Before your baby’s birth, you will need to find a health care provider for your baby. With a midwife as a partner in your care, you have an excellent resource to help you choose a provider. Your midwife can provide well newborn care for the first month, and there are many options available for long term care as your child grows, including pediatric or family nurse practitioners, pediatricians, and family physicians.
The questions that you ask early on will shape the kind of relationship you develop with your baby’s care provider, and can help you decide the kind of care your baby will receive. Your midwife can also assist you with questions to ask that will help you choose the right care provider for your baby. Your midwife may provide or direct you to other health care services for your baby, including newborn screening, vaccinations, and circumcision.
Common Problems for Babies
Babies may get sick a lot as they build immunity to viruses and other germs. For some illnesses, the best protection for your baby is ensuring that you and everyone around the baby practice regular hand washing and receive all the recommended vaccinations, particularly the flu and whooping cough vaccines. Since newborns cannot receive these vaccines, and are most likely to catch these diseases from others who care for them, it is critical that caregivers protect themselves in order to form a cocoon of safety for the baby. To help you prioritize and be prepared, here is a guide to some of the top health concerns new parents need to know.
Jaundice. Identified by yellowish color of the skin and whites of the eyes, jaundice occurs in half of all newborns, typically around day 2 or 3. Just as with nearly every other organ of a new baby, the liver is immature and not fully developed. Often, the natural breakdown of red blood cells within the baby’s body causes bilirubin to build up and get stored in the layer of fat just underneath the skin, which causes the yellowish, or darkish, cast. Another form of jaundice, found in about 2 out of every 100 breastfed babies, is caused by a component in breast milk that interferes with the absorption of bilirubin. Breastfed babies may be jaundiced if they’re not getting enough milk. In rare instances, jaundice occurs because the mother and baby’s blood types are incompatible, or because there is some infection, or a blood or liver disease. Jaundice usually goes away without any special treatment. However, at high enough levels, bilirubin can cause brain damage. Your health care provider may order light therapy, which changes the bilirubin so it moves into the bloodstream, where it can be excreted. Also, whether you’re breast or bottle feeding, the more you feed the baby, the more bowel movements s/he will have, which can clear out the bilirubin.
Spitting up. Also called reflux or regurgitation, these “wet burps” usually occur shortly after feedings. Babies spit up because, in about half of all infants, the valve at the upper end of the stomach (the esophageal sphincter) hasn’t closed properly. This should change by the end of the first year.
Until then:
- Try smaller feedings. If you breastfeed, try nursing on one side and pumping the other. Wait at least 2 hours between feedings to give the baby’s stomach time to empty. If you bottle feed, use less formula per feeding.
- Avoid putting pressure on the abdomen. This means not wrapping the diaper too tightly, especially when baby is in a sitting position.
- Pay attention to position. Try to keep baby upright in a front carrier just after feeding. Once baby is older, a stationary walker or bouncy seat might work. If your baby is vomiting frequently and not gaining weight, call your health care provider. S/he may have a condition called pyloric stenosis, a narrowing of the outlet from the stomach to the intestines. If the vomit is brown, green, or tinged with blood, call your health care provider right away.
Rashes. More than 30% of newborns develop baby acne of the face—mainly small red bumps, with some whiteheads interspersed. It’s caused by exposure to the mother’s hormones just before birth. Wash your baby’s face gently with warm water 2 to 3 times per day. You may also see a red rash on baby’s chin as s/he starts teething. With teething comes drooling, which, particularly in winter months, can lead to dry, chapped skin. Keep your infant’s skin clean with warm water, and change her sheets regularly.
Diaper rash. No matter how careful you are, whether you use disposable or cloth diapers, it’s nearly inevitable that at some point your baby will get diaper rash. Up to 35% of all babies get diaper rash. Even if you’ve escaped it for the first 6 months, you may encounter it as you introduce new foods to your baby’s diet. The key is catching it early and treating it immediately, or preventing it completely. Each of these preventatives also works as a treatment:
- Change diapers often to prevent skin contact with urine and feces.
- Take a break from diaper wipes, which can dry out baby’s skin. Use lots of warm water and a soft washcloth. And be thorough, any speck of poop left on your baby could lead to a rash.
- Expose your baby’s bottom to air each day. Put baby on a blanket naked to play for 20 minutes. The air will help prevent and treat the rash.
- Avoid plastic pants.
- Use a protective cream or ointment. Ask your health care provider for a recommendation.
Dehydration. In very young babies, dehydration can happen suddenly and without much warning. Common causes include diarrhea, vomiting, or simply not getting enough formula or breast milk. Signs to watch for are:
- Crying without shedding any tears
- Dry mouth, often ringed with white
- Cool, dry, pale skin
- Excessive thirst
- Listlessness, rapid pulse
- Sunken eyes
- Urinating less than once every 8 hours
- Sunken soft spot
If your baby has any of these symptoms, call your health care provider immediately.
Diarrhea. Food allergies, changes in diet, reactions to medications, viruses, and other infections are common causes of diarrhea in babies. The best defense: wash your hands often before touching your child, before breastfeeding, and make sure any caregiver does the same. Always wash your hands with soap after changing a diaper. The best treatment is time and fluids, particularly breast milk or oral rehydration solutions such as Pedialyte. Call your care provider if your baby is less than 6 months old or has a fever, bloody stools, prolonged vomiting, and signs of dehydration. Keep in mind that breastfed babies’ bowel movements tend to be softer and looser than bottle-fed babies’. They may even be watery for the first few weeks of life. This is normal, not a sign of diarrhea.
Respiratory Syncytial Virus (RSV). Almost all children in group child care settings get a common cold virus called respiratory syncytial virus (RSV) their first year, usually during the winter. Typically, it results in nothing more than a bothersome cold. Half of the infections result in lower respiratory tract infections, called bronchiolitis, and ear infections. But very young babies and children with heart or lung disease and weak immune systems are at increased risk of developing severe infections and complications. If your baby has a cold, treat the symptoms early with a humidifier, nasal aspirator, and mild saline nasal drops. Make sure your baby drinks lots of fluids so she doesn’t get dehydrated. Call your care provider immediately if baby appears at all dehydrated, has a worsening cough, or has trouble breathing or starts wheezing. To prevent RSV, keep baby away from crowds and other children if possible during winter months when the RSV virus is particularly prevalent. Also, make sure you and other people holding your baby wash their hands frequently. Hand washing is the best protection against RSV.
Croup. With its hallmark seal-like barking cough, croup is an inflammation of the voice box and windpipe. It occurs when the airway just below the vocal cords becomes swollen and narrow, making breathing difficult and noisy. It’s most common in children between 6 months and 3 years, when their windpipes are very small and slight swelling can actually shut them off. If you think your child has croup, call your care provider immediately. The care provider may suggest you take the baby into the bathroom, turn the hot water in the shower on, close the door, and sit in the makeshift steam room for 15 to 20 minutes. This opens the airways and helps baby breathe. If that doesn’t help, try carrying baby outside where the cool, moist air might help. If your child is truly struggling to breathe, makes a whistling sound that gets louder with each breath, seems pale or has a bluish mouth or fingernails, drools, or has real difficulty swallowing saliva, call 911.
Fever. Though not an illness in and of itself, fever is a sign of infection or illness. Most fevers in babies are related to viruses that can’t be treated with antibiotics and get better on their own. But fever in an infant still needs to be watched carefully, because even a relatively mild temperature could signify a serious infection that can quickly overtake a newborn’s immature immune system. Ask your health care provider for specific guidelines on how to monitor and what to do about fever. Never give any child aspirin for a fever. Instead give ibuprofen or acetaminophen as directed by your health care provider. Aspirin has been linked to Reye’s Syndrome, a potentially fatal infection.
Colic. Do you have a child who wails every night for 2 to 3 hours at a time and no amount of care can calm her down? You may have a colicky baby. Even today, experts don’t know for sure what causes colic. Studies suggest a myriad of reasons: it’s an early warning sign of certain allergy-related conditions; it’s fussing due to painful digestion; it’s baby’s way of unwinding after a stressful day. But the reasons don’t matter much when you just want the screaming to end. Most colic disappears at around 3 months. To cope in the meantime wear your baby in a sling or other carrier. The closeness, warmth, and sound of your heart may help soothe her. Ask your health care provider for additional tips for getting through this difficult period.
Ear infections. Most ear infections (otitis media) are caused by viruses and do not always require antibiotics. Ear infections affect nearly 75% of all children at least once by the time they turn 3 years old. Symptoms include inflammation of the middle ear, often with fluid building up behind the eardrum, fever, and fussiness. Your child may also tug at the ear, have problems hearing, and have diarrhea, nausea, and vomiting. Ear infections are also more prevalent in young children because their eustachian tubes, the small passageway that connects the upper part of the throat to the middle ear, are shorter and straighter in children than they are in adults. This makes it easier for fluid from a blocked tube to collect in the normally air-filled middle ear. Children’s adenoids—tissue filled with infection-fighting cells located in the upper part of the throat near the eustachian tubes—can interfere with the tube opening if they get enlarged, as they often do when children are sick. Left untreated, repeated bouts of otitis media can interfere with a child’s hearing, which could delay speech and other developmental milestones. An untreated infection could also spread from the middle ear to the nearby parts of the head, including the brain. To prevent ear infections, don’t allow your child to be in smoke-filled rooms, don’t let your baby sleep or lie on his or her back with a bottle, and breastfeed if at all possible. Studies show that breastfed infants have fewer ear infections.
Additional Resources
There are many resources online that can help you prepare for caring for your newborn. These are a few of our favorites, but be sure to talk to your midwife about additional advice and resources:
Promoting Skin-to-Skin Contact
Umbilical Cord Clamping After Birth
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