My One-Month-Old Baby and Me

A new baby really does change everything! While there is not an official “one month well check” in the medical world, many parents come to my office at this time due to concerns.

Here are answers to some frequently asked questions:

"I didn't know it would be this hard!”

• A new baby really does rock your world. Find balance; visit relatives and friends.
• Go for lots of walks outside (before 10 am, after 4pm) with baby in the stroller.
• Listen to music and read a novel you enjoy aloud to your baby as you nurse him.
• Join a new mother’s group:

Bellaire Young Mothers: http://www.bellaireyoungmothers.org/

Meyerland Young Mothers (and Fathers): https://www.bigtent.com/groups/mmoyc

Bellaire Mothers of Multiples: http://www.bellairemoms.org/

Mothers of Preschoolers (birth to kinder): http://www.mops.org/

La Leche League: http://www.llli.org/

On Line Connection Center (great for a working parent with limited daytime hours): http://community.babycenter.com/

Houston New Moms: http://www.houstonnewmoms.com/

Southwest Houston Resource Directory: http://swhouston.macaronikid.com/

• Houston Public Library Infant Story Time:

http://houstonlibrary.org/learn-explore/kids/storytimes-playgroups

• Bellaire Public Library Story Time: http://www.ci.bellaire.tx.us/668/Childrens-Programs-and-Events

• Exercise with your baby:

http://www.motherhoodcenter.com/yoga-and-fitness-classes/

http://fit4mom.com/programs/stroller-strides

https://www.babybootcamp.com/

YMCA’s across Houston offer on site child care as an option for 1 hour while you participate in a group exercise program. https://www.ymcahouston.org

• Remove the pressure you may place on yourself to “get things done” while on maternity leave because really this time is just about nurturing your new baby and regaining some balance and health for yourself.

 

"You have to love your children unselfishly. That is hard. But it is the only way."

 — Barbara Bush, Former First Lady of the United States

 

"Is she getting enough milk?"

If your baby makes 6 diapers per day of pee or poo, she is getting enough. Keep in month that the stool pattern changes between 4-6 weeks of life. Your infant will loose the Gastro-Colic Reflex that made her pass a stool after each feeding initially and may only pass a stool every 3-5 days. If it is soft, then it is normal. If it is hard like clay balls and only passing every 3-5 days, that is constipation. Adding 1 tsp (5mL) of undiluted prune (Gerber brand) or apple juice (Minute Maid brand) to her feedings a few times per day will help to soften the stools.

Do not give water until your baby is 6 months of age to avoid hyponatremic seizures. She will be weighed and measured for review of her growth during each well care visit.

 

"He's just not interested in eating!"

When your baby was born, he could only see a distance of about 12 inches, but now his vision is much better, as are all of his senses. He is more easily distracted and will feed in bursts separated by a few minutes of play (looking around and wiggling). Make a new goal of feeding you baby for about 10-15 minutes on each breast (1-3 oz of formula) every 3 hours during the daytime:

If Baby falls asleep after just a few minutes (<10 min) of feeding, awaken Baby by unwrapping his blanket, loosening warm clothes and taking off his socks. Play with his hands and feet, talk to him and make eye contact. Awaken him by wiping his forehead and feet with a cool wet cloth. Never shake Baby as this damages the brain.

If Baby is awake and nurses for a few minutes then detaches, take this time as a chance to play with him. He is taking in his environment and your facial expressions as he feeds. Leave him in his feeding position and sing and talk to him between his "bursts" of feeding. He will probably play for 2-3 minutes then return to nursing. If you understand that this behavior is normal and a chance to interact with Baby, you will not become frustrated by his interest in other things while feeding.

 

"Each day of our lives we make deposits in the memory banks of our children."

 — Charles R. Swindoll, Insight for Living Ministries

 

“I rock my baby to sleep and she seems to wake up within minutes of me laying her down to sleep. Should I just keep her in my bed so she will not wake up?"

An important task for Baby at this age is to learn to fall asleep on her own. You can aid her in this process by creating a regular very short bedtime routine with a consistent bedtime (aim for 7 pm). This routine might include bathing her, a short massage with unscented cream (Vanicream, CeraVe cream, Aveeno Baby cream), feeding her while rocking or reading to her.

It is best for her eyes still be open when you lay her to sleep. If she has fallen asleep while being held or rocked, you should move that bedtime routine up earlier so she is not quite so tired and try again the next night to lay her down before those eyes completely close. If she is drowsy but still a little awake when you lay her down she will begin to learn some skills of falling asleep without need to be nursed to sleep.

It is helpful to place a flat cloth (thin wash cloth or burp cloth) under her head while you are nursing/rocking her and lay her down in the crib with that thin cloth still under her head. Sometimes the coolness of the crib sheet can startle your newborn when you lay her down in the crib. Always lay your infant in the crib face up (laying on her back) to reduce risk of SIDS. Do not put pillows, thick blankets, cushioned bumper pads, stuffed animals in the crib with her.

Some babies like pacifiers. There is some evidence of reduced risk of SIDS with pacifier use from 1- 6 months of age. If you find that a pacifier helps your infant, feel free to use one after breastfeeding is well established. Many infants prefer to use their own hand or fingers to suck. This does not necessarily mean your baby will be a “thumb sucker.” Only time will tell if the sucking/soothing process resolves on its own or persists. It is best not to give a pacifier when your infant is awake to avoid a strong reinforcement of this habit and to prevent problems with speech development.

 

“I have been co-sleeping with my baby but I’m not getting good rest. What should I do?”

It is not too late to teach your baby is able to fall asleep on his own if you allow him the opportunity and provide him some coaching as described above. The crib is the safest place for him to sleep. You can keep his crib in your room for the first few months of life to ease late night feedings. It is easier to teach him to fall asleep in his own crib if you do this from the very beginning rather than waiting until he is older.

Also keep in mind that your baby will best be served by a strong loving parental relationship. The stress and fatigue of having a new baby can be challenging on a marriage. To protect your marriage and family, let your baby learn to sleep in his own crib to allow you and your spouse better solid rest in between feedings. Keep the bedtime early (7pm) to allow time alone for you and your spouse. Sure it is good for the working parent to have time with the baby in the evening, but that can occur around 10 pm when your baby awakens for a feeding. It does not have to be as soon as the working parent arrives home. Ideally, after you lay your baby to sleep at 7pm, pump for 15-20 minutes to remove any excess milk. Then pump again at 9:30 or 10pm. Your spouse can give the expressed milk from both pumping sessions (leave milk at room temp during this time) at 10 pm while you go directly to sleep for a few hours before your baby awakens for another feeding.

 

"I think my baby is in pain because he cries for 3-4 hours every evening. I've tried everything!"

Most babies will have fussy periods during the evening for several hours (8pm to 2 am). In many studies, newborn crying time consistently increases around 4 weeks of life, peaks at 6 weeks of life and then disappears after 3 months of life. The average baby cries for 1 hr and 50 minutes (total for the whole day) at 1 month of life. Some specialists speculate that the fussy period is due to overstimulation as the hearing and vision are becoming keener during the first month of life. More than 90% of babies respond to decreased stimulation. 50% of babies respond to changes in diet such as removal of cow milk protein or addition of lactobacillus probiotics.

 

Consider these techniques for your baby when she experiences this fussy period:

• Dim the lights by 6pm to set the stage for sleep. And take 2 walks outside in the daytime (once before 10 am and once after 4pm). Sunlight helps create a natural melatonin pattern which adjusts our sleep patterns.
• Keep the television off while your baby is awake and avoid passive TV exposure completely for your young baby. Many studies show sleep difficulties in children related directly to screen time, even passive screen time.
• Do not start flashing light mobiles at bedtime. They are too stimulating. A night light is good as it can be helpful for nighttime feedings to see your infant yet not arouse them too much.Sometimes soft music helps an infant fall asleep, but this is not the case for every infant. If you enjoy hearing soft music as you prepare your baby for sleep, then play it because a happy parent is a happy baby.
• Consider a trial (1 week or more) of a probiotic that is formulated for infants and contains Lactobacillus GG or reuteri. There are several brands on the market. A study performed in 2010 showed a reduction in crying in 50% of young babies evaluated. Do not use in babies less than 1 month of age, premature babies, or babies with other health problems unless advised by a pediatrician.
• Eliminate large servings of cow milk from your diet if you are breastfeeding your infant. Do not stop breastfeeding your infant. If your baby is formula fed, consider a trial of a partially hydrolyzed formula such as Alimentum, Nutramigen or Gerber Good Start Soothe (already contains probiotics) or Gerber Good Start Gentle.
• Create some soft  "white noise" such as a HEPA air filtration machine, low speed fan, or baby room humidifier to drown out extraneous noises. Be careful of commercially marketed white noise makers as they can be too loud and damage your infant’s hearing. Prolonged exposure (8 hours or more) to sounds above 85 decibels can cause permanent hearing damage.
• Swaddle baby snuggly in a thin receiving blanket to suppress the startle (Moro) response but keep the legs loosely bundled to allow for normal hip development.
• Hold and rock baby gently. Never shake her, as you may cause permanent brain damage. If this makes her more upset, place her in the crib and gently pat her at a slow steady rate until she calms. Sometimes fast rocking and jiggling can stimulate Baby even more and increase crying from an hour to several hours. Do not put the baby carrier on the dryer or washer as it runs; it could wiggle its way off and injure your baby.
• Swings can easily become a sleep crutch, but if you have tried everything else, you may want to consider a swing for use for a short period to calm your baby only during this fussy time. Swings do not work for every fussy baby.
• Feed your baby to see if she is hungry.
• Change her diaper to make sure she is dry.
• If crying continues, check the temperature. Fever is 100.4 degrees F (38 degrees C) per rectum; call your pediatrician immediately for fever in a 1 month infant.
• Call your pediatrician if crying lasts for more than one hour, excessive vomiting occurs (ER for green color vomiting) or if your infant has breathing problems.
• If you feel extremely frustrated and think you may harm or shake your baby, set your baby down in the crib with the rails up, leave the room and call a relative or friend to help you.
• Excellent resource for a new parent to learn soothing techniques:

The Happiest Baby on the Block: The New Way to Calm Crying, and Help Your Baby Sleep Longer: by Harvey Karp

 

"When is she going to sleep through the night? I'm exhausted!"

Sleep cycles last for 3-4 hours; as Baby passes from the light sleep phase of one sleep cycle to the next, she will stir and make sounds and may even cry out.

It is important to allow her a chance to soothe herself into the next sleep cycle before arousing her more with touch or voice. If she cries out, wait for 2 minutes to see if she will stop on her own. If she does not stop crying, pick her up momentarily (a few seconds) to calm her, then lay her back down, offer her a pacifier if you like and lay a warm hand on her tummy for a moment.

If she goes back to sleep, she is not hungry and will begin to sleep through the night (6-8 consecutive hours) after 3-5 nights of this routine.

If she continues crying, feed her, change her diaper and put her back to sleep in her crib. She will eventually have shorter and shorter feeding times. Do not force her to feed longer than she is interested. Always try waiting for 2 minutes when she cries out to see if she will go back to sleep on her own before you pick her up.

Many babies can sleep for 6-8 hour stretches at night by 2-3 months of age.

Sleep Counseling Resources:

Book: Good Night. Sleep Tight by Kim West and Joanne Kenen.

Sleep Consultant: http://www.dreamteambaby.com/

Summary of Sleep Books/ Resources can be found at the Baby Center Website:

http://www.babycenter.com/0_baby-sleep-experts-and-other-resources_1509204.bc

 

"Is my baby constipated? She pulls her legs in and out, turns bright red, makes noises and sometimes cries just before she stools."

Stooling patterns vary greatly for each baby. She may pass up to 8 stools per day or as few as one stool every 5 days. Baby needs to pull her legs up to her tummy to help straighten the rectum and let the stool pass, but sometimes she will do just the opposite. If she makes her legs straight and her body stiff, help her to pass the stool by bicycling her legs and gently pulling her legs up toward her head. It is normal for her to turn bright red as she strains to push the stool out.

• If the stool is soft and free of blood when she does finally pass the stool, you do not need to do anything special for her.
• If the stool is hard, add 1 tsp of Gerber Prune Juice or Minute Maid apple juice (undiluted) a few times a day to her feeding schedule until the stool becomes soft.
• If there are blood streaks on hard stool, place some Vaseline on her anal opening and call your pediatrician during office hours.
• If there are blood streaks and the stool is soft, bring your baby into your pediatrician’s office to be evaluated.
• If she does not have a stool within 5 days, call your pediatrician during office hours.
• If she has strong vomiting or any green colored spit-ups call your doctor immediately. Green colored vomiting must be evaluated immediately in the ER.

 

"Are gas drops, gripe water and chamomile tea ok to give my baby if she is very fussy?"

Little Tummies and Mylicon gas drops are simethicone which is a very safe over the counter remedy for excessive swallowed air/ stomach gas bubbles. They are safe to use at a dose of 0.3mL after each feeding to help small bubbles break apart and the gas to be burped up more easily.

Gripe water is generally not a good choice. They may contain fructose (sugars) that cause some immediate endorphin release and temporary soothing but later results in increased intestinal gas. Some gripe water contains alcohol which is dangerous for your baby’s health and cognitive development. And some gripe water and teething remedies contain belladonna which is a neurotoxin. Gripe waters are not required to pass rigorous FDA testing and even though they are “natural” they can be dangerous!

Chamomile tea and fennel tea are ok to use in very small quantities such as a tablespoon (1/2 oz) once or twice a day. Be sure the tea is not hot when you give it to your baby. Do not give Baby any honey or honey pacifiers to prevent botulism exposure.

“Gerber Colic Soothe” drops are actually probiotic drops and are fine to use in a healthy term infant who is already 1 month of age.