The Neonatal Intensive Care Units (NICUs) at Riley Hospital for Children and IU Health Methodist Hospital are putting visitor restrictions in place starting Monday, Nov. 18th. Only visits by parents plus four designated adults identified by the parents will be allowed on the NICU floor.
Siblings and children under 18 will not be permitted. These restrictions minimize risk of infection to patients already at risk and will be in place through spring 2020.
Having a new baby brings a lot of excitement and with that, a lot to learn! Shortly after birth, you will come to realize you know your baby better than anyone else.
A full-term baby born after nine months (38-42 weeks) of pregnancy generally:
Brain Fact: Babies are born with 100 billion nerve cells – almost all of the nerve cells the brain will ever have. Before birth, nerve cells are formed at a rate of 250,000 cells per minute.
Many parents begin to bond with their baby before he or she is born. After your baby’s birth, these feelings deepen and grow as you get to know your baby and understand his or her needs. This bond between you, called attachment, provides the essential building blocks for a lifetime of healthy relationships.
Responding to crying does not spoil babies. Until the age of 3 or 4 months most babies lack self-soothing skills. Crying is their nonverbal way of asking for help. By always responding to your baby’s cry for help, you make your baby feel secure and help your child develop a sense of trust, the two most important gifts you can give your baby.
Brain Fact: Your baby’s early experiences are so important that they change the structure of his or her brain and will have a lifelong effect on his or her emotional make-up, as well as their ability to learn.
Your baby’s teeth begin to form during the third month of pregnancy. The tooth buds, which will develop into the 20 “baby” or primary teeth, form first. Next, the permanent teeth begin to form, and the primary teeth begin to calcify. This process continues throughout the nine months of pregnancy. When your baby is born, these primary teeth remain beneath the gums. Tooth eruption for most babies begins around 4 months, though for some children occurs as late as 15 months.
The five senses – sight, smell, taste, hearing, and touch – are mostly developed at birth. Your baby begins using his or her senses immediately to make sense of what is going on in the world.
Sight: Although newborns have blurry vision, they can focus fairly well on objects at about 8 to 14 inches – the distance from your baby’s face to your face when you are holding your baby in your arms.
Smell: Newborns have a very well-developed sense of smell. In the first days of life, a newborn can recognize his or her mother’s natural scent and prefers it over anything else.
Taste: Newborns prefer sweet tastes. Nursing infants sometimes refuse to nurse when they taste garlic or heavy spices in mom’s breast milk.
Hearing: A baby’s hearing is developed inside the womb. At birth, they can recognize their mother’s voice.
Touch: Gentle touch stimulates your baby’s physical development while relieving stress. Fussy babies are sometimes calmed by a “baby massage” – some baby lotion warmed in your hands and gently applied to baby’s arms, legs and back.
Brain Fact: Thanks to new imaging technology, scientists are actually able to watch the brain at work. Research confirms that the most active areas in the newborn’s brain are the areas concerned with sight, smell, taste, sound, and touch.
These areas “register” the world as the baby senses it. Then the signals are sent on to memory or emotion. In this way, the newborn connects the sight and smell of mom and dad with the pleasant memory of comfort and gentle handling.
Immediately after birth, your infant will be warmed, dried and assessed at the bedside. If you are planning on breastfeeding, this is the best time to begin, as your baby will be rather alert for the first hour after birth followed by a rather sleepy period for the next 36 to 48 hours.
Your baby will be placed under a warmer, thoroughly examined, weighed, measured and foot printed. An antibiotic ointment will be placed in the eyes to prevent infection, and an injection of Vitamin K will be given to prevent bleeding. Blood glucose may be measured and your baby’s blood type may be determined from the umbilical cord blood. The Hepatitis B vaccine is recommended for all infants at birth, consistent with the recommendations of the American Academy of Pediatrics.
Once the baby can maintain a stable temperature, he or she will be given a bath. We encourage you to have your baby “room in” with you as much as possible in the hospital. If you are breastfeeding, please request that your newborn not be given bottle feedings for the first 2 to 3 weeks of life, unless directed by your pediatrician. The usual length of stay for a mom and baby is two days for a vaginal delivery and 2 to 3 days for a cesarean section.
If you have a male infant, you may choose to have him circumcised. In most cases, your obstetrician or pediatric hospitalist will do this procedure before you leave the hospital. According to the American Academy of Pediatrics, the benefits of newborn male circumcision outweigh the risks, but the benefits are not significant enough to recommend circumcision for all newborns. Specific benefits include the reduced risks of urinary tract infections, penile cancer, and the transmission of some sexually transmitted infections such as human immunodeficiency virus (HIV). The American Academy of Pediatrics recommends that infants receive local anesthesia (pain control) prior to circumcision.
Some women naturally carry bacteria known as Group B Streptococcus in the birth canal. This organism usually causes no harm to the mother, but it can cause a significant infection in the newborn that has passed through the birth canal. Your obstetrician will check for this organism around the 35th to 37th week of your pregnancy, and if it is present, antibiotics will be administered to you during labor. This practice has significantly decreased the number of serious infections in newborns. We closely monitor babies whose mothers are colonized with this bacterium for a full 48 hours. We may need to do some blood screening work on the baby if labor ensues too quickly and the antibiotics are not even at least four hours prior to delivery.
Your baby will receive a hearing test prior to discharge. A state mandated “Newborn Screen” blood test will also be completed prior to discharge. This test is most reliable after the infant has fed for 48 hours. The newborn screen tests for over 30 different serious illnesses that children can be born with. The results are sent to your baby’s physician. Be sure to ask about these results at the baby’s one-month check-up, especially if your doctor did not see your baby in the hospital.
There are a variety of supplies you will need once your baby is born. Some of these supplies include a digital thermometer, car seat, bulb syringe, saline drops, cool mist humidifier, smoke alarm, carbon monoxide detector, breastfeeding supplies, formula and other medication. Learn more details about each of these necessary supplies.
To protect your baby, be sure everyone caring for your baby follows this rule:
Use a rear-facing infant safety seat that is properly installed in the back seat every time your baby rides in a car.
To protect your baby, be sure everyone caring for your baby knows and follows these rules:
To protect your baby, be sure everyone caring for your baby knows and follows this rule: Never, never shake a baby!
Your baby must never be handled roughly. Sudden, jerking motions such as shaking cause violent back-and-forth movement of the baby’s head – and the brain inside the skull. Bleeding into the brain from torn blood vessels or swelling of the tissue itself, can result in tragic outcomes such as seizures, blindness, deafness, and even death.
Babies must be handled gently to prevent physical and emotional harm. Although every part of your baby’s body is fragile, your newborn’s relatively large head and weak neck muscles require extra special handling. Head support is a MUST while your baby’s neck muscles are growing strong enough to hold his or her head up without support.
During the first hour after delivery, your baby will go through a period of alertness. Then, your baby may sleep a lot for the next one to two days as he or she adjusts to living outside of the uterus. He or she may cough, sneeze, cry and have occasional jerking motions of the arms, legs or chin for the first few months. You will notice that your baby likes to be held by you, cuddled, talked to softly, walked or rocked. It is normal for a newborn to sleep between 16 to 20 hours each day.
It is common for newborn babies to have an irregular breathing pattern. This will vary from shallow, fast breathing to deep breathing to not even taking breaths at all for a few seconds. Babies commonly cough and sneeze to clear mucus out of their noses and throats. Small amounts of mucus or milk in the baby’s upper airway often cause breathing to sound congested. This is all normal. If you have concerns, please call your pediatrician.
All babies cry. Crying is a part of normal healthy development. Sometimes it is a baby’s way of telling you he or she is wet, cold, tired, hungry or wants to be held. As babies become more alert, they are more sensitive to noises, lights and even to their own digestive sensations. They tend to cry more between two and six weeks of age, often up to three hours per day. Thereafter, babies learn to tune out excessive sensory input and the amount of crying decreases.
Generally babies have a “fussy time” during the day when they cry. For most babies this is in the evening. This may develop into colic, a condition defined by the American Academy of Family Physicians as “unexplained crying in excess of three hours per day, in the first three months of life, three or more days per week for three consecutive weeks in otherwise healthy, well-fed infants.” Colic usually begins after two to four weeks of life and ends by four months of age. There is no cure for colic. If you feel your baby’s crying is excessive, it is best to make an appointment with your pediatrician to ensure your baby is healthy and to discuss ways to manage colic. When your baby is fussy, check to make sure he or she is not wet, hot, hungry or pinched anywhere by clothing (especially the toes and fingers.) Soothe him or her for a while and then simply let your baby cry, checking on him or her every 15 minutes or so. Call your doctor if your baby cries inconsolably for over two hours. Even though some babies may fuss this long, they are usually content for at least a few minutes during this time.
Swallowing air, especially during fussy periods can cause babies to have gas. Babies will draw their legs up and cry as if in pain. These occurrences are normal and tend to be the worst between two and six weeks of age and begin to improve thereafter. Simethicone gas drops may provide some relief. Be sure to discuss with your baby’s provider before trying these gas drops. For bottle-fed babies, sometimes changing to a Playtex, Evenflo, or Dr. Brown’s bottle can help. Changing formula usually only helps if the baby is fussy 30 to 60 minutes after most feedings. Please talk with your pediatrician before changing formulas. After a change in formula, it may take the infant up to one week to adjust.
A newborn has delicate and soft skin. Commonly the skin becomes dry and then peels, especially on the hands and feet. Hands and feet may also seem blue compared to the rest of the body, which is normal. Other normal skin findings may include:
As the baby comes through the birth canal, the head is compressed which causes “molding.” This is a process that allows the bones of the skull to overlap so the baby can get through the birth canal. Due to this, your baby’s head may appear pointed or misshapen. This should resolve over the first week of life. Some babies even have bruising of the scalp, which is a normal part of childbirth. Your baby will have a large soft spot in the center of his or her head which will close by 18 months of age. He or she will also have a smaller soft spot on the back of their head which will close sooner. You should notify your child’s doctor immediately if you notice your baby’s soft spot is bulging or hard.
If your baby has recurrent drainage from his or her eyes after you go home, this is most likely due to a temporarily blocked tear duct. To help ease this, massage from the inner corner of the eye with a warm wet washcloth in a downward fashion. If drainage is persistent or redness occurs in or around the eye, please inform your pediatrician. When a baby first starts to look around, he or she cannot focus well on objects, so you may notice his or her eyes crossing. Intermittent eye crossing is normal until 4 to 6 months of age.
Babies’ noses commonly become congested with mucus. Use a bulb syringe to help clear the mucus. To use a bulb syringe: 1. Squeeze the bulb before placing the tip in the nostril with your thumb in the center in a downward motion (do not pinch). 2. Slowly release the bulb and let the suction draw out the mucus. 3. Remove any mucus from the bulb using a tissue. 4. Repeat process for other nostril, if necessary. 5. Limit bulb syringe use to four times a day to avoid irritating the lining of the nose. Saline drops or Ocean Saline Nasal Spray® may be put in the nose to loosen secretions prior to suctioning. If your baby has a cold, it may sound as if your baby’s chest is congested and you may feel “rattling” in the chest when you put your hand on your baby’s back. As long as your baby is feeding well, not coughing much and not running a temperature, there is no cause for concern. If your baby has excessive symptoms or if the “congestion” does not clear after a few days, call your pediatrician.
Clean only the outer portion of the ear. Do not use cotton swabs to clean the ear canal. It is normal to have some earwax in the canal since the ears are continually cleaning themselves. It is a myth that cold air or water in the ear causes middle ear infections. Ear infections are uncommon during the first few months of life.
Many babies’ nipples get swollen and feel like they have a lump underneath. Sometimes milk may leak out. This occurs because of the mother’s hormones and will disappear.
The umbilical cord will usually fall off during the first to third week of life. There may be some bleeding when this occurs. This is normal. Routine cleaning of the umbilical cord with alcohol is not necessary.
If the tummy or cord looks red or infected, please call your pediatrician. Give sponge baths only until the cord falls off and is healed completely. Also, fold the diaper down to prevent irritation.
This area may be swollen at birth. Girls may have a white or bloody discharge from the vagina for the first one to two weeks. Always wipe female infants from front to back in order to reduce the risk of urinary tract infections.
Boys, if circumcised, may require a small amount of Vaseline applied to the penis to keep it from sticking to the diaper for the first few days of life. If uncircumcised, simply clean the penis with soap and water. You do not need to retract the foreskin for cleaning in an uncircumcised male since it normally cannot be pulled down until after three years of age.
Sometimes, you may observe a “pink stain” in the diaper that looks like blood. The color is due to urate crystals, a normal finding in newborn urine. Be sure to discuss any concerns of blood in the urine with your baby’s doctor.
Your newborn will sleep 16 to 20 hours per day, perhaps even more during the first two days of life. Always place your baby on his or her back to sleep, with nothing else in the crib. This will decrease the incidence of Sudden Infant Death Syndrome (SIDS). It is best for your baby to sleep in his or her own crib or bassinet without fluffy pillows, blankets, sheepskin or bumper pads. Consider putting your baby in a Sleep Sack if he or she sleeps better while swaddled. The newest SIDS prevention recommendations also state that your baby should sleep near the parents, but not in the same bed. Pacifier use while sleeping, after one month of age, has also been shown to decrease the risk of SIDS.
Typically your newborn will be most comfortable if you dress him or her as you are dressed plus one extra layer. Washing the baby’s clothes with a hypoallergenic detergent such as All Free Clear®, Dreft® or Tide Free and Gentle®, as well as avoiding fabric softeners is advised, but many babies tolerate regular laundry detergent and fabric softeners without problems.
The room temperature should be comfortable, usually around 68 to 72° F.
It is generally easier for you and your baby if the bathing occurs in a plastic tub or the sink. Set the hot water heater temperature at no more than 120° F to prevent burns. Use baby soap or Dove soap for sensitive skin on your baby’s body. Wash your baby’s face with clear water. Have all of your supplies ready before you begin and test the water to make sure it is not too hot. Never leave your baby or child alone in the water even for a second. Do not put your baby in bath water until the umbilical cord has fallen off and healed. Your baby will only need a bath two to three times each week.
You can choose to use either disposable or cloth diapers. Regardless of your preference, diaper rash may occur. To prevent diaper rash, wash the baby’s bottom with clear water and allow it to dry completely before diapering. Use Desitin®, Aquaphor®, A&D Ointment®, Vaseline, plain zinc oxide or other diaper rash medications at the first sign of redness. Should a rash occur, change the baby as soon as he or she wets their diaper and leave the diaper area open to air as much as possible. If the rash gets worse, or does not improve after three to four days despite these measures, call your child’s pediatrician.
Newborn basic activities are sleeping and feeding. Feeding is one of the most pleasurable things they can do. Whether breast- or bottle feeding, this should be a time when the infant is held closely and loved. It can be a rewarding experience for both the parents and the baby. Your baby should eat small amounts often, every 2-3 hours, in the first few months of life. Your baby may need to eat more frequently if he or she is having difficulty gaining weight.
All babies are different. It is normal for some babies to have a bowel movement with every feeding and others to have one every two to three days. It is also normal for them to turn red and strain. Unless the stools become hard and pellet-like do not be concerned, especially if the baby is feeding well and not fussy. Breastfed babies commonly have very loose stools.
You can tell that your baby is getting enough to eat by the number of wet diapers and stools he or she produces. After the third to fourth day of life, your baby should have a minimum of four to six wet diapers and three to four stools during a 24-hour period. He or she will also be content and sleep for two to three hours at a time.
Meconium, the blackish, green stools that your baby has after birth, should begin to disappear by the fourth or fifth day of life. Then you will see yellow, sometimes runny, seedy stools.
Breast milk is the ideal food for infants. In fact, the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life, and then combining it with solid food from 6 to 12 months of age. Successful breastfeeding begins with knowledge and information about breastfeeding. Begin breastfeeding as soon as possible after your baby is born; start in the delivery room if you can.
Human milk has many advantages. It decreases the frequency and severity of a wide range of diseases, such as bacterial meningitis, severe bloodstream infections, diarrhea, colds, ear infections, pneumonia and urinary tract infections. It has also been shown to decrease the rate of SIDS during the first year of life. In addition, it leads to health benefits later in life by decreasing the likelihood of diabetes, obesity, asthma, high cholesterol, lymphoma and leukemia. Breastfeeding is convenient and economical; however, to be successful it requires a strong commitment from the mother and support from the family.
If you have questions about whether or not to breastfeed please talk to your pediatrician or a lactation consultant.
Breastfeeding will cause cramping of the uterus, which will help it return to its pre-pregnancy size.
For the first few days you will produce a clear fluid called colostrum. This is rich in calories and contains proteins and antibodies for the baby. Do not supplement with formula or water. Nurse your baby from both breasts at every feeding. Begin with 5 to 10 minutes on each side or for as long as the baby desires during the first three to four days of life. Feed “on demand” (when the baby is hungry) for the first three to four weeks. This may be as frequent as every 1 ½ to 3 hours, but it will help to build and establish your milk supply.
A breastfed infant needs to eat 8 to 12 times within a 24-hour period after the second to third day of life. Remember that the mother should drink plenty of fluids (six to eight ounces) with every feeding. Take your prenatal vitamins with iron regularly as your baby is totally dependent on you for his or her nutrition. After the rest of your milk supply comes in, usually between two and five days of life, you should nurse 10 to 15 minutes on each side. You may find it necessary to wake your baby up during the day for feedings and stimulate him or her during feedings by undressing and providing skin-to-skin contact, as he or she may want to fall asleep soon after latching on.
It is completely normal for your baby to lose weight during the first week of life. Do not be alarmed. Your baby should regain any lost weight by his or her two week well child visit. Some breastfeeding mothers find it useful to keep a log of the number of feedings, wet diapers and stools.
Do not discontinue breastfeeding for a mild illness. If you have a cold, your baby will still benefit from receiving breast milk. Please call your baby’s doctor if you have any questions regarding the safety of breastfeeding while taking a certain medication.
Lactation consultants are available to assist you during and after your hospital stay. If you plan on returning to work and wish to continue breastfeeding, or if you wish to have breast milk available for bottle feedings on more than just an occasional basis, you may consider buying or renting a breast pump.
If you are unable to breastfeed or choose not to breastfeed your baby, iron-fortified formula is the recommended substitute for breast milk for feeding your full-term baby during the first year of life. This is also a very rewarding experience for you and your baby. By two weeks of age, most babies are taking 1½ to 3 ounces of formula every three to four hours. Feed on demand. As your baby grows, the amount of formula taken at each feeding will increase and the number of feedings each day may gradually decrease.
Never heat your baby’s bottle in the microwave. The formula may heat unevenly and could burn your baby’s mouth and throat. Never prop the bottle; this can cause the baby to choke and get formula in his or her lungs.
The following table shows the average amounts of formula most full term babies consume at their respective ages:
|Ages||Ounces Per Day||Ounces Per Feeding|
Most babies hiccup from time to time. Usually this bothers parents more than the infant. If your baby hiccups during a feeding, change his or her position and try to get him or her to burp, or help him or her relax.
• Make sure you are not over-feeding your baby. Sometimes they are comforted by sucking and are not really hungry.
• Burp your baby frequently (after ½ to 1 ounce).
If your baby is spitting up frequently, keep his or her head elevated for 30 to 45 minutes after a feeding. As long as your baby is gaining weight and not fussy during the feeding, the spitting up is typically normal. If you have any concerns, please call your pediatrician, especially before changing your baby’s formula.
Just as you have received regular obstetric checkups to ensure the health of your pregnancy, continued preventative health visits for your baby are recommended after birth. At these visits, your child’s growth and development will be assessed. Information on diet, development and safety will be provided. Immunizations and lab tests will be completed.
Immunizations are very important and it is strongly recommend that you have your child immunized fully and on time. Routine childhood immunizations have significantly reduced serious illness and even death in children. New vaccines must undergo three stages of rigorous testing to ensure safety and effectiveness. Before vaccines are incorporated into the Routine Childhood Immunization Schedule, panels of experts who specialize in vaccines and infectious diseases must approve their use. After vaccines are recommended, there are several organizations that monitor the safety of these vaccines. There is a lot of conflicting and controversial information available on vaccines, and you should discuss any concerns that you may have about having your child vaccinated with your doctor. Vaccines are safe, effective, and have never been proven to cause autism or any other developmental disorder. None of the routine vaccines contain thimerosal or mercury.
After kindergarten, we recommend a checkup at least every other year until adolescence and then yearly checkups are required, especially if your child is participating in interscholastic sports or has an underlying medical condition.
In the first two months of life, babies do not fight infections as well. To prevent infection, you should keep your baby away from people with colds, the flu or other contagious illnesses. This could mean not taking your newborn out of the house as much as you would like, especially during the first four to eight weeks of life. Good hand washing will help prevent infection as well as breastfeeding, delaying child care attendance for as long as possible and keeping your baby away from tobacco smoke.
A fever is a very common symptom of illness in children. However, a fever in a newborn can also be an emergency. A fever indicates illness, but the magnitude of the illness does not always correspond to the degree of the fever. For some infections, which cause a fever, an antibiotic is helpful. For colds and flu, an antibiotic is not useful and may even be harmful. Only by examination in the office can we tell what is causing your child’s fever and whether an antibiotic would be helpful. We cannot prescribe antibiotics over the phone because we are unable to identify what we are treating. Please be sure to take your child’s temperature with a thermometer before calling. For fevers over 100.4° F (rectally), your child should be seen immediately until over two months of age.
All children catch colds. You can expect to see five to seven colds per year, which can last an average of 10 to 14 days. Because viruses cause colds, there is no cure. The treatment goal is to make breathing easier by keeping the nose clear of mucus.
Mucus can be cleaned from the nose using your bulb syringe. This should be done before feedings and at bedtime. If the mucus seems thick or your baby is very congested, saline nose drops may be helpful. You can buy these at the pharmacy or make them at home by mixing 1⁄4 teaspoon of salt with one cup boiled and cooled water. Place two to three drops in each nostril. Placing a cool mist humidifier in the baby’s room can also be beneficial.
Do not use over-the-counter cold and cough medicines. We do not want to suppress the baby’s cough because it is the natural way for him or her to clear the mucus from his or her lungs. Please call your pediatrician’s office if your baby has a constant cough and any of the following conditions:
• Is not improving after 10 days
• Is younger than two months and develops a temperature greater than 100.4° F
• Is two months or older and develops a temperature greater than 101° F
Please call us immediately if your newborn shows any of these symptoms: