newborns, miscellaneous tips

Babies tend to breathe with an irregular pattern of fairly rapid shallow breaths, followed by several seconds of no visible respiration. This is referred to as periodic breathing. It is normal, and does not signify true apnea. It is caused by an immature breathing regulation center in the newborn's brain. This phenomenon specifically does not involve any color change - the baby stays pink. Touching your baby gently will stimulate him to breathe again, but this is not necessary.

Sneezing is normal and expected in newborns. Dry, possibly dust-laden air is irritating to the newborn nasal membranes for the first few weeks. Don't sweat it. (But of course, don't do anything stupid, like smoke in the house.)

Nasal stuffiness is caused largely by the same factors that cause sneezing,with an added twist: the soft palate - the flap of tissue at the back of the roof of the mouth, from which hangs the uvula - is supposed to seal off the rear of the nasal passages during swallowing or vomiting (spitting up). This system doesn't work so well in newborns. There is considerable leakage and regurgitation of milk into the nasal passages from the rear, causing stuffiness and some difficulty breathing.

This is most evident during feedings, and may be enough obstruction to cause the baby to need to come up for air many times during the feeding. Needless to say, babies are generally unhappy with this. A few drops of saline in each nostril, followed by good suctioning, gives temporary relief. Do this before feedings and before naptime.

Why do babies exhibit such impressive peeling after birth? "You would too, if you swam around for 9 months." Actually, the amount of peeling of a newborn's skin is related to how mature the baby is when born. Preterm babies peel very little, term babies peel quite a bit, and post-term babies may shed the skin in large flakes, especially the skin of the palms and soles.

Babies usually develop quite runny bowel movements two or three days after birth. These loose watery stools in newborns are caused by the fact that when they are born, babies' intestinal lining lacks adequate amounts of the enzyme lactase to digest the sugar of breast or cow milk - lactose. Undigested lactose in the colon causes water to be retained in the stool, producing the characteristic watery consistency. After a few days, the levels of lactase rise in the small bowel, and this phenomenon gets better.

Breast fed babies also get colostrum for the first few days, which has a laxative effect.

Older breast fed babies have loose stools for a different reason - breast milk is such a low residue diet (it is almost all used by the baby) that there is little solid waste material left over to form a stool.

Newborns have hiccups quite often. No one knows with absolute certainty why this is, but hiccups are caused by reflex stimulation of the vagus nerve to the diaphragm. We assume the frequency of hiccups in newborns is a feature of their neurologic immaturity. Hiccups are harmless, do not bother the baby in the least, and go away in a few weeks.

Why do babies cry when laid down in the bassinet? Although often interpreted by the mother as "He doesn't like his crib," actually the reason babies cry shortly after they are laid in the crib is that they are allowed to fall into REM (dream) sleep in their mothers' arms. This reinforces rocking or nursing to sleep, which leads to the predictable problems of poor napping and erratic daytime schedules, and night waking and crying at around 8 months - leading their mothers in desperation to my most excellent video.

Umbilical cords separate in two to three weeks on average. People who don"t see newborns for the two-week checkup may not realise this and tell you differently. They are wrong.

Care of the umbilical cord is one of the topics about which doctors disagree. I have done all the different methods over the years in my practice, following local custom (i.e., whatever the nursery nurses were used to). I have also never had a serious cord infection in several thousand babies. In truth, the only reason to worry about the cord is that modern babies wear diapers with plastic liners that predispose urine-soaking of the cord. That moisture allows germ growth.

The alcohol cleansing business is quite popular. "Clean the cord 3, 4, or X-times daily with rubbing alcohol to prevent infection." Frankly, I rarely to met a parent who did this properly - cleaning down inside the umbilical stump under the cord - because it is SO ICKY!

The leave it alone approach is the one I use now. Believe it or not, nature seems to have this one pretty well figured out. I tell my parents to just call if the skin around the cord looks red or there is smelly drainage. Keeping the diaper bent down and preventing urine soaking of the cord works quite well. Back sleeping with better drying is also an advatage.

Icky, oozing umbilical stumps that don't dry up in a week after cord separation are umbilical granulomas and need to have brief attention from your pediatrician.

Skin color is expected to be a little yellow for the first one to two weeks, depending on whether your baby is breast or bottle fed. Breast fed babies clear the normal, natural jaundice of all newborns a little slower than bottle feeders on average, but this means nothing. Your doctor will tell you if he or she is concerned about significant jaundice before you go home and may have other instructions or guidelines for you. But in general, if you only notice a slight yellow color of the face, and the body and extremities look pink, don't be concerned.

Eye color is as light as it is going to be at birth, and will probably darken a little to a lot with time. So if your newborn has brown eyes - he has brown eyes. If his eyes are blue, they may remain blue or turn a darker shade with time.

Birth marks are common in babies - all babies have them without exception. White babies all* have the stork bite birth mark on the face and the nape of the neck. Dark complected babies commonly have the mongolian spot at the base of the spine. Other birthmarks are much less common right at the time of birth, but hemangiomas (strawberry birthmark) often develop soon after birth.

*At least I can't remember one that didn't.

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