By Sudhakar Rendla, MD
San Juan Health Partners Pediatrics
There is no instruction manual for becoming a parent. However, there are many common questions parents ask. To help parents take care of their newborn babies with more confidence, I’m sharing some routine concerns and my answers. Please don't hesitate to call your doctor when you have questions about your newborn.
Q: My baby is looking yellow, is it normal?
A: Your baby is looking yellow because of a condition called Jaundice. Almost all babies develop Jaundice within the first week. Only 3-6 percent of babies need special treatment to reduce the level of Jaundice. In some cases Jaundice might last as long as 2-3 weeks. Your baby's Jaundice level will be monitored by your doctor during the follow up visits. Call your doctor if you have any concerns about Jaundice in your baby.
Q: What causes Jaundice?
A: The yellow discoloration of the skin and eyes comes from a chemical called Bilirubin. Bilirubin is produced as the end product of red blood cell breakdown.
Q: How much weight can my baby safely lose?
A: Full term babies can lose up to 10 percent of their birth weight. For example, a 6 pound baby can lose up to 9 ounces of weight. Typically babies regain their birth weight by the time they are 10-14 days old. Those babies who lose more weight than usual or are not gaining weight as expected need close monitoring and evaluation for potential underlying causes.
Q: Should I wake my baby to feed?
A: Typically, babies feed every 2-3 hours if they are breastfed and every 3-4 hours if they are formula fed. Babies may need to be awakened if they are sleeping for more than 4 hours. If a baby is not showing interest in feeding as usual, he or she may need to be seen by a pediatrician or in the ER.
Q: Is my baby getting adequate nutrition during each feeding?
A: During the first few days, babies don't need to eat very much. They spend up to 16 hours a day sleeping. It is hard to quantify how much milk breastfed babies are getting; if a baby is sucking for about 10 minutes on each side, sleeping for about 2 hours after every feed, gaining weight as expected and producing adequate amounts of urine then the baby is getting adequate nutrition. In formula fed babies, feeding intake might reach up to 2 ounces every 2-3 hours by the end of the first week. Each baby may be different when it comes to eating. After the first week, milk intake gradually increases, reaching 2-4 ounces every 2-3 hours for the first 2 months and then 4-6 ounces every 3-4 hours from 2 months to 6 months. In the first 6 months, all nutritional requirements for babies are met by either breast milk or formula, no other foods or liquids are recommended.
Q: My baby is having hiccups, is it normal?
A: It is normal for babies to have frequent episodes of hiccups. No intervention is necessary.
Q: I just changed my baby's diaper and it has light red/orange staining, is it worrisome?
A: No, orange or light red staining on newborn baby diapers is normal and it is from a chemical in their urine called uric acid crystals.
Q: My girl baby has thick mucous and bleeding from her private area, should I be worried?
A: Female newborns might have thick mucous discharge and very rarely, slight bleeding from their private areas which is normal and is from the mother's hormones acting on the baby's system. Usually these symptoms resolve within 2-3 weeks after birth. If symptoms persist beyond 3-4 weeks after birth, the baby needs to be evaluated by her doctor.
Q: How much urine is my baby supposed to produce?
A: In the first 4 days, up to 4 wet diapers per day are adequate, but most babies have more. After 4 days, babies typically produce at least 6 wet diapers per day.
Q: I am breastfeeding my baby and my baby is passing stool up to 10 times in a day, is it normal?
A: The first stool is passed usually within 24 hours after birth, but some babies might take up to 48 hours. After the initial stool, they usually pass 1-10 stools per day in the first week. Stools look dark green in color in the first week, then change to yellow soft seedy stools. After the first week, normal stool frequency is one stool in 3 days to 12 stools per day. Breastfed babies have more frequent stools. You can always speak to your doctor if you have any concerns about your baby's stool.
Q: How do I take care of my baby's umbilical cord? When will it come off?
A: There is no need to apply any alcohol or any antiseptic solutions to your baby’s belly button. Keep the cord clean and dry. Keep the diaper folded below the belly button. Usually the cord will separate from belly button in 7-10 days. If the cord does not get separated in 3 weeks or if you see any tissue growth at the center of the belly button with possible discharge, your baby needs to be seen by your doctor. If redness is noted around the belly button, it could be a potential infection and your baby needs to be seen by your doctor right away.
Q: My baby is spitting up, is it normal?
A: Small amounts are normal, but if the baby has frequent and large spittings, he or she needs to be seen by your doctor for possible GE reflux and overfeeding. Burping after every feed helps to decrease spitting.
Q: Is it OK to let my baby sleep on its side?
A: NO. The concern is SIDS (sudden infant death syndrome). All babies should be put to sleep on their backs, ideally for the first year, especially for the first 6 months. Ideal bedding is a flat, firm crib mattress covered with a sheet. Avoid soft materials, sheets and stuffed toys around the baby. Never co-sleep with the baby.
Q: When should I be worried about my baby?
A: If your baby has a rectal temperature of more than 100.4 degrees Fahrenheit or feels unusually cold, breathing fast, irritable, excessively sleepy, refusing feedings or has decreased feeding, not producing adequate amounts of urine, has signs of dehydration, has any changes in color, looks less active than usual or if you have any concerns about your baby’s unusual behavior, you should take the baby to the ER or to your doctor for immediate evaluation and treatment.
These are just a few common questions parents have about their babies, but there are many more. Any time you have questions about your baby’s health, growth and development, please don't hesitate to talk to your doctor and ensure you have received the education and information you need.