Class 1 - Newborn Care 101

Section 1 - Feeding in the First 2 Months of Life

We discuss the fine details of breastfeeding (schedule, mechanics, pumping, etc) in our second class - Breastfeeding 101. In this class I simply want to teach you how to know when your baby is hungry, and when he is full.

First 2 Months

How To Know Your Baby is Hungry:

In the first 2 months of life crying = hungry
- This is true no matter how recently, or how much, you fed your baby.
  - Remember: "You can't overfeed a baby."
  - There's no such thing as too much.
- Try not to let yourself be distracted by other “reasons” your baby is fussy or crying:
  - Needs to burp, needs to pass gas
  - Too hot/cold
  - Only wants to be held, hates the bassinet, hates being on his back
If your baby is crying and won’t eat from the breast, offer food from the bottle (pumped milk or formula).
- More on this in our second class - Breastfeeding 101
Important: If your baby won't stop crying and won’t eat from the breast or the bottle, you should contact us right away.

How to Know Your Baby is Full: The Hunger Test

In the first 2 months of life, babies often fall asleep at the breast or stop crying when you pick them up.
- This does not (necessarily) mean the baby is full.
- We often tell caregivers that it's impossible to know if a baby is still hungry when they are being held.
  - Right from the start, caregivers are very good at soothing their newborn.
When you think your baby is done eating, perform The Hunger Test, by placing him down in the bassinet or crib (not your lap, a pillow, or any other comfortable/cozy location).
- If he doesn't cry, he is full and the feed is complete.
- If he wakes up and cries, he is still hungry.
  - If this happens, and baby has already fed on both breasts, offer pumped milk or formula from the bottle.
    - Offer as much as it takes for baby to pass The Hunger Test.
  - More on this in our second class - Breastfeeding 101.
Please remember: “You can’t overfeed a baby”
- There is no such thing as "too much."
- If your baby is full, she will fall asleep, and you can verify she is actually full by performing The Hunger Test.

Section 2 - Developmental Milestones

There are four major areas of development we think about in pediatrics:
- Gross Motor - whole body movements, such as rolling over, sitting, crawling, and walking.
- Fine Motor - finger and hand skills such as transferring objects between hands, and picking up small objects with the thumb and index finger.
- Expressive Language - sounds and words produced by your baby.
- Receptive Language - ability to understand what is said to your baby.
In the first year of life, babies need two activities for their development:
- Hearing as many words as possible from people they care about.
  - The more words a baby hears from people they care about, the better their language development will be.
- Tummy time
  - Tummy time is the foundation for gross and fine motor development in the first year of life.
  - When
    - Whenever she is awake and quiet during the day
    - These periods happen more often starting at 2 weeks of life.
  - How long
    - Leave your baby in tummy time until she fusses
    - We want your baby to "feel the burn" from the exercise!
  - Technique
    - Place your baby in the push up position on hard, flat surface. A yoga mat is a great option!
      - Many caregivers make the mistake of choosing a surface that is too soft, which prevents baby from generating the traction needed to hold their head and chest off the mat.
    - Keep your baby's head facing forward.
      - When she moves her face to one side of the other, gently move it back to center position.

Section 3 - Sleep Safety for SIDS Prevention

Sleep safety is about creating a sleep environment for your baby which reduces the risk of sudden infant death syndrome (SIDS). SIDS is exactly what it sounds like. It can occur without warning, at any age in the first year of life, and results in death. It only happens during sleep, but that includes daytime naps as well as overnight sleep.

There are many leading theories about why SIDS occurs, but unfortunately we do not know for sure. Thankfully, a great deal of research has been done to determine how to prevent prevent it from happening. If you follow these recommendations closely, you can safely remove this terrifying possibility from your mind altogether.

The ABCs of Safe Sleep

The ABCs should be followed for both daytime naps and overnight sleep.
The ABCs should be followed for the entire first year of life.
After 12 months of life, most experts believe these restrictions can be lifted.

A - Alone

Your child should be completely alone in the sleep environment.
- Items such as teething necklaces, pillows, toys, stuffed animals, loose bedding (blankets, quilts, comforters, loose sheets), crib liners (even if advertised as “breathable”), wedges to keep your baby is a particular position, and bumper pads should never be present in the sleep environment.
- This also includes caregivers. Co-sleeping (when both caregiver and baby are sleeping in the same place together, such as your bed, the couch, a recliner, etc) increases the risk of SIDS, separately from events where a child is accidentally suffocated or injured by a sleeping adult.
- Put your baby in the same room as you, but not the same bed.
  - Sleeping in the same room as your baby is recommended for the first 6 months, as this has been shown to reduce the risk of SIDS.
Only two items are safe for your baby to have during sleep:
- Pacifier
  - The pacifier should not have anything attached to it (stuffed animals, strings/ropes).
  - The pacifier should be inspected regularly for signs of wear and tear, and discarded if these are present.
- Swaddle
  - A swaddle should be tight, and positioned low enough to see the top of the chest and shoulders.

B - Back

Always place your baby on their back for sleep.
If your baby has rolled from her back to her side or stomach on her own, she is safe to be left in that position, and does not need to be replaced on her back again.
Stop swaddling once your baby is 4 months old, or as soon as she can roll from her back to her belly on her own, whichever comes first.

C - Crib

The sleep surface must be two things: Firm and Flat

Firm

Cribs, bassinets, and play yards (portable cribs) are safe because they meet the safety standards set forth by the Consumer Product and Safety Commission (CPSC).
Cover the mattress with a tight-fitting sheet.
Measure the dimensions of this sheet to be sure it is the same size as the mattress.
Never put rolled blankets or pillows between the mattress and the sheet.

Flat

Never put your baby to sleep at an inclined position.
This is true for daytime naps and overnight sleep.
Swings, rockers, bouncers, floor chairs, in-bed sleepers, car seats, and cushions/pillows increase the risk of SIDS and are not safe for sleep during the day or at night.
- Example of unsafe sleep environments include:
- This list not complete, of course. Sleeping on anything that is not firm and flat is not safe.
- DO NOT place the DockATot in the bassinet.
If your baby falls asleep in any of these items, he should be moved to a safe sleep environment as soon as possible.
Sleeping in a car seat is safe for short periods of time while in a moving car.
- The exact amount of time has not been thoroughly studied, unfortunately.
- Nevertheless, it is always safer for your baby to be in a carseat while the car is moving.

Additional Prevention Strategies

Don't Overheat During Sleep:

Overheating increases the risk for SIDS.
Set the thermostat between 68-72ºF.
Dress your baby is the same number of layers of clothing as you need to feel comfortable at that temperature.

Section 4 - Daily Care

Poop

Please do yourself a favor: ignore your baby's poop!
The frequency of poop gets a ton of attention, but if your baby is passing the hunger test, and peeing normally (see next section), it doesn't matter how often your baby poops.
- Breastfed babies will frequently go 10-14 days in a row without any poop.
- This is normal as long as they are passing the hunger test and peeing normally.
Every color of the rainbow is normal, except for bright red blood.
- White or acholic (without color) poop indicates an extremely uncommon, but dangerous, problem in children under 2 months old.
  - If older than 2 months old, this is not concerning.
Every consistency is normal, except for dry, hard pellets, which means your baby is constipated.
We'll discuss this more in later classes, but here's a link to our resource center article for more information.

Wet Diapers

Wet diapers are important medically, because this tells us that your baby is hydrated and eating well.
The frequency will be discussed in Breastfeeding 101, and When To Worry About Your Baby.

Rectal Thermometer

In the first 90 days of life, the only way to take your baby's temperature is with a rectal thermometer.
- Other methods (forehead, in-ear, armpit) can't be trusted, unfortunately.
In the first 90 days of life, a true fever (above 100.4 F, or below 97.0 F) must be brought to the pediatrician's attention immediately.
- A fever will never hurt your child (regardless of age), it simply tells us there is an infection.
- In the first 90 days of life, however, there is a higher chance the fever is caused by a dangerous, potentially life-threatening, bacterial infection hiding somewhere in the body.
- Here's a link to our resource center article on this topic for full details.
Only take your baby's temperature if a change in their behavior is worrying you.

Umbilical Stump Care

The umbilical cord is cut shortly after delivery, and a small amount of the cord remains attached to the baby. This is called the umbilical stump.
- The stump gradually dries out and begins to look like a scab attached to the belly button.
- The stump falls off on it's own, usually between 7-14 days of life.
- Your baby can't feel the stump because there are no nerve endings in this area.
Do not wash, clean, or treat the umbilical stump in any way.
The cord will likely bleed for a day or two before and after it falls off.
- You may find blood on the diaper or the clothing overlying the stump.
- This can be ignored, unless the blood is soaking through the clothing.
The cord may develop an odor before it falls off.
- This can also be ignored.

Bathing

Bathe your baby every 3-4 days.
Use a warm, wet washcloth to bathe baby until the umbilical cord falls off and the circumcision (if present) has healed.
After this happens (around 10-14 days of life), use a normal baby bath and gentle baby cleanser every 3-4 days.