The First Few Weeks

The first few weeks are a time when you're just learning to become a parent. Getting to know your new baby and trying to figure out what is normal can leave you with many questions. 

Head

Your baby’s head may be shaped like a ‘cone’ for several days to weeks after birth. This is caused by the soft skull bones sliding over each other to make room for the baby to pass through the birth canal. Babies are born with “soft spots” or “fontanelles” which allow for these bones to slide. The soft spot at the back of the skull is the “posterior fontanelle” and is usually closed by 2 months of age, and may even be closed when the baby is born. The front soft spot is called the “anterior fontanelle” and is usually closed by 18 months of age. Your baby’s head will be nice and round with time.¹

Your baby’s scalp may also appear to be scaly and dry which is known as “cradle cap”.  This can be treated by applying some baby or mineral oil to help loosen up the scales, then brushing gently with a soft, baby brush. This condition usually goes away on its own, even without treatment.²

Eyes

Your baby’s eyes will be bright and clear, but you may notice they go a little cross-eyed at times. This is simply due to immature muscles that require a little time to strengthen and is not an indication for concern. With respect to distance, a newborn is able to see their parents’ face while being held.³

Blocked Tear Ducts

You may notice some clear to slightly cloudy discharge from one or both of your baby’s eyes. This is caused by a blocked tear duct and is very common amongst newborns. Almost all resolve on their own without any intervention. Keep the eye clean by using a warm, wet washcloth and gently massage from the inside of the baby’s eye towards the outside of the eye. Use a different, clean part of the washcloth each time you touch the eyes, especially when you go to the second eye. If the drainage becomes thick, green or yellow, moves to both eyes when it was only in one eye, causes swelling or redness around the eye area itself, or seems to cause your baby discomfort, please contact your health care provider.⁴

Skin

A baby’s skin can vary greatly from one baby to another. Some babies are born covered in a thick, white substance called vernix, while others have very dry and peeling skin. A generalized newborn rash is common, as is baby acne and milia, which are tiny white dots across the nose. The baby may also have a covering of very fine, silky hair called lanugo on their skin, most commonly found on the forehead, back, shoulders, and cheeks. None of these conditions require treatment and all will resolve on their own.²

Cord Care

The average time for separation of the cord is 1 to 3 weeks. There is no need for concern if there is just a small amount of bleeding from the umbilicus. Keep the area clean and dry, monitoring for signs of infection such as a strong foul odour coming from the cord, yellow or green discharge from the site, or if the area becomes inflamed (red and swollen). Contact your health care provider if any of these symptoms are present.²

Genitals

You may notice that your baby’s breasts (both with boys and girls) and their genitals are a little bit swollen after birth. Baby girls may even have a small amount of bleeding or mucousy discharge from the vagina. All of these are caused from mom’s hormones and the swelling will go away once the hormones pass through the baby’s body.[REF-4de]

Circumcision Care

The incision will be tender and red for the first few days, and there will be swelling which should start to decrease in about 48 hours. Your baby boy may come home with gauze wrapped around his penis, which will be coated with petroleum jelly. Your doctor will give you detailed instructions on how to care for your son’s circumcised penis, but here some general tips to follow: a) clean the area with water whenever it gets soiled, especially with stool then apply petroleum jelly to the incision to keep the gauze from sticking to it, and b) use petroleum jelly along the incision line, to protect the incision and keep it soft while it is healing. It takes between 7-10 days for a circumcision to heal.⁶ If you notice the head of the penis turning black or blue, the incision bleeding more than a few drops, urine coming out in drops instead of a stream, or that your son develops a fever or looks sick, please take him to the nearest emergency room.⁶

Diaper Area Care

Babies have very sensitive skin, especially in their diaper area. The most common cause of a diaper rash is from urine and stool sitting against their bottoms. The best way to prevent a diaper rash is to change dirty diapers often. If your baby does get a diaper rash, use warm water and a mild soap to wash the area or alcohol-free unscented baby wipes. Allow a few minutes with the diaper off to air dry then apply a thin layer of unscented barrier ointment, such as petroleum jelly or a zinc-oxide based cream, to protect the skin. Remember to avoid using baby powder, talc and cornstarch as this can cause respiratory problems.¹¹ Alcohol-based wipes also can be more irritating to a sore bottom as they can cause a burning sensation. For baby girls, remember to always wipe front to back and to clean skin folds really well so that stool doesn’t get trapped against the skin.⁷  Please  contact your Health Care Provider if the rash is severe or is worsening despite treatment.

Newborns: Feeding Your Baby

Breastfeeding

Breastfeeding can be a special way for you to feel close to your baby. The World Health Organization (WHO), Health Canada, the Dietitians of Canada and the Canadian Pediatric Society all agree that: “Breastfeeding - exclusively for the first six months, and sustained for up to two years or longer with appropriate complementary feeding - is important for the nutrition, immunologic protection, growth, and development of infants and toddlers”.  Your newborn needs to feed at least 8-10 times in 24 hours; which means you will be waking your baby up to feed even in the middle of the night. Remember, your baby’s tummy is only the size of a cherry for the first 2 days and the size of a walnut at about 3-4 days. By the end of the first week, it has grown to about the size of an apricot and an egg by the end of the first 3 weeks. Your baby only needs small amount of breast milk at each feeding, but does need it frequently.⁸

Weight Gain

Your baby may lose on average 7-8% of their body weight during the first few days of life. Typically, infants reach their lowest weight within 3-4 days of delivery.  By the age of 10-14 days, babies should be back up to their birth weight again. Some may take up to 2-3 weeks to surpass their birth weight.  After the initial weight loss has been regained, the recommended weight gain is:

• 6oz-8.50z/week in the first 0-4 mths OR 0.9+oz/day[REF-4di]

To check your infant’s growth, you can visit a Public Health Nurse at an Healthy Start Infant Drop-in location near you.

Wet and Dirty Diapers

Your baby should have enough wet and dirty diapers according to his/her age:

• Day 1-2: at least 1-2 wet diapers and at least 1-2 black or green stools (poop)
• Day 3-4: at least 3-4 wet diapers and at least 3 brown, green, or yellow stools
• Day 5-7: at least 6 pale yellow, heavy wet diapers and at a least 3 large, yellow, soft and seedy stools. This should continue until at least 3 weeks of age.
• 3 weeks and beyond: at least 6 heavy wet diapers; the frequency of stools can vary widely. Some babies will stool several times a day while others may only stool once every few days. Both are completely normal.⁸

If you don’t think your baby is having enough wet and dirty diapers, especially in the first few days home, please contact your Health Care Provider. 

Vitamin D Supplement

Babies need Vitamin D for healthy growth and development of strong bones and teeth. A daily Vitamin D supplement of 400 IU is recommended for breastfed babies starting at birth until 2 years of age. Continue with this supplementation until your baby is receiving enough Vitamin D from their diet of solid foods.[REF-4di]

Jaundice

Jaundice is very common in newborn babies. A yellowing of the skin and sometimes the eyes from a build-up of bilirubin will be seen, when the newborn’s liver can’t break it down fast enough. Bilirubin is a substance that comes from broken down red blood cells and is usually eliminated from the body in the stool (poop). Feeding your baby (especially breastfeeding) frequently during the first few days of life will help prevent this build-up of bilirubin, because your baby will poop more often. The breast milk will also help give the liver the energy it needs to break down the bilirubin and help eliminate it from the body in the stool.⁹

Dressing Your Newborn

When babies are first born, their circulatory system is a little immature and you may notice that your baby’s hands and feet may feel cooler than the rest of their bodies. The hands and feet may even look pale with a bluish/white colour when they are first born. A good rule of thumb to remember when dressing your new baby is to apply one more layer of clothing than you need. Babies are not able to shiver to keep warm or sweat to keep cool the way that adults can, so keep this in mind while dressing your new baby. When you are undressing your baby, if you notice that they are sweaty and very warm, you may be overdressing them too. Overheating infants is a known risk factor for SIDS, so it is important to keep them comfortable, but not too warm.¹⁰