If you have a newborn, you may be feeling overwhelmed with all the information you didn’t know you’d need to know. Unfortunately, babies don’t come with an “owner’s manual” or a “user's guide.” But Dr. Abby Werner, a pediatrician with Atrium Health Levine Children's Charlotte Pediatrics, is no stranger to newborns – or their first-time caregivers.
“Skin flakes over the first few weeks, red spots come and go and weird noises may be heard from various locations,” says Werner. “It’s understandable to be concerned, but this is all normal baby behavior.”
To help put your mind at ease, Werner shares answers to some common concerns about your newest addition.
Feeding
If your baby spits up right after finishing a bottle, you may worry that they’re not getting enough to eat. But Werner says this is the messy, but normal, reality of feeding infants.
“A baby's stomach is only as big as their tiny fist, so they can only fit so much milk in at a time,” Werner says. “Their stomach slowly expands over the first several weeks of life.”
To make things more complicated, the muscle at the top of a baby’s stomach is loose, so it is easier for liquid to overflow back up – meaning it may seem like more is coming up than going down.
In general, Werner says, newborns need to eat every 2-3 hours. This ensures they get enough nutrients in their system over the course of the day to grow.
Babies also tend to swallow air when eating, which is why some find it helpful to be burped. . Some milk may come up with the burp as well. It can be annoying to go through several burp clothes and outfit changes throughout the day (for baby and for you!). But Werner says spitting up isn't typically a reason to be concerned. Reach out to your baby’s pediatrician if the spit up is dark green or bloody, if the baby looks uncomfortable during actual feeds, or if the spit up is projectile.
The best way to gauge that your infant is getting enough milk throughout the day is by their growth and their output. "An easy way to keep track is by the number of wet diapers per the number of days old they are (one diaper in the first 24 hours of life, two on the second day, etc.) up through day six,” says Werner. “After that, as long as they make at least six wet diapers every 24 hours, you can feel confident they are getting enough to grow.”
Many families start out the parenting journey hoping to exclusively breastfeed. This is a wonderful goal, but it doesn’t always work out. Dr. Werner explains that breast milk has all the nutrients an infant needs, and contact with a mother's skin offers benefits from microbial transfer and bonding. However, breastfeeding and/or pumping may not work for all families.
“Breastfeeding is wonderful if it works for you. But formula is also a great option,” Werner says.
Adequate infant-mother bonding can happen naturally with skin-to-skin contact at other times, including bottle feedings. Plus, with formula and bottle feedings, fathers and other caregivers can share in the joy of feeding the baby.
“Having a newborn can be stressful enough. If breastfeeding becomes its own source of anxiety, babies can pick up on the tension,” Werner says. “It is most important to go with what works best for you and your baby. We support you however you choose to provide for your family.”
Sleeping
It may seem natural to assume if a baby goes to bed later, they will sleep later. But Werner explains infants can become overtired and have even more difficulty falling asleep if they are awake for too long.
“Routines are important for babies,” Werner says. “It is best to pay attention to their wake windows and support them in developing healthy sleep routines as they show signs of sleepiness. They will typically wake around similar times regardless of when they go down due to internal hormonal cues such as hunger, or external cues.”
While some “sleep regressions” (a period of time when a baby’s sleep patterns seemingly shift or they sleep poorly) are due to major developmental milestones, Werner explains that several factors can also influence sleep patterns in infants and toddlers.
“Some sleep regressions are recognized patterns, such as the 4-month sleep regression where the brain is transitioning away from neonatal sleep cycles,” Werner says. “But teething, growth spurts, sickness and nightmares can also cause some rough nights along the way.”
Werner says it is easier to get back on track if there is a solid schedule foundation.
“You can address these challenges in various ways, and sometimes different approaches work better than others in different situations. But ultimately it is important to establish routines so babies learn what to expect,” Werner says. “This also helps set them up for success to learn to comfort themselves when they wake up overnight.”
Meaning: you can hopefully get a little more shut-eye as baby learns and adapts to the schedule you set.
If you’re concerned that giving your baby a pacifier will disrupt their ability to breastfeed or sleep through the night, you’re not alone. This is another common question Werner hears, but there is no reason to be concerned.
“Most babies don't have any confusion between a nipple and a pacifier, and the sucking reflex can be calming to infants,” Werner says. “This is very much a personal choice. Some babies aren't interested. For those who love it, they are looking for something soothing for comfort.”
Infants may want to use their mother as a pacifier, but this can cause a lot of stress, negatively impact feeding schedules and add to maternal exhaustion. Pacifiers can help soothe the baby and give the mother a break.
Breathing
A baby’s breathing can be especially concerning for new parents. The bottom line, Werner says, is that babies do weird things when they breathe. Periodic breathing – when they do several fast breaths in a row then hold their breath for a few seconds, can be especially nervewracking but is completely normal. Werner says this is very common and not dangerous. Additionally, babies only know how to breathe through their nose (a reflex that allows them to breathe and eat at the same time). Sometimes milk or snot gets caught in the back of their throat and upper airway, so they make all sorts of sounds. It sounds like they are congested, but it also is not dangerous.
“As long as they are breathing comfortably, albeit a little noisy, they are perfectly safe,” Werner says.
Development
In the first few weeks, it seems like all babies do is eat, sleep and poop. While this can feel monotonous from the outside, it may help to know that babies are seeing, smelling, hearing and making neural connections at the highest rates of their life.
Werner says having basic needs met (food when hungry, clean diapers when dirty, warmth and stability) lays the groundwork for more complex associations as they grow.
“They're subconsciously learning about their environment at every moment. In a few short months they'll start reflecting back,” Werner says. “That first social smile is such a bright spot for parents to enjoy some reciprocity, but truly the infant has been taking in their world from the moment they arrived, and before.”
Lingering Questions
We know parents of newborns have an ever-growing list of questions. No question is a dumb question for our Atrium Health Levine Children’s pediatricians. Rest assured, we are here to help your child get the compassionate care they deserve even before birth.
For a deeper look into these topics and more, download a free copy of Atrium Health’s trimester-by-trimester guide to pregnancy and newborn care.
Whether you’re expecting your first child, a new parent or new to town, picking a pediatrician is one of the first decisions you’ll make for your child’s well-being. By scheduling a tour, you can check out one of our pediatric primary care offices, meet the team and see if they're the best fit for your family.
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