chin trembling
- Lower lip quivering
- Irregular breathing. (Normally, if your baby is content, the rate is less than 60 breaths per minute, a pause is less than 6 seconds, and your baby doesn’t turn blue)
- Passing gas (not a temporary behavior)
- Sleep noise from breathing and moving
- Spitting up or belching
- Startle reflex (also called the Moro or embrace reflex) following noise or movement
- Straining with bowel movements
- Throat clearing (or gurgling sounds)
- Trembling of arms and legs during crying