“Is this normal?” Newborn Questions with Dr. Sarnoff of Premier Pediatrics

Thursday, September 22, 2022

Eighty percent of the families we teach have little to no experience with newborn babies ahead of time. If you’re expecting a little one or in the throws of immediate postpartum and feeling nervous, please know that you’re not alone! A lack of exposure and experience to anything new in life can breed insecurity – and – when it comes to caring for a newborn the stakes are pretty high.

We want parents to trust themselves more – even in the very early days. So, to help you get there, we asked Dr. Jon Sarnoff, of Premier Pediatrics to help us think through some of the most common concerns newborn parents experience. You can watch our IG Live on Surviving the First Few Weeks Postpartum or read on to get a sense of when you can take that first big sigh of relief and notice that baby is doing OKAY!

Of course, the timeline for relaxing is going to be different for every family depending on how your birth, immediate postpartum period, and feeding journey unfold. Our best advice is to prepare for the unexpected – by having medical providers you trust and emotional and logistical support, like family, friends, and doula care lined up.

Newborn Health Basics + Warning Signs

When your baby is born, they are monitored closely by your medical team until their first formal head-to-toe exam. At 1 minutes and 5 minutes after birth nurses will conduct an “APGAR” test: a loose gauge on your baby’s appearance, pulse, grimace, activity, and respiration. The points the receive in each category are added up to equal a max of 10 (though it’s very rare for a baby to receive a 10/10, especially right away). It’s expected that the 5-minute score will be higher than the 1-minute score. Healthy babies typically receive between a 7 and 9. Babies who’s APGAR score is between a 4 and 6 may need additional breathing support within the delivery room and babies who have an APGAR below 4 may benefit from additional medical support in the NICU or Neonatal Intensive Care Unit.

Within 24 hours your baby will receive their first full-body physical. Pediatricians are looking for signs of illness, birth defects, and general functioning – monitoring everything from their temperature, heartbeat, and breathing patterns, to the shape of their head and genitals. A small sample of blood is collected from your newborn’s heel to test for jaundice by looking at their bilirubin levels. Jaundice can be visually observed in the yellowing of skin (for light skinned babies) and the yellowing around the whites of the eye and the palm of the hand. Most cases are mild and resolve on their own within the first week as the baby stays hydrated and flushes the bilirubin out of their system.

Assuming a good bill of health, your baby will be discharged from the hospital and their birth weight, discharge weight and bilirubin levels will be sent to the primary pediatrician. Pediatricians in the hospital ensure your baby’s immediate physical well being and that you have an adequate feeding plan and primary pediatrician in place.

Keep track of your Discharge Papers + Ask for your Complete Medical Records

While they might not track anything of critical importance, it’s a good idea to hold onto your discharge papers and bring them to your first pediatrician visit, in case there is anything noteworthy you didn't realize or forgot. (We’ll also say: request a copy of your complete medical records of childbirth to have down the line incase you want to review, process, or discuss your birth with other providers in the future.)

How to know my baby is eating enough!?

First of all, by being interested in this question it shows that you’re thinking well and have the best intentions. Good job instincts! From there, we want you to know that babies can _loose_ up to 10% of their body weight after birth. A baby gaining weight is one of the key measures for ensuring that they’re eating enough, but it’s important to know that in the first 7 to 14 days, pediatricians are just looking to see that babies have regained their birth weight, not necessarily gained more. Working with a pediatrician to track their growth (make sure the scales are calibrated correctly) is the best way to get a stamp of approval that they’re eating enough.

If a baby is being breastfed, one of the most important things to understand is the frequency with which they nurse! It’s common for newborns to eat at least 10-12 times per day. We discuss the physiological reasons for this in our newborn care and prenatal lactation classes since many parents aren’t expecting this cadence, and might worry if when baby shows hunger signs around the clock. (It’s important to learn more about the early days of breastfeeding, since if you’re hoping to breastfeeding giving a baby a bottle of formula if they seem “extra hungry” is often counter productive when you’re trying to increase your supply!) Frequent eating is not a cause of concern if your baby is sleeping well between feeds. Babies who need to be continuously nursing to seem satisfied, struggle to wake up, fall asleep regularly during feeds, or have a weak latch, may be struggling to take in enough calories.

In addition to babies gaining weight and eating consistently, we can track a baby’s growth by monitoring the frequency of elimination: how many wet / dirty diapers do they have each day? We like to see corresponding dirty diapers to the number of days old a baby is in the first five days of life. Two dirty diaper on day two and four on day four etc.

The combination of regular elimination along with distinct eating and sleeping sessions, and a baby who has regained their birth weight is a great indication you’re good to go! While it can sometimes be hard for parents to trust, Dr. Sarnoff emphasized: “It’s really that simple.”

Is my baby’s breathing normal?

In addition to feeding, we get a lot of questions about newborn breathing patterns. Did you know that babies might stop breathing for 5-10 seconds at a time? If you didn’t, and your baby does it, it can be really scary!

As Dr. Sarnoff explained, newborns are periodic nose breathers. This means they exclusively breath through their nose (unless they have a cold or are crying), can stop breathing for a few seconds, and then take a few very quick breaths to catch up. Physiologically, this is quite different from how adults breathe. But, there’s nothing to be worried about. Want to double check? Dr. Sarnoff says: “if they’re feeding ok, they’re breathing ok!” Feeding is very energy intensive (a’la exercise) for infants and we can’t exercise well if we’re not breathing well.

While there are many other miscellaneous health and hygiene concerns parents have to navigate worried parents can move through this big picture checklist to find their sign of relief!

\[ ] My baby’s physical exam and vital signs, including bilirubin levels, looked good to the pediatrician.

\[ ] My baby is feeding well (hydrated) and gaining weight.

\[ ] My baby seems content much of the day

Want more specific information or guidance? Dr. Sarnoff’s recommends Heading Home With Your Newborn, which he described as a a non-alarmist comprehensive guide on newborn care from the American Academy of Pediatrics. We also like Dr. Sear’s The Baby Book! Having either of these as a hard copy can really help you stay off the internet. And if we know anything we know that new parents should hardly ever be allowed to google: the internet can be a scary place!

How about germs!? When can I take my baby outside?

Of course there’s reason to be cautious around newborns. Physiologically, babies have passive immunity from the birth parent which can help them stave off illness for most of the first two months. Around 8-10 weeks this immunity weans and baby has to start making their own active immune response. (Dr. Sarnoff noticed that many babies get their first cold around the two month mark, and the transition in their immune system is a logical reason as to why). An infant’s immune system is not significantly working on its own until they’re closer to the three month mark.

There’s a tendency to treat babies in the first ~4 weeks as very fragile. If they develop a fever of 100.4 or more, it requires admission to the hospital, a significant workup, and antibiotics. Each month of the fourth trimester the risk and intensity of interventions lower so by month three newborns who develop a fever are watched for symptoms but are not automatically hospitalized or given antibiotics.

If you’ve heard that a baby is in the clear after six weeks, or that you should wait until a baby has gotten their vaccines… it’s a little more nuanced. Studies that were done on infant illness often use the 6-week mark in research, but there is no clear physiological changes at that point in time. Similarly, while vaccinations can be extraordinarily beneficial, the reality is that the 2-month vaccinations begin to protect a baby from incredibly uncommon illnesses – not the bread and butter bugs going around the playground or music class.

All that said, there’s no true consensus on when a baby is “out of the woods” and safe to be out and about. As a point of reflection, and to check in with your own comfort level, we’d recommend asking your pediatrician when they suggest your baby begins to venture in public spaces and see if their answer matches your own instincts.

As you prepare to take baby out and have people come visit, Dr. Sarnoff recommends being cautious about three specific groups of people: folks who are sick, school aged kids (the younger the potentially yuckier), and people you don’t know. Older school aged kids are likely more mindful about exposing a newborn to illness, but if you have a toddler planning to visit, especially a toddler in daycare, it can be a good idea to keep some separation between them and the baby - especially the baby’s face. Giving the toddler their own baby doll can help keep them occupied!

While it’s always a good idea to have people wash their hands and limit touching or kissing a newborn baby’s face, Dr. Sarnoff and the Birthsmarter team agree that you cannot and should not risk your own mental health to keep a newborn cocooned. It’s important to live your life, within the confines of laying low to recover from childbirth, and weigh exposure risks based on your individual family values.

As you make sense of all of this, feel free to reach out to our team with thoughts or questions. We’d love to see you in an upcoming Fourth Trimester Survival Group as we find that being in community can help prevent the isolation and anxiety any new parents face. And, if you’re looking for more resources here are a few of Dr. Sarnoff’s favorites:

Find live, virtual & on-demand classes and support groups near you:

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