All babies reach milestones on their own developmental time line. If your baby seems not to have reached one or more of these milestones, rest assured, he or she probably will very soon. Your baby’s rate of development is almost certainly normal for your baby. Keep in mind, too, that skills babies perform from the tummy position can be mastered only if there’s an opportunity to practice. So make sure your baby spends supervised playtime on his or her belly. If you have concerns about your baby’s development, check with the doctor. Premature infants generally reach milestones later than others of the same birth age, often achieving them closer to their adjusted age (the age they would be if they had been born at term), and sometimes later.
WHAT YOUR BABY MAY BE DOING THIS MONTH
All parents want to know if their babies are developing well. The problem is that when they compare their babies to the “average” baby of the same age, they find that their own child is usually ahead or behind—few are exactly average.
To help you determine whether your baby’s development fits within the wide range of normal rather than just into the limited range of “average,” we’ve developed a monthly span of achievements into which virtually all babies fall, based on the Denver Developmental Screening Tests and on the Clinical Linguistic and Auditory Milestone Scale (CLAMS). In any one month, a full 90 percent of all babies will have mastered the achievements in the first category, “What your baby should be able to do.” About 75 percent will have gained
command of those in the second category, “What your baby will probably be able to do.”
Roughly half will have accomplished the feats in the third category, “What your baby may possibly be able to do.” And about 25 percent will have pulled off the exploits in the last category, “What your baby may even be able to do.”
Most parents will find their babies achieving in several different categories at any one time. A few may find their offspring staying constantly in the same category. Some may find their baby’s development uneven—slow one month, making a big leap the next. All can relax in the knowledge that their babies are perfectly normal.
Only when a baby is not achieving what a child of the same age “should be able to do”
on a consistent basis, need a parent be concerned and consult the doctor. Even then, no problem may exist—baby may just be marching (or rolling over, or pulling up) to a different drummer.
Use the What Your Baby May Be Doing sections of the book to check progress monthly, if you like. But don’t use them to make assessment of your baby’s abilities now or in the
future. They are far from predictive. If checking your baby against such lists becomes anxiety- provoking rather than reassuring, by all means ignore them. Your baby will develop just as well if you never look at them—and you may be a lot happier.
By one month, your baby … should be able to:
lift head briefly when on stomach on a flat surface focus on a face
… will probably be able to:
respond to a bell in some way, such as startling, crying, quieting
… may possibly be able to:
lift head 45 degrees when on stomach
By the end of this month, a baby should be able to focus on a face.
vocalize in ways other than crying (e.g. cooing)
smile in response to your smile
… may even be able to:
lift head 90 degrees when on stomach hold head steady when upright
bring both hands together smile spontaneously
What You Can Expect at This Month’s Checkup
Well-baby checkups will be events you’ll come to look forward to; not only as an opportunity to see how much your baby’s grown, but to ask the dozens of questions that have come up since the last visit with the practitioner but didn’t rate an immediate frantic phone call (there will be plenty of those, too). Make sure you keep a list of these questions and bring them along to appointments.
Each practitioner will have his or her own approach to well-baby checkups. The overall
organization of the physical exam, as well as the number and type of assessment techniques used and procedures performed, will also vary with the individual needs of the child. But, in general, you can expect the following at a checkup when your baby is between one and four weeks old. (The first visit may take place earlier, or there may be more than one checkup in the first month, under special
circumstances, such as when a newborn has had jaundice, was premature, or when there are any problems with breastfeeding.)
Questions about how you and baby and the family are doing at home, and about baby’s eating, sleeping, bowel movements, and general progress.
Measurement of baby’s weight, length, and head circumference, and plotting of progress since birth.
Vision and hearing assessments.
A report on results of neonatal screening tests (for PKU, hypothyroidism, and other inborn errors of metabolism), if not given previously. If the doctor doesn’t mention the tests, the results were very likely normal, but do ask for them for your own records. If your baby was released from the hospital before these tests were performed, or if they were done before he or she was seventy-two hours old, they will probably be performed or repeated now.
A physical exam. The doctor or nurse practitioner will examine all or most of the following; some evaluations will be carried out by the experienced eye or hand, without comment:
heart sounds with a stethoscope, and visual check of the heartbeat through the chest wall abdomen, by palpation (feeling outside), for any abnormal masses
hips, checking for dislocation by rotating the legs
hands and arms, feet and legs, for normal development and motion
back and spine, for any abnormalities
eyes, with an ophthalmoscope and/or a penlight, for normal reflexes and focusing, and for tear duct functioning
ears, with an otoscope, for color, fluid, movement
nose, with otoscope, for color and condition of mucous membranes
mouth and throat, using a wooden tongue depressor, for color, sores, bumps
neck, for normal motion, thyroid and lymph gland size (lymph glands are more easily felt in infants, and this is normal)
underarms, for swollen lymph glands
the fontanels (the soft spots on the head), by feeling with the hands
respiration and respiratory function, by observation, and sometimes with stethoscope and/or light tapping of chest and back
the genitalia, for any abnormalities, such as hernias or undescended testicles; the anus for cracks or fissures; the femoral pulse in the groin, for a strong, steady beat
healing of the umbilical cord and circumcision (if applicable) the skin, for color, tone, rashes, and lesions, such as birthmarks reflexes specific to baby’s age
overall movement and behavior, ability to relate to others
Guidance about what to expect in the next month in relation to feeding, sleeping, development, and infant safety.
Possibly hepatitis B vaccination, if baby did not receive it at birth and won’t be getting the combined DTaPhepB-IPV vaccine (Pediarix) starting at two months.
Before the visit is over, be sure to:
Ask for guidelines for calling when baby is sick. (What would necessitate a call in the middle of the night? How can the doctor be reached outside of regular calling times?)
Express any concerns that may have arisen over the past month—about baby’s health, behavior, sleep, feeding, and so on.
Jot down information and instructions from the doctor so you don’t forget.
When you get home, record all pertinent information (baby’s weight, length, head circumference, blood type, test results, birthmarks) in a permanent health record.
Feeding Your Baby This Month: EXPRESSING BREAST MILK 1
Though this early in the parenting game you and your baby probably haven’t been apart for more than an hour or two (if that), there comes a time in every nursing mother’s life when she needs, or wants, more flexibility than round-the-clock breastfeeding can provide. When she can’t breastfeed her baby
—because she’s working, traveling, or just out for the evening—but still wants her baby to be fed breast milk. Enter expressed milk.
WHY MOTHERS EXPRESS MILK
It’s not so much a law of physics as it is a law of busy motherhood: You can’t always count on your baby and your breasts being at the same place at the same time. There is a way, however, to feed your baby breast milk (and keep your milk supply up) even if you and baby are miles apart: by expressing milk.
There are many situations (short- or long-term, on a regular schedule or just occasionally) when a mother might need or want to express breast milk, usually by pumping. The most common reasons why women pump are to:
Relieve engorgement when the milk comes in Collect milk for feedings when working Provide relief bottles when away from home Increase or maintain the milk supply
Store milk in the freezer for emergencies
Prevent engorgement and maintain milk supply when nursing is temporarily halted because of illness (mother’s or baby’s)
Maintain milk supply if nursing needs to be stopped temporarily because mother is taking medication that is incompatible with nursing
Provide breast milk for a hospitalized sick or premature baby
Provide milk for bottle or tube feeding when a baby (premature or otherwise) is too weak to nurse or has an oral defect that hinders nursing
Stimulate relactation, if a mother changes her mind about nursing or if a baby turns out to be allergic to cow’s milk after early weaning
Induce lactation in an adopting mother, or in a biological mother whose milk is slow in coming in
CHOOSING A PUMP
At one time, the only way to express milk was by hand, a long and tedious process that often failed to produce significant quantities of milk (and, frankly, hurt—a lot). Today, spurred by the resurgence of breastfeeding, manufacturers are marketing a variety of breast pumps—ranging from simple hand- operated models that cost a few dollars to pricey hospital-grade electric ones (that are now more affordable for home use)—to make pumping easier and more convenient. Though an occasional mother will still express by hand, at least to relieve engorgement, most will invest in either an
electric, battery-operated, or manual pump.
Before deciding which type of pump is best for you, you’ll need to do a little homework:
Consider your needs. Will you be pumping regularly because you’re going back to work or will be out of the house on a daily basis? Will you pump only once in a while to provide a relief bottle?
Or will you be pumping full-time to provide nourishment for your sick or premature baby, who may be in the hospital for weeks or months?
Weigh your options. If you’ll be pumping several times a day for an extended period of time (such as when working or to feed a preterm infant), a double electric pump will probably be your best bet. If you need to pump only for occasional outings, a single electric, battery, or manual pump will fill your needs (and those few bottles). If you’re planning on expressing only when you’re engorged or for a rare bottle feeding, you can probably get away with expressing by hand (though an inexpensive manual pump may still make sense; it can take a lot of squeezing by hand to fill even one bottle).
Investigate. Talk to friends who use pumps to see which they prefer. Not all pumps are created equal—not even among the electric ones. Some electric pumps can be uncomfortable to use, and some hand pumps painfully slow (and sometimes just plain painful) for expressing large quantities of milk. Also, discuss the options with a lactation consultant or your doctor. Research the types of pumps available (call up the manufacturers, check their Web sites), and consider your wallet as well as the models’ features before choosing one.
ALL ABOUT PUMPS
All pumps use a breast cup or shield that’s placed over your breast, centered over your nipple and areola. Whether you’re using an electric or manual pump, suction is created when the pumping action is begun, mimicking baby’s suckling. Depending on the pump you use (and how fast your let-down is), it can take anywhere from ten to forty-five minutes to pump both breasts. Pumping shouldn’t hurt; if it does, make sure you’re pumping correctly. If you are, and it still hurts, the fault might lie with the pump; consider making a switch.