Please enjoy this exclusive preview of our Baby PediaGuide! This is the first article in the guide. There are a total of 53 articles (including this Bonus article) to guide you through each week of your baby’s first year of life.
Bonus PediaGuide: Happy “Birth” Day Baby!
The big day has finally arrived, and your baby is here! Whether this is your first child or your fifth, the early days are typically one big surreal blur. You’re probably bruised and battered from your delivery, your hormones are raging, sleep deprivation (an actual form of torture) is kicking in, and you’re holding a sweet but needy stranger in your arms.
Although your head might be spinning, there’s actually a well-orchestrated dance going on around you in the hospital. Below is some handy-dandy info to help you make sense of your post-delivery stay. It includes:
Get Wise About It All Below…
What to Expect in the Hospital Post-Delivery
After the delivery, your doctor will put your baby directly on your chest for skin-to-skin contact and bonding (assuming no interventions are needed). The nurse will then take your baby over to the warmer to dry and swaddle them. After this is done, your baby will be placed in your arms once again. (FYI: you can ask the nurse to dry and swaddle your baby before they’re handed to you.)
If your OB/GYN says it’s ok, you can try to feed your baby within the first hour of life.
Before Your Newborn Can Be Discharged From the Hospital, the Following Need to Happen:
- The Vitamin K Shot: To prevent internal bleeding.
- The Application of Erythromycin Eye Ointment: To prevent an eye infection (particularly pink eye caused by chlamydia and gonorrhea).
- The First Bath: To wash off the amniotic fluid and vernix (the white cheesy substance that protects the baby’s skin).
Insider Info: New evidence suggests that delaying the first bath for 6+ hours (ideally for 24 hours) is beneficial. Get Wise about this idea here.
- The Initial Physical Exam: The hospital pediatrician will perform the initial head-to-toe exam (unless your baby’s designated pediatrician is one of the few docs who still visits their newborn patients in the hospital).
Get Wise about what the pediatrician looks for during your baby’s first exam.
Bonus: The Top 10 Newborn Skin Findings.
- The Hepatitis B Vaccine: This is the first vaccine your baby will receive. The second round of immunizations is typically administered at the 2-month visit. Get Wise about the Hepatitis B Vaccine and Vaccine Safety, in general.
- Feeding: Whether you’re breastfeeding, formula feeding, or still deciding, check out the PediaWise Feeding Primer for tips on how to feed your newborn.
PediaTip for All of the Breastfeeding Mamas Out There: It can take a little while to get the hang of nursing, so be patient with yourself. And don’t be afraid to ask for help. Most hospitals have lactation consultants who automatically visit all of the postpartum breastfeeding Moms to give them advice. Ask the nurse if your delivery hospital provides this service.
- Circumcision (If You Have a Baby Boy and That’s Your Preference). Get Wise about the Pros and Cons of Circumcision.
- The Discharge Exam: The discharge exam is basically a repeat of the initial newborn exam. During this exam, the pediatrician will make sure that your baby continues to look healthy and that their weight & bilirubin levels are within an acceptable range.
- Pee & Poop Watch: Babies should have their first poop and pee within the first 24 hours of life. If there was “meconium at birth” (i.e. if the baby pooped inside of you), that counts as the first poop.
If no poop or pee is seen on the first day, it could mean that your baby has an issue OR that someone accidentally threw the diaper away. The latter happens more than you’d think!
- The Newborn Screen: The newborn screen is comprised of 3 tests. These include:
1. The Newborn Screen Blood Test.
2. The Hearing Screen.
3. The Critical Congenital Heart Disease (CCHD) Screen.
Get Wise(r) About These Tests Below…
1. The Newborn Screen Blood Test (aka the “PKU”): This simple blood test is done via a “heel prick” (in which a drop of blood is taken from your baby’s heel). It screens for a variety of diseases, including cystic fibrosis and sickle cell disease. The results are back within 10-14 days and will typically be relayed to you at your baby’s 2-week visit.
Insider Info: States vary in terms of the number (and type) of diseases they test for on the newborn screen blood test. Get Wise about what’s offered in your particular state.
2. The Hearing Screen: All newborns undergo a hearing screen prior to discharge from the hospital. The audiologist will perform the hearing screen in your room or in the nursery (whichever is quieter). During the test, the audiologist will put tiny headphones on your baby. They will then measure the brain waves that your baby generates in response to the sounds delivered through the headphones.
PediaTip: Don’t freak out too much if your baby fails the newborn hearing screen. Leftover amniotic fluid or vernix in the ears can interfere with the test results. If your baby fails the test, they’ll need to do a repeat hearing screen by 3 months of age.
3. The Critical Congenital Heart Defect (CCHD) Screen: The CCHD is a non-invasive test that screens babies for severe congenital heart defects by measuring the oxygen levels in their blood.
Get Even Wise(r) About the Details of the Newborn Screen Here.
A Word About Discharge Weights & Bilirubin Levels
Parents and pediatricians alike obsess over newborn weights. Here’s what you can expect in terms of your baby’s weight and how the pediatrician will manage it in the hospital:
- All babies lose weight after they’re delivered, but they typically regain it by 2 weeks of age. This is normal and docs know that it’s going to happen. Pediatricians don’t, however, let babies go wild with their weight loss.
- Doctors typically allow babies born vaginally to lose up to 10% of their birth weight before they intervene. They tend to be a bit more lax with babies born via C-section, and will often let them lose up to 12% of their birth weight, before stepping in. Any more than that and the discharge from the hospital will be delayed until the baby starts feeding better and their weight stabilizes.
If you’re breastfeeding and your baby has lost more weight than expected, the pediatrician will probably encourage you to supplement with formula (i.e. to offer formula after each breastfeeding session) until some weight has been regained.
Like Math? Get Wise about how doctors calculate a baby’s weight loss percentage.
Why are Doctors So Strict About Weight Loss in Babies?
Because babies who lose too much weight initially have a greater risk of developing jaundice.
What’s Jaundice?
Jaundice is the abnormal yellow color that’s seen in babies’ skin and in the whites of their eyes when their bilirubin levels get too high.
What’s Bilirubin?
Bilirubin is a pigment that’s formed in the liver when red blood cells are broken down. If the bilirubin level gets too high, it causes jaundice, which can create problems for the baby. Get Wise(r) about jaundice here.
The Bottom Line:
The pediatrician will measure your baby’s weight and bilirubin level at least twice before discharge to make sure that everything is copacetic and nothing is missed.
Insider Info: The bilirubin level is measured either through the blood (this requires a skin prick) or with an instrument that’s rubbed over the forehead (i.e. the “transcutaneous” method). The transcutaneous method is less invasive than the skin prick method, but it’s also less accurate.
When Will I Get Out of the Hospital?
The Short Answer: It depends. To figure out your “release date,” your prenatal healthcare provider will take the following into account:
1. The Type of Delivery You Had (Vaginal Delivery vs. C-Section): Babies born vaginally are usually discharged from the hospital after 48 hours, whereas babies born via C-section are typically discharged after 96 hours (~4 days).
2. Your GBS (Group B Strep) Status: If you were GBS-positive and had a vaginal delivery, your baby is at a higher risk of infection even if you received adequate antibiotic treatment. As a result, the pediatrician will want to make sure that your newborn is observed for at least 48 hours prior to discharge.
Insider Info: Docs typically refuse to grant “early discharges” (before 48 hours) to GBS-positive Moms because they find it too risky.
3. How Your Baby is Doing: If your baby is losing weight, is jaundiced, or has some other issue the pediatrician is concerned about, they may need to stay in the hospital longer than expected.
PediaTips:
- Before you leave the hospital, book your baby’s first appointment with the pediatrician. The first visit should take place 1-2 days after discharge from the hospital. Make sure to bring your discharge paperwork with you to the visit.
Caveat: Some practices insist that you wait until after your baby leaves the hospital to call the office (in case the discharge gets delayed). If this is the office policy, make the appointment on the way home from the hospital or when you get home.
If the scheduler gives you any pushback when you call and says there aren’t any available appointments, let them know that you have a newborn, and that you have to be seen. Pediatricians and family medicine doctors must honor this request (although you might not be able to get an appointment with your doctor of choice for this first visit if it’s a practice with multiple doctors).
- Call your insurance company to add your baby to your policy (if you haven’t already).
- Sneak Peek: Go here for a list of the first-year pediatric visits and when they occur.
The Bottom Line
Congrats! You’ve made it through pregnancy and have your sweet little bundle of joy in your arms. You’re probably happy, exhausted, slightly terrified, and a bit (or a lot) overwhelmed. Don’t worry, that’s normal! In the beginning, you can expect to feel like you’re in a fog of feeding, changing diapers, and cuddling your baby while physically recovering from the delivery and trying to catch some Zzzzs. This is survival mode. The rainbows, sparkles, and sleep come later.
Celebrities Are Just Like Us!
“The biggest thing I remember is
that there was just no transition.
You hit the ground diapering.”
~Paul Reiser
Looking Ahead:
If you’re curious about what’s around the corner, click on the hyperlinks below.
- When to Introduce a Pacifier and/or a Bottle When You’re Breastfeeding.
This is a somewhat controversial topic in the medical world. Some experts think you should wait until the 2-week mark to offer the pacifier and/or bottle to avoid “nipple confusion.”
What’s That? Nipple confusion is when a newborn gets the breast “confused” with the pacifier or bottle and doesn’t nurse as efficiently. This happens because the sucking motion for the pacifier and bottle is a bit different than the sucking motion for breastfeeding. There’s also a theory that parents might miss their baby’s hunger cues (e.g. lip smacking, opening and closing the mouth) if their little one is sucking on a pacifier.
What Does the Other Camp Say? People in the other camp think the whole “nipple confusion” thing is waaayyy overblown and believe there’s no reason to delay the introduction of the bottle and pacifier.
So, What Should I Do? Ask your doctor for their take on all of this, but know that whatever you do is probably okay.
On the Fence About Whether to Introduce a Pacifier at All? Get Wise about the pros and cons of pacifiers.
- Make Sure That Your Baby’s Car Seat is Properly Installed in Your Vehicle (It Should Be Rear-Facing).
Check out our Car Seat Safety Primer for the 411 on Car Seats and Car Seat Safety.
- Follow These Two Home Safety Tips:
1. Set your home water heater to less than 120°F (to avoid burns).
2. Install smoke detectors and carbon monoxide detectors throughout your home. Combination smoke and carbon monoxide detectors are available, as well.
PediaWise Pick: Kidde Combination Carbon Monoxide and Smoke Alarm.
Get Wise about Carbon Monoxide Poisoning.
- Feed Your Baby Every 2-3 Hours When You Get Home From the Hospital. Wake them up for feeds if they try to sleep through them.
- Put Your Baby on Their Back to Sleep With No Pillows, Blankets, Bumpers, or Stuffed Animals in the Crib.
Why? To reduce the risk of Sudden Infant Death Syndrome (SIDS). Get Wise(r) about SIDS here.
- Know That a Fever in a Baby Under 1 Month of Age is a Medical Emergency & Requires a Trip the ER. A fever is defined as a temperature of 100.4°F (or higher) taken rectally (i.e. up the bum).
Get Wise(r) about fevers in newborns & why they’re taken so seriously.
And…Breathe
Reality Check: I know that I just threw a lot of information at you. But don’t worry! You don’t have to learn everything at once. My goal is to arm you with the most important newborn health facts right out of the gate so they’re familiar to you. I’ll review these topics in subsequent PediaGuides, so your sleep-deprived brain will see them multiple times.
And…That’s a Wrap!
