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May 24, 2017

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Health Care Quarterly:

Baby talk: Questions all new parents have

First-time parents are bombarded with well-meaning advice from family, friends, social media and even strangers.

Often the advice is out of date or conflicting, so it is important to have a pediatrician who is experienced in helping families navigate the first few months of a new baby’s life.

Pediatricians are the best source of information for medical

advice for your children, but when it comes to checkups, new parents may feel rushed, forget their questions or even feel too awkward or embarrassed to ask certain questions, and don’t get the answers they need. I’ve been a pediatrician for more than 20 years, and working locally since 1995. My experience is that the hardest time is from 1 to 3 months of age.

There are a few topics I review with all new parents:

What is this weird creature?

Newborns are just different creatures. A lot can be explained simply by their immature nervous system. Immature muscle-nerve coordination explains a lot. They have jittery little arm and leg movements. They can see perfect up close, but can’t control their eye muscles, so they go cross-eyed, or their eyes roll back at times. This is why previous generations assumed babies can’t see, but we know this is wrong.

They breath irregularly through their nose, where they may take 5 to 10 fast breaths and then pause for 10 seconds. This can make their breathing slightly noisy, making parents worried they have allergies or a cold. They sneeze randomly. They hiccup, often after eating. This is just immaturity of the diaphragm muscle with breathing. As they eat more, they spit up more. As long as more goes down than up and babies gain weight appropriately, spitting up is a laundry problem, not a medical problem.

To poop, they have to contract their abdominal musculature, yet relax their anal sphincter. They will grunt like they’re constipated, then finally have a soft stool.

They have lots of different newborn rashes and marks — they just got out of a bath tub after nine months.

Their skin will peel; they have purple hands and feet; they develop pimples from sharing mom’s hormones for nine months. Little girls will have a mucousy vaginal

discharge and sometimes a mini-period with bloody discharge a week after birth.

We expect a lot of questions when you have a new baby, so don’t be shy about asking anything.

Enough sleep – for you and baby

The good news! Babies sleep 12 to18 hours a day. The bad news! They only sleep in 1 ½- to 4-hour intervals and won’t sleep through the night without re-fueling their gas tank for the first four to six months. The most important advice I give is to nap when the baby is napping. I tell my families, in a tongue-and-cheek manner, “if you have a chance to sleep, the only reason you shouldn’t is if the house is on fire”. If you take a few naps when the baby is napping, then the night shift won’t be so brutal. Turn off the phone. Get paper plates (recycle if you feel guilty). If the house is a mess, don’t have people over if it is going to bother you and keep you from resting. Learn how to meditate, to empty your head so you can allow yourself to sleep.

Of milk and formula

During the first one to two weeks, feeding your baby can be a challenge, especially for nursing mothers who are adapting to feeding their babies. Babies are learning to eat. Their tummies start out small and expand. Babies are expected to lose significant weight for the first three to six days while they are learning to feed and mom’s milk supply is increasing. This is part of their design: they are born with extra water and calories to get them through this, so don’t worry unless the pediatrician is worried about too much weight loss.

In the hospital and then at home, there are many resources to support nursing women who are having difficulty. We pediatricians strongly support breast feeding, however, moms who cannot or choose not to breast feed deserve our support and not made to feel guilty. I see a lot of crying moms who feel guilty they were unable to nurse, so I feel strongly about supporting them. Feed on demand, ranging typically from every 1 ½ to 4 hours.

Keeping baby safe

Baby safety starts with having a car seat and making sure it is securely installed before the baby arrives. Sleep practices are also very important. Babies should sleep in their parent’s room, on their back in their bassinet or crib — and not bed share. Don’t smoke around the baby — better yet, stop smoking, of course.

Avoid crowds during the first two months, while baby’s immune system is maturing. Sometimes you may need to go to the market, but avoid large crowds of children. You don’t get sick from physically being outside, you get sick from breathing aerosolized virus coughed out by others.

What is baby crying about?

Yes, over time you will be able to identify many of your baby’s needs by the way he or she is crying. Picking up on the patterns (pitch, duration, volume — and what is going on at that moment) will help you better respond to your baby’s cries. What is baby crying about? Well, consider what your crying baby could be thinking:

• I’m hungry!

• I want to suck on something!

• I’m hot!

• I’m cold!

• I’m lonely!

• I want to move!

• I’m tired!

•I’m wet!

• I’ve had enough! (i.e., too much noise, movement or visual stimulation)

I don’t believe that you can “spoil” a baby, so I recommend generally trying to figure out what is making yours cry or fuss and attending to the problem. I tell parents “she is the queen, and we are her humble servants. Her majesty has soiled herself, I shall change thy diaper.” Sometimes however, if your baby simply might be overtired, its ok to let your baby fuss for a few minutes in a crib in a darkened room.

If the baby is crying more than usual, can’t be comforted, is not eating well, or your “gut” tells you something else is going on, then it is time to get advice, be seen by your pediatrician or go to the ER if you are really worried.

Blair Duddy, M.D., is the associate medical director of pediatrics for Southwest Medical Associates.

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