What to Expect the First Year (41 page)

Newborns are actually a whole lot sturdier than they appear to their nervous newbie parents. The truth is—and it's one that should keep you from shaking in your slippers every time you get ready to pick up your tiny little bundle—you can't break a baby. That delicate-looking, vulnerable-seeming infant is actually an incredibly resilient, elastic little being—one who's really built to take even the clumsiest care and handling a new parent can dish out.

And here's another happy truth: By the time your newborn turns 3 months old, he'll have gained the weight and control over his head and limbs that will make him seem less floppy and fragile … and you'll have gained the experience that will make you feel completely confident as you carry him and care for him.

“My baby's soft spot on her head seems so … soft. Sometimes it seems to pulsate, which really makes me nervous.”

That “soft spot”—actually there are two and they are called fontanels—is
tougher than it looks. The sturdy membrane covering the fontanels is capable of protecting a newborn from the probing of even the most curious sibling fingers (though that's definitely not something you'd want to encourage), and certainly from everyday care.

These openings in the skull, where the bones haven't yet grown together, aren't there to make new parents nervous about handling their baby (though that's often the upshot) but rather, for two very important reasons. During childbirth, they allow the fetal head to mold to fit through the birth canal, something a solidly fused skull couldn't do. Later, they allow for the tremendous brain growth during the first year.

The larger of the two openings, the diamond-shaped anterior fontanel, is located on the top of a newborn's head, and it may be as wide as 2 inches. It starts to close when an infant is 6 months old and is usually totally closed by 18 months.

This fontanel normally appears flat, though it may bulge a bit when baby cries, and if baby's hair is sparse and fair, the cerebral pulse may be visible through it (which is completely normal and absolutely nothing to worry about). An anterior fontanel that appears significantly sunken is usually a sign of dehydration, a warning that the baby needs to be given fluids promptly. (Call the baby's doctor immediately to report this sign.) A fontanel that bulges persistently (as opposed to a little bulging with crying) may indicate increased pressure inside the head and also requires immediate medical attention.

The posterior fontanel, a smaller triangular opening toward the back of the head less than half an inch in diameter, is much less noticeable and may be difficult for you to locate (and no need to try). It's generally completely closed by the third month but may be closed at birth or shortly after. Fontanels that close prematurely (they rarely do) can result in a misshapen head and require medical attention.

“When my milk came in, my breasts were overflowing. Now that the engorgement is gone, I'm not leaking anymore. Does that mean I'm not making enough milk?”

Since the sides of your breasts don't come marked with ounce calibrations (and aren't you pretty glad they don't?), it's virtually impossible to tell at a glance how your milk supply is holding up. Instead, you'll have to look to your baby. If he seems to be happy, healthy, and gaining weight well, you're producing enough milk—which the vast majority of moms do. Leaking like a faucet or spraying like a fountain are more common early on, when supply often exceeds demand (though some moms continue to leak and spray, and that's normal, too). Now that your baby
has caught up to your flow, the only milk that counts is the milk that goes into him.

True problems with supply happen, but they're pretty uncommon. If at any time your baby doesn't seem to be getting enough milk, more frequent nursing plus the other tips
here
should help you boost your supply. If they don't, check with the doctor.

“My baby was nursing about every 2 or 3 hours and seemed to be doing really well. Now, suddenly, she seems to want to nurse every hour. Could something have happened to my milk supply?”

Unlike a well, a milk supply rarely dries up if it's used regularly. In fact, the exact reverse is true: The more your baby nurses, the more milk your breasts will produce. And right now, that's what your hungry little girl—who's probably going through a growth spurt that's spurring her appetite into overdrive—is counting on. Growth spurts most commonly happen at 3 weeks, 6 weeks, and 3 months, but can occur at any time during an infant's development. Sometimes, even a baby who's been sleeping through the night begins to wake for a middle-of-the-night feeding during a growth spurt. Simply put, your baby's active appetite is likely her way of ensuring that your breasts will step up milk production to meet her growth needs. (
Click here
for more on these so-called cluster feedings.)

Just relax and keep your breasts handy until the growth spurt passes. Don't be tempted to give your baby formula (and definitely don't consider adding solids) to appease her appetite, because a decrease in frequency of nursing would cut down your supply of milk, which is just the opposite of what the baby ordered. Such a pattern—started by baby wanting to nurse more, leading to mom doubting her milk supply, prompting her to offer a supplement, followed by a decrease in milk production—is one of the major causes of breastfeeding being ditched early on.

Sometimes a baby begins to demand more daytime feedings temporarily when she begins to sleep through the night, but this, too, shall pass with time. If, however, your baby continues to want to nurse hourly (or nearly so) for more than a week, check her weight gain (and see below). It could mean she's not getting enough to eat.

“How can I be sure my breastfed son is getting enough to eat?”

When it comes to bottle-feeding, the proof that baby's getting enough to eat is in the bottle—the empty bottle. When it comes to breastfeeding, figuring out whether baby's well fed takes a little more digging … and diaper diving. Luckily, there are several signs you can look for to reassure yourself that your breastfed baby is getting his fair share of feed:

He's having at least 5 large, seedy, mustardy bowel movements a day.
Fewer than 5 poops a day in the early weeks could mean he's not getting enough to eat (though later on, around age 6 weeks to 3 months, the rate could slow down to one a day or even one every 2 to 3 days).

His diaper is wet when he's changed before each feeding.
A baby who pees more than 8 to 10 times a day is getting adequate fluid.

His urine is colorless.
A baby who is not getting enough fluids passes urine that is yellow, possibly fishy smelling,
and/or contains urate crystals (these look like powdered brick, give the wet diaper a pinkish red tinge, and are normal before breast milk comes in but not later).

You hear a lot of gulping and swallowing as your baby nurses.
If you don't, he may not be getting much to swallow. Don't worry, however, about relatively silent eating if baby is gaining well.

He seems happy and content after most feedings.
A lot of crying and fussing or frantic finger sucking after a full nursing could mean a baby is still hungry. Not all fussing, of course, is related to hunger. After eating, it could also be related to gas, an attempt to poop or to settle down for a nap, or a craving for attention. Or your baby could be fussy because of colic (
click here
). Keep in mind, however, that no crying at all in a newborn (or very little crying) can be a red flag—a possible sign that baby is not thriving (babies should cry).
Click here
for more.

You experienced engorgement and your breasts feel full in the morning.
Engorgement is a good sign you can produce milk. And breasts that are fuller when you get up in the morning and after 3 or 4 hours without nursing than they are after a feed indicate they are filling with milk regularly—and also that your baby is draining them. If baby is gaining well, however, lack of noticeable engorgement shouldn't concern you.

You notice the sensation of let-down and/or experience milk leakage.
Different women experience let-down differently (
click here
), but feeling it when you start feeding indicates that milk is coming down from the storage ducts to the nipples, ready to be enjoyed by your baby. Not every woman notices let-down when it occurs, but its absence when baby's not thriving is a red flag.

You don't get your period during the first 3 months postpartum.
If you're breastfeeding exclusively, you're not likely to get your period, particularly in the first 3 months. If you do, it's possible you may not be producing enough milk.

Supplemental Nursing System

Here's how the SNS works: A bottle filled either with pumped breast milk or formula hangs around your neck. Narrow flexible tubes leading from the bottle are gently taped onto your breasts, extending slightly past the nipples. As your little one nurses at the breast, he or she gets the supplement through the tube along with any milk that comes from your breasts. It's win-win, since baby gets the nutrition he or she needs and your breasts get the stimulation they need.

That is, when it works according to plan. Some moms find their babies fuss over or even reject feeding from a breast that has a tiny tube hanging off it (it could make it uncomfortable or difficult for some babies to latch on properly). If you find your baby is struggling to nurse when you're using the SNS, have a lactation consultant watch your technique and offer advice and tips on how to make using the SNS easier and better, if possible.

“I thought that breastfeeding was going pretty well, but the doctor says my baby girl isn't gaining weight quickly enough. What could be the problem?”

Breastfed babies typically don't pack on the ounces as fast as their formula-fed friends, and that's not usually a concern. It's also the reason why charts that use formula-fed babies to gauge average growth have fallen out of favor. It's a good idea to make sure the one your pediatrician is using to gauge your baby's gain is based on breastfed averages (the World Health Organization, or WHO, chart is). Occasionally, however, a baby truly doesn't thrive on breast milk alone, at least not from the start, and there are several possible reasons why. Identify what's holding up your baby's weight gain, and chances are you'll be able to find a fix for the problem, so she can continue nursing and start gaining weight faster:

Possible problem:
You're not feeding baby often enough.

Solution:
Increase feedings to at least 8 to 10 times in 24 hours, and try never to go more than 3 hours during the day or 4 at night between feedings. That means waking up a sleeping baby so that she won't miss dinner or feeding a hungry one even if your slowpoke just finished a meal an hour earlier. If your baby is “happy to starve” (some newborns initially are) and never demands feeding, it means taking the initiative yourself and setting a busy feeding schedule for her. Frequent nursings will not only help to fill baby's tummy (and fill out her frame), they will also stimulate your milk production.

Possible problem:
Baby's not draining at least one breast at each feeding, or you're switching breasts too early on in
a feed. The result: Your baby doesn't get the rich, higher-calorie hindmilk that's intended to fill (and fatten) her up, and she doesn't gain enough weight.