Whether it’s a breast or a bottle that will be your newborn’s ticket to a full tummy, the guidelines that follow should help make the trip a smoother one:
Minimize the mayhem. While you’re both learning the ropes, you and your baby will have to focus on the feeding, and the fewer distractions from that job, the better. Turn off the
television (soft music is fine), and let voice mail pick up the phone at baby’s mealtimes.
Retire to the bedroom to feed baby when you have guests or when the general atmosphere in the living room rivals that of a three-ring circus (which in many homes, is around the clock). If you have other children, chances are you’ll already be pretty proficient at feeding—the
challenge will be keeping your older ones and your baby happy at the same time. Try
diverting their attentions to some quiet activity, like coloring, that they can settle down with at your side, or take this opportunity to read them a story.
Make a change. If your baby is relatively calm, you’ve got time for a change. A clean diaper will make for a more comfortable meal and reduce the need for a change right after—a
definite plus if your baby has nodded off to dreamland and you’d rather he or she stay there for a while. But don’t change before middle-of-the-night feedings if baby’s only damp (sopping’s another story); such a disruption makes falling back to sleep more difficult, especially for infants who are mixing up their days and nights.
Wash up. Even though you won’t be doing the eating, it’s your hands that should be washed with soap and water before your baby’s meals.
Get comfy. Aches and pains are an occupational hazard for new parents who use
unaccustomed muscles to carry growing babies around. Feeding baby in an awkward position will only compound the problem. So before putting baby to breast or bottle, be sure you’re comfortable, with adequate support both for your back and for the arm under baby.
Loosen up. If your baby is tightly swaddled, unwrap him or her so you can cuddle while you feed.
Cool down a fired-up baby. A baby who’s upset will have trouble settling down to the
business of feeding, and even more trouble with the business of digesting. Try a soothing song or a little rocking first.
Sound reveille. Some babies are sleepy at mealtimes, especially in the early days, and a concerted effort is required to rouse them to the task of nursing at breast or bottle. If your little one is a dinner dozer, try the wake-up techniques on page 122.
Break for a burp. Midway through each feeding, make a routine of stopping for a burp. Burp, too, any time baby seems to want to quit feeding prematurely or starts fussing at the nipple—it may be gas, not food, that’s filling that little tummy. Bring up the bubble, and you’re back in business.
Make contact. Cuddle and caress your baby with your hands, your eyes, and your voice.
Remember, meals should fill your baby’s daily requirements not just for nutrients but for parental love as well.
If you’ve ruled out all of the above scenarios—as well as done a quick check for a dirty or uncomfortably wet diaper—and your baby’s still crying, then consider that perhaps she really hasn’t gotten enough to eat. It’s possible that a growth spurt may be temporarily sending her appetite into overdrive. But keep in mind that offering your daughter food every time she cries after eating won’t just blimp her out but may also get her hooked on a snack-and-snooze habit that will be difficult to break her of later on.
Do be sure, however, that your baby is gaining weight at an adequate rate. If she isn’t, she may indeed be crying out of chronic hunger—which may be a sign that you’re not producing enough milk.
(See pages 165–168 if your baby doesn’t seem to be thriving.)
QUIVERING CHIN
“Sometimes, especially when he’s been crying, my baby’s chin quivers.”
Though your baby’s quivering chin may look like another one of his ingenious inborn ploys for playing at your heartstrings, it’s actually a sign that his nervous system, like those of his newborn peers, is not fully mature. Give him the sympathy he appears to be craving, and enjoy the quivering chin while it lasts—which won’t be for long.
STARTLING
“I’m worried that there’s something wrong with my baby’s nervous system. Even when she’s sleeping, she’ll suddenly seem to jump out of her skin.”
Assuming your baby hasn’t been over-doing the black coffee, the jumpiness you notice is due to her startle reflex, one of the many very normal (though seemingly peculiar) reflexes newborns are born with. Also known as the Moro reflex, it occurs more frequently in some babies than in others,
sometimes for no apparent reason, but most often in response to a loud noise, jolting, or a feeling of falling—as when a young infant is picked up or placed down without adequate support. Like many other reflexes, the Moro is probably a built-in survival mechanism designed to protect the vulnerable newborn; in this case, it’s likely a primitive attempt to regain perceived loss of equilibrium. In a Moro, the baby typically stiffens her body, flings her arms up and out symmetrically, spreads her usually tightly clenched fists wide open, draws her knees up, then finally brings her arms, fists
clenched once again, back to her body in an embracing gesture—all in a matter of seconds. She may also cry out.
While the sight of a startled baby often startles her parents, a doctor is more likely to be concerned if a baby doesn’t exhibit this reflex. Newborns are routinely tested for startling, the presence of which is actually one reassuring sign that the neurological system is functioning well.
You’ll find that your baby will gradually startle less frequently and less dramatically, and that the reflex will disappear fully somewhere between four and six months. (Your baby may occasionally startle, of course, at any age—just as adults can—but not with the same pattern of reactions.)
BIRTHMARKS
“I’ve just noticed a raised bright red blotch on my daughter’s stomach. Is this a birthmark? Will it ever go away?”
Long before your daughter starts petitioning parental powers for her first bikini, that strawberry
birthmark—like most birthmarks—will be a part of her childish past, leaving her belly ready (even if her parents aren’t) for beach baring. Of course, when you look at a newborn’s birthmark—which can be quite large and quite vibrant—this often seems hard to believe. Sometimes the mark (which often appears not at birth but rather in the first few weeks of life) grows a bit before fading. And when it
does begin to shrink or fade, the changes from day to day are often difficult to see. For that reason, many doctors document birthmark changes by photographing and measuring the mark periodically. If your baby’s doctor doesn’t, you can do so just for your own reassurance.
Birthmarks come in a variety of shapes, colors, and textures and are usually categorized in the following ways:
Strawberry hemangioma. This soft, raised, strawberry red birthmark, as small as a freckle or as large as a coaster, is composed of immature veins and capillaries that broke away from the
circulatory system during fetal development. It may rarely be visible at birth but typically appears suddenly during the first few weeks of life, and is so common that one out of ten babies will probably have one. Strawberry birthmarks grow for a while but eventually will start to fade to a pearly gray and almost always finally disappear completely, sometime between ages five and ten. Although parents may be tempted to demand treatment for a very obvious strawberry mark, particularly on the face, such birthmarks are often best left untreated unless they continue to grow, repeatedly bleed or become infected, or interfere with a function, such as vision. Treatment apparently can lead to more complications than a more conservative let-it-disappear-on-its-own approach.
If your child’s doctor determines treatment is advisable, there are several options. The simplest are compression and massage, both of which seem to hasten its retreat. More aggressive forms of therapy for strawberry hemangiomas include the administration of steroids, surgery, laser therapy, cryotherapy (freezing with dry ice), and injection of hardening agents (such as those used in treating varicose veins). Many experts believe few of these birthmarks require such therapies (though if it is decided that a strawberry mark needs to be removed, it will be easier to treat when it is small). When a strawberry, reduced by either treatment or time, leaves a scar or some residual tissue, plastic
surgery can usually eliminate it.
Occasionally a strawberry mark may bleed, either spontaneously or because it was scratched or bumped. Applying pressure will stem the flow of blood.
Much less common are cavernous (or venous) hemangiomas—only one or two out of every
hundred babies has one. Often combined with the strawberry type, these birthmarks tend to be deeper and larger, and are light to deep blue in color. They regress more slowly and less completely than strawberry hemangiomas, and are more likely to require treatment.
Salmon patch, or nevus simplex (“stork bites”). These salmon-colored patches can appear on the forehead, the upper eyelids, and around the nose and mouth, but are most often seen at the nape of the neck (where the fabled stork carries the baby, thus the nickname “stork bites”). They invariably become lighter during the first two years of life, becoming noticeable only when the child cries or exerts herself. Since more than 95 percent of the lesions on the face fade completely, these cause less concern cosmetically than other birthmarks.
Port-wine stain, or nevus flammeus. These purplish red birthmarks, which may appear anywhere on the body, are composed of dilated mature capillaries. They are normally present at birth as flat or barely elevated pink or reddish purple lesions. Though they may change color slightly, they don’t fade appreciably over time and can be considered permanent, though treatment with a pulse-dyed laser anytime from infancy through adulthood can improve appearance.
Café au lait spots. These flat patches on the skin, which can range in color from tan (coffee with a lot
of milk) to light brown (coffee with a touch of milk), can turn up anywhere on the body. They are quite common, apparent either at birth or during the first few years of life, and don’t disappear. If your child has a large number of café au lait spots (six or more), point this out to her doctor.
Mongolian spots. Blue to slate gray, resembling bruises, Mongolian spots may turn up on the buttocks or back, and sometimes the legs and shoulders, of nine out of ten children of African, Asian, or Indian descent. These ill-defined patches are also fairly common in infants of Mediterranean ancestry but are rare in blond-haired, blue-eyed infants. Though most often present at birth and gone within the first year, occasionally they don’t appear until later and/or persist into adulthood.
Congenital pigmented nevi. These moles vary in color from light brown to blackish and may be hairy. Small ones are very common; larger ones, “giant pigmented nevi,” are rare but carry a greater potential for becoming malignant. It is usually recommended that large moles, and suspicious smaller ones, be removed if removal can be accomplished easily, and that those not removed be followed carefully by a dermatologist.
COMPLEXION PROBLEMS
“My baby seems to have little white pimples all over his face. Will scrubbing help to clear them?”
No need to break out the Clearasil yet. Though parents may be dismayed to find a sprinkling of tiny whiteheads on their newborn’s face (particularly around the nose and chin, occasionally on the trunk or extremities, or even on the penis), these blemishes are temporary and not a signal of complexion troubles to come. The best treatment for these milia, which are caused by clogging of the newborn’s immature oil glands, is no treatment at all. As tempting as it may be to squeeze, scrub, or treat them, don’t. They’ll disappear spontaneously, usually within a few weeks, leaving your son’s skin clear and smooth—at least until middle school.
“There are red blotches with white centers on my baby’s face and body. Are these anything to worry about?”
Rare is the baby who escapes the newborn period with skin unscathed. The newborn complexion woe that caught your baby is also one of the most common: erythema toxicum. Despite its ominous-
sounding name and alarming appearance—blotchy, irregularly shaped reddened areas with pale
centers—erythema toxicum is completely harmless and short-lived. It looks like a collection of insect bites and will disappear without treatment.
MOUTH CYSTS OR SPOTS
“When my baby was screaming with her mouth wide open, I noticed a few little white bumps on her gums. Could she be getting teeth?”
Don’t alert the media (or the grandparents) yet. While a baby very occasionally will sprout a couple of bottom central incisors six months or so before schedule, little white bumps on the gums are much more likely to be tiny fluid-filled papules, or cysts. These harmless cysts are common in newborns and will soon disappear, leaving gums clear in plenty of time for that first toothless grin.
Some babies may also have yellowish white spots on the roof of their mouth at birth. Like the cysts, they are neither uncommon nor of any medical significance in newborns. Dubbed “Epstein’s pearls,” these spots will disappear without treatment.
EARLY TEETH
“I was shocked to find my baby was born with two front teeth. The doctor says she’ll have to have them pulled—why?”
Every once in a while, a newborn arrives on the scene with a tooth or two. And though these tiny pearly whites may be cute as can be—and fun to show off—they may need to be removed if they’re not well anchored in the gums, to keep her from choking on or swallowing them. Such extra-early teeth may be preteeth, or extra teeth, which, after they’ve been removed, will be replaced by primary teeth at the usual time. But more often they are primary teeth, and if they must be extracted, temporary dentures may be needed to stand in for them until their secondary successors come in.