Well Child Care, Newborn

NORMAL NEWBORN APPEARANCE

  • Your newborn's head may appear large when compared to the rest of his or her body. 

  • Your newborn's head will have two main soft, flat spots (fontanels). One fontanel can be found on the top of the head and one can be found on the back of the head. When your newborn is crying or vomiting, the fontanels may bulge. The fontanels should return to normal once he or she is calm. The fontanel at the back of the head should close within four months after delivery. The fontanel at the top of the head usually closes after your newborn is 1 year of age.  

  • Your newborn's skin may have a creamy, white protective covering (vernix caseosa). Vernix caseosa, often simply referred to as vernix, may cover the entire skin surface or may be just in skin folds. Vernix may be partially wiped off soon after your newborn's birth. The remaining vernix will be removed with bathing.  

  • Your newborn's skin may appear to be dry, flaky, or peeling. Small red blotches on the face and chest are common.  

  • Your newborn may have white bumps (milia) on his or her upper cheeks, nose, or chin. Milia will go away within the next few months without any treatment. 

  • Many newborns develop a yellow color to the skin and the whites of the eyes (jaundice) in the first week of life. Most of the time, jaundice does not require any treatment. It is important to keep follow-up appointments with your caregiver so that your newborn is checked for jaundice.  

  • Your newborn may have downy, soft hair (lanugo) covering his or her body. Lanugo is usually replaced over the first 3–4 months with finer hair.  

  • Your newborn's hands and feet may occasionally become cool, purplish, and blotchy. This is common during the first few weeks after birth. This does not mean your newborn is cold.

  • Your newborn may develop a rash if he or she is overheated.  

  • A white or blood-tinged discharge from a newborn girl's vagina is common.

NORMAL NEWBORN BEHAVIOR

  • Your newborn should move both arms and legs equally.

  • Your newborn will have trouble holding up his or her head. This is because his or her neck muscles are weak. Until the muscles get stronger, it is very important to support the head and neck when holding your newborn.

  • Your newborn will sleep most of the time, waking up for feedings or for diaper changes.  

  • Your newborn can indicate his or her needs by crying. Tears may not be present with crying for the first few weeks.  

  • Your newborn may be startled by loud noises or sudden movement.  

  • Your newborn may sneeze and hiccup frequently. Sneezing does not mean that your newborn has a cold.  

  • Your newborn normally breathes through his or her nose. Your newborn will use stomach muscles to help with breathing.  

  • Your newborn has several normal reflexes. Some reflexes include:  

  • Sucking.  

  • Swallowing.  

  • Gagging.  

  • Coughing.  

  • Rooting. This means your newborn will turn his or her head and open his or her mouth when the mouth or cheek is stroked.  

  • Grasping. This means your newborn will close his or her fingers when the palm of his or her hand is stroked.

IMMUNIZATIONS

Your newborn should receive the first dose of hepatitis B vaccine prior to discharge from the hospital.

TESTING AND PREVENTIVE CARE

  • Your newborn will be evaluated with the use of an Apgar score. The Apgar score is a number given to your newborn usually at 1 and 5 minutes after birth. The 1 minute score tells how well the newborn tolerated the delivery. The 5 minute score tells how the newborn is adapting to being outside of the uterus. Your newborn is scored on 5 observations including muscle tone, heart rate, grimace reflex response, color, and breathing. A total score of 7–10 is normal.  

  • Your newborn should have a hearing test while he or she is in the hospital. A follow-up hearing test will be scheduled if your newborn did not pass the first hearing test.  

  • All newborns should have blood drawn for the newborn metabolic screening test before leaving the hospital. This test is required by state law and checks for many serious inherited and medical conditions. Depending upon your newborn's age at the time of discharge from the hospital and the state in which you live, a second metabolic screening test may be needed.  

  • Your newborn may be given eyedrops or ointment after birth to prevent an eye infection.  

  • Your newborn should be given a vitamin K injection to treat possible low levels of this vitamin. A newborn with a low level of vitamin K is at risk for bleeding.

  • Your newborn should be screened for critical congenital heart defects. A critical congenital heart defect is a rare serious heart defect that is present at birth. Each defect can prevent the heart from pumping blood normally or can reduce the amount of oxygen in the blood. This screening should occur at 24–48 hours, or as late as possible if your newborn is discharged before 24 hours of age. The screening requires a sensor to be placed on your newborn's skin for only a few minutes. The sensor detects your newborn's heartbeat and blood oxygen level (pulse oximetry). Low levels of blood oxygen can be a sign of critical congenital heart defects.

FEEDING

Signs that your newborn may be hungry include:

  • Increased alertness or activity.  

  • Stretching.  

  • Movement of the head from side to side.  

  • Rooting.  

  • Increase in sucking sounds, smacking of the lips, cooing, sighing, or squeaking.  

  • Hand-to-mouth movements.  

  • Increased sucking of fingers or hands.  

  • Fussing.  

  • Intermittent crying.  

Signs of extreme hunger will require calming and consoling your newborn before you try to feed him or her. Signs of extreme hunger may include:

  • Restlessness.  

  • A loud, strong cry.  

  • Screaming.

Signs that your newborn is full and satisfied include:

  • A gradual decrease in the number of sucks or complete cessation of sucking.  

  • Falling asleep.  

  • Extension or relaxation of his or her body.  

  • Retention of a small amount of milk in his or her mouth.  

  • Letting go of your breast by himself or herself.  

It is common for your newborn to spit up a small amount after a feeding.

Breastfeeding

  • Breastfeeding is the preferred method of feeding for all babies and breast milk promotes the best growth, development, and prevention of illness. Caregivers recommend exclusive breastfeeding (no formula, water, or solids) until at least 6 months of age.  

  • Breastfeeding is inexpensive. Breast milk is always available and at the correct temperature. Breast milk provides the best nutrition for your newborn.  

  • Your first milk (colostrum) should be present at delivery. Your breast milk should be produced by 2–4 days after delivery.  

  • A healthy, full-term newborn may breastfeed as often as every hour or space his or her feedings to every 3 hours. Breastfeeding frequency will vary from newborn to newborn. Frequent feedings will help you make more milk, as well as help prevent problems with your breasts such as sore nipples or extremely full breasts (engorgement).  

  • Breastfeed when your newborn shows signs of hunger or when you feel the need to reduce the fullness of your breasts.  

  • Newborns should be fed no less than every 2–3 hours during the day and every 4–5 hours during the night. You should breastfeed a minimum of 8 feedings in a 24 hour period.  

  • Awaken your newborn to breastfeed if it has been 3–4 hours since the last feeding.  

  • Newborns often swallow air during feeding. This can make newborns fussy. Burping your newborn between breasts can help with this.  

  • Vitamin D supplements are recommended for babies who get only breast milk.  

  • Avoid using a pacifier during your baby's first 4–6 weeks.  

  • Avoid supplemental feedings of water, formula, or juice in place of breastfeeding. Breast milk is all the food your newborn needs. It is not necessary for your newborn to have water or formula. Your breasts will make more milk if supplemental feedings are avoided during the early weeks.

Formula Feeding

  • Iron-fortified infant formula is recommended.  

  • Formula can be purchased as a powder, a liquid concentrate, or a ready-to-feed liquid. Powdered formula is the cheapest way to buy formula. Powdered and liquid concentrate should be kept refrigerated after mixing. Once your newborn drinks from the bottle and finishes the feeding, throw away any remaining formula.  

  • Refrigerated formula may be warmed by placing the bottle in a container of warm water. Never heat your newborn's bottle in the microwave. Formula heated in a microwave can burn your newborn's mouth.  

  • Clean tap water or bottled water may be used to prepare the powdered or concentrated liquid formula. Always use cold water from the faucet for your newborn's formula. This reduces the amount of lead which could come from the water pipes if hot water were used.  

  • Well water should be boiled and cooled before it is mixed with formula.  

  • Bottles and nipples should be washed in hot, soapy water or cleaned in a dishwasher.  

  • Bottles and formula do not need sterilization if the water supply is safe.  

  • Newborns should be fed no less than every 2–3 hours during the day and every 4–5 hours during the night. There should be a minimum of 8 feedings in a 24 hour period.  

  • Awaken your newborn for a feeding if it has been 3–4 hours since the last feeding.  

  • Newborns often swallow air during feeding. This can make newborns fussy. Burp your newborn after every ounce (30 mL) of formula.  

  • Vitamin D supplements are recommended for babies who drink less than 17 ounces (500 mL) of formula each day.  

  • Water, juice, or solid foods should not be added to your newborn's diet until directed by his or her caregiver.

BONDING

Bonding is the development of a strong attachment between you and your newborn. It helps your newborn learn to trust you and makes him or her feel safe, secure, and loved. Some behaviors that increase the development of bonding include:

  • Holding and cuddling your newborn. This can be skin-to-skin contact.  

  • Looking directly into your newborn's eyes when talking to him or her.  Your newborn can see best when objects are 8–12 inches (20–31 cm) away from his or her face.  

  • Talking or singing to him or her often.  

  • Touching or caressing your newborn frequently. This includes stroking his or her face.  

  • Rocking movements.

SLEEPING HABITS

Your newborn can sleep for up to 16–17 hours each day. All newborns develop different patterns of sleeping, and these patterns change over time. Learn to take advantage of your newborn's sleep cycle to get needed rest for yourself.

  • Always use a firm sleep surface.  

  • Car seats and other sitting devices are not recommended for routine sleep.  

  • The safest way for your newborn to sleep is on his or her back in a crib or bassinet.  

  • A newborn is safest when he or she is sleeping in his or her own sleep space. A bassinet or crib placed beside the parent bed allows easy access to your newborn at night.  

  • Keep soft objects or loose bedding, such as pillows, bumper pads, blankets, or stuffed animals, out of the crib or bassinet. Objects in a crib or bassinet can make it difficult for your newborn to breathe.  

  • Dress your newborn as you would dress yourself for the temperature indoors or outdoors. You may add a thin layer, such as a T-shirt or onesie, when dressing your newborn.  

  • Never allow your newborn to share a bed with adults or older children.  

  • Never use water beds, couches, or bean bags as a sleeping place for your newborn. These furniture pieces can block your newborn's breathing passages, causing him or her to suffocate.  

  • When your newborn is awake, you can place him or her on his or her abdomen, as long as an adult is present. "Tummy time" helps to prevent flattening of your newborn's head.

UMBILICAL CORD CARE

  • Your newborn's umbilical cord was clamped and cut shortly after he or she was born. The cord clamp can be removed when the cord has dried.  

  • The remaining cord should fall off and heal within 1–3 weeks.  

  • The umbilical cord and area around the bottom of the cord do not need specific care, but should be kept clean and dry.  

  • If the area at the bottom of the umbilical cord becomes dirty, it can be cleaned with plain water and air dried.  

  • Folding down the front part of the diaper away from the umbilical cord can help the cord dry and fall off more quickly.  

  • You may notice a foul odor before the umbilical cord falls off. Call your caregiver if the umbilical cord has not fallen off by the time your newborn is 2 months old or if there is:  

  • Redness or swelling around the umbilical area.  

  • Drainage from the umbilical area.  

  • Pain when touching his or her abdomen.

ELIMINATION

  • Your newborn's first bowel movements (stool) will be sticky, greenish-black, and tar-like (meconium). This is normal.

  • If you are breastfeeding your newborn, you should expect 3–5 stools each day for the first 5–7 days. The stool should be seedy, soft or mushy, and yellow-brown in color. Your newborn may continue to have several bowel movements each day while breastfeeding.  

  • If you are formula feeding your newborn, you should expect the stools to be firmer and grayish-yellow in color. It is normal for your newborn to have 1 or more stools each day or he or she may even miss a day or two.  

  • Your newborn's stools will change as he or she begins to eat.  

  • A newborn often grunts, strains, or develops a red face when passing stool, but if the consistency is soft, he or she is not constipated.  

  • It is normal for your newborn to pass gas loudly and frequently during the first month.  

  • During the first 5 days, your newborn should wet at least 3–5 diapers in 24 hours. The urine should be clear and pale yellow.

  • After the first week, it is normal for your newborn to have 6 or more wet diapers in 24 hours.

WHAT'S NEXT?

Your next visit should be when your baby is 3 days old.