Newborn Questions with the Experts

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I was so excited when Johnson’s Baby gave me the opportunity to ask some really important newborn questions for new moms.

I remember when my firstborn came home, I was feeling so overwhelmed, I spent a good portion of every day (during nursing, of course) plowing through parenting books.

These were some of the questions I was asking and searching for answers on! If you have any more, please post in the comments and I’ll get an expert opinion for you!

We’re asking the tough ones, the ones every mom needs to know!

newborn questions

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Clinical Nurse Specialist, Luisa Ciofani

Q: How can I tell if my baby is getting enough milk while breastfeeding?

A: Whenever a breastfeeding assessment is performed, whether it is from the perspective of the mother or your infant, there are two elements which require punctual and continued assessment. These two elements include evaluation of milk production and milk transfer. We must assess if the mother is producing milk and if the baby is getting the milk the mother is making. To answer your question, in the first few days of life, exclusively breastfed babies will lose weight*, so while weight gain is the gold standard for assessing milk intake at later points in time, it is not what we rely on in the first few days of life. Milk insufficiency is quite rare, so if breastfeeding is managed well and there are no risk factors then there is no reason to suspect that the mother will not make enough milk. Now to know how the baby is doing.

Newborn Questions

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The baby will receive approximately 30 mls (1 ounce) of colostrum in the first 24 hours of life. This will be sufficient to regulate temperature and blood sugar, but will not provide enough calories for weight gain. The mother goes from producing 30 mls of colostrum on Day 1 of the baby’s life to 500 mls (2 cups) on Day 5 of the baby’s life. This milk increase happens through endocrine (hormonal) and autocrine (mechanical – stimulation and drainage) pathways. The way we know if baby is getting enough milk is by ensuring sufficient access to the breast as well as monitoring urine and stool output. (It might be interesting to demonstrate the size of a newborn’s tummy – it is quite small).

The baby’s behaviour should also be observed. The baby should wake up spontaneously to feed and be satiated after the feed. The baby will feed frequently in the first few days (often 10 to 12 times in 24 hours) and this allows the milk production to increase on Day 3 instead of on Day 5. It is important not to compare the pattern of feeding for a breastfed infant to the pattern of an infant who receives formula because they are quite different.

Stool is an excellent indicator of caloric intake. It the baby is stooling every day for the first two months of life and the stool is yellowish, somewhat loose and looks like it has cucumber seeds in it after Day 5, then the baby is doing well and very likely gaining weight.

*We do monitor weight loss and consider a 7 to 10% loss within acceptable parameters. Infants often lose weight in the first 3 to 4 days of life and then regain their birth weight by 2 weeks of life. This is physiologically normal and another indicator that baby is doing well.

Q: Am I spoiling my baby if I pick him up every time he cries?

A: Newborn babies should not be left to cry unattended. Paying attention to their cries and meeting their needs (comfort, feeding, diapering, and holding) in the early period will establish a sense of security in your infant and the baby will cry less in the long run. Try to respond to the baby quickly if he starts to cry. It is harder to calm a baby if he has been crying for a long time. In the first few weeks, we tell parents to assume every cue is a feeding cue (hunger is often a late feeding cue) so that the baby gets offered the breast to feed. After the first few weeks, parents will get to know their baby and will be better able to interpret the cues and respond differently.

Q: How can I get my partner to be more involved in caring for our baby?

A: It is important for all parents to get support for infant care. There is a role and plenty to do for each parent. Partners may sometimes not feel as prepared as the mother who has been carrying the baby for months, may be speaking to other mothers and may have previous childcare experiences. Previous exposure to newborns is an important factor to consider. If there has been little or no contact with small infants, a partner may feel unprepared to take on tasks related to childcare or to even hold the baby. It is important to create an environment that allows the partner to express whether they are comfortable with infant caretaking and to withhold judgment if caretaking activities are not done perfectly (if safety principles are followed). The mother can also demonstrate how the partner can be helpful and can provide positive feedback. There are many ways the partner can be involved (diapering, bathing, massaging, holding). Health care professionals should include partners in care decisions and be attentive to their needs as well as those of the mother. This will create an atmosphere where the partner will be able to ask questions and prepare to fully participate in parenting.

Q: How do I know when to start feeding solids and what to start with?

A: The World Health Organization (WHO) and UNICEF recommend:

·       Early initiation of breastfeeding within 1 hour of birth;

·       Exclusive breastfeeding for the first 6 months of life;

·       The introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.

The first foods offered to the baby need to be rich in iron. These include: well cooked iron rich meat or meat alternatives such as whole eggs, tofu, legumes (beans, lentils, chickpeas) as well as iron-fortified infant cereals. Foods with thick consistencies (“lumpy”) should be introduced by 9 months of age. Parents can then also begin to introduce a variety of nutritious foods from the family meals. This can include progressing towards foods with a variety of textures, by one year of age.

Q: How much sleep should my baby really be getting?

A: On average, between 0 to 3 months, infants sleep 14 to 17 hours per 24 hours. This includes many brief periods of sleep, ranging from 30 minutes to 3-4 hours at a time. Babies wake for 2 hours or less at a time. Babies may cry a lot or have fussy period lasting 3 to 6 hours.

A: Newborns sleep a lot, but not for very long at any one time. Sleep deprivation is like a rite of passage for new moms. Thankfully, there are ways to help ease your newborn into a regular schedule so you can both sleep longer, sooner.

For the first few months, your baby will fall asleep and wake up at all hours of the day (and night!). Newborn babies can have quite a range in total sleep time (10-18 hours per day), with sleep usually spaced throughout the 24-hour day with no real difference between day and nighttime sleep. Babies may sleep 2 to 5 hours at a time. Be sure to respond to your newborn when he signals, as he will likely need feeding…and diapering!

So, what can you do?

·       Create a nighttime routine for your baby that includes a warm bath, massage with lotion and quiet time.

·       For help, download the JOHNSON’S  BEDTIME  baby sleep app.

Establishing brief routines before bedtime and naptime will help. Your infant will learn to associate the bedtime and nap routine with going to sleep. Choose a couple of activities like breastfeeding, bathing, telling a story, singing or massaging. The routine should be enjoyable and relaxing. Keep your infant’s sleeping area comfortable with dim lighting and appropriate temperature. Keep the night time quiet. Speak softly and repeat comforting words or sounds. Place your infant in his crib, cradle or bassinet to sleep. Over time your infant will learn that this is the place where he sleeps.

Newborn Questions

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Pediatric Dermatologist, Dr. Joseph Lam

Q: My child has what looks like cradle cap. Any advice to get rid of it (and does it hurt)?

A: Some babies have cradle cap or seborrheic dermatitis — a skin condition that looks like crusty or scaly patches on the scalp or eyebrows. This is a very common condition that may begin in the first few weeks and usually lasts several weeks or months. Fortunately, it usually resolves completely when your baby is between eight and 12 months old.

To help alleviate cradle cap, you can gently massage a moisturizer or oil like JOHNSON’S® baby oil onto the patches to soften the crust. Wait a few minutes, then comb gently to remove the flakes. Then you can shampoo with a gentle, made for babies’ shampoo like JOHNSON’S® baby shampoo.

Q. What are some common skin conditions among newborns?

A:  As baby’s skin adapts to their new world outside the womb, many newborns experience the following common skin conditions. Please note, even though many of these conditions resolve on their own, if you do have any worries or concerns, it’s best to speak to your health care professional.

·       Baby Acne: Baby acne is related to hormones from the mother passed through the placenta. Baby acne occurs in approximately 20 percent of all babies. It generally resolves itself during the first few months. It may take the appearance of pimples, whiteheads or a minor rash.

·       Neonatal Milia: Small white pimples or spots called milia usually appear on the face, especially the nose and chin. They aren’t itchy and won’t bother your baby and will disappear without treatment.

·       Skin Peeling: You may also notice during the first few days that your newborn’s skin peels slightly, especially on the palms of his hands, soles of his feet and his ankles. This is perfectly normal, especially if your baby was born past his due date. After a few days the peeling will go away. You can ask your baby’s healthcare provider if using a baby ointment or moisturizer, like JOHNSON’S® baby lotion might be helpful.

·       Eczema & Dry Skin: Many babies experience eczema or dry skin. In babies, eczema often appears as a rash on the hands, face, neck, inside of the elbows and back of the knees, but may spread to other areas. Eczema rashes are associated with intense itching (pruritus). If the condition continues or is severe, you should definitely talk to your baby’s healthcare provider to understand if the condition is clinical eczema (atopic dermatitis) or dry skin, and to learn the best way to treat and manage.

o   There is good evidence that for children who have a family history of eczema, it’s worth moisturizing your infants at least daily – this seems to halve the chance of getting eczema in your infant! *Study available, if needed.

·       Diaper Rash: Many babies experience diaper rash at some point, which can be caused by bacteria’s, urine, friction and moist closed environments. The signs will be sensitivity, chafing, flaking and redness. To treat:

o   Clean, using mild wipes or a warm, wet washcloth to gently cleanse your baby’s skin.

o   The key to healing diaper rash is keeping your baby’s skin as clean and dry as possible.

o   Apply a thick layer of medicated / diaper rash cream to entire diaper area with each diaper change.

·       Cradle Cap: Noted above in first response.

Q: Should you treat/use different products on your baby during different seasons (i.e. summer vs. winter)?

A: Here are some of the best ways to prepare for summer heat, wet or cold weather with your baby. Babies are especially sensitive to temperature changes, so wherever you are, please make sure your child isn’t too cold— or too warm.

·       In winter –  be wary of frostbite, eczema flare-ups, and dry chapped skin. Remember to moisturize, moisturize, moisturize! Your baby’s skin is about 30% thinner than yours and while it absorbs more water, it loses it faster. Also, if your baby is bundled up, he can become overheated; itchy red bumps appear when tiny sweat glands get clogged.

Newborn Questions

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·       In summer, when moisturizing your baby’s skin, try lighter weight products in the summer like JOHNSON’S® HEAD-TO-TOE™ baby lotion and a thicker, heavier moisturizer in the winter like JOHNSON’S® HEAD-TO-TOE™ extra moisturizing baby cream and baby wash.

·       Here are some tips to help protect your baby from the sun; remember the sun is out all year round:

o   Avoid the sun during the hottest part of the day between 10 am and 2 pm (especially in the summer!). Stay in the shade, and remember that reflected light can also be harmful. Water, sand, and snow are three big reflectors, so just be aware of your surroundings!

o   Dress infants in lightweight long pants, long-sleeved shirts and brimmed hats that shade the neck to prevent sunburn.

o   Even on cloudy days or while riding in the car, always use a sunscreen specially developed for babies. If your baby is younger than 6 months of age, discuss the use of sunscreens with your pediatrician.

o   Choose a broad-spectrum sunscreen with SPF 30 or higher, apply early and often, keep them covered and in the shade as much as possible.

·       Consult your doctor if you see any signs of heat rash, sunburn, dehydration, etc.

Q: Anything else worth noting or to keep an eye out for on newborn’s skin?

A: Limiting the number of baths is not necessary for infants with eczema, as long as they are moisturized after they get out of the bath.

Dermatologist, Dr. Julia Carroll

Q: We think my baby has eczema, will she grow out of it? What can we do to improve her comfort level?

A:  Eczema is an inflammatory skin condition that is characterized by dry skin with patches that are red and intensely itchy. Eczema is often a chronic condition however some children do outgrow their eczema. Symptoms of eczema can range from mild to severe and can come and go. Although there is no cure for eczema, there is a wide range of products to relieve baby of dry skin and discomfort. Avoid the things you think may cause itching, such as dust, wool clothing and certain soaps, detergents, fabric softeners and perfumes. It may help to keep a diary to determine the cause. To manage your baby’s eczema, it is important to keep their skin moisturized and create a barrier to protect the skin. The natural skin barrier, which would normally trap moisture in the skin, doesn’t work as well for patients with eczema. This leaves the skin dry, rough and sensitive to irritants.

My key advice includes:

·       Give your baby short baths — no more than 5 to 10 minutes — in water that is lukewarm, not hot.

·       Use mild skin cleansers or shampoos specially made for babies with sensitive skin.

·       Dry the skin after a bath by patting with a soft towel, and then immediately apply moisturizer. Do not rub the skin.

·       Moisturize frequently throughout the day, especially after bathing.

Although eczema can be an irritating condition, especially during periods of flare-ups, by following these tips you can help to make your baby more comfortable.

Q: How do I know if my child is allergic to something? How to know what products are best for your baby’s skin?

A: Some of the signs of skin allergy include redness, swelling, itch and flaking skin. The signs of allergy could appear within hours to days of exposure to the possible cause of the allergen. In terms of testing products for your baby, I recommend a “Repeat Open Application Test” also known as a ROAT. A ROAT is done by applying a small amount of the product in question to the forearm. It is done over 5 days. If there is no reaction then you may use this product.

Baby’s skin is different than adult skin. Because it is more delicate, baby’s skin needs more protection from environmental changes and harsh cleansers. So, when caring for your little one, use mild and gentle cleansers and moisturizers that are developed especially for baby like JOHNSON’S® HEAD-TO- TOE® baby wash and JOHNSON’S® baby lotion. JOHNSON’S® products are dermatologist-tested, pediatrician-tested, hypoallergenic and paraben-free.

Q: Should you treat/use different products on your baby during different seasons (i.e. summer vs. winter)?

A: Great question! Generally, I recommend lighter creams and lotions in the warmer months and thicker creams in the winter. However, if you tend to have drier skin then it is absolutely fine to continue using a thicker cream over the summer or a lighter cream over the winter. It really is an individual choice.

Q: Anything else worth noting or to keep an eye out for on newborns skin?

A: With babies, it’s always best to keep it simple. It’s hard enough to keep it all together as a parent, so don’t make your routine or your baby’s routine too complicated.

I want to thank the experts and Johnson’s Baby for helping out with the answers on this very important post!

*Sponsored by Johnson’s Baby

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