We discuss normal newborn behavior and common questions asked by parents. We are joined by Abby Patterson, MD, Assistant Professor of Neonatal-Perinatal Medicine at the University of Texas Southwestern Medical Center.
Welcome to Newborn News, a podcast where we discuss educational topics for medical professionals who care for newborns. I'm your host, Dr. Neeta Goli, a pediatrician in the UT Southwestern Newborn Nursery.
Dr. Neeta Goli:
Welcome back to the podcast. In this episode, we'll be discussing normal newborn behavior. We're joined again by Dr. Abby Patterson. Dr. Patterson, thanks again for joining us today.
Dr. Abby Patterson:
Thanks for having me back.
Dr. Neeta Goli:
So, while some of our listeners might have experienced taking care of children of their own or younger siblings, some may have never taken care of babies before. What are some things that you might suggest to make it easier for them or less nerve-wracking?
Dr. Abby Patterson:
The most common concern I hear from, especially, our newer learners is that they're worried they're going to hurt the baby, or they're going to break the baby. So, I always reassure people that with normal handling and normal physical exam, they are highly unlikely to hurt a baby. I also remind them, this is a term healthy baby. And if they've seen a delivery before, I remind them that that itself is not necessarily a gentle process either, and that the babies are much more durable than we think they are.
Dr. Neeta Goli:
That is very reassuring. What kind of behavior can we expect from normal newborns, especially maybe for these first-time parents who haven't had babies before? What kind of things do you counsel?
Dr. Abby Patterson:
Yeah. My one-liner for that is that the first day is a sleepy baby, the second day is a fussy baby or a hungry baby. So, I remind parents, especially on that first time I see the baby, that all that work mom did in labor or getting a C-section, that was hard work for the baby too, so they're sleepy, they're recovering from all of that work that they did. And so, I remind parents that the baby does need to wake up to eat, but if they really sleep the rest of the time, that's okay. I also like to warn families that sometime between 12 and 24 hours, the baby will usually wake up, and they often will wake up with a vengeance. So, all that sleeping they did the first day, they make up for it the second day.
Dr. Abby Patterson:
Often, the second, third, even the fourth day, the baby will be awake a lot. They won't sleep for long periods of time. They'll be very hungry, want to feed a lot. We call that cluster feeding. So, the baby is working really hard to feed frequently to meet their needs, for two reasons. One, their stomach is really small, it hasn't gotten stretched out by food before. And two, they're not used to using their gut for food, so it's a slow process as they initiate it. The good part about this is a breastfeeding baby is using all that cluster feeding to bring in their mom's milk, so it's great long-term, but it can be a little frustrating as it's happening.
Dr. Neeta Goli:
Yeah. Absolutely. So, it's good to hear that that can be normal.
Dr. Abby Patterson:
Yeah. I also like to remind parents that babies spent nine months being inside mom, and when they were there, it was warm, they didn't have to work for their food, they always heard their mom's heartbeat and they could feel her warmth, so it's normal that once they come out, that they're still going to crave that, that they're going to want to be held, they're going to want to move, they're going to want to hear people's voices, they're not wanting to be by themselves. And so, the parents shouldn't be distressed or worried that their baby is abnormal, that there's something wrong, if they're crying a lot or fussy a lot. It's also really normal for babies to be more awake at nighttime than the daytime. It can be rough adjusting into the bigger family. Luckily, it's a temporary stage.
Dr. Neeta Goli:
Yeah. You mentioned that they like to be held. Can you spoil a baby? Is that possible?
Dr. Abby Patterson:
Yeah. So, for a newborn baby, you really can't spoil them. One, developmentally, they can't really make patterns from one day to the next very well, so in that way they can't be spoiled. And also, two, they have these needs that huge transition from inside mom to out, they need support and love and cuddling from their family to help navigate that transition. So, I say at least six weeks you have until you can spoil them. Some people say even longer than that, I've heard up to two years before you can spoil.
Dr. Neeta Goli:
So, big picture for our listeners. It is okay to hold newborn babies as much as families want. They don't need to be worried that they're going to spoil the baby.
Dr. Abby Patterson:
Yes. The only time I tell parents that they need to put the baby down is if they're feeling sleepy.
Dr. Neeta Goli:
Yes, absolutely. Okay. So, what about helping when babies are crying? What kind of advice do you have for parents as far as how to calm their babies?
Dr. Abby Patterson:
The biggest thing I tell parents who are breastfeeding is that the baby can breastfeed as often as they want, and that's often the first go-to, but sometimes mom's not available or needs a break from breastfeeding, and then we've got other techniques we can try. I have no financial disclosures to give, but one of the best resources I've seen for this is Dr. Harvey Karp's book called The Happiest Baby on the Block, it's also a DVD, and he talks about the five S's. The first S is sucking, so that's obviously the comfort baby gets from feeding from a pacifier, or sometimes, in a pinch, another family member may offer a finger to suck on as well. The learners will also know that we often will do that as part of our exam to help the baby feel more comfortable with the exam.
Dr. Abby Patterson:
Babies also like movement, so they like swaying. So, you can either hold the baby and sway back and forth, or some people will hold the baby out in front of them and jiggle the baby to mimic that motion. Babies also like feeling calm and secure, so the next one is swaddling. So, using a blanket to help that baby feel really secure can help them calm down. Babies often like a side-lying position, so I tell people to think about the position the baby would be in when your mom is nursing the baby and to just flip them with their face out so that they can breathe well. Then the last one is shushing, that's the shh shh sound. It reminds them of being inside mom and helps the baby calm down. You're not telling the baby to be quiet, you're just helping them to feel comfortable.
Dr. Neeta Goli:
So, now that we know how to calm babies, another question that a lot of parents will have for me is whether or not the baby can see when they're first born.
Dr. Abby Patterson:
Yeah. I tell parents that the newborns can see, but they can't see very well. So, when they're holding the baby in a cradle position, the baby can see the face of the person holding them, but really not much else. Parents sometimes ask me if I'm checking their baby's vision. It's too early to check visual acuity in a brand new newborn. So, typically, I see the vision improves as the baby's mobility improves. So, by about four to six months, when they're starting to roll, that's when they can start to see better. And then usually by 12 months, they can see pretty much the same as an adult.
Dr. Neeta Goli:
Okay. What other kinds of questions do parents have for you, that you have to answer all the time?
Dr. Abby Patterson:
I hear this a lot later in the hospital stay when baby's about three days old, parents will ask me, "When is baby going to sleep through the night?" Because by then the baby's been up a lot, everybody's a little exhausted, and they want to know when it's going to end. I tell them it varies baby to baby. So, I start from the beginning and tell parents that for the first six weeks to not try and impose any schedule on the baby, that if baby wakes up, if baby's hungry, if baby needs comforting, to tend to their needs and not really worry too much about a schedule, as long as the baby's eating frequently enough.
Dr. Abby Patterson:
After six weeks, it varies a little bit situation to situation, so I always tell parents to discuss with their pediatrician based on their own baby's growth and needs, but the most babies don't accomplish five to six hours straight until they're about 6 to 12 months old. I know my daughter didn't sleep for a whole night until she was at over 12 months old, and she's not the only one. So, I tell parents to buckle in there and just make sure their baby's fed for the beginning.
Dr. Neeta Goli:
Yeah. It can be rough, but we'll get through it.
Dr. Abby Patterson:
Yeah. I also say it's easy to enlist somebody to come over and hold the baby for a couple hours. So, mom can take a nap, even if baby doesn't want to lay in their bed.
Dr. Neeta Goli:
Absolutely. Then what do you recommend for pacifiers?
Dr. Abby Patterson:
Yeah. So, for pacifiers, I talked about sucking as being a way to soothe the baby, they can be a great tool. For the first three weeks, we, in the AAP, recommend focusing on initiating breastfeeding in a breastfeeding baby. So, for the first three weeks to avoid the pacifier, and then after three weeks to introduce the pacifier, ensuring that the baby is getting enough feedings. The pacifier can actually be a great tool for prevention of SIDS as well, because babies who have pacifiers have shown to lower risk of SIDS than babies who don't take a pacifier.
Dr. Abby Patterson:
The only caveat to pacifiers is I make sure that parents are using a safe pacifier for their baby. Any pacifier you can get in one of the big box stores in the United States is safe for a small baby. In other countries, however, you can get pacifiers with honey in them. And so, I always make sure that the parents are not buying the pacifier with honey.
Dr. Neeta Goli:
Yes. As our listeners will know, because honey before 12 months of age can be a risk for botulism for baby. So, definitely no to that. Then what about all this baby gear that you see in the stores? What do families actually need to buy?
Dr. Abby Patterson:
Babies need less than we probably think they do. When you break it down to the basics, really, a baby needs a place to sleep. We want to make sure that's a safe place to sleep, Of course. So, a flat firm mattress, baby's own sleep space, no extra things in the bed with baby, but that's really what they need for that. They need a car seat to make sure they can have safe travel. They need food, whether it be breast milk or formula. They need diapers of some sort. And they need some amount of clothes. How many clothes depends on how often mom wants to do laundry.
Dr. Neeta Goli:
Okay. Those were the things that parents will need. What about things that you don't recommend parents buy?
Dr. Abby Patterson:
There's a few things that I, pretty much across the board, don't recommend. The first thing is kind of extra things for the crib, like crib bumpers, those fluffy bumpers people put around the crib. They look really cute, but the baby could easily get their face in those when they're sleeping. Other extra things in the crib would be things like wedges or positioners. Those are getting harder to find here, but you could still probably find them, if you looked hard. Really the baby's mattress should be flat and firm and empty.
Dr. Abby Patterson:
The second thing I don't recommend is they sell monitors that are marketed that they monitor baby's pulse-ox or heart rate to be used in the home setting. I don't recommend those for term healthy babies, especially when bought commercially. There may be situations where an ill baby is recommended to use a monitor by their physician, that's a different situation, but the commercial monitors, I don't recommend. They're often very expensive and they haven't been shown to be very reliable, and a term baby should be okay without them.
Dr. Abby Patterson:
Then the third thing I always tell people is to not buy too many things for their baby. When you go to the baby store, there are literally thousands of products available, and often your baby doesn't need very many of them. I know for my daughter, we had a lot of people give us various swings and rockers and sleepers, and she did not like any of them. So, I'm glad I didn't purchase them, but it's something where often you buy all the things and then the baby doesn't like any. So, maybe borrow one from a friend or realize the baby probably doesn't need it.
Dr. Neeta Goli:
Right. Every baby's different too, so play it by ear.
Dr. Abby Patterson:
Yeah.
Dr. Neeta Goli:
Then just in terms of practical tips for families, when can they start taking the baby out for errands, if they need to go grocery shopping, if they want to go for a walk?
Dr. Abby Patterson:
Yeah. I like to tell parents of a newborn that this baby's going to change a lot in their life, but they're not giving up their life for the baby. So, if mom and dad are feeling really stir-crazy and want to go on a walk in their neighborhood, they can do that really whenever they want to. When thinking about ground rules for taking a new baby outside, primarily about risk of infection, so taking baby to a crowded busy place may not be where you want to go. But if you're going to be just out in your front yard or in your neighborhood, that should be okay pretty much whenever. I also start to think about temperature and sun exposure. So, I want to make sure if the mom and dad are taking the baby outside, that it's a comfortable temperature, they're avoiding direct sunlight and the heat of the day, so that baby doesn't have any sunburns.
Dr. Neeta Goli:
You mentioned temperature. How many layers of clothing does baby need to be wearing to be comfortable?
Dr. Abby Patterson:
Yeah. I usually tell parents, baby needs one layer heavier than they're comfortable in, in the current environment. So, if mom and dad are comfortable in long sleeves and long pants, maybe have the baby in a similar outfit and then add a blanket when they're going out for a while.
Dr. Neeta Goli:
Okay. Then what about at home, in the baby's room?
Dr. Abby Patterson:
Yeah. I tell people most temperatures that are comfortable for the family are safe for the baby. Most people, I feel like, like to keep their house and that 68 to 72 to 74 range, and that safe for babies. If family likes an extreme of temperature, I'd like them to try and move it a little closer to the median. But for most families, their regular temperature is fine for their new baby.
Dr. Neeta Goli:
Okay. Well, Abby, thanks so much for joining us today and for these hands-on practical tips for our listeners. I'm sure they will be much appreciated. Since you shared your tips for success in our last episode, today we can talk about what is your favorite part of your work day?
Dr. Abby Patterson:
My favorite part of the work day is when I really get to connect with a mom and her baby, whether it be reassuring her or helping the baby to latch and nurse. It just feels great to see that couplet succeeding and being able to play a part in that.
Dr. Neeta Goli:
Yeah, that's so sweet. That's the best part of the job.
Recording:
Thanks for listening to Newborn News. We hope you join us next time. If you like what you hear, make sure to subscribe and leave us a review. If you have questions, comments, feedback, or suggestions for future episodes, please email me at NewbornNews@utsouthwestern.edu. As a reminder, this content is educational and is not meant to be used as medical advice. Views or opinions expressed in this podcast are those of myself and my guests and do not necessarily reflect the views of the university.