Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version
First Weeks at Home with a Newborn
PREVENTING FATIGUE AND EXHAUSTION
For most mothers the first weeks at home with a new baby are
often the hardest in their lives. You will probably feel
overworked, even overwhelmed. Inadequate sleep will leave
you fatigued. Caring for a baby can be a lonely and
stressful responsibility. You may wonder if you will ever
catch up on your rest or work. The solution is asking for
help. No one should be expected to care for a young baby
alone.
Every baby awakens one or more times a night. The way to
avoid sleep deprivation is to know the total amount of sleep
you need per day and to get that sleep in bits and pieces.
Go to bed earlier in the evening. When your baby naps you
must also nap. Your baby doesn't need you hovering while he
or she sleeps. If sick, your baby will show symptoms.
While you are napping take the telephone off the hook and
put up a sign on the door saying MOTHER AND BABY SLEEPING.
If your total sleep remains inadequate, hire a baby sitter
or bring in a relative. If you don't take care of yourself,
you won't be able to take care of your baby.
THE POSTPARTUM BLUES
More than 50% of women experience postpartum blues on the
third or fourth day after delivery. The symptoms include
tearfulness, tiredness, sadness, and difficulty in thinking
clearly. The main cause of this temporary reaction is
probably the sudden decrease of maternal hormones. Since
the symptoms commonly begin on the day the mother comes home
from the hospital, the full impact of being totally
responsible for a dependent newborn may also be a
contributing factor. Many mothers feel let down and guilty
about these symptoms because they have been led to believe
they should be overjoyed about caring for their newborn. In
any event, these symptoms usually clear in 1 to 3 weeks as
the hormone levels return to normal and the mother develops
routines and a sense of control over her life.
There are several ways to cope with the postpartum blues.
First, acknowledge your feelings. Discuss them with your
husband or a close friend as well as your sense of being
trapped and that these new responsibilities seem
insurmountable. Don't feel you need to suppress crying or
put on a "supermom show" for everyone. Second, get adequate
rest. Third, get help with all your work. Fourth, mix with
other people; don't become isolated. Get out of the house
at least once a week--go to the hairdresser, shop, visit a
friend, or see a movie. By the third week, setting aside an
evening a week for a "date" with your husband is also
helpful. If you don't feel better by the time your baby is
1 month old, see your physician about the possibility of
counseling for depression.
HELPERS: RELATIVES, FRIENDS, SITTERS
As already emphasized, everyone needs extra help during the
first few weeks alone with a new baby. Ideally, you were
able to make arrangements for help before your baby was
born. The best person to help (if you get along with her)
is usually your mother or mother-in-law. If not, teenagers
or adults can come in several times a week to help with
housework or look after your baby while you go out or get a
nap. If you have other young children, you will need daily
help. Clarify that your role is looking after your baby.
Your helper's role is to shop, cook, houseclean, and wash
clothes and dishes. If your newborn has a medical problem
that requires special care, ask for home visits by a public
health nurse.
THE FATHER'S ROLE
The father needs to take time off from work to be with his
wife during labor and delivery, as well as on the day she
and his child come home from the hospital. If the couple
has a relative who will temporarily live in and help, the
father can continue to work after the baby comes home.
However, when the relative leaves, the father can take
saved-up vacation time as paternity leave. At a minimum he
needs to work shorter hours until his wife and baby have
settled in.
The age of noninvolvement of the father is over. Not only
does the mother need the father to help her with household
chores, but the baby also needs to develop a close
relationship with the father. Today's father helps with
feeding, changing diapers, bathing, putting to bed, reading
stories, dressing, disciplining, homework, playing games,
and calling the physician when the child is sick.
A father may avoid interacting with his baby during the
first year of life because he is afraid he will hurt his
baby or that he won't be able to calm the child when the
baby cries. The longer a father goes without learning
parenting skills, the harder it becomes to master them. At
a minimum, a father should hold and comfort his baby at
least once a day.
VISITORS
Only close friends and relatives should visit you during
your first month at home. They should not visit if they are
sick. To prevent unannounced visitors, the parents can put
up a sign saying MOTHER AND BABY SLEEPING. NO VISITORS.
PLEASE CALL FIRST. Friends without children may not
understand your needs. During visits the visitor should pay
special attention to older siblings.
FEEDING YOUR BABY: ACHIEVING WEIGHT GAIN
Your main assignments during the early months of life are
loving and feeding your baby. All babies lose a few ounces
during the first few days after birth. However, they should
never lose more than 7% of the birth weight (usually about
8 ounces). Most bottle-fed babies are back to birth weight
by 10 days of age, and breast-fed babies by 14 days of age.
Then infants gain approximately an ounce per day during the
early months. If milk is provided liberally, the normal
newborn's hunger drive ensures appropriate weight gain.
A breast-feeding mother often wonders if her baby is getting
enough calories, since she can't see how many ounces the
baby takes. Your baby is doing fine if he or she demands to
nurse every 1 1/2 to 2 1/2 hours, appears satisfied after
feedings, takes both breasts at each nursing, wets 6 or more
diapers each day, and passes 3 or more soft stools per day.
Whenever you are worried about your baby's weight gain,
bring your baby to your physician's office for a weight
check. Feeding problems detected early are much easier to
remedy than those of long standing. A special weight check
1 week after birth is a good idea for infants of a
first-time breast-feeding mother or a mother concerned about
her milk supply.
See also:
Feeding: Breast Milk
Feeding: Formula (Bottle)
DEALING WITH CRYING
Crying babies need to be held. They need someone with a
soothing voice and a soothing touch. You can't spoil your
baby during the early months of life. Overly sensitive
babies may need an even gentler touch.
For additional help on this subject, see Colic.
SLEEP POSITION
Remember to place your baby in his crib on his back (or
side). As of 1992, this is the sleep position recommended
by the American Academy of Pediatrics for healthy babies.
The back (supine) position reduces the risk of SIDS.
TAKING YOUR BABY OUTDOORS
You can take your baby outdoors at any age. You already
took your baby outside when you left the hospital, and you
will be going outside again when you take him or her for the
two-day or two-week checkup.
Dress the baby with as many layers of clothing as an adult
would wear for the outdoor temperature. A common mistake is
overdressing a baby in summer. In winter, a baby needs a
hat because he or she often doesn't have much hair to
protect against heat loss. Cold air or winds do not cause
ear infections or pneumonia.
The skin of babies is more sensitive to the sun than the
skin of older children. Keep sun exposure to small amounts
(10 to 15 minutes at a time). Protect your baby's skin from
sunburn with longer clothing and a bonnet.
Camping and crowds should probably be avoided during your
baby's first month of life. Also, during your baby's first
year of life try to avoid close contact with people who have
infectious illnesses.
MEDICAL CHECKUP ON THE THIRD OR FOURTH DAY OF LIFE
Early discharge from the newborn nursery has become
commonplace for full-term babies. Early discharge means
going home within 24 to 48 hours after giving birth. In
general this is a safe practice if the baby's hospital stay
has been uncomplicated. These newborns need to be
re-checked 2 days after discharge to see how well they are
feeding, urinating, producing stools, and breathing. They
will also be checked for jaundice and overall health. In
some cases, this special re-check will be provided in your
home.
THE TWO-WEEK MEDICAL CHECKUP
This checkup is probably the most important medical visit
for your baby during the first year of life. By two weeks
of age your baby will usually have developed symptoms of any
physical condition that was not detectable during the
hospital stay. Your child's physician will be able to judge
how well your baby is growing from his or her height,
weight, and head circumference.
This is also the time your family is under the most stress
of adapting to a new baby. Try to develop a habit of
jotting down questions about your child's health or behavior
at home. Bring this list with you to office visits to
discuss with the physician. Most physicians welcome the
opportunity to address your agenda, especially if your
questions are not easily answered by reading or talking with
other mothers.
If at all possible, both the mother and father should go to
these visits. Most physicians prefer to get to know both
parents during a checkup rather than during the crisis of an
acute illness.
If you think your newborn is sick between the routine
visits, be sure to call your child's physician for help.
See The Sick Newborn: Subtle Symptoms
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