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Lewisville pediatric teamDr. Justin Smith's

Newborn University 101

Read articles that address some of the most common questions asked by parents of newborns.

Newborn University 101 is a collection of my writing on the most common medical issues that have been brought to me in my pediatric practice. They will hopefully arm you with good information, so you won't have to worry in the middle of the night.

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Soft spot

There’s a spot on the top of a baby’s head that’s often referred to as the soft spot. Maybe you learned about it the hard way by touching a newborn’s head and hearing a sharp, “Don’t touch the soft spot!” from across the room.

The soft spot on a baby is the area between the different skull bones that aren’t all stuck together, or fused, when a baby is born. The most obvious one is usually the one at the top and front of the skull (called the anterior fontanelle). In many babies, there can be a second opening in the back of the head as well (known as the posterior fontanelle). In some babies, you might see "soft lines" instead of a spot because there can be a gap that runs between the two soft spots.

Soft spots are usually flat and not tense. If the soft spot is sunken in or is bulging out, contact your doctor, so they can check to be sure that everything is alright.

So, is touching the soft spot dangerous?

Well, you don't want to go overboard on it. Check out this video: http://www.johnsonsbaby.com/baby-massage-techniques. Something about the video cracks me up ~ I think it's because it’s so formal. Gently touching or an accidental brush against the soft spot is not going to cause any brain damage, but using caution around it is a good idea. Teaching other kids about your baby’s soft spot is also a good idea.

Penis care: Just another piece of skin

To circumcise or not to circumcise? This is a somewhat complicated question and one that doesn't lend itself well to discussions in print or online. If you have questions about whether you want it done, let's talk about it in person.

Let's say you've decided to have a circumcision done. Now what?

The head of the penis will be quite red, and there will be swelling, especially in a circle just below the head of the penis. The best thing you can do to help everything heal is put a thick layer of petroleum jelly on the head of the penis with each diaper change. The easiest way to do it is to use a tube of petroleum jelly and squeeze it on. This keeps the healing tissue from sticking to the diaper each time you change it. Some methods of circumcision will leave a little plastic ring around the head of the penis, as the foreskin is falling off. Follow the directions of the doctor who did the circumcision, but for the most part, just leave it alone until the ring falls off.

So you elected to skip the circumcision. Now what?

You now have a penis that should be treated like any other piece of skin. You can do a sponge bath and just wash the outside and later you can do a full bath and just clean it like you do a big toe. There's no need to try and retract the foreskin and this should never be done. Usually by school age or sometimes a little later, the skin is retractable and trying to force it causes pain and is unnecessary. Sometimes, you might see little white collections of skin that look like little "pearls." These are normal and nothing to be concerned about.

Explaining your decision to either circumcise or not to other people can be difficult. Ultimately, there is no truly "right" answer to this question. Just rest comfortably knowing that you made the decision that you thought was best for your family. If you chose not to circumcise, it's important to graciously inform other caregivers of your desire to leave the foreskin intact. There is never a need to pull back the foreskin, as boys will eventually do it on their own.

How to take a temperature

What’s a normal temperature for a newborn?

Between 97 and 100 degrees.

The best way to take the temperature, especially with a newborn, is with a rectal thermometer. Yes, that means you have to insert the thermometer into the rectum. This gives you the most accurate temperature.

There is no formula that you can use to get an accurate temperature from an axillary thermometer, so don't try it.

If you measure a temperature above the 97-100 range, call your doctor. A fever in a newborn is considered a medical emergency (or at least urgency).

Weight loss

Sometimes when a new baby comes home, parents will worry about how much the baby is getting to eat, and the baby may lose weight.

Weight loss is normal during the first week of life. Normal weight loss is usually around seven percent of the birth weight, but can be as high as 10 percent. If you're in the seven percent range, I would not recommend that you do or change anything, but I might feel differently. Always give our office a call if you have any questions.

If your baby's weight loss is closer to 10 percent, you might consider supplementing with formula or at least close follow with your doctor to check their weight frequently. Most babies regain their birth weight by two weeks of age.

Scalp/head swelling

There are several different types of swelling that can happen on the baby's scalp after birth. Most of these are simple and not a big concern.

Cephalohematoma

This is swelling that occurs usually on the back and side of the head. This type of swelling will not spread across the middle of the head and occasionally, looks like Mickey Mouse ears. It can be one-sided or on both sides. If it’s on both sides, there will be a separating line in the middle. This swelling will typically go away in 1-2 weeks, but once it’s away, you can see a leftover hard place that is slightly raised from the rest of the skull. This is leftover calcium that can last several months.

Caput

Caput is an area of swelling that is usually thinner, but can spread further across the scalp than a cephalohematoma. This type of swelling will also resolve quickly in 2-3 days and no treatment is required.

When should you worry about scalp swelling?

Look for these signs:

Matted eyes

Are your baby's eyes getting goopy, especially after they've been asleep for a while? What can this be?

There is a small tear duct that drains from the inner corner of the eye to behind the nose. In some babies, this duct is too small and will get clogged up which leads to matting left behind when the tears evaporate. It can occur with either or both eyes. There are generally no other changes to the eyes and the white part of the eye is still white (not red).

Some will recommend that you massage the corner of the eye, but there have been no studies that have proven this an effective treatment and the only benefit may be that it gives the parents something to do. You can wipe the eyes with a warm washcloth, but otherwise leave them alone. Massaging them doesn't seem to do anything, but let you feel like you are doing something.

The majority of blocked tear ducts resolve within the first few months. Most doctors will refer babies to the eye doctor to have them fixed if it lasts longer than a year, but this is very rare.

Burping

"We try and try, but he won't burp."

Oh, the magical burp. It's that often elusive sound that would be offensive for you to let loose at the dinner table, but everyone celebrates when it comes from your newborn.

So, what's the point? Easy, to get some of the air that's trapped in the stomach below the milk…out. Some babies are easy to burp. They can suck down eight ounces of milk in five minutes and you barely get them upright before your hear a big, manly burp. There are other babies who, no matter what you do: pat, bounce, dance or turn them upside down… they are not going to burp.

I actually don't think it matters. I think the biggest benefit of the process of burping is simply that you aren't immediately laying them down flat in their crib right after they feed. Keeping them upright helps the milk settle lower in their stomach and provides some protection from spitting up, but actually obtaining the precious belch is probably not all that important.

Normal stool

So, you have a new baby. That means your automatic, "I worry about poop" button is switched into active mode. It seems that you can't have a new baby and not worry about their stool. Suddenly, it's the main topic of conversation at the dinner table, in bed before you go to sleep at night -- anywhere, anytime is the appropriate time to discuss pooping habits. (Just remember, your child might be discussing your pooping habits and diaper changes around a dinner table in the future.)

So, what is normal poop?

We generally state that babies should be having wet and dirty diapers about six to eight times per day in the first week. However, there can be a lot of variability in this. Babies can poop every time they feed or just once a week and still be normal. You should worry if the baby is having hard stools or has a lot of swelling of their belly.

Normal stool color and consistency also varies. The color can be all over the place.

Also, straining and turning red and pushing with all their strength is normal. They're learning what muscles to push with to get the stool out. Imagine if you didn't know and were just guessing how to poop. It wouldn't go so well.

Dry skin

Is your baby dry and flaky all over?

What can you do? Nothing.

And there's nothing you should try to do. That top layer of skin will fall off. No famous, expensive lotion or oil will stop it, so there's no point in trying.

If you get concerned about particularly dry spots on the baby, a little petroleum jelly won't hurt anything.

Sneezing

All babies sneeze. It doesn't mean that they have allergies or a cold or anything else. It is what it is... all babies sneeze.

The main point is: don't worry about your baby's sneezing.

Hiccups

Hiccups are very common in newborns. Yes, little bitty cute hiccups are normal and big whole-body shaking, scare-themselves-to-death hiccups are normal also.

Hiccups are a contraction of the diaphragm (the muscle that sits just below your lungs). It's thought that a newborn's diaphragm is more sensitive than us old folks and that could be why they have more problems with hiccups than we do.

You cannot stop the hiccups. So, you don't have to get your baby to drink water or scare them or tell them to hold their breath while standing on one foot while singing their ABCs (they don't even know their ABCs, they're just babies).

The hiccups will stop over time. Usually after the first few weeks.

What to register for

There's nothing more fun than walking around the store with a scanner and zapping products that other people will buy for you. Here are three things you need to register for and some tips about each one.

1) Car seat: They won't let you take the baby home without one, so it seems like this should be number one. The pop-in carrier types seem to be pretty handy and are common. Just don't use them as an excuse to turn the baby forward in the car sooner than two years because "They're just too long for their car seat." When your child has outgrown the old one, buy the convertible type that can face forward or backwards.

2) Snot sucking device: Buy whatever type you want. The manual, big blue thingy, the battery-powered, nose vacuum cleaner or the fancy (if you can stomach it) Nosefrida. You should always have your device handy, because you never know when the baby might choke on snot or milk.

3) Crib/bassinet: If you have a really wealthy gift buyer that's going to buy something expensive, the crib/furniture is probably the most expensive thing you'll need. If someone is going to buy a mattress for the crib, be sure to let them know what you are looking for: FIRM. In addition to the crib, also buy a smaller bassinet or crib to put in the room with you. This way, you can have the baby sleeping in the room for those nights when you're waking up several times.

What to leave at the store

1) Sleep positioners: Babies should sleep on a firm mattress on their backs. It's OK to swaddle them until they're rolling over, but they don't need a fancy contraption that sticks up around their sides. They haven't been studied for safety and usually are fluffy which completely contradicts most doctors' advice that they don't need to be sleeping around big, soft cushions.

2) Bumper pads: They look cute in the nursery pictures and it surely makes your bedding set more "complete," but there really is no benefit to having them in the crib and they are potentially a huge risk. The likelihood of your child rolling around and hurting themselves in the crib is low (it's hard for a four-month-old to generate enough momentum to hurt themselves on crib rails).

3) Lavender (or any other scent) body wash or laundry detergent: Your baby will smell good just because they're a baby, and even better, because they're your baby. Lavender won't make them sleep better and any scent in the wash or lotion can make their skin break out (especially if they're sensitive).

Umbilical cord care

For some, it's the "grossest" part about taking care of a new baby. Many would take changing the worst blowout diaper over having to get in the same ZIP code as that crusty belly button. Well, there’s good news for you, just stay away from it. There are still hospitals that recommend that you put alcohol around the cord at each diaper change, but this is unnecessary and just a pain. Leaving it alone doesn't increase the risk for infection and might even lead to it falling off sooner.

Two things you need to do:

  1. Wipe around the cord during your every other day sponge bath.
  2. Fold the top of the diaper down to keep from tugging on the cord and to keep pee off of it.

Two things you don't need to worry about:

  1. A few drops of blood here and there on the diaper or around the cord. If you can't see where it's actively bleeding, it's nothing to worry about.
  2. Yellow tissue and a little goop underneath the cord. If it's not foul-smelling and there's no surrounding redness, it's probably not infected.

Two things you do need to worry about:

  1. Foul-smelling yellow discharge and redness surrounding the belly button.
  2. If the cord doesn't fall off by eight weeks.

Breastfeeding tips

There are many books about breast feeding that offer great information. Read what you can and ask questions to a lactation consultant.

Here are a couple of observations:

  1. Expect the unexpected, even moms who have successfully breastfed five kids before might have a different struggle with number six. You can read all the books about breastfeeding in the whole world and still not be prepared for what happens when you actually try to put a baby to your breast.
  2. Get help. A lot of moms try to breastfeed, many of them successfully. But some moms have trouble. One of the best predictors of success I have seen is mom's willingness to be helped. When you're in the hospital, even if things seem to be going well, have the lactation consultant and the nurse watch a few feedings. They might offer advice even with a successful feed that you can use later on when there is a struggle.

House temperature

"What temperature should we keep the house?"

The question can either come from mom or dad. At the risk of using a stereotype, when mom asks, it usually means, "Dad likes the house really cold, especially at night. Can you give me some evidence to prove that we need to turn the temperature up?" The answer is... sort of.

Make yourself comfortable and then add one extra layer to the baby than what you're wearing. If you're comfortable in shorts and a T-shirt, then a onesie and a light swaddling blanket would be fine.

Laundry detergent

Many people think that baby laundry detergent is a pretty simple find and easy way to go. Many of the detergents advertised for baby actually contain pretty strong scents. It is precisely these scents that can irritate a baby's skin and make them red and dry. In fact, any scent can do this (including Aunt Ruth and her crazy amount of perfume). Because of this, look for a brand that is scent-free.

Babies smell good anyway, don't stress about the way their clothes smell.

Bathing

It’s best to wait until after the cord falls off for a submersion bath.  

Sponge baths are fine for the beginning. Remember to use a low-scent or scent-free soap. Your child isn't doing much exercise, so don't worry about giving a bath every day. Every other or every third day is fine.

When to call the doctor

First off, call you doctor for any questions or concerns you may have. New parents often have questions and doctors, more commonly their nurses, have answers and great practical advice. It'll put you at ease and help you take care of your baby rather than living with anxiety.

Here's a list of things that might require a call to the doctor:

  1. Cough
  2. Jaundice or yellowing of the skin or eyes
  3. Eating less than usual (or not waking up to feed occasionally throughout the day)
  4. Spitting up more often or with each feed
  5. Crying more than usual (remember that hours of crying is normal)
  6. Temperature below 97 or above 100 (if after hours, go to the emergency room)

When to go to the emergency room (overnight)

There are a few things in the newborn period that cannot be managed over the phone. If these things happen in the middle of the night, a visit to the emergency room is in order.

Here are a few of those issues:

  1. Temperature below 97 or above 100
  2. Any breathing problem, such as fast-breathing or difficulty breathing
  3. Extreme tiredness and not waking up to feed
  4. Signs of dehydration, such as a sunken soft spot or no wet diaper for six hours
  5. Seizure
  6. Bloody urine or vomit (little red specks in the diaper are not blood and you can call the doctor about them)

There are other things that could necessitate a visit to the emergency room and if you have any urgent concerns that cannot be addressed by the pediatrician quickly, you should call 911 or go to the emergency room immediately.

 
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