Newborn Care

If you have decided to breastfeed, we will do all that we can to make it go as smoothly as possible. While you were in the hospital, you took advantage of the nursing staff that provided instruction and support. We are also available to help you now that you have been discharged. Patience and relaxation are two important qualities needed during the first few weeks. Always start by finding a quiet, comfortable environment in which to breastfeed. It takes time and practice both on the part of the mother and the child to successfully learn the art of breastfeeding.

Breastfed babies must feed 8-12 times per day. At first, allow your baby to feed on the first breast until sucking and swallowing slow or stop. Burp your baby and allow as much time on the second breast as it takes for the baby to avidly feed. Some babies will feed only on one breast per feeding— this is OK. Your baby will benefit from both the fore milk (first few minutes of a feed) and the richer hind milk (the later minutes of a feed). Frequent feedings or “cluster feeds” can also occur in early infancy, so do not be discouraged if there are periods of time when your baby feeds more frequently. Frequent feedings will help stimulate your milk production. The only rules of breastfeeding are that you are comfortable, and your baby is getting enough to eat. It is very rare for a mother not to make enough milk.

Frequently, parents are concerned that their newborn is sleepy and not feeding well in the first few days of life. However, most babies start out this way and go on to successfully breastfeed. All babies lose weight after birth. Weight loss of up to 6-8% of birth weight is not uncommon. This loss is usually made up within the first two weeks of life. Patience and perseverance are a must! Once your milk “comes in” there are a few indicators that your baby is getting enough to eat:

• Your baby is nursing 8-12 times in a 24 hour period and you can hear him/her swallowing. 
• During the baby’s first week, your baby should be urinating the number of diapers that he/she is in days of life. For example, on day of life number 3, he/she should have at least 3 urine diapers.   
• After the first 2-3 days of life, your baby’s stool should change from black meconium stool to a yellow-brown color.  It should remain loose, and often has a “seedy” appearance. 
• Your baby seems content after feeding. 

Please call the office if your baby is not doing the above things or you have other concerns.

Sore nipples can be a problem with nursing mothers. Many women experience temporary soreness that goes away within the first week of nursing. If soreness does not improve, please contact your baby’s clinician for assistance. Sometimes poor positioning can be the cause of sore nipples. Your baby should latch with a wide open mouth and draw the nipple and some of the areola into the mouth. Your baby’s lips should be tilted outward on top and bottom, not tucked in.  Let your nipples thoroughly air dry after feeding. Do not wipe away milk left on the breast after feeding; it acts as a natural moisturizer. In addition, you may apply a small amount of Masse cream, lanolin (if you are not allergic to wool) or vitamin E oil if needed.

Although in some instances breastfeeding may take persistence to become established, it is well worth the investment. Successful breastfeeding has many advantages for you and your infant including decreased illness and decreased risk for asthma and allergies. If you need help, please contact the Exeter Hospital’s Family Center at 603-580-6358 and ask for the lactation consultant.

Storing & Freezing Breast Milk

Express milk by hand or with a breast pump into a clean container. Once the milk is expressed it may be left at room temperature for 6-8 hours. It may be refrigerated for use within 5 days or stored in an insulated cooler with ice packs for 24 hours. You may add chilled fresh breast milk to a previously chilled amount, but never add additional breast milk to a frozen supply as that will cause defrosting and refreezing of some of the milk. Breast milk may be chilled and frozen in containers labeled with the date. Breast milk should be stored in the freezer chest, not the freezer door. Milk may be safely frozen for 3-6 months in a standard freezer or 6-12 months in a chest or upright freezer. Thawed milk should be kept in the refrigerator and used within 24 hours.

There are several well-tested brands of cow’s milk formula marketed at this time. There is usually no difference in the way a baby tolerates these different brands. Formulas are available as ready-to-feed, concentrate, or powder. In rare cases where there is a family history of formula intolerance or allergy, we may advise that you try a soy-based or hydrolyzed formula. To prepare powdered formula, mix one scoop of powder to 2 ounces of warm water to a clean bottle and mix to dissolve.

To prepare the concentrate, pour one-half of the amount of formula you will need into a clean bottle and add an equal amount of warm water (boiling tap water is not necessary). This will give you the correct amount of warm formula.

If you are using ready-to-feed formula, it can be poured into a clean bottle and the chill taken off by warming with a bottle warmer or under hot tap water. Ready-to-feed individual cans may be used at room temperature.

Do not use a microwave to heat a bottle. This is not recommended because the liquid can heat up in pockets and can give burns of the mouth. Excessive heat can also destroy some of the nutrients in the formula or breast milk. Finally, know that it is not necessary to warm bottles.

The average baby will take 1/2—2 ounces per feed initially and increase to 2-4 ounces per feed by one week. Intake may vary by 2 ounces or more per feed. Formula is the only necessary liquid or nutrient that a baby needs for the first 6 months of life and mature babies usually take in 18-30 ounces per day. We recommend that your baby continue with iron-fortified formula by cup or bottle feedings until 1 year of age.

The average infant will do well if burped once during the middle of a feeding and once at the end. The baby will decide when a burp is necessary by stopping if a bubble really bothers him/her.

In general, breastfed babies burp less well than bottle-fed babies since they ingest less air while feeding. Burping for several minutes is usually sufficient.

All babies who are breastfed should be given 400 IU of vitamin D preparation daily starting as early as two weeks of age. Vitamin D is critical for strong bones. Infants on formula need no added vitamins, as necessary vitamins are included.

When your child is 6 months old, discuss whether or not your child needs fluoride supplementation with your provider.

Please note that excessive amounts of vitamins can be harmful to your child.

Until the cord is off and dry, bathing should be accomplished by sponging. Afterward, using a tub is advisable. A new baby may be bathed every 2-7 days with an unscented moisturizing soap that does not contain hexachlorophene. In general, a baby’s bath is just like your own. All skin surfaces you can touch with your hands should be washed with soap and water, including the face. 

Care of the Belly Button/Umbilicus

There may be a discharge from the base of the navel (umbilical cord) before and after the stump falls off. To clean this area, soap and water sponge bathe as needed. As the cord separates (usually between the 7th and 14th day), a small amount of bleeding may occur. This is of no significance and requires no special care other than the above instructions. 

Care of the Genitalia: Boys

If you have chosen circumcision, you need to keep the area clean. Apply a thin layer of Vaseline or OTC antibiotic ointment at each diaper change and cover with clean gauze. It is usually healed by the one-week visit to our office. If your boy was not circumcised, DO NOT attempt to retract the foreskin or use cotton swabs to clean underneath it. Normal bathing maintains cleanliness until the foreskin becomes easily retractable (usually around 5 years of age). 

Care of the Genitalia: Girls

Girls may have vaginal discharge. This can be white or blood-tinged. Do not panic if you see blood.  Bleeding should be mild and may be intermittent. All you need to do is to keep the area clean with water and a soft cloth. The discharge goes away once the mother’s hormones decrease in the baby’s body — usually within 3 weeks. 

After arriving home, many babies will have a soft, seedy stool. In the first two weeks it is good to see at least one stool a day. Some babies have 8-12 stools a day. At about one month of age the baby’s gut matures and babies tend to poop less often; some babies can go days without pooping.

The important factor is not so much the frequency of stools, but rather the consistency. If stools are more than ten per day and watery, or hard, pebble-like and painful, or there is blood in the stool, you should check with us.

Changes in stool consistency and frequency are particularly common from 3-6 weeks of age for both breast and formula fed babies. It often coincides with the infant fussy period.

Most babies have fussy periods during their first few weeks at home. Although it usually peaks at about six weeks of age, fussiness can begin as early as two weeks and last as long as four months.

The infant fussy period can be frightening to parents particularly when a baby has been relatively calm for the first few weeks of life. The fussiness and gassiness are especially noticeable during the late afternoon and early evening.

Motion of some kind, such as in a swing or a car ride, may help. Fussiness is often interpreted as hunger, yet often feeding only helps temporarily. Frequently, the baby gets fussier and is more uncomfortable because he/she is being overfed.

Sometimes a pacifier will help. If the period of fussiness is excessive, please call during office hours so we can discuss it with you.

A fever is any rectal temperature above 100.4°F. Fever is the body’s way of fighting off infection and normally is not dangerous. However, fever in an infant less than three months of age requires an immediate call to us no matter what time of day or night.

For older infants and children, acetaminophen can be used for fever if the child is uncomfortable. Follow dosing charts for acetaminophen (such as Tylenol).  Aspirin is not recommended in the treatment of fevers and childhood illnesses. This is because of the strong association with aspirin use and Reye’s Syndrome. Never use aspirin for a fever or illness.

Ibuprofen (such as Motrin) can be safely used in addition to acetaminophen for most children over six months of age or as directed by your clinician.

Hiccups are very common during the whole first year. They have no significance and there is no treatment required. A burp or a drink of warm water may help, but very often you will find that the hiccups will continue and disappear by themselves.

Spitting and occasional vomiting (more forceful) are also common during this newborn period. These often alarm a new parent but are no cause for concern if the baby is otherwise well. About 80% of babies spit up regularly. A much smaller percentage actually develop acid reflux. Good burping, keeping upright for 20-30 minutes after feeding and avoiding over feeding can help with spitting up symptoms.

Spitting up peaks between 4-6 months of age, therefore, increasing spitting up for the first few months of life is normal.  As long as your baby is not in pain when spitting up, and as long as your baby is feeding normally and gaining weight appropriately, there is no cause for concern. However, if your baby vomits excessively or is in pain with vomiting, please check with our office.

These symptoms occur randomly in the first two weeks. There is nothing a parent needs to do for them.

When a baby gets a cold, the sneezing and cough are more persistent and usually also involve a runny nose and other symptoms associated with upper respiratory infections. We do not recommend use of infant decongestants or over-the-counter cold medications in children under six years of age. Saline nose drops and bulb suction work well for temporary relief of problematic nasal congestion.