Taking care of a newborn baby: advice from a paediatrician on everything from sleep to feeding & car seats

A new baby ushers in the new in every sense of the word. New routine, new responsibilities, new roles, and a whole new way of thinking. When we talk about new, what is more exciting and more daunting than being handed a little, wriggling bundle and being told: “it’s all yours”?

I often watch the expression on parents’ faces as they exit the maternity ward, ready to go home with their new baby for the first time. There is such joy but, at the same time, I know that there are also many concerns about what it will be like to have this little human at home and what it will take to keep it safe, healthy and happy.

Below are some of my take-home tips for surviving the first few weeks with a newborn. I hope you will find them useful in the first few weeks of being home.

Support structures available to parents with a newborn baby:

First-time parents don’t feel alone! There are many support structures available to you:

1. Clinic sisters on duty at the nursery 24 hours a day
2. Municipal clinic sisters
3. Your paediatrician
4. Private baby clinics
5. Private sisters who can call at your home
6. Breastfeeding association

Remember to choose the support that best suits you and your baby.

Taking care of a newborn baby: car seat advice

• Babies must be transported in a car seat at all times. Spend money on a car chair, as having your baby properly secured in a car is of absolute importance.
• Car accidents are one of the leading causes of injuries in babies and children.
• I am putting this point first as it is vital that your baby be transported home from hospital in a well-fitting car seat. They are never too little for a car chair.

Taking care of a newborn baby: feeding advice

• Breastfeeding is always the best option for a newborn. This is a very sensitive issue for new mothers and it comes with a tremendous amount of stress if the breastfeeding is difficult.
• Please don’t feel inadequate if you are struggling to feed. There are a number of resources available to assist with feeding. Mothers can make use of a lactation specialist who can visit you while you are still in hospital. Organisations such as La Leche have people who will come to your home and help you to get the breastfeeding established.
• Generally, breastfed babies will feed every 2.5 to 4 hours.
• Allow your baby to drink from one breast for about 10 minutes. If baby falls asleep on the breast, you may want to change the nappy at this point so that they wake up and are ready to feed on the other breast. Baby may not feed as long on the second breast.
• Try not to become your baby’s dummy. Baby should have at least two hours between feeds to allow baby to sleep and for you to get a break.
• Put a safety pin or ribbon onto your bra strap to remind yourself which breast you finished on. This way you will remember where to start the next feed. Starting on the same breast each time may result in you becoming engorged and baby may then begin to favour one breast over the other.
• If baby appears to be gulping, try putting pressure above the areola for a few minutes until your strong let-down reflex has subsided. This way the milk flow will slow down. You can also lie back on your bed or in a comfortable chair so that your breast milk doesn’t come out as fast.
• Wind baby properly between breasts.
• If you are not able to breastfeed, then find a formula that best suits your baby. It is important that you don’t chop and change between formulas too often, as this may upset the gut.
• A bottle-fed baby should not be fed more frequently than every three hours, as you are able to ensure the correct amount of milk per feed.

Taking care of a newborn baby: sleep advice

Each baby is different and their sleep patterns will be too.

• A newborn will sleep on average 9 to 18 hours per day.
• One stretch of between 4 to 5 hours in a 24-hour period is acceptable.
• Do not allow the baby to go longer than this without a feed in the first six weeks. If baby does sleep for too long, their blood sugar levels drop and they may find it difficult to feed later.
• Breastfeed on demand as frequent feeding increases the breast milk production.
• Try to encourage regular feeds during the day so that baby doesn’t make up for missed feeds at night. This helps to reduce the chances of day/night confusion, where baby sleeps well during the day but then makes up feeds at night.
• It is important that you try to establish a good sleep routine from the beginning. Swaddle baby in a light blanket so that they feel secure.
• Try to keep baby in a darkened room for each sleep and away from loud noise or excessive stimulation.
• Talking softly to your baby or singing will soothe baby.
• If you need to hold your baby to get them to sleep, that is absolutely fine. Once baby is asleep you can put them into their crib.

Taking care of a newborn baby: advice about crying

Crying is a baby’s only means of communication.

• A baby may cry because:
  • They are hungry.
  • They need a nappy change.
  • They are uncomfortable.
  • They are in pain.
  • They are tired.
• Remember to cuddle your baby as much as possible if needing to be soothed.
• If you are unable to soothe your baby and baby cries for an extended period of time, please contact your nurse or paediatrician. Your baby may be ill or in pain.

Taking care of a newborn baby: advice about poo (stools)

• A breastfed baby may pass a stool seven times in one day or as infrequently as once in seven days.
• Breastfed babies pass very wet and, at times, “explosive” stools.
• In breastfed babies, stools are watery with globular specks. The colour of the stool is usually bright yellow but can also be green or brown.
• Bottle-fed babies tend to have one or two stools a day.
• Bottle-fed babies may suffer from constipation and if this does occur please seek help from your clinic sister or paediatrician.

Taking care of a newborn baby: caring for the umbilical cord

• Clean the umbilical cord and the base of the cord with surgical spirits after each nappy change.
• When the cord starts to separate, the umbilical stump may bleed a little. Continue routine care.
• Babies cry when you clean the cord. This is because the spirits are cold and not because the cord hurts the baby.
• If the stump bleeds, it may also be that the cord is catching on the nappy. Fold the nappy down away from the cord to avoid this.

Taking care of a newborn baby: advice on what to do if they have jaundice

• If baby looks yellow, they may be suffering from jaundice. This is common and may lead to poor feeding and excessive sleeping.
• Please contact your clinic sister or paediatrician. It is of utmost importance that you communicate with the doctor’s rooms once you have done a jaundice test at the laboratories. This will enable correct management of jaundice.

Taking care of a newborn baby: weekly weight check at the baby clinic

• Adequate weight gain is an important sign of your baby’s well-being. If your baby gains less than 90 grams per week for two successive weeks, please contact your paediatrician.
• Weekly weight gain checks are important to ensure that baby is getting adequate milk. This is especially important if baby is breastfed.
• There are a number of places one can go for weekly weight checks and these include pharmacies, private nurses or clinics.
• I would advise that baby gets weighed on the same scale each week for the first few weeks. Scales do differ so you want to have consistency with the weight assessment.

Taking care of a newborn baby: advice on immunisations

• Your baby should receive the BCG and oral Polio drops while still in hospital or within 10 days after birth.
• The next immunisation date will be between six and eight weeks of age.

Taking care of a newborn baby: advice on vitamins

• Babies are not exposed to sufficient sunlight in a modern lifestyle. For this reason, vitamin D needs to be supplemented. Your baby should, therefore, receive a multivitamin that contains 400IU of vitamin D daily. Some of these products contain probiotics and are also suitable for use.

Taking care of a newborn baby: advice on cardiopulmonary resuscitation and first aid

• A course in CPR can save your baby’s life in an emergency.
• There are a number of different people offering such courses and they will usually cover other medical topics such as burns, poisoning and choking.
• I would highly recommend that all parents do a CPR course before their baby even arrives or as soon as possible after birth.

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Advice on your newborn baby: Google it

• Google is an amazing tool for getting information, but you have to be careful.
• Please use recognised medical websites or those that make use of multi-disciplinary teams for information.
• Not all information on Google is necessarily acceptable practice.

Newborn baby: gadgets and technology

I know I am talking to Millennials who probably know way more than I do about gadgets and apps, so I’m going to note some items I feel are important. What I want to stress is that there are so many products and apps and sites available that new parents can be left feeling overwhelmed, anxious and certainly out of pocket. A parent’s intuition and common sense, in my opinion, is often way more accurate than that of a gadget. Remember, you know your baby’s every cry, you know your baby’s feeding and sleep routine, and you are the one who spends time with your baby. No gadget or healthcare professional can ever take the place of the carer.

• Screening tests are performed prior to your baby’s birth to make sure of the baby’s health. After the birth, there are further tests available to ensure that your baby is in optimal health. The thyroid function is critical for normal brain development and growth. This test should be performed either on cord blood or as part of a newborn screen after 48 hours of birth. The newborn screen is a test which looks for metabolic disorders and 24 conditions including cystic fibrosis and galactosemia can be identified. This new technology allows these conditions to be managed before they cause damage to your baby.
• Hearing tests can be performed from birth onwards to ensure that your baby can hear properly. This will be vital for the development of normal speech.
• Eye screening – A highly specialised visual screening machine is used to take a photo of your baby’s eyes. This can be done from six months of age and can exclude many eye abnormalities, allowing us to refer your baby for specialist treatment if necessary. Eyesight is a very important component of development.
• Thermometer – Invest in a good electronic thermometer. A baby’s temperature should be between 36.5 and 37.5 degrees Celsius. A reading lower or higher than that may indicate a medical problem.
• A baby monitor that allows you to hear and see your baby will give you peace of mind, especially if baby is sleeping in another room or being taken care of by another individual while you are at work. There are products which include audio and visual technologies. These technologies can link to your smart device and allow you to be aware of your baby’s well-being when you are not present.
• Heart-rate and breathing monitors – Babies who are high risk should have some form of heart-rate and breathing monitor. The most accurate of these are extremely expensive and not in the range of the average parent. I recently came across a little sock which does measure these functions. This is not the only product on the market, so I would recommend that you investigate various products to find one that best suits your needs. Babies who are at risk are premature babies or those with cardiac or other serious conditions. In my opinion, such a device is not necessary for every healthy, newborn baby.
• Vaccine record app – Every new parent is discharged with a vaccine record card. It is such an important record because many schools require it before enrolment and obtaining certain travel documents can only be done with proof of vaccinations. The problem is that we move house, misplace or misfile these cards. If all the child’s vaccines are done by a single professional then obtaining a copy of the records may be possible.

Generally, people struggle to get vaccination records if they lose their cards. There are, however, a number of apps that allow you to record your child’s vaccine schedule. I’d recommend that you investigate an app that is comprehensive and that has good backup so that your child’s vaccination records are forever safe on the cloud.

Your newborn baby: when to call your doctor

• If baby is lethargic to the extent that baby is not sucking well.
• Inconsolable irritability or crying.
• Jaundice (yellow skin discolouration)
• Frequent large vomits.
• Fever (temperature greater than 37.5 degrees Celsius or 99.5 degrees Fahrenheit).
• Low temperature (less than 36 degrees Celsius or 96.8 degrees Fahrenheit)

Parental health

• Parents also have needs and, on occasion, rights too.
• Take care of your own health. Keep a lookout for signs of postnatal depression (baby blues). Symptoms may include excessive weepiness, anxiety about the baby’s well-being and poor sleep. Seek medical advice earlier rather than later if such symptoms appear.
• Get rest while your baby rests. It is a good idea to get a family member or friend to babysit on occasion in order for you to get some rest.

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Six to eight-week check-up

• This is an important check-up post discharge when baby is examined and normal development is assessed.
• Your baby will also receive a set of vaccinations at this age.
• Remember to bring along questions you wish to ask. So often parents get to the end of an appointment and have forgotten to ask about things that have been of concern.

Our modern world is filled with technology and all sorts of items intended to make our lives easier. That is all fine and well in the world of predictive outcomes. Unfortunately, babies do not fall into this category. They have not read the manuals, blogs or posts of the experts. They are little individuals who have unique needs.

As healthcare professionals, we can guide parents along a path that has proved successful in the past. Professionals writing blogs are communicating their professional opinions as well as their experiences. What we cannot do is predict if your baby is going to respond in the same way to the last. My advice is always for parents to find sources that speak to their heart when seeking advice. A multi-disciplinary approach is often the most comprehensive.

There is no right way or wrong way as long as your baby is loved, fed, warm and healthy. Trust your instincts, use products and sites that support your way of thinking, but never lose sight of the human factor. We have been raising healthy children for thousands of years. The modern parent is no different. Believe in yourself, find what fits into your lifestyle and trust your gut.

This article was written for BabyYumYum by our partner paediatrician, Dr Maraschin. Visit his webpage www.drmaraschin.co.za for in-depth information on what to do when faced with a medical emergency.