Common Concerns in the Early Weeks - Part One

So much happens so fast as your baby adjusts to life outside the womb and you adjust to life with this little person. Knowing what to expect and understanding why babies do what they do will help you ease more comfortably into parenting.

Early Newborn Changes

Big changes occur in your newborn Part of getting to know your child is cherishing these fleeting changes.

Breathing Patterns and Sounds

Watch your newborn breathe. Notice the irregular patterns. Baby takes many short breaths of varying lengths, an occasional deep sigh, and even has a worrisome ten-to-fifteen-second period when she doesn't appear to breathe; then baby breathes deeply (and so do you), and the cycle continues. Called periodic breathing, this irregular pattern is normal for the first few weeks. Breathing becomes more regular by the end of the first month. The younger or more premature the baby, the more irregular the breathing.

First "cold."
Because the nasal passages are small in the newborn, even a slight amount of clogging can cause noisy, uncomfortable breathing You may think that this is your baby's first cold. But, although very loud and noisy, these early sniffles are usually not caused by an infection. Babies' nasal passages are easily congested with lint from blankets or clothing, dust, milk residue, or environmental irritants such as cigarette smoke, perfumes, hair sprays, and aerosols. A stuffy nose may cause baby a lot of difficulty breathing because newborns are obligate nose breathers, meaning they need to breathe through their noses rather than their mouths. A newborn with a stuffy nose does not switch easily to breathing with her mouth but rather struggles to get more air through her nose. One of the reasons that newborns sneeze a lot is to clear their nasal passages. It is unlikely to be her first cold. She is trying to clear her nose.

Gagging and choking.
Your baby's lungs were filled with fluid while in the womb. Most of this fluid was squeezed out of the lungs during passage through the birth canal or was suctioned by the doctor or nurse after birth. Your baby may cough up some remaining mucus, which momentarily sticks to the back of the throat. Baby gags, then swallows the excess mucus and is all right/ Placing baby on her side prevents this mucus from pooling in the back of the throat.

Noisy breathing.
In addition to being uneven breathers, newborns are noisy breathers. Toward the end of the first month you may her a gurgling sound in baby's throat and feel a rattling in her chest. Your bay seems generally well and happy -- she is just noisy. This is not a cold, since it is seldom caused by an infection. Near the end of the first month or during the second month of age, babies begin to produce a lot of saliva, often more than they can comfortably swallow. Some of the saliva pools in the back of the throat. Air passing through it produces gurgling noises. When you place your hand on baby's back or chest, the rattle you hear and feel is not really coming from the chest but from the vibrations produced by air passing through saliva in the back of the throat. These normal sounds subside when baby learns to swallow the saliva at the same rate she produces it.

Normal noises.
Newborns are anything but silent, even when they are asleep. Most noises are caused by too much air passing too fast through small passages. Here are some precious sounds: gurgles caused by air passing through pooled saliva in the back of the mouth; if accompanied by nasal congestion they are a combination of a snort and a gurgle called snurgles. A burping sound may pass through mucus in the mouth or nose and become a blup or, if accompanied by bubbles, a burble, Normal breathing may take on a purring quality when air and saliva compete for the same space. During sleep the already narrow breathing passages relax and become even narrower, causing each breath to take on either a musical, grunting, or sighing quality. And don't forget those delightful birdlike chirps and squeaks. Enjoy these sounds, for they won't last long.

Hiccups.
All babies hiccup, in the womb and outside. Hiccups frequently occur after burping. We don't know the cause, and they don't bother baby. Feeding during hiccups usually settles the spell.

Clearing Little Noses

Here's how you can help your newborn breathe more easily.

* When your newborn is awake, place her on her stomach with her head turned to one side. This position allows the tongue and any saliva in the throat to come forward, making more room for air to pass.

* Keep your baby's sleeping environment as fuzz free and dust free as possible. Remove dust collectors such as feather pillows, fuzzy animals, and dozens of furry gifts that surround most newborns. (There is no need to defuzz baby's sleeping environment if her nose is not congested.)

* Keep baby away from nasal irritants: cigarette smoke, paint and gasoline fumes, aerosols, perfumes, and hair sprays. Do not allow smoking in the same house as baby. This is one of the most common irritants to baby's sensitive nasal passages.

* Hose the little nose. Use saline nasal spray or drops to loosen the nasal secretions and stimulate baby to sneeze the secretions from the back of the nose toward the front, where you can gently remove them with a bulb syringe, called a nasal aspirator, available to your drugstore.

Baby's Elimination Patterns

Changes in your baby's stools.
Expect your newborn's stools to progress from black to green to brown to yellow. The first few days baby's stools contain a black, tarlike, sticky substance call meconium, which is composed of amniotic-fluid debris from the newborn's intestines. Your newborn should have a meconium stool within the first twenty-four hours. If not, notify your doctor. Near the end of the first week your baby's stools will become less sticky and turn greenish brown. between one and two weeks later they assume a yellowish-brown color and more regular consistency.

Breastfed versus bottle fed.
The stools of breastfed and formula-fed infants are different. If you are breastfeeding, after a week or two, as your baby gets more of the fatty hindmilk, expect his stools to become yellow, seedy, and mustard like in consistency. Because breast milk has a natural laxative effect, the stools of breastfed babies are more frequent, softer, more yellow, and have a not unpleasant buttermilk-like odor. The stools of the formula-fed infant tend to be less frequent, firmer, darker, greenish, and have an unpleasant odor. While the stools of the newborn baby are usually mustard yellow, an occasional green stool is of no significance if your baby seems generally well.

How frequent.
How many stools a day varies greatly among newborns. As mentioned previously, breastfed infants usually have more stools than formula-fed infants. Some babies have a loose stool after or during every breastfeeding. And mothers often hear the gurgly sounds of the soft stool a few minutes into the feeding. An occasional watery gush (called an explosive stool) is usual and not to be confused with diarrhea. A newborn who is getting enough breast milk usually has two to five bowel movements a day, but I can also be normal to have one or two a day. Occasionally baby may even go two to three days without a bowel movement as a normal bowel pattern, but usually not until one or two months of age. Infrequent stooling in a breastfed baby less than two months old may mean he baby is not getting enough milk.

Blood in the stool.
Occasionally babies have a hard stool, or a sudden explosive stool, that causes a tiny tear in the rectum, called a rectal fissure. If you notice a few spots of bright red blood on baby's diapers or streaks of blood in the stools, a fissure is probably the cause. These heal easily by lubricating baby's rectum with over-the-counter pediatric glycerin suppositories (cut in half lengthwise).

Wet Diaper changes.
In the first week baby's urine is very unconcentrated, like water. After a few weeks the urine may assume a more concentrated yellow-amber color. During the first week your newborn may normally have two to three wet diapers a day. Thereafter expect your baby to wet at least six to eight cloth diapers (four to five disposables) a day.

What about reddish urine? Within the first week it is common to see a few orange or reddish spots on the diaper that may alarm you, since they resemble blood. These red spots are caused by urates, normal substances in the urine of the newborn that form an orange-to-red color on the diaper.

RX For Inconsolable Crying

Sometimes a baby who is generally not colicky and was previously well suddenly shows an outburst of unexplained, inconsolable crying. Before racing to the phone to summon your doctor, go through the following checklist.

[] Does baby have an emergency medical problem? Two concerning signs are (1) persistent vomiting and (2) pale all over. If neight4r of these signs are present and baby does not look sick, it is not necessary to call your doctor immediately before going through the next steps.

[] Is baby hurting? Undress baby completely and observe the following:

* Are any of baby's limbs not moving normally? Do you notice any unusual lumps or welling? These observations are important to detect any injury from a recent fall; consult your doctor if a problem is noted.
* Is there swelling in the groin? This could indicate intestinal obstruction from a hernia, which requires medical attention.
* Is baby's abdomen tense and bloated, with more welling on one side than on the other; or tense or tender when you try to massage it? These signs plus sudden onset of colicky behavior could indicate an intestinal obstruction, but this emergency medical problem is usually associated with persistent vomiting and a pale, generally ill-appearing baby. Be sure to feel baby's abdomen. between outburst because crying babies often swallow air and have tense-feeling abdomens.
* Does baby have a scalded-skin type of diaper rash? This can be very painful.
* Is there a thick yellow discharge from the nose? This is often a sign of ear infection.
* Has baby been straining to pass a stool? This suggests constipation: try a glycerin suppository.
* Does baby have swollen gums with profuse drooling? He may be experiencing teething pain.
* Does baby have a hair wrapped around a finger or toe? Carefully remove it.

If your parent exam does not suggest any of the above problems or trigger an alarm that you need to seek immediate medical attention, proceed to the next step.

[] Have you introduced any new foods that could upset baby? If breastfeeding, have you eaten any gas-producing foods within the past few hours? If bottle-feeding, have you recently changed formulas? Have you introduced baby to a new solid food?

[] Is your baby just upset? If you parent detective work does not suggest any medical, physical, or allergic cause of baby's crying, try the following soothing techniques:

* putting baby in a sling and taking a walk
* nursing while carrying baby
* infant massage, especially the abdomen

If none of these suggestions yield either cause or consolation, consult your baby's doctor.

There will be more articles on infants, breast or bottle feeding and other related topics to follow. So please keep an eye out for more of my articles.