Common Concerns in the Early Weeks - Part Two

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.

The Newborn's Body

Weight Changes.
Newborns usually lose around 6-10 ounces (170-280 grams), or about 5-8 percent of their birth weight, during the first week. Babies are born with extra fluid and fat to tide them over until their mother's milk can supply sufficient fluid and nutrition. How much weight a newborn loses depends on the following factors.

Large babies with a lot of extra fluid tend to lose the most weight; babies who are fed frequently on cue and room-in with their mothers tend to lose the least weight. How quickly your milk appears also influences your newborn's weight loss. If you room-in with your baby and breastfeed every two hours, you high-calorie hindmilk will appear sooner, and bay will lose less weight. Babies who are separated from their mothers a lot during the first week or who are fed on a three-to four-hour schedule, tend to lose the most weight. Remember to record your baby's weight upon discharge from the hospital. This is an important reference for measuring weight gain at your baby's first checkup.

Normal lumps.
When you run your hand over baby's head you may feel lots of bumps and ridges, especially on top of the head, on the back of the head, and behind the ears. Babies' skull bones consist of many small bones that are unconnected to allow for brain growth and also for molding to the birth canal. During the second year baby's head will feel much smoother.

Another normal lump is a hard lump in the center of baby's chest, just above the tummy. This is the end of the breastbone, and in some babies it sticks out for a few months. Around the second or their month you will find several pea-sized lumps beneath the skin on the back of the head and along the neck. These are normal lymph glands.

Swollen scrotum.
The testicles begin inside the abdominal cavity and, usually before birth, push through the groin tissue forming a scrotal sac. (Occasionally, one or both testes do not descend into the scrotum by birth time but may come down later. If the testes remain undescended by one year of age, they can be brought down by hormonal or surgical treatment.) The opening in the abdominal wall through which the testes migrated usually closes. Sometimes this passageway remains open, allowing fluid to accumulate around the testis. Called a hydrocele, this swelling seldom bothers baby and usually subsides by the first birthday. During your son-s checkup the doctor may shine a penlight on the scrotum, illuminating the water around the testicle to confirm the diagnosis.

Occasionally a loop of intestines may poke through this opening into the scrotum. This is called an inguinal hernia. Unlike a hydrocele, which is round and soft, a hernia feels more firm and oblong, about the size of a thumb. A hernia swelling comes and goes, usually disappearing back into the abdomen when baby is asleep or relaxed and bulging out again during crying. Mention this swelling to the doctor on baby's next checkup. The hernia will need to be repaired by a minor surgical procedure, usually without an overnight stay in the hospital.

Rarely, the loop of intestines gets stuck in the scrotum, prompting immediate surgical release to prevent damage to the intestines. Call your doctor right away if the swelling suddenly gets larger, harder, darker, tender, or baby is vomiting and suffering colicky pain.

Lump in the labia.
The labia are equivalent to the scrotal sac in males, Sometimes an ovary can migrate into the labia and feels like a movable marble beneath the skin. Mention this to your doctor, who will arrange to have the ovary repositioned in the abdominal cavity by a minor surgical procedure.

Baby's swollen breasts.
Because of a surge of breast-enlarging hormones at birth, your baby's breasts may become swollen, firm, and lumpy within a week after birth. And these baby breasts may even produce a few drops of milk. These are normal physiologic changes in both girl and boy babies. The swelling should subside within a few months.

Closing vagina.
Commonly during the first year or two you may notice that the slit like opening in your daughter's vagina begins to close. Mention this to your doctor during your baby's regular checkup. Called labial adhesions, this condition occurs because the sides of the vaginal opening are so close to each other that they begin growing together. This does not cause baby any discomfort or harm. Oftentimes these adhesions open by themselves. But if the adhesions are becoming thicker or obstructing the whole orifice enough to block the flow of urine, your doctor may gently open the adhesion. You can prevent them from growing back together again by daily gently spreading the labia apart. If they continually grow back, the doctor may prescribe an estrogen cream to be applied around the edges to prevent further adhesion. Around two years of age, as your daughter begins producing her own estrogen in this tissue, the labial adhesions will subside.

Protruding naval.
Babies are born with an opening in the abdominal wall through which the umbilical-cord vessels connect with the placenta. When the cord is cut, the stump shrivels up. Sometimes the newly formed naval bulges out -- other times it stays flat or inverts. Whether it's an "outie" or and "innie" depends on the individual way a stump heals, not the way it's cut. Most outies flatten with time.

Two large bands of muscles grow down the center of baby's abdomen and encircle the naval. Sometimes there is an opening between these muscles, and when baby cries or strains the navel protrudes. The intestines poke through beneath the skin, and you feel a squishy bulge of intestines in the protruding naval. This is called an umbilical hernia. It may be the size of a golf ball or a fingertip. As the muscles grow, the opening in and around the navel seals, and the hernia disappears. Umbilical hernias are particularly common in African American babies. They do not hurt baby. Above all, don't tape over the hernia. This doesn't speed the closure and can lead to Irritation. Nearly all heal with only the treatment of time, usually by the second birthday.

Quivers and shakes.
Baby's immature nervous system causes frequent muscle twitches: quivering chin, shaking arms and legs, and grin like lip twitches. These normal movement, especially noticeable while baby is drifting off to sleep, subside by three months.

Creaking joints.
When you move baby's joints you may hear crackles or "joint noises." These are normal, caused by loose ligaments and loose bones.

Crooked Feet

A newborn's legs and feet reflect the scrunched-up position of "no standing room" in the womb. The legs are normally very bowed, and the feet turn in. Since the bones were curved that way for many months inside, expect several months of free kicking before the legs and feet straighten. You can help the straightening process by not letting baby sleep in the fetal position -- with feet and legs curled beneath. For the persistent fetal sleeper, sewing the pajama feet together prevents sleeping in this tucked-in position.

When not to worry.
Pick up those precious feet and look at the soles. It's normal for the front of the foot to be curved in a bit. Now hold the heel of baby's foot with one hand and gently stretch the front of the foot to the straight position. If the foot straightens easily with gentle stretching, this is normal curvature that will self-correct with a few months. To help these little feet straighten, do these stretches with each diaper change and minimize sleeping in the fetal position, as mentioned above.

When treatment may be needed.
If the front of the foot is curved inward and you see and feel the following features, your doctor may suggest treatment.

* The front half of the foot is very curved in relation to the back.
* You are unable to straighten the foot with gentle pressure.
* There is a deep crease in the sole where the front of the foot begins to curve inward.

If your baby's foot or feet (usually it's both) have these features at birth and show no signs of self-correcting over the following month or two, your doctor may send baby to an orthopedic specialist for a simple and painless treatment called serial casting. Plastic casts resembling little while boots are placed over your baby's feet. The doctor changes these casts every two weeks, each time straightening the foot a bit, over the course of two or three months. After the cast treatment your doctor may prescribe special shoes for a few more months to keep baby's fee straight.

Spitting Up

The spots of dried milk on your clothing are telltale signs that you are the parent of a spitter. Most babies regurgitate, or spit up, their milk or formula several times a day during the early months This is more of a laundry problem than a medical problem and seldom bothers baby. Dress for the occasion. If you are blessed with a baby who shares a bit of each meal with your clothing, wear prints and avoid dark-colored clothing. Keep a cloth diaper handy as a burp cloth.

Not much lost.
When baby spits up, you may feel she has lost the whole meal of the milk your body worked so hard to produce or wasted the expensive formula you bought. But you are likely to vastly overestimate the volume of regurgitated milk, Pour a tablespoon of milk or formula on the countertop and watch the huge puddle it makes. Now, does that amount match the spot on your dress? most spit-u measures only a teaspoonful.

Why babies spit up.
Babies spit up because they are just being babies. They gulp milk and air, and the air settles beneath the milk in the stomach. When baby's stomach contracts, like an air gun the stomach shoots some milk buck up the esophagus, and you have sour curdled milk on your shoulder. Some ravenous eaters gulp too much milk too fast, and the overloaded tummy sends some back. Jostling babies after eating may also trigger regurgitation.

Settling the spitter.
Here are some suggestions that may help your spitter.

* Slow the feedings. Respect that tiny babies have tiny tummies. If you are formula feeding, give your baby smaller-volume, more frequent feedings.
* Burp baby during and after the feedings. Formula-fed spitters should be burped after every three ounces (ninety milliliters) of milk, and breastfed spitters should be burped when switching sides or during a pause in baby's sucking if baby lingers on one side.
* Feed upright and keep baby upright twenty to thirty minutes after feeding. If you do not have time simply to sit and hold your baby upright, wear your baby in the upright position in a baby sling as you go about your work. Gravity is the spitter's best friend.
* Avoid jostling or bouncing baby for at least a half hour after a feed.
* If bottle-feeding, be sure the nipple hole is neither too large or too small.

When to expect the last spat.
Most spitting up subsides around six to seven months when baby sits upright and gravity holds down the mil.

Blood in spit-up.
Don't panic at baby's first bleed. If you breastfeed, most often this is your blood, not baby's. It usually comes from cracked nipples during breastfeeding and subsides when you nipples heal. Occasionally baby may retch or spit up forcefully and tear a tiny blood vessel at the end of the esophagus. This also heals quickly. If neither of these causes seem likely and the bleeding continues, notify your doctor.

Spitting Up: When To Worry

Spitting up becomes a problem and needs medical attention if any of the following occur:

* Baby is losing weight or not gaining weight sufficiently.
* The vomiting increases in frequency and volume and becomes projectile (the spit-up flies across your lap and onto the floor).
* The vomitus is consistently green (bile stained).
* Painful colicky behaviors accompany the vomiting.
* Baby gags and coughs during every feeding.

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.