Common Concerns About Newborns

Newborn Jaundice

A yellow tint to the baby’s skin and in the whites of the eyes, called jaundice, is caused by large amounts of bilirubin in the blood. (Bilirubin forms normally as red blood cells break down.) Because a newborn’s liver is immature, he is less able to handle the bilirubin in a normal way until he is a week or two old. Mild jaundice (sometimes called “physiological jaundice”) is considered harmless and occurs in about 50 percent of full-term and 80 percent of premature babies. It is the most common type of jaundice in newborns. It usually appears on the second or third day after birth, peaks, and then goes away, disappearing before the end of the second week.

Jaundice can also be the result of certain blood incompatibilities, such as when the mother is Rh negative and her baby is Rh positive, or when certain differences in the mother’s and baby’s blood types exist, (referred to as an ABO incompatibility). Jaundice is sometimes associated with infection, significant bruising of the baby during birth, or certain drugs taken by the mother during labor (for example Pitocin, some sulfa drugs, and Valium).

Very rarely, jaundice occurs with breast-feeding. With “breast milk” jaundice, the bilirubin levels begin to rise after the third day of age and usually peak between the seventh to tenth day. Diagnosis is made by ruling out all other possible causes. (see Breast Milk Jaundice for more information.) You may be the first to notice jaundice in your baby. If so, notify your baby’s doctor or nurse.

If significant jaundice occurs, your doctor will order a test of the baby’s blood, obtained by a heel stick, to measure the blood’s bilirubin level and look for other causes such as infection. If the bilirubin level is high, the baby may be treated with phototherapy (light therapy) or in severe cases, with an exchange transfusion, in which all the baby’s blood is removed and replaced with intact red blood cells. If jaundice is associated with infection, the baby will receive antibiotics. With phototherapy, the naked baby wears eye patches to protect his eyes and is placed under special lights (bililights) that help to break down the bilirubin in the skin. A newer form of phototherapy utilizes a plastic body wrap and fiberoptic lights. The baby does not wear eye patches and the parents can feed and hold the baby without interrupting treatment.

Circumcision

Circumcision, the removal of the foreskin covering the head (glans) of the penis, is probably the oldest surgical operation known, dating back some six thousand years. It is a ritual of the Jewish religion and one of the puberty ceremonies of some Islamic, African, and New Guinean cultures. It is also commonly performed in North America, more in the US than Canada, for nonreligious reasons as a matter of parental choice. Performed by physicians (usually the obstetrician or family physician), circumcision is a surgical procedure that requires written permission from the parents. Since the decision about circumcision is up to you and your partner, discuss the subject during pregnancy when you have more time to gather information.

While you are making this decision, you might consider whether other males in the family, schools, and community have been circumcised. You may feel thay your son should look the same. In reality, however, the rate of circumcision today is about 60 percent in the US (much lower in Canada), so the social pressure to circumcise may be lower than ten or twenty years ago when circumcision rates in the US were much higher. In Canada, circumcision has never been routinely performed for nonreligious reasons. The circumcision status of a child may have no greater implications than the other physical differences that exist between individuals.

Facts to Consider

• There are no legal and few medical reasons for circumcising the male newborn.
• There is no recommendations regarding routine circumcision, only that parents be well-informed before making the decision.
• Circumcision should not be done for sick infants, infants with bleeding disorders, and infants with hypospadius, an anomaly where the urethral opening is on the underside of the head of the penis.
• The procedure usually takes less than a half hour. Healing takes seven to ten days.
• The newborn will feel pain.
• Local anesthesia is sometimes used. This reduces but does not eliminate all pain associated with circumcision. Complications from the anesthesia are rare and consist of local tissue damage, bruising, and subtle alterations in some reflexes.
• Complications from the circumcision procedure itself occur 0.5 to 2 percent of the time. These range from the minor to the serious and include infection, bleeding, irritation of the head of the penis from the friction of wet diapers, pain on urination, and scarring of the urinary outlet.
• There is a fee, which may be covered by health insurance.
• Some studies note an increased incidence of cancer of the penis in uncircumcised males. This may be due to the combination of being uncircumcised and having poor hygienic care of the penis. There are recommendations that parents and then the child as he grows older make a lifetime commitment to careful hygienic care of the uncircumcised penis to reduce the potential risk of penile cancer.
• Some studies, though not conclusive, have found an association between not being circumcised and urinary tract infection. Again, good hygienic practices may negate this possibility.
• Contrary to previous reports, there is no evidence that circumcision prevents cancer of the prostate gland, nor does it prevent sexually transmitted diseases.
• There is no evidence that circumcision or noncircumcision affects sexual performance.

Care of the Circumcised Penis

If you choose to have your son circumcised, ask the medical staff about care of the penis. They often suggest frequent diaper changes, gentle washing with soap and water, and application of Vaseline or petroleum jelly to aid healing and prevent irritation. You can expect very slight bleeding, but report any excessive bleeding or swelling to your doctor. Some babies sleep more comfortably on their sides until the area has healed.

Care of the Uncircumcised Penis

The foreskin of an uncircumcised newborn does not usually retract (pull back). It is normally joined to the glans, so avoid forcing it back over the end of the penis. It will gradually become looser, and between three and five years of age most boys’ foreskins are fully retractable. Normal bathing provides adequate cleansing during infancy.

Spitting Up

Many babies spit up milk during or after a feeding. Some babies spit up more than others. Your baby is more likely to spit up if he cries hard before a feeding, eats too much too quickly, or swallows air during the feeding. Some babies have an immature sphincter muscle at the top of their stomachs, which allows milk to come up with air bubbles. Spitting up is usually not harmful, but you can reduce it by burping your baby during and after feedings (burp newborns after each breast or after each two ounces of formula), not overfeeding him, handling him gently, and positioning him in the following ways after feeding: on his side, sitting in an infant or car seat with his head elevated twenty to thirty degrees, or laying him on his tummy. Babies outgrow the tendency to spit up by five to nine months of age.

If spitting up seems to be associated with pain, call your baby’s doctor. Continuous or frequent forceful (projectile) vomiting is more serious and can lead to dehydration. If your infant vomits after two or three consecutive feedings, consult your baby’s doctor.

Bowel Movements

A newborn’s stool pattern is different from an adult’s. Your baby’s first bowel movements will consist of meconium, a sticky, green-black substance present in the intestine before birth. For two to six days following birth, his stools will be a mixture of meconium and milk by-products, spinach-green or yellow in color. Later, your baby will have yellow, green, or brown stools with or without curds. The frequency and consistency of stools depend on the individual baby and on the food he is fed. Breast-fed babies should have a stool after each feeding or at least three ot four large runny stools a day once your milk is in. Formula fed babies may have fewer stools.

Constipation, hard, dry stools that are difficult to pass, is rarely found in breast-fed babies. Some older breast-fed babies have only one bowel movement per week. These babies are not constipated; their more mature digestive systems are efficiently using more of their mothers’ milk. Call your doctor, however, if your baby seems constipated.

Your baby probably has diarrhea if his stools are mucousy, foul smelling, more frequent than usual, blood-tinged, or watery (the diaper shows a water ring around the stool). When in doubt, note the color, consistency, and frequency of your baby’s stool; then call your doctor.

Diaper Rash

Many substances can irritate your baby’s skin, including urine and stool, some laundry products, inadequate diaper washing, or chemicals used in some disposable diapers. To prevent or treat diaper rash caused by urine, change diapers frequently, rinse the diaper area with water at each change, and avoid plastic pants, which retain moisture. You can reduce irritation from laundry detergents by running the diapers through an extra rinse cycle or by changing to a milder product. To reduce the amount of ammonia retained in the diapers, add half a cup of vinegar to the diaper pail or the rinse water.

Other treatments for diaper rash include exposing the rash to fresh air for a few hours each day, blow-drying your baby’s clean bottom with a hair dryer set at medium heat, or applying a commercial ointment to the clean, dry, irritated skin. (You can remove the heavy white ointment with a cotton ball moistened with baby oil.) If diaper rash persists, consult your physician.

Facial Rashes

Mild rashes on the face commonly occur in the first months of life. The rashes–smooth pimples, small red spots, or rough red spots–come and go and rarely require treatment.

Prickly Heat

This common, warm-weather rash appears on overdressed or overwrapped babies. Found most often in the shoulder and neck regions, prickly heat looks like clusters of tiny pink pimples surrounded by pink skin. As it dries, the rash becomes slightly tan. Prickly heat may look worse than it apparently feels to your baby. To avoid this rash, keep him from becoming overheated.

Cradle Cap

Cradle cap is a yellowish, scaly, patchy condition found on the scalp or sometimes behind the ears. Daily washing or brushing of the scalp may prevent cradle cap and will help treat it if it does appear. Comb or brush out the scales, using a baby comb, fingernail brush, or soft toothbrush; wash with mild soap. Continue this procedure until the scales are gone. Neither baby oil nor vegetable oil helps.

Newborn Breathing Pattern

Periods of irregular breathing are normal in newborns but may be frightening to new parents. When your baby is sleeping, he will snort, gasp, groan, and even occasionally pause in his breathing. These irregularities disappear in a month or two.

Crying

A newborn who is not eating or sleeping may spend a lot of time crying, and most parents feel frustrated when they cannot understand why their baby cries. This is a natural reaction. Remember to stay as calm as possible. Your tension is contagious; move slowly and calmly around a crying infant.

After you have ruled out hunger, consider whether the baby needs cuddling, rocking, walking, or your attention. Is he overdressed, underdressed, sick, or bored? Does he need to burp? Does he have diaper rash or colic? Is he just plain tired? Exhaustion commonly causes crying. If nothing seems to calm him, he may simply need to be put to bed and allowed to cry a while to settle himself. (Set the timer between five and fifteen minutes or it may seem like an eternity.) Patting or stroking his bottom or back or gentle rocking may also help him relax.

Many infants have a regular fussy time every day. Unfortunately this period often occurs in the late afternoon or evening, when everyone else in the house is tired and wants peace. You might find that attention and cuddling quiet him down. If not, consider these suggestions:

• Babies love motion, so try a swing, rocker, front pack, or sling, or a walk in a stroller. You can even go for a ride in the car.
• Wrap your infant snugly in a receiving blanket. Many newborns love the security this provides.
• Let the baby suckle and comfort himself at your breast. Or, let him suck on your clean finger with your fingernail placed against his tongue. Once your milk supply is well established, try giving your baby a pacifier. Wet the pacifier first in water.
• Play music, turn on the radio or television, or sing. The dishwasher, washing machine, clothes dryer, or vacuum cleaner may provide soothing noises.
• Your baby may be bored; put him in the center of family activity. Keep in mind, however, that some babies get overstimulated and need quieter surroundings.
• Try letting your baby rest on a lambskin–this is soothing to some babies.
• If the baby’s fussy time occurs at dinner, try preparing dinner early.

Some parents fear that if they give their babies too much attention, they will spoil them. A newborn, however, cannot be spoiled. He needs feeding, attention, cuddling, and handling to develop a trust in your ability to meet his needs. Enjoying and responding to your baby is not spoiling him. When your infant cries, he needs more care, not less. Your newborn infant is not manipulating you when he cries for attention; he simply has no other way to tell you he needs something. You might have trouble figuring out exactly what he wants, but pick him up, cuddle him, and trust your instincts and feelings.

Colic

Colic is another reason that babies cry. No one knows the exact cause of colic, so it is sometimes difficult to confirm. You may suspect colic, however, if your baby cries inconsolably at about the same time every day–often between 6 and 10 P.M. or after most feedings. The infant draws his knees up in pain and screams loudly for two to twenty minutes; then the crying stops, only to resume later. He may pass gas from the rectum. Despite the apparent discomfort, colicky babies seem to thrive.

Try comforting your baby by doing the following:

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• Using a comfort hold that provides pressure against his abdomen: lying on his abdomen across your lap or on a hot water bottle wrapped in a towel, sitting on your hip facing away from you, or lying on your arm looking away from you.
• Letting him suck on your breast, pacifier, or finger.
• Walking or rocking him.
• Maintaining a tension-free atmosphere as much as possible. This may mean getting away from a colicky baby for a while.
• Swaddling him, holding him close, or putting him in a front pack.
• Talk to your caregiver to determine whether food sensitivities might be contributing to the problem.

The colicky period is very stressful for parents. It may seem impossible to maintain a calm atmosphere. Try to keep in mind that colic does not produce any lasting harmful effects and that is usually disappears by the third or fourth month. Consult your doctor if constant crying is associated with vomiting, a cold, a fever, or hard stools.