Most babies are quite mucousy for their first 24 hours, some even having ‘blue turns’ when it sticks in their throat.
Don’t worry, babies are very good at getting fluid out of their airway. They’re okay on their back and will not choke. Babies, as I will say many times in this book, are very well designed for birth and its aftermath.
Babies develop red wheals on their skin in the first day or so. These can look like mosquito bites. They are more common in areas that are in contact with nappies or clothes.
This rash is called ‘toxic erythema’, and is a response of the skin to contact, especially with textiles such as cotton. It is harmless, not irritating and will go away without treatment. Your baby does not have an allergy.
Milk comes in at about two and a half days. Before that, babies are all over the place with their feeds, sometimes feeding constantly, sometimes sleeping for long periods.
Your breasts produce only a dribble of colostrum for the first couple of days. So, for some babies, there’s not a lot to wake up for. Let him do whatever he wants to do. The milk will come in anyway. Your job is to protect your nipples from damage from your baby’s little mouth.
Get a midwife to help you attach the baby to the breast.
Babies need to learn the correct breastfeeding technique – how to ‘latch’ on to the breast, with mouth wide, enveloping the areola. If they ‘nipple-suck’, they can quickly damage the skin of their mother’s nipples.
When you feel your breasts changing and filling, it means there are about 12 hours until the arrival of the milk. Then your baby will start to feed frequently and greedily – he may seem insatiable (the ‘feeding frenzy’). He’ll be on and off the breast continually for 24 hours. Let him feed.
Despite the way he behaves, he does not have a pain in his tummy, and he does not ‘have wind’. He just wants to feed and induce your milk flow. Let him.
To start with, babies prefer to feed at night and sleep during the day.
Your baby knows that night feeds induce the hormone prolactin (which boosts milk supply) better than day feeds do. When the milk is in and the supply is secure the baby will get day and night sorted out.
Babies are ‘marine animals’ in the womb and are waterlogged when they are first born. They ‘dry out’ in the first few days and can lose up to 10 per cent of their birth weight.
That’s why milk takes a few days to come in. Other animals’ milk comes in with delivery, but humans need the delay to dry out. Don’t worry about the weight loss. It’s normal and it’s only water and meconium.
There is no such thing as overfeeding your baby.
Your baby is just trying to induce enough milk flow. Overfull babies vomit. It’s okay.
You can’t cuddle your baby too much.
Your baby has just left the warmth and security of your womb. He wonders where he is. He can’t hear the familiar sound of your heartbeat that filled his life when nestling inside you. When he’s upset, pick him up, cuddle him against your chest and put his ear against your heartbeat. He will settle.
You can’t spoil your baby at this age.
Babies can’t have too much, or too close, contact with their mother. They can’t have too much attention. They cannot learn bad habits for months. Disregard all advice to the contrary.
Once the milk comes in, the snuffles and mucousiness may restart. Your baby does not have a cold.
When your milk comes in the volume of milk increases enormously. The baby may ‘siphon’ the milk into his nose and sinuses. To protect the delicate mucous lining of these structures from the milk (or even gastric acid, if he vomits), the walls produce mucus. It can last for weeks, and after you go home, it may be worse at night.
All babies vomit. However, they should not vomit bile.
Regurgitation is normal in the baby. It doesn’t mean he will suffer from reflux or that he is unwell. If he vomits bile (bright green vomit), he might need attention – call the staff.
It’s not blood in the urine.
Most babies pass pink crystals of ‘urate’ in the urine in the first few days. The red stain in the nappy is not blood and is quite normal. It will go when the baby gets more fluid after the milk comes in.
NEVER give up breastfeeding and start formula at 2 am!
Things often seem terrible in the middle of the night – in the light of day, most of them don’t seem so bad. If you give up at night, when you’re tired, upset and in pain and your baby’s screaming non-stop, you may well wish you hadn’t the next morning. Make the decision in the cold light of day – this gives you a much better chance to make sure it’s the right one!
Most babies have yellow skin (jaundice) by day 3.
The jaundice is caused by the breaking down of blood, which is a normal process that happens in the body all the time. When the baby is in the womb, the mother’s liver processes and deals with the breakdown products from her blood and her baby’s. After birth, the baby’s liver takes a few days to learn to process it, hence the jaundice level rises for 3-5 days before settling.
How to settle the baby Why is learning to settle your baby so important? As with most other important baby management issues, the amount of conflicting, useless advice out there is in direct proportion to the importance of the problem….. Why is learning to settle your baby so important? For most baby problems the best approach is to use parenting’s two most useful tools:
trial and error.
However this is a special case: you need a bit of basic knowledge to deal with it sensibly.
First, don’t respond immediately to every grunt, whinge or yelp from your baby. Most babies will drift up into a very light level about every hour…….
The distressed baby is different. She is definitely unhappy and you can hear and feel the difference. This baby needs your help……
When humans take their baby home they actually don’t take a full-term newborn. In comparison with most other mammals, human babies are premature, with brains that are only 25 per cent formed.
Other mammals … have over 80 per cent of their brains formed when they are born. …..
Why do humans do it that way? It’s because of these two characteristics:
We walk upright on two legs. This means the whole weight of our body falls on our hip joints. ….And to make matters worse …
Humans have big brains. Great for designing computers but difficult for their big-headed babies to fit through this narrow athletic pelvis.
The solution to this evolutionary dilemma was to have our babies earlier in pregnancy, while they were still small enough to be delivered safely.
Only 25 per cent of a baby’s brain is formed at birth. The rest of the brain to be formed is mostly the connections between them. The neurobiologists tell us that much of this wiring is laid down in the first 18 months after birth.
The way babies are brought up – their experiences, relationships and surroundings – profoundly change the way their brains make these internal linkages
The way our babies are today was influenced by the weather in Ethiopia about 4 million years ago!
We’re just smart apes – Two legs, not four – Homo Sapiens emerges – Our premature babies – Long childhood – The Development of human society – Using sex to select a society – Sex for Meat – The hunter-gather community – Women, the backbone of society – Help from Alloparents – Babies’ needs: then as now – Food and Feeding – Primate breastfeeding – The contraceptive effect – Human breast milk – Warmth – Touch – Protection and Care.
Nature was not so foolish as to deliver these premature infants into the hands of their parents without making sure that there was a good reception
waiting for them. Evolution put in place numerous little mechanisms to make sure that the parents rapidly attached to the baby and worked for her survival…..
Vision – Hearing and Auditory memory – Sound Recognition – Smell and Taste – Baby smelling mother – and mother smelling baby – Nipple pheromones.
I once had a celebrity patient – Things did not go smoothly – imagine the position of my eyebrows when a couple of months later I picked up a women’s magazine …… if only she had told of the agony as well as the ecstasy, the reality, not the idealised fantasy that somehow we have come to think of as normal…..
Attachment and Bonding – It takes time to fall in love with your baby.
In the Delivery room – Breathing and lung issues – Infections – Vitamin K
We’ve come a long way since ‘Breast is best’. For today’s woman, a better slogan would be: ‘Breastfeeding is normal!’
Giving and receiving – The first few days – Colostrum – Water feeds – Milk ‘coming in’ – Attaching the baby to the breast – How long should feeding the baby take – How often should the baby feed? – The Letdown Effect – Issues – Not enough milk – Too much milk – Grazed and painful nipples – Things not going well – Lactose intolerance – Burping – Vomiting – Twins and more – Bottle-feeding – Mixing the formula – Giving the feed – Doing both – Travelling
Even trained paediatricians who have babies of their own are anxious about them when they first get to the postnatal ward!
Babies, for their part, sometimes aren’t very reassuring either. They get mucousy, have blue spells, irregular breathing, sleep deeply or not at all … on the whole, they rarely fit into the pattern we were expecting…..
Mucus – Snuffles – Cough – Sticky eyes – Hiccups – Fever on day 2 – Weight loss – Skin rash: toxic erythema – Dry skin – Fat necrosis – Sweating – Blue around the mouth – Nails – Pink-stained nappies – Urinary stream – Tongue-tie – Umbilical cleaning – Umbilical granuloma – Umbilical hernia – Wrapping babies – Dummies and thumb-sucking – Fourth-day blues – Naming the baby.
Research done in the early 1990s by a team led by Professor James McKenna – who is, significantly, an anthropologist, not a paediatrician – has opened up the whole question about the advisability of sleeping with your baby and this work is worth examining in some detail.
The evolution of closeness
The Industrial Revolution
The fortress nursery
The final barrier
Do you want to bed-share?
Check out your sleeping arrangements
A cot next to the bed
If you want to bed-share, do so, but stick to the rules
Most first-time mothers can’t wait to get home after having their babies. Most second-time mothers have to be prised out of their hospital bed and sent home, kicking and screaming! There is a lesson here for first-timers….
Siblings – Friends – Sleep – Mother, not martyr – Sex and the new parents – From partner to father – Superdad – Out and about – Driving – Flying.
Remember: all you need to look after a baby successfully is common sense and trial and error. And one or two facts. Here are some useful ones …
How much weight should the baby put on? – Nappy rash – Contact rash – Rash in moist areas – Excoriated buttocks – Eczema – Cradle cap – Waxy ears – Sun kicks – Oral thrush – Reflux – Breastfed baby – Bottle-fed baby – Diarrhoea – Lopsided head – Is my baby sick? – Fevers, coughs and colds.
There’s hardly a parent who doesn’t know what colic is, and judging by the responses on talkback radio, they all have a little theory about how to fix it: ‘Try massaging the tummy (in a clockwise direction) with warm olive oil’, or maybe ‘Put the baby, tummy down, over a rolling pin and move the gas along that way.’ Poor parents. Poor baby.
Before leaping to diagnosis – A portrait of colic – Timing: ‘evening’ or ‘3 month’ colic – It’s not tummy-ache – The cause of colic – At 4 weeks: the beginning of the problem – Dealing with discomfort – Crying – Tension – Comfort sucking – More about wind – The vicious cycles of colic – The answer – Calming the baby.
Most of us know that circumcision is an ancient Jewish ritual dating back to the time of Abraham, but few of us realise that the Jews were not the first to practise it. Carvings on the walls in the Temple of Karnak depict Egyptian priests over 6000 years ago performing circumcision, making it probably the oldest surgical operation known. Many cultures continue the practice today.
The function of the foreskin – When the foreskin draws back – Medical studies – The parents’ decision – The safest time for circumcision – Consequences
You’ve seen the advertisements. A beautiful woman, looking as if her day job is modelling for shampoo commercials, gently smiles down at her baby. The chubby baby smiles back with just the cutest little hint of drool emerging from her gummy grin. Their eyes are locked in love and bliss. This, truly, is what motherhood is all about.
I’ve got news for you. One of the best-kept secrets in maternity is that for 20 per cent of mothers (1 in 5), things are very different. She is deeply miserable, desperately tired, anxious and frightened, and the baby does nothing but scream abuse at her. Somehow her life seems to be coming apart at the seams.
Postnatal psychosis – Postnatal depression – Deep depression and misery – Anxiety – Anger – Loss of self-esteem – Chronic fatigue – Causes and reasons – What to do – In conclusion
To a greater or lesser extent, being delivered of a baby with a congenital malformation or, even worse, suffering the loss of a baby, sets in train the grieving process. Its function is to help us adjust and recover and go back to living our lives in fullness and contentment.
With children, as with our own life, every age has both special joys and aspects we would prefer to forget. It is tempting to consider every stage our babies go through as merely preparation for the next phase of development.
Suddenly they look us in the eye and say goodbye – and we wonder where their childhood went. Their childhood went while we were waiting for them not to do this or that, to be a bit more mature, and not get in our way so much. It went when they screamed all night with earache, when they ran their tricycle into the furniture and when they refused to go to bed and stay there.
Our babies are our immortality, right here and now. They are also the best personal growth experience available. Anybody who wants to tread a spiritual pathway that will hold up a mirror to the person he or she truly is need search no further than having a baby.
There is no better teacher anywhere. We can be anyone we like to our friends – compassionate, patient, sensible – but our little ones will see through the façade and show us who we really are. Like no one else, our babies can push our secret, psychic buttons.
Parenthood is an essential part of existence, for those who wish to grow and for those who would rather avoid it.
Don’t miss the opportunity or the experience.
I wish you joy and enough sleep.
Physician to babies and toddlers,
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