Chapel Hill Children's Clinic
Chapel Hill Children's Clinic
301 Kildaire Rd., Ste. 200
Chapel Hill, NC 27516
Phone: (919) 967-0771
Fax: (919) 967-9207
After-hours Phone:
(888) 267-3675 or
(919) 966-3820
Clinic Hours:
Mon-Fri 9:00am - 4:30pm
Walk-in Hours:
Mon-Fri 7:30am - 9:00am
and 4:30pm - 6:30pm
Sat 9:00am - 11:30am
Sun 1:00pm - 3:00pm
›› Newborn
Congratulations! Over the next few weeks you and your baby will be getting to know each other better every day and learning how best to respond to each others' needs as the bonds of love between you grow. Parenting skills are learned and developed, often through trial and error, as your relationship with your baby evolves. Your baby is a unique individual. As parents, trust your intuition, for you will always know your child better than anyone.
The first few days and weeks at home together can be a stressful adjustment time for all. Your baby is just getting to know a new world filled with sights and sounds that he/she must learn how to respond to. In this packet you will find basic information to help you meet your child's needs.
A common feeling for first time parents arriving at home with their newborn is "now what do we do?" Your life will never be the same, but it will begin to make more sense as the days go by. Be careful not to exhaust yourself in these first few weeks. Friends and relatives who offer help can be encouraged to assist with housework, meals, errands, and care of siblings, leaving mom and dad free to care for baby. You may be surprised at how much time and energy it takes to care for such a small, innocent baby. Though often tiring, these very special and precious first weeks are brief, so enjoy this unique and important time with your baby!
Your Newborns Physical Appearance and Characteristics
There are a number of newborn behaviors and characteristics, which are normal aspects of a newborn's development that may cause concern for new parents. This information about some of these common concerns (in alphabetical order) may answer some questions and provide reassurance.
In the first few days of life your baby will have very tarry, black-green, sticky stools called meconium. As your baby takes in more breast milk or formula, the stools will gradually change to brownish-green and then to brownish-yellow (if formula-fed) or mustard, yellow-greenish (if breast-fed). Your baby will probably strain and grimace and may get fussy when having bowel movements. This is normal, as it takes a lot of effort for a baby to have a bowel movement!
If formula-fed, the baby's stools will probably be pasty in consistency. Your baby may have 1-8 stools per day or just 1 every 3-7 days. If breast-fed, the stools will be looser or curd-like occurring 1-12 times a day. There is a wide range of patterns that are normal. If your baby develops hard, pellet-like stools however, call us for advice.
Both boy and girl babies may show some effects from maternal hormones that have passed through the placenta to them. Their breasts may be swollen for several weeks and may even secrete milk. Call us for advice if they become reddened, warm, and tender. Baby girls may have a slight bloody vaginal discharge for several weeks due to the withdrawal of mom's hormones.
Your baby's breathing pattern will be very irregular for several months as his/her nervous and respiratory systems mature. You may notice rapid breaths followed by very irregular, slow breaths, with periods of shallow then deep breaths. This is normal for a newborn. Pauses in breathing of up to 5 to 10 seconds may also be normal. If you notice pauses of greater than 10 seconds call our office for advice. You may also hear some mucus in your baby's nose when he/she breathes, sounding somewhat "snorty" at times. This is normal and doesn't necessarily mean your baby has a cold. Because babies at this age are obligate nose breathers, you may need to help clear this mucus by using a bulb syringe. However, if you are concerned about your baby's breathing or congestion, be sure to ask us for guidance and advice.
Small, red broken blood vessels may appear in your baby's eyes. These are due to the pressure exerted on his/her head during birth. They will gradually resolve over several weeks. There may be some swelling and yellow drainage for 1-3 days of age, secondary to the antibiotic ointment placed in your baby's eyes after birth. Call us for advice if this does not resolve within a few days.
Your baby is able to see best about 8-12 inches away during the first few months. You may notice that he/she crosses his/her eyes frequently as his/her visual skills are continuing to develop. Eye color may change up until 6 months of age.
Your baby's head may be slightly lopsided or oddly shaped after birth. This is due to molding of the skull as the baby passes through the birth canal, and will gradually disappear over the next few weeks. The soft, "open" spot on the top of your baby's head is the anterior fontanel. Don't be afraid of hurting it; it is very tough, and protects your baby's brain while giving it room to grow until the bony plates at the top of the skull gradually grow together. You may notice a pulsing of the fontanel; this is normal. If you notice that the fontanel appears to be bulging, call our office, as this can indicate possible illness.
Hair loss and growth in infants is very individual. Some babies lose part or all of their initial hair in the first few months, while others do not. Many babies have red marks on their scalp, forehead, neck or eyelids, commonly called "storkbites". These will gradually fade. You may also notice small white bumps on the face, especially over the nose. These bumps, called milia, are caused by clogged oil glands and will resolve over several weeks without treatment.
Sucking blisters may develop during the first few weeks on your baby's lips and are harmless. Your baby's ability to turn, lift, and control his/her head will occur gradually over the next few weeks as he/she develops in a head-to-toe fashion.
Because your baby's skin was immersed in fluid for nine months and is now exposed to air, it is common for the superficial layer of skin to peel away, looking very dry and flaky. It is usually most pronounced on the hands and feet, and some babies may develop reddened cracks in the skin. A small amount of mild lotion or Vaseline may be helpful. Your baby's hands and feet may look slightly bluish and feel cool to touch, due to an immature circulatory system. If your baby is appropriately dressed for the environmental temperature there is no need to add more clothing. His/her actual body temperature is probably fine; this too will pass with time and maturity.
Jaundice is the term for a yellow tinge to the skin and the whites of the eyes. It is common in newborns, and is caused by the baby's production of bilirubin, a waste product of red blood cells. It is not harmful to the baby except at very high levels. The doctor may recommend putting your baby in indirect sunlight, which helps break down bilirubin so it can be excreted in your baby's stools, thus lowering the level in the bloodstream.
Feeding your baby is a very special time for closeness, providing your baby with a sense of security, love and nourishment. During the first 4-6 months your entire baby's nutritional needs are met by milk, either in the form of breast milk, infant formula or a combination of the two.
Babies do not necessarily eat at the same time every day and their feeding schedule may vary in the first few weeks. You can help your baby achieve a fairly regular pattern by using distraction, like holding and sucking (pacifiers, etc.) in between feedings, to work toward a more consistent feeding schedule.
Nature protects newborns by supplying plenty of extra food and fluids to tide them over in the first few days of life. Newborns will normally lose 5-10% of their birth weight in these first few days. By the 4th or 5th day they should begin to gain weight, gaining from about 4 to 7 ounces a week in the first 6 months. Your baby will have his/her own feeding and growth pattern, which may be quite different from other babies.
Many babies are very sleepy in the first 1-2 weeks and may need to be vigorously aroused and stimulated to an alert state before and during the feeding in order to take in enough nourishment. Generally, infants should be fed every 21/2 to 3 hours. Some babies become satisfied and content with too little and need to be stimulated to fill themselves at each feeding. Babies' stomachs are very small, holding only a few ounces initially, but able to take more and more at a feeding as they grow. Other babies are voracious eaters. This type of baby may feed beyond the stomach's comfortable capacity, causing discomfort, burping, excessive spitting up and gas.
Breast milk is the perfect food, rich in immunologic protection factors. It is digested very easily and rapidly, making for frequent feedings (every 2-4 hours) and frequent bowel movements (from 1-12 or more a day). Most babies require feedings at least 8-10 times a day in the first few weeks in order to receive ample nourishment and calories for growth; this means about every 2-3 hours around the clock. Your milk will probably come in between 3 and 6 days after birth, changing from yellow colostrum to whitish milk.
Some babies are not interested in feeding, preferring to nurse briefly or to sleep. These babies are dependent on you to awaken them, stimulate them and teach them how to feed correctly. Be sure to awaken your baby during the day if he/she doesn't awaken on his/her own after 3 hours and at night after 5 hours from the start of the last feeding. This will insure adequate stimulation of your breasts to increase milk supply and prevent engorgement.
Encourage your baby to feed about 10 to 15 minutes on each side with a vigorous, active suck in order to fully empty the breast and get the richer, fattier hind milk which will help keep him/her satisfied longer. Your breasts will probably feel very full and uncomfortable, especially during the 3rd-6th day due to engorgement. The best cure is frequent feedings to empty the breasts (or use a pump if your baby is not adequately emptying them). Toward the end of the first week discomfort should decrease as the swelling of the breasts subsides. Be sure to consult with our nurses or doctors if you are having difficulty with engorgement, sore nipples, or have other questions about breast-feeding.
Some indications that your baby is feeding well in the first few weeks are:
Don't be discouraged if breast-feeding isn't the wonderful, easy, natural event you thought it would be immediately. It doesn't always come naturally to baby or mother. About 10% of mothers will be physiologically unable to breast-feed.
There are several types and forms of infant formula available in the market: cow's milk-based, soy-based and hypoallergenic formulas. We always recommend using a formula with iron to prevent iron-deficiency. Our doctors can recommend which type may be best for your baby.
In the first few days most babies only take 1-2 ounces at a feeding. They are just learning how to suck and swallow and the stomach's capacity is still very small. This amount should gradually increase to where he/she is taking 3-4 ounces at each feeding during the first month. He/she will probably need to feed every 3-5 hours around the clock in the first 2 weeks. Each feeding should last about 15-30 minutes. Any longer is tiring for the parent and encourages "grazing", with your baby taking in only small amounts over a long period of time.
To help prevent stomach discomfort, hiccups and gas, it is a good idea to give your baby a chance to burp about halfway through a bottle-feeding and between sides with breast-feeding. You can hold your baby over your shoulder or across your lap and lightly pat or rub his/her back. Sometimes a little milk will come up with the burp and that's normal. Most babies will spit up small amounts of milk (up to a few tablespoons) during, after or between feedings.
Bathing : Your baby should receive sponge baths, avoiding submersion in water, until the umbilical cord falls off. A bath every 2-4 days will keep your baby clean. When giving a sponge bath, cover the parts of the body not being washed to keep the baby warm and comfortable. Use a mild soap (Dove, Phisoderm), warm water and a washcloth. Clean the "clean" parts of your baby first, starting with the eyes, ears, face and scalp, and wash and rinse well. You may use soap or a baby shampoo on your baby's hair. Then wash the rest of his/her body, paying special attention to the creases, especially in the neck and groin area where dirt and irritation develop. Be sure to rinse well afterwards. Then wrap your baby in a towel and dry well.
Circumcision Care : The type of care depends on the method used to circumcise your baby. With either method if you notice increasing swelling, redness, pus, bleeding or difficulty urinating call our office. "Gomco": This is the method commonly used by most obstetricians. After the foreskin is surgically removed, Vaseline gauze is wrapped around the circumcision site. This should be changed with each diaper change for the first 48 hours. After that, apply Vaseline to the area as needed to keep it protected from rubbing and irritation.
Skin Care/Nail Care : We do not recommend the routine use of lotions, oils and powders as they may cause more problems than they cure. Use mild soap and water when cleaning your baby after bowel movements, being careful to wipe from front to back with baby girls and cleaning the penis well with boys. Commercial wipes may be used, however many babies have sensitive skin that is easily irritated by diaper wipes. A small, portable spray bottle of water may aid in cleaning the diaper area instead of wipes.
If you notice a diaper rash developing, these suggestions may help:
Call our office for advice if there is no improvement. Some diaper rashes are fungal infections and require a prescription ointment.
When your baby's nails need trimming, use baby nail scissors to cut the nails. It's best to trim the nails when the baby is asleep, to lessen the possibility of nicking the fingertip. If this happens, simply apply pressure to stop any bleeding.
Umbilical Care : The cord should be kept clean and dry. Always fold the diaper back to avoid irritation and wetness. Clean the cord thoroughly with a Q-tip/cotton ball dipped in alcohol 1-2 times a day, being sure to get down to the base of the cord near the skin. There are no nerves in the cord, so there is no pain or discomfort to your baby. The cord should fall off in 2-3 weeks. There is sometimes a small amount of bleeding if irritation occurs or when the cord falls off. If you notice a foul odor, redness around the stump, a yellow discharge, a "soupy" cord or bleeding larger than a fifty-cent piece, call us for advice. Continue to use alcohol on the navel for a day or two after the cord falls off to help it dry up.
Comfort and Clothing : If your baby is a normal, healthy newborn, then he/she only needs to wear an amount of clothing that you would find comfortable in the same environment. The only exception is in cooler weather, when your baby should wear a hat to decrease heat loss through his/her proportionately large head. Diapers and baby clothes should be washed in a mild detergent (i.e. Ivory Snow) and rinsed well. Do not use harsh detergents, as they destroy the flame retardant in the clothing.
Safety : You may take your baby on outings in the first few weeks. Avoid people with colds and respiratory infections. Be certain anyone holding or touching your baby has washed their hands well, as this is the primary way germs are spread. Your baby depends on you to keep him/her safe. Always give him/her credit for being able to do more than you think he/she can. Chances are he/she will learn to turn over or creep before you expect him/her to do so. The following suggestions may help you avoid potentially unsafe situations:
Crying is the primary way your infant has to communicate with you in the first few months, and during this time it is important to go to your baby whenever he/she cries. This will not spoil your baby. As he/she learns that you will come promptly to care for him/her, he/she will be more content, secure, trusting and less demanding in the months ahead. However, it is also helpful to realize that your baby may need to cry at times to let out anxiety and tension in order to be able to relax and go to sleep. Babies sometimes need to be given this opportunity in a quiet, calm, environment without extraneous stimulation.
You will learn over the next few weeks how to best respond to your baby's cries. Babies are frequently fussy for a certain period each day, usually in the late afternoon and evening hours. They may seem to "fall apart" at the end of the day. We all know the feeling! Some things that may help at this time are: swaddling; rocking; walking; putting your baby in a "Snuggli" or other baby carrier; swinging; listening to music or a constant sound (i.e. fan, vacuum cleaner, hair dryer); taking your baby for a ride in the car; or minimizing family activity. If your baby is crying excessively and all your comforting measures are ineffective, be sure to call our office for advice.
All babies have an innate need to suck in the first few months, which can be met by feeding, pacifiers or finger sucking. Sucking comforts and soothes babies and is an important part of their development. Avoid the use of homemade pacifiers (a bottle nipple, etc.), as it is possible for a baby to swallow these. Never give honey on a pacifier or in liquids to an infant under 15 months due to risk of infantile botulism.
Like adults, all babies need different amounts of sleep. During the first few weeks, most babies have very brief alert, awake periods, which gradually get longer as they get older. Their sleep cycle patterns in the first few weeks are much different than they will be even a month from now, with many cycles of sleep in a 24-hour period. Your newborn probably won't sleep for more than 3-4 hours at a time, though some babies will sleep for longer stretches.
Sleep Position: Infants should sleep either on their side or on their back. Recent data have shown that infants sleeping on their stomach have a greater risk of dying of crib death (SIDS). The AAP recommends placing an infant in a side or back-to sleep position, turning baby from side to side to prevent uneven head growth. The exception may be certain infants with significant reflux (frequent vomiting) or premature babies. Talk with us if you have any questions or concerns.
Your baby may give you very subtle signs when he/she is ill, or clear and definite symptoms. Changes in behavior and in feeding/sleeping patterns are among the most common signs of illness. These may include:
We don't expect parents to be medical experts. Always call if you are concerned about your baby's health and well being. When calling the office about your baby, ask for one of our nurses, identify yourself, give your baby's name and date of birth, describe what your concerns are and tell us your baby's rectal temperature. The nurse may then ask you for more information, offer advice about how to help your baby, advise you to make an appointment to have your baby examined or consult with the doctor and call you back with recommendations.
Many mothers in our practice return to work when their baby is six to eight weeks old. If you will be doing so, you will need to make arrangements for your baby's care when you return to work.
If you have not already done so, locate a sitter, a home day care or a day care center for your baby. For infants, we recommend a situation where the caregiver to infant ratio is 1:3 or 4. Though North Carolina licensing requirements permit a ratio of 1:6, it is very difficult for one person to adequately meet the needs of more than three or four babies at a time on a daily basis. A clean and cheerful environment, loving caregivers and an "open door policy" which welcomes parents who can drop by are all-important factors in choosing appropriate care. Be sure to obtain and check references (preferably other parents who have used the sitter or day care) to help determine what situation will be best for your baby. Our area is fortunate to have several resource and referral centers, which provide information and assistance for parents seeking day care. These agencies are listed at the end of this information packet.
Many mothers who return to work are able to continue breast-feeding their baby. They express and freeze their breast milk and/or use a combination of breast and bottle-feeding for their baby. Talk with your day care provider about your baby's usual daily routine before you return to work. This can help you and your baby make a smooth transition to day care.
Parents who are blessed with twins or any multiple births may experience twice the joy but also twice the challenges of becoming parents. There is a local chapter of the Mother of Twins Group, which meets monthly to provide support advice and encouragement to parents of multiples. Please ask one of our nurses if you would like more information about this organization.
New Parents Group and Lecture Series
Ask our nurses about when and where they will meet.
Please see our front desk staff, or call us at: 919/967-0771
We strongly recommend that parents purchase a copy of Barton Schmidt's Your Child's Health. This is an excellent resource guide that every parent needs to own! We are also fortunate to have a computerized patient education program, which is based on Barton Schmidt's advice. Ask Pat Muir, our Nurse Practitioner, for information on topics such as:
Below is a list of links that may be useful in the care and parenting of newborns.