Read What to Expect the First Year Online
Authors: Heidi Murkoff
What to Expect the First Year (35 page)
To avoid future infections (as well as to prevent reinfection), regularly clean and sterilize pacifiers, bottles, and breast pump parts that touch your nipples (using a microwave sterilizer bag makes this easier). Also helpful: allowing your nipples to completely dry between feedings, changing nursing pads after feedings, and wearing cotton bras that don't trap moisture and washing them daily in hot water (drying them in the sun may provide extra protection). Since antibiotics can trigger a yeast infection, they should be used only when neededâand that goes for both you and baby.
Ever wonder why your baby's tongue is white after a feed ⦠or even worried that it might be due to thrush? If a white tongue is your baby's only symptom, his or her milk-only diet is probably the cause. Milk residue often stays on a baby's tongue after feeding but usually dissolves within an hour. Still want to be sure? Simply try to wipe off that white film using a soft, damp cloth. If the tongue is pink and healthy looking after wiping, it's just a matter of milk. Call the doctor if you suspect thrush or if you're just not sure.
“The doctor says my baby is jaundiced and has to spend time under the bili lights before she can go home. He says it isn't serious, but anything that keeps a baby in the hospital sounds serious to me.”
The skin of more than half of babies has begun to yellow by their second or third daysânot with age, but with newborn jaundice, caused by an excess of bilirubin in the blood. The yellowing, which starts at the head and works its way down toward the toes, tints the skin in light-skinned newborns and even the whites of their eyes. The process is the same in black- and brown-skinned babies, but the yellowing may be visible only in the palms of the hands, the soles of the feet, and the whites of the eyes. Jaundice is more common in babies of East Asian or Mediterranean descent, though their dark, olive, or yellow-tinged skin may make it more difficult to detect.
Bilirubin, a chemical formed during the normal breakdown of red blood cells, is usually removed from the blood by the liver. But newborns often produce more bilirubin than their immature livers can handle. As a result, the bilirubin builds up in the blood, causing the yellowish tinge and what is known as physiologic (normal) newborn jaundice.
In physiologic jaundice, yellowing usually begins on the second or third day of life, peaks by the fifth day, and is substantially diminished by the time baby is a week or 10 days old. It appears a bit later (about the third or fourth day) and lasts longer (often 14 days or more) in premature babies because of their extremely immature livers. Jaundice is more likely to occur in babies who lose a lot of weight right after delivery, in babies who have diabetic mothers, and in babies who arrived via induced labor.
Mild to moderate physiologic jaundice usually requires no treatment. Usually a doctor will keep a baby with high physiologic jaundice in the hospital for a few extra days for observation and phototherapy treatment under fluorescent light, often called a bili light. Light alters bilirubin, making it easier for a baby's liver to get rid of it. During the treatment, babies are naked except for diapers, and their eyes are covered to protect them from the light. They are also given extra fluid to compensate for the increased water loss through the skin, and may be restricted to the nursery except for feedings. Freestanding units or fiber-optic blankets wrapped around baby's middle allow more flexibility, often permitting baby to go home when her mom is released.
In almost all cases, the bilirubin levels (determined through blood tests) will gradually diminish in an infant who's been treated, and the baby will go home with a clean bill of health.
Rarely, the bilirubin increases further or more rapidly than expected, suggesting that the jaundice may be nonphysiologic (not normal). This type of jaundice usually begins either earlier
or later than physiologic jaundice, and levels of bilirubin are higher. Treatment to bring down abnormally high levels of bilirubin is important to prevent a buildup of the substance in the brain, a condition known as kernicterus. Signs of kernicterus are weak crying, sluggish reflexes, and poor sucking in a very jaundiced infant (a baby who's being treated under lights may also seem sluggish, but that's from being warm and understimulatedânot from kernicterus). Untreated, kernicterus can lead to permanent brain damage or even death.
Many hospitals monitor the level of bilirubin in babies' blood through blood tests or with a special measurement device (a bilirubinometer) and follow-up visits to ensure that these extremely rare cases of kernicterus are not missed. The pediatrician will also check baby's color at the first visit to screen for nonphysiologic jaundice (especially important if mom and baby checked out of the hospital early or if baby was born at home). The treatment of nonphysiologic jaundice will depend on the cause but may include phototherapy, blood transfusions, or surgery. Any visible jaundice that persists at 3 weeks of age should be checked by the pediatrician.
“I've heard that breastfeeding causes jaundice. My baby is a little jaundiced. Should I stop nursing?”
Blood bilirubin levels are, on the average, higher in breastfed babies than in bottle-fed infants, and they may stay elevated longer (as long as 6 weeks). Not only is this exaggerated physiologic (normal) jaundice nothing to worry about, but it's also not a reason to consider giving up on breastfeeding. In fact, interrupting breastfeeding doesn't decrease bilirubin levels, and can interfere with the establishment of lactation. What's more, it's been suggested that breastfeeding in the first hour after birth can reduce bilirubin levels in nursing infants.
True breast milk jaundice is suspected when levels of bilirubin rise rapidly late in the first week of life and nonphysiologic jaundice has been ruled out. It's believed to be caused by a substance in the breast milk of some women that interferes with the breakdown of bilirubin, and is estimated to occur in about 2 percent of breastfed babies. In most cases, it clears up on its own within a few weeks without any treatment and without interrupting breastfeeding. If it doesn't clear up by 3 weeks, check back with the pediatrician.
“When I changed my baby's diaper for the first time, his poop was greenish black. Is this normal?”
This is only the first of many discoveries you'll make in your baby's diapers during the next year or so. And for the most part, what you will be discovering, though occasionally unsettling, will be completely normal. What you've turned up this time is meconium, the tarry greenish black substance that gradually filled your baby's intestines during his stay in your uterus. That the meconium is in his diaper instead of his intestines is a good signânow you know that his bowels are doing their job.
Sometime after the first 24 hours, when all the meconium has been passed, you'll see transitional stools, which are dark greenish yellow and loose, sometimes “seedy” in texture (particularly among breastfed infants), and may occasionally contain mucus. There may even be traces of blood in them, probably the result of a baby's swallowing some of his mom's blood during delivery (just to be sure, save any diaper containing blood to show to a nurse or doctor).
After 3 or 4 days of transitional stools, what your baby starts putting out will depend on what you've been putting into him. If it's breast milk, the movements will often be mustardlike in color and consistency, sometimes loose, even watery, sometimes seedy, mushy, or curdy. If it's formula, the stool will usually be soft but better formed than a breastfed baby's, and anywhere from pale yellow to yellowish brown, light brown, or brown green. Iron in baby's diet (whether from formula or vitamin drops) can also lend a black or dark green hue to movements.
Whatever you do, don't compare your baby's diapers with those of the baby in the next bassinet. Like fingerprints, no two stools are exactly alike. And unlike fingerprints, they are different not only from baby to baby, but also from day to day (even poop to poop) in any one baby. The changes, as you will see when baby moves on to solids, will become more pronounced as his diet becomes more varied.
So you think if you've seen one dirty diaper, you've seen them all? Far from it. Though what goes into your baby at this point is definitely one of two things (breast milk or formula), what comes out can be one of many. In fact, the color and texture of baby poop can change from day to dayâand bowel movement to bowel movementâcausing even seasoned parents to scratch their head. Here's the scoop on what the contents of your baby's diaper may mean:
Sticky, tarlike; black or dark green.
Meconiumâa newborn's first few stools
Grainy; greenish yellow or brown.
Transitional stools, which start turning up on the third or fourth day after birth
Seedy, curdy, creamy, or lumpy; light yellow to mustard or bright green.
Normal breast milk stools
Slightly formed; light brownish to bright yellow to dark green.
Normal formula stools
Frequent, watery; greener than usual.
Diarrhea
Hard, pelletlike; mucus or blood streaked.
Constipation
Black.
Iron supplementation
Red streaked.
Milk allergy or rectal fissure (a tear around the rectum, usually due to constipation)
Mucousy; green or light yellow.
A virus such as a cold or stomach bug
“Will my baby become addicted to the pacifier if she gets one in the hospital nursery?”
Babies are born suckers, which makes pacifiers pretty popular in the hospital nurseryâboth with the tiny occupants and those who care for them. Not only won't she get hooked from a day or two of pacifier use, but as long as your little sucker is also getting her full share of feeds, enjoying a little between-meal soothing from a soothie is no problem at all. In fact, there are benefits to pacifier useâthe AAP suggests that parents consider offering one during sleep to protect against SIDS, a good reason to get baby started on one early (wait too long to introduce the pacifier, and your little one may resist). Nursing mamas can pop the paci, too, without concern about it causing nipple confusion or interfering with breastfeedingâthere's no consensus that either is true.
However, if you're concerned about the pacifier satisfying too much of your baby's sucking needs (especially if you're breastfeeding, and particularly if she hasn't been feeding all that well yet), you may decide you'd rather the staff not offer a pacifier when she's in the nursery. Don't be shy about letting them know that you'd prefer to feed her when she cries, or if she's just finished up a feed, use other comfort measures instead of plugging in the paci. If your baby seems to need more between-meal sucking once you're home, and you're considering starting her on a pacifier,
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.
In the 1930s, healthy new babies and their moms came home from the hospital after a whopping 10 days, in the 1950s after 4 days, in the 1980s after 2 days. Then, in the 1990s, insurance companies, in a cost-cutting effort, began limiting hospital stays to just hours. To protect against such so-called drive-through deliveries, the federal government passed the Newborns' and Mothers' Health Protection Act in 1996. The law requires insurance companies to pay for a 48-hour hospital stay following a vaginal birth and 96 hours following a cesarean delivery, though some practitioners and mothers may opt for a shorter stay if baby is healthy and mom is up to going home sooner.
Itching for your own bed and hungry for some real food? The decision to check out early is best made on a case-by-case basis with a physician's input. Early discharge is safest when an infant is full term, is an appropriate weight, has started feeding well, is going home with a parent (or parents) who knows the basics and is well enough to provide care, and will be seen by a practitioner (doctor, nurse practitioner, or visiting nurse) within 2 days of discharge.
If you and your baby are discharged early (or if you delivered at home), make sure you schedule that first checkup within the next 48 hours. In the meantime, watch carefully for signs of newborn problems that require immediate medical attention, such as refusal to eat, dehydration (fewer than 6 wet diapers in 24 hours or dark yellow urine), constant crying, moaning instead of crying, or no crying at all, fever, or red or purple dots anywhere on the skin. Also keep an eye out for signs of jaundice, which include yellowing of the eyes and of the skin in light-skinned babies and yellowing of the eyes, palms of the hands, and soles of the feet in dark-skinned newborns. To run a check for jaundice in your newborn, press down on his or her thigh or arm with your thumbâif the skin turns yellowish instead of white, your little one may be jaundiced. On dark-skinned or Asian babies, the blanch test is done on the inner cheek or lip, or on the palms and soles of the feet.
Starting with that first ride home from the hospitalâand every ride after thatâyour baby will have to be properly secured into a properly installed car seat. That's because safety seats, like seat belts, are the law. Not to mention that an unstrapped baby is an unsafe baby. Car crashes are a leading cause of injury and death among children. So even if your destination is literally just a few blocks away (most accidents occur within 25 miles of home and not, as is often believed, on highways), even if you're driving slowly (a crash at 30 miles per hour creates as much force as a fall from a third-story window), even if you're wearing a seat belt and holding your baby tight (in a crash, baby could be crushed by your body or whipped from your arms), even if you're driving very carefully (you don't actually have to crash for severe injuries to resultâmany occur when a car stops short or swerves to avoid an accident), and even if you're just going from one space to another in the same parking lot, your baby needs to be buckled up safely.
Getting your baby used to a safety seat from the very first ride will help make later acceptance of it almost automatic. And young children who ride in safety restraints regularly are not only safer but also better behaved during drivesâsomething you'll appreciate when you're riding with a toddler.
In addition to checking that a seat meets federal safety standards, be sure that it is appropriate for your baby's age and weight and that you install and use it correctly:
⢠Follow manufacturer's directions for installation of the seat and securing of your baby. Check before each ride that the seat is properly secured and the seat belts, or LATCH system (
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) holding it, are snugly fastened. The car seat should not wobble, pivot, slide side to side, tip over, or move more than an inch when you push it from front to back or side to sideâinstead, when properly installed it should stay tight. (You'll know the rear-facing infant seat is installed tightly enough if, when you hold the top edge of the car seat and try to push it downward, the back of the seat stays firmly in place at the same angle.) To make sure you've installed the car seat correctly, have it assessed (car seat safety checks are offered at fire and police stations, hospitals, car dealerships, baby stores, and other locations). Keep in mind, however, that only a certified car seat safety technician is likely to be up-to-date on all the latest recommendations. For peace of mind at a price (a relatively small one) you can search locally for a certified car seat technician to install your car seat or check your work at
cert.safekids.org
.
⢠Infants should ride in a rear-facing car seat (reclining at a 45-degree angle) until they reach age 2âor until the the weight limit is outgrown (usually around 35 pounds). Experts say that a rear-facing child safety seat does a much better job protecting a young child in a car crash (children under age 2 are 75 percent less likely to be severely or fatally injured in a crash if they are riding rear-facing). That's because in a rear-facing car seat, the child's head, neck, and spine are better supported, making the risk of serious injury much less likely. The majority of kids don't hit that upper weight limit for the car seat until after age 2, but some toddlers may be big enough to be turned forward-facing earlier than age 2. Once baby has outgrown the infant seat, use a convertible seat,
which can accommodate larger babies in the rear-facing position.
⢠Place the infant safety seat, if at all possible, in the middle of the backseat (if there is a LATCH system in the middle seat; if not, then use one of the window seats with a LATCH system). Never put an ordinary rear-facing infant seat in the front seat of a car equipped with a passenger-side air bagâif the air bag is inflated (which could happen even at slow speeds in a fender bender), the force could seriously injure or kill a baby. In fact, the safest place for all children under 13 is in the backseatâolder children should ride up front only when absolutely necessary and when safely restrained and sitting as far from the passenger-side air bag as possible.
⢠Adjust the shoulder harness to fit your baby. The harness slots on a rear-facing safety seat should be at or below your baby's shoulders, and the harness chest clip should be at armpit level. The straps should lie flat and untwisted, and should be tight enough so that you can't get more than two fingers between the harness and your baby's collarbone. Check the instructions to see how the carrying handle should be positioned during travel, if applicable.
⢠Dress your baby in clothes that allow straps to go between his or her legs. In cold weather, place blankets on top of your strapped-in baby (after adjusting the harness straps snugly), rather than dressing baby in a snowsuit. A heavy snowsuit can come between your baby and an adequately tight harness.
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for more.
⢠Most infant seats come with special cushioned inserts to keep a very young baby's head from flopping around. If not, pad the sides of the car seat and the area around the head and neck with a rolled blanketâbut never underneath baby. And never use inserts that don't come with the car seat. It not only will void the warranty, but it could also make baby unsafe.
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.
⢠For older babies, attach soft toys to the seat with velcro or plastic links (never a cord that's 6 inches or longer). Loose toys tend to be flung around the car or dropped, upsetting baby and distracting the driver. Or use toys designed specifically for car seat use.
⢠Many infant car seats can lock into shopping cartsâsomething that's sure to be convenient but is also potentially dangerous. The weight of the baby and car seat makes the shopping cart top-heavy and more likely to tip over. So be extra vigilant when placing your baby's car seat on a shopping cart, or, as recommended by the AAP, for optimum safety use a sling, baby carrier, or stroller when shopping.
⢠The Federal Aviation Administration (FAA) recommends using a child safety seat in flight (secured with the airplane seat belt) until age 4. Most infant, convertible, and forward-facing seats are certified for use on airplanes (
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for more).
⢠See
Chapter 2
for more on choosing an infant safety seat, the types of harnesses available, and other safety information. For specific information about installing your car seat, to find out if your car seat has been recalled, and for other safety information, consult the National Highway Transportation Safety Administration at
nhtsa.gov/Safety/CPS
.
⢠The most important rule of car seat safety is: Never make an exception. Whenever the car is moving, everyone in the car should be safely and appropriately buckled up.