Read What to Expect the First Year Online
Authors: Heidi Murkoff
What to Expect the First Year (29 page)
During your baby's hospital stay, the nurses and/or doctors will:
⢠Record your newborn's first pees and poops to rule out any problems in the elimination department.
⢠Administer a vitamin K shot, to enhance baby's blood clotting ability.
⢠Take blood from your infant's heel (with a quick stick), to be screened for phenylketonuria (PKU) and other metabolic disorders (some states mandate tests for only 21 disorders, but you can arrange for a private lab to screen for 30 to 40 metabolic disorders; see
box
).
⢠Possibly (depending on the state and hospital you deliver in) screen for congenital heart disease using pulse oximetry (see
box
).
⢠Administer the first dose of the hepatitis B vaccine sometime before hospital discharge. (
Click here
for a complete immunization schedule.)
⢠Conduct a hearing screening (see
box
).
The first test most babies are givenâand which most pass with good scoresâis the Apgar test. The scores, recorded at 1 minute and again at 5 minutes after birth, reflect the newborn's general condition and are based on observations made in five assessment categories. Babies who score between 7 and 10 are in good to excellent condition and usually require only routine postdelivery care, those scoring between 4 and 6 are in fair condition and may require some resuscitative measures, and those who score under 4 are in poor condition and require immediate attention. While this test can tell a lot about your baby's condition in the few minutes after birth, it doesn't tell you much about anything long term. In fact, even babies whose scores remain low at 5 minutes usually turn out to be completely healthy.
APGAR TABLE
| SIGN | POINTS | ||
| Â | 0 | 1 | 2 |
| Appearance (color) | Pale or blue | Body pink, extremities blue | Pink |
| Pulse (heartbeat) | Not detectible | Below 100 | Over 100 |
| Grimace (reflex irritability) | No response to stimulation | Grimace | Lusty cry |
| Activity (muscle tone) | Flaccid (weak or no activity) | Some movement of extremities | A lot of activity |
| Respiration | None | Slow, irregular | Good (crying) |
You'll have more control over the birth, comfortable surroundings, way better food, no limits on the number of friends and family who welcome your little bundle with you, and no bags to packâbut having your baby at home also means you'll have more homework to do later. Some procedures that are routine in hospitals and birthing centers may just be bureaucratic red tape that you and your baby can easily skip. Others, however, are necessary for your baby's health and future well-being, and still others are required by law. Give birth in a hospital, and the following are automatically taken care of, but give birth at home, and you'll need to:
⢠Give some thought to eye ointment. Some midwives allow the parents of a newborn to give informed consent not to administer antibiotic eye ointment (which protects babies from infection) after birth. Though the ointment used is not irritating to baby's eyes, it can blur vision, making that first eye-to-eye contact in mommy's and daddy's arms less clear (
click here
). That said, avoiding the ointment can lead to blindness in a baby if infection is missed, so discuss this with your practitioner before delivery.
⢠Plan for routine shots and tests. All babies born in a hospital receive their first dose of hepatitis B vaccine, and all receive a shot of vitamin K (to prevent serious bleeding) shortly after delivery. They're also given a heel stick to screen for PKU, hypothyroidism, and a variety of other conditions (see
box
). Speak to your baby's doctor about when these procedures can be performed on your newborn. Also ask the pediatrician about arranging a hearing test (see
box
) and congenital heart disease (CHD) screening test, typically administered to newborns before they leave the hospital (
click here
). The test for CHD is most valuable if done in the first day or two of life to pick up conditions that can make a baby very sick by day 3 or 4.
⢠Take care of business. The filing of a birth certificate is usually taken care of by hospital staff. If you're planning to give birth at home, you (or your birth attendant) will need to be responsible for the paperwork. Contact your state's Office of Vital Records and Statistics for information on how to file a birth certificate.
⢠Schedule baby's first doctor appointment, stat. Be sure to contact your pediatrician immediately after the birth to arrange an appointment for your baby as soon as possible.
Babies learn everything about their environment from their sensesâfrom the sight of daddy's smiling face, to the feel of warm skin as they're cradled in loving arms, to mommy's familiar scent, to the sound of her voice as she matches coo for coo. But for approximately 2 to 4 out of every 1,000 babies born in the United States, the sense of hearingâso integral to the development of speech and language skillsâis impaired. Since a hearing deficit can affect so many aspects of a young child's development, early diagnosis and treatment is key. Which is why the AAP endorses universal screening of infants for hearing loss and why nearly three-quarters of all states require that newborns be tested in the hospital for hearing defects. (If your state is not among those that require newborn hearing screening, make sure you ask for it before your baby leaves the hospital.)
Newborn hearing screening tests are highly effective. One test, called otoacoustic emissions (OAE), measures response to sound by using a small probe inserted in the baby's ear canal. In babies with normal hearing, a microphone inside the probe records faint noises coming from the baby's ear in response to a noise produced by the probe. This test can be done while the baby is sleeping, is completed within a few minutes, and causes no pain or discomfort. A second screening method, called auditory brainstem response (ABR), uses electrodes placed on the baby's scalp to detect activity in the brain stem's auditory region in response to “clicks” sounded in the baby's ear. ABR screening requires the baby to be awake and in a quiet state, but it is also quick and painless. If your baby doesn't pass the initial screening, the test will be repeated to avoid false-positive results.
With health insurance, that is. One of the many calls you'll need to make after the birth of your baby (though grandparents will probably want to hear the news first) will be to your health insurance company, so your new arrival can be added to your policyâsomething that doesn't happen automatically. (Some insurance carriers require that they be notified within 30 days of the birth of a baby.) Having baby on the policy will ensure that those doctor's visits will be covered right from the start. So, add that to your list of 101 things to do. Don't have insurance?
Click here
.
There's not much you need to learn about feeding your baby a bottleâand not much your baby needs to learn, either (newborns have little trouble figuring out how to suck from an artificial nipple). But while breast milk is always on tap and ready to serve, formula must be selected, purchased, sometimes prepared, and often storedâand that means you'll need a lot of know-how before you mix up that first baby bottle. Whether you're formula feeding exclusively or just supplementing, here's what you'll need to know to get started. (
Click here
for tips on choosing nipples and bottles for your formula-fed baby.)
If you're breastfeedingâeither exclusively or in combination with the bottleâyou'll find everything that you need to know in
Chapter 3
, beginning
here
.
Formula can't replicate nature's recipe for breast milk precisely (for instance, it can't pass along mama's antibodies), but it does come pretty close. Today's formulas are made with types and proportions of proteins, fats, carbohydrates, sodium, vitamins, minerals, water, and other nutrients similar to breast milk's, and must meet standards set by the FDA. So just about any iron-containing formula you choose for your baby will be nutritionally sound. Still, the vast selection of formulas on store shelves can be dizzyingâand more than a little confusing. Before you contemplate that selection, consider the following formula facts:
⢠Your baby's doctor knows a thing or two about formula. In your search for the perfect formula for your precious bundleâwhether you'll be using it as a supplement to breast milk or as baby's exclusive feedâstart with a recommendation from the pediatrician. But for best results, look to your baby as well. Different formulas work well for different babies at different times. Coupled with the advice of the pediatrician, your baby's reaction to the formula you're feeding will help you assess what's best.
⢠Cow's milk formula is best for most babies. The majority of formulas are made with cow's milk that has been modified to meet the nutritional and digestive needs of human babies (regular cow's milk is a no-go until the first birthday). Organic formulas made from milk products untouched by growth hormones, antibiotics, and pesticides are readily available, if at a premium price.
⢠Iron-fortified is always best. Formulas come in low-iron formulations, but they aren't considered a healthy option. The AAP and most pediatricians recommend that babies be given iron-fortified formula from birth until 1 year to prevent anemia (
click here
).
⢠Special formulas are best for some babies. Vegan parents can select soy-based formula for their babies. There are also formulas available for premature babies, babies who have a hard time digesting regular formula, babies who turn out to be allergic to cow's milk and/or soy, babies who are lactose intolerant, and babies with metabolic disorders, such as PKU. For some babies, these formulas are easier to digest than standard formulations, but not surprisingly, they are much more expensive. See
box
, for more.
⢠Follow-ups are not always best. Follow-up formulas are designed for babies older than 4 months who are also eating solid foods. Most doctors don't recommend them, as regular formula plus a healthy diet (once solids are introduced) provides all the nutrients your little one needs until he or she is a year old, when you can switch to cow's milk (no “toddler formula” needed). Check with your baby's doctor before using follow-up formula.
With so many types of formula on the market, choosing the right one for your little one can be a confusing proposition, whether you'll be feeding formula exclusively or as part of the breast-bottle combo. Here's a rundown of varieties you'll see on the store shelves or on online shopping portals. If you're considering trying a specialty formula (say, one that's soy-based), ask the doctor before you stock up:
Milk-based formulas.
The vast majority of babies do well on standard milk-based formulasâand that even goes for those babies who end up being fussy (most babies are) or have colic. Most of the time, cow's milk formula can't be blamed for those symptoms. Still, some babies with mild tummy troubles seem to do better on cow's milkâbased “sensitive” formulas geared to lactose-sensitive infants, in which the milk proteins are easier to digest. Ask the doctor about switching to a sensitive formula if your baby seems to be especially gassy on standard milk-based formulaâjust keep in mind that the much higher price may be hard for you to swallow (these formulas are more costly).
Soy-based formulas.
Formula made with soy proteins are plant-based and don't contain lactose (the sugar found in milk). It's the formula alternative for vegan families, and may also be recommended for some babies who have certain metabolic disorders such as galactosemia or congenital lactase deficiency. If your baby ends up having a true allergy to cow's milk formula, it's unlikely the doctor will recommend a soy-based one, because many babies who are allergic to cow's milk are allergic to soy milk as well. Hydrolysate formulas (see below) will be a better bet.
Protein hydrolysateâbased formulas.
In these formulas, the protein is broken down into small parts that are easier for your baby to digest (it's why they are often called “predigested” formulas). These hypoallergenic formulas are recommended for babies who have true allergies to milk protein, and possibly for those with skin rashes (like eczema) or wheezing caused by allergiesâbut don't change your baby's formula to hydrolysate without the doctor's advice. Preemies may also need a hydrolyzed formula if they have trouble absorbing nutrients (if a specialized preemie formula isn't recommended, that is). These formulas are also more expensive than standard milk formulas. Hydrolysate-based formulas also have a very different taste and smell, which many babies (and their parents) find unpleasant, making a switch difficult for finicky infants (though some babies have no trouble chugging it down).
Lactose-free formulas.
If your baby is lactose intolerant, or if he or she has galactosemia or congenital lactase deficiency, the doctor might recommend a lactose-free formula instead of soy-based, sensitive, or hydrolysate ones. These are cow's milkâbased formulas that are completely free of lactose.
Reflux formulas.
Reflux formulas are prethickened with rice starch and are usually recommended only for babies with reflux who are not gaining weight. Sometimes a doctor will also recommend a reflux formula for a baby whose reflux is causing very uncomfortable symptoms (not just standard spitting up).
Preemie formulas.
Babies who were born early and/or at a low birthweight sometimes need more calories, protein, and minerals than a regular formula can provide. The doctor may recommend a special type of preemie formula, many of which also contain a more easily absorbed type of fat called medium-chain triglycerides (MCT), for your tiny baby.
Supplementation formulas.
Doing the combo (breastfeeding and supplementing)? There is formula designed specifically for supplementing breastfed babies. It contains lutein, an important nutrient found in breast milk, as well as more prebiotics than other formulas to help keep your baby's stool soft and seedyâlike a breastfeeding baby's poop.
There are also other, specially developed formulas for babies with heart disease, malabsorption syndromes, and problems digesting fat or processing certain amino acids.