Top Ten Newborn Questions, and Answers

Written by Jenn Gruen MD

Photo Credit: http://www.newbornbloodspots.org

1. Does my baby have a cold?

Many, if not most, newborns have a congested nose and frequent sneezing for the first month or so. Unless you see mucus coming from the nose, it’s usually not a cold. Unless your baby has difficulty with feeding due to nasal congestion, you do not have to use the nasal bulb syringe. In fact, if you use it frequently, you may irritate the nose linings and make the congestion last longer.

2. What about my newborn’s peeling skin?

It looks so dry—should I use lotion? This is normal – most newborns “peel like a snake” and this requires no treatment. If there is some cracking or excessive irritation around the ankles or wrists, you can lubricate with a little Vaseline or diaper ointment.

3. Should I worry if my baby is breathing funny?

Well, yes and no. Normal newborn breathing can seem strange. Sometimes they will stop breathing for a second or two and then breathe very quickly for several seconds. Sometimes they sound funny because they snort due to a congested nose (see #1).

Sometimes they make a high-pitched whistle when they breathe in due to a flexible windpipe (tracheomalacia). However, if you see very fast breathing (more than 70 times a minute) that persists, or if the baby has to work very hard to breathe, or you have worries about his or her breathing, don’t hesitate to contact us.

4. What if there is oozing or blood when the cord falls off?

A bit of yellowish wet gunk at the site of the cord that dries over a few days is normal, as long as the skin around the base of the cord remains normal color (if it becomes increasingly red, call us immediately).

You do not need to use alcohol. A few drops of blood on the diaper as the cord is falling off is also normal. If it bleeds a whole lot (which almost never happens), apply pressure to stop the bleeding and call us.

5. How many bowel movements are normal?

Breastfed newborns generally have 3 or more bowel movements per 24 hours by day 3 or 4. Formula fed infants generally have at least 1 bowel movement per 24 hours. But some infants can have up to 20 per day and still be normal! And normal breastfed newborn stool is extremely loose.

In an adult, this would be called diarrhea, but it is normal for a newborn. Formula fed stool tends to be more pasty. Any color from bright yellow to green to brown is normal. By age 3 to 6 weeks, the frequency of stool decreases (even once a week for a breastfed infant at this age can be normal as long as it is soft and passes easily).

6. Is the discharge from my baby girl’s vagina normal?

Yes, it may be clear, white or bloody, and it is from withdrawal from the mother’s hormones. You don’t have to wipe it away, but you can if you want to (top to bottom).

7. Is it normal for my nipples to hurt (for breastfeeding mothers)?

It is normal in the first week to have pain for the first 1-2 seconds of latch on, but if you have pain in the nipples beyond the first second or two, ask us about it.

8. Can my baby see me?

Baby’s sharpest vision is the distance from the breast to the face. Babies recognize their mother’s faces within a short time after birth. They can identify their mother’s breastmilk smell immediately, and will recognize the voices (and soon the faces) of close family that they heard talking while in the womb, like fathers or siblings.

9. Is it normal that my baby lost weight after birth?

Yes, most babies lose weight after birth and this is normal. We will tell you if we are concerned that the weight loss is too much.

10. When should my next appointment be?

Usually 1-2 days after you leave the hospital, we would like to see you back in the office to check your baby’s weight, color, and heart.

If your baby has a fever more than 100.4 rectally (only take temperature if baby seems warmer than usual), is irritable, lethargic or not feeding well, call right away. If your baby seems yellow other than the eyes/gums/face (i.e. chest/abdomen/legs), call us during office hours. Also call during the day if your infant is not having normal stool (see #5).

Have your baby sleep on the back or side. Make sure that your car seat is correctly installed and used, call 1-866-SEATCHECK or go to seatcheck.org for a free car seat checkpoint near you.

CONGRATULATIONS! ENJOY YOUR BABY

Dr. Gruen opened her practice, Village Pediatrics, in 2009, but prefers spending time creating fantastic kids birthday parties.

On Mother’s Day, We Should Be Supporting ALL Mothers

By Jennifer Shaer, MD FAAP IBLC

Time Magazine has caused quite a stir this week with its cover featuring a three year old breastfeeding. The article is about a philosophy of parenting called attachment parenting and the controversy is two-fold.

The first issue surrounds the cover title “Are you mom enough?”. This provocative title implies that if you do not breastfeed your child until he is three and do not practice attachment parenting then you are less of a mother.

While attachment parenting works for many, to imply that it is the only way to raise a well-adjusted child is misleading and inflammatory.

The second issue surrounds the cover photo and the concept of nursing a toddler. As a pediatrician and a breastfeeding medicine specialist the photo of a three year old standing up while nursing and looking at the camera should be easy for me to look at, and yet it is not.

Why does this photograph evoke such emotion?

Medically speaking, there is every reason for a child to continue nursing until he self-weans. In most societies that embrace self-weaning, children routinely breastfeed until well over two years old.

However, it is so rare to see a toddler in our society nursing that the image is unsettling. I ask myself, “why am I uncomfortable looking at this picture when I am such a strong supporter of breastfeeding?”

There is truly a societal and social expectation that is ingrained in all of us, and it works to the detriment of breastfeeding as a whole. As I think about my patients, I recognize a pattern.

Upon initiating breastfeeding, most women are proud to give their baby the best start to life and are proud of themselves for being successful in the first big parenting challenge. However, as mothers continue to breastfeed, there comes a point when they turn from proud to embarrassed.

I see the look on their faces or the tone in their voices when they tell me that the 15 or 18 month old is STILL nursing. The mother who was once confident and proud begins to feel like an outcast and a social deviant.

Many women at this point either force the baby to wean, secretly nurse (the “closet nurser”) or stand up for themselves as Jamie Lynne Gumet has done in this article.

What can I say about this situation? This child is not being forced to breastfeed. He is not being abused and this is not pornography as some people suggest. Nobody can force a 3 year old child to do most of anything that he doesn’t want to do, let alone breastfeed.

The problem with this image is that it is so contrary to what we accept as normal. The problem with this image is that we as a society cannot accept breastfeeding a toddler.

I know in my heart that this is normal but my gut reaction can’t easily be changed. Just as I know in my heart that gay couples should have the right to marry, yet when faced with two men kissing in front of me, I am uncomfortable.

The unsettled feeling that I get when looking at this picture is my own weakness. I applaud Jamie Lynne Grumet and Time Magazine for helping me take one step closer to accepting what is biologically normal.

On mother’s day, we should be supporting ALL mothers. If we stop passing judgment on one another then we will truly be showing our children how to behave as adults.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.

You want me to what? 10 Tips on going back to work while breastfeeding

Written by Jennifer Shaer MD, FAAP, IBCLC

The working mother has a lot of responsibilities. She is usually expected to run the household, take care of the kids and succeed at the office. She is expected to do all of this and make it look effortless. Now, throw in a new baby and a mother is expected to breastfeed while going back to work. The modern day mother has a lot on her plate. Here are 10 tips to help ease the transition back to work for the breastfeeding mother.

1. Set your goals and expectations: Doing something for your baby while you are at work often helps you feel connected despite being separated. As in everything you do, setting a goal will help you achieve success. If you plan to pump when you return to work then you will succeed.
2. Plan in advance: Think about your day at work. When can you pump, where will you pump and where will you store your milk? Speak with your employer about your intentions. Many states have labor laws requiring employers to accommodate nursing mothers. Don’t forget to plan your clothes. You will need easy access for pumping at work.
3. Ease back into the workforce: If at all possible, start back to work midweek. This way you will have a weekend home with your baby in just a few days.
4. Take one day at a time: You do not have to plan to pump milk for the next year. Each day that you bring home a bottle of pumped milk is a gift for your baby.
5. Take time for yourself: As difficult as this seems, it is critically important to your mental health. A happy woman makes for a much better mother. Figure out what works for you and make it happen. Less stress is healthy for you, your baby, your family and your job. It also helps protect your milk supply.
6. Multitask: Most women are masters at multitasking. Often work does not need to stop while you are pumping. With hands free breast pumps, many women can pump while working at their desks. Some women even pump while commuting to and from work.
7. Find a breastfeeding friendly daycare or supportive babysitter: In general, it is best to surround yourself with people who are supportive of your breastfeeding goals.
8. Continue nursing when home: Plan to nurse before work and when you get home. Tell the sitter when to expect you and do not give a bottle just before you arrive. Nursing when you are home and on the weekends helps maintain supply and helps you feel close to your baby.
9. Be flexible and reassess your goals: If you do not maintain a full milk supply, do not get upset. There are many things you can do to increase your supply. Nursing at night and on the weekends often helps. You might want to seek help from a professional lactation consultant. Remember, if you do not have enough breastmilk then you should use formula. It is not the end of the world if you can’t keep up completely. If your supply is not complete, it does not mean you should quit. Partial breastmilk is always better than no breastmilk. Keep it up and be happy for what you can give.
10. Enjoy: You CAN do it all and you should enjoy the process. Have fun, enjoy your baby and be proud of yourself!

Dr. Shaer is a pediatrician, board certified lactation consultant (IBCLC) and a member of the Academy of Breastfeeding Medicine. She is founder of the first breastfeeding medicine practice on Long Island. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.

An Ounce of Prevention. Supporting Breastfeeding Saves Money

Written by Jennifer Shaer MD., FAAP., IBCLC

Why don’t insurance companies cover breastfeeding services? As a pediatrician and breastfeeding medicine specialist, I’d like to add my perspective to the discussion. I do not want to detail the health benefits of breastfeeding. The benefits are numerous and deserve a separate story. My goal here is to point out that supporting breastfeeding saves the country money.

I would like to bring attention to a couple of publications. The Department of Health and Human Services has a publication called “The Business Case for Breastfeeding”. This publication highlights the financial benefits to breastfeeding. It shows how breastfeeding working mothers have lower absentee rates and lower turnover rates. Breastfed babies utilize fewer healthcare dollars. The publication features a number of companies that have saved hundreds of thousands of dollars annually simply by implementing lactation support programs in the worksite. You can view this publication here .

Just last year there was a study titled “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis”(PEDIATRICS (doi:10.1542/peds.2009-1616)) reported that if 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion dollars per year.

The evidence is clear. Breastfeeding improves health, saves money for insurance companies, for corporations, for parents and for WIC programs. Investing a small amount of money to support breastfeeding will bring huge financial savings to us as a nation. Why are the insurance companies too short -sighted to see the benefits of supporting breastfeeding?

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.