Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

CHAPTER 17. Taking baby home

Finally, the moment you’ve been anticipating is here — you’re bringing home the newest member of your family! You’ve set up the crib and nursery, bought and borrowed cute little outfits, and stocked up on diapers, wipes, blankets and other supplies. You’ve been thinking about all of the changes this new baby will bring to your life, and you’re likely feeling both excited and scared.

Now you wonder: Am I ready? Are we ready? Probably not — and that’s perfectly normal.

No matter how many pregnancy and baby-care books you’ve read or how meticulous you’ve been in getting everything in place, nothing can fully prepare you for the first few weeks after your baby’s birth — a time that’s often exciting and overwhelming.

During the first few weeks after your baby is born (postpartum weeks), you’re dealing with many different physical, practical and emotional issues all at once. You’re getting used to this new being and trying to understand his or her needs and habits. At the same time, your body is recovering from pregnancy and childbirth.

Given all of these changes, the first few weeks after you bring your baby home are likely to be one of the most challenging times of your life. It may take weeks to months to feel back to normal. Be patient with yourself and your baby. You’ll get there in your own way and in your own time.

This chapter gives you a glimpse into your newborn’s world and offers some advice on taking care of your baby and keeping him or her safe. Having a new baby in your life is a special experience.

YOUR BABY’S WORLD

During the first few weeks of a newborn’s life, it may seem like all he or she does is eat, sleep, cry and keep you busy changing diapers. But your baby is also taking in the sights, sounds and smells of his or her new world, learning to use his or her muscles and expressing a number of innate reflexes.

As soon as babies are born, they begin to communicate with you. Infants can’t use words to communicate their needs, moods or preferences, but they have other ways of expressing themselves, especially by crying.

You may not always know how your newborn is feeling, and sometimes it may seem as though he or she is communicating in a foreign language. But you can learn about how your baby experiences the world and relates to you and others. In turn, your baby will learn your language of touching, holding, and making sounds and facial gestures.

Reflexes Newborns are just learning to enjoy the freedom of movement outside the cramped quarters of the uterus. In their first few days, they may seem a bit reluctant to experiment with their new mobility, preferring to be wrapped and held snugly. Over time, however, your baby will begin to explore a range of movements.

Babies are born with a number of reflexes (automatic, involuntary movements). Some of these movements — such as turning the head to avoid suffocating — seem to be protective responses. Some may be preparing babies for voluntary movements. Most reflexes diminish after a few weeks or months and then disappear completely as they’re replaced with new, learned skills.

In the meantime, watch for some of these reflexes:

 Rooting. This reflex prompts babies to turn in the direction of the food source, whether it’s a breast or bottle. If you gently stroke a newborn’s cheek, he or she will turn in that direction, with his or her mouth open, ready to suck.

 Sucking. When a breast, bottle nipple or pacifier is placed in a baby’s mouth, he or she will automatically suck. This reflex not only helps the newborn eat but also can calm him or her.

 Hand to mouth. Babies will try to find their mouths with their hands. This reflex may be why many babies bring their hands to the breast or bottle.

 Stepping. When you hold infants under their arms and let the soles of their feet touch the ground, they may place one foot in front of the other as if they’re walking. This stepping reflex is most apparent after about the fourth day and disappears at about two months. Most babies won’t actually learn to walk until almost a year later.

 Startle (Moro reflex). When startled by a noise or sudden movement, babies may throw both arms outward and cry. You may notice this if you put your baby in the bassinet or crib too quickly.

 Fencing (tonic neck reflex). If you turn your baby’s head to one side while he or she is lying on his or her back, you may see this classic baby pose, in which one arm is crooked and raised behind the head and the other is straightened and extended away from the body in the direction the head is turned. Your baby may also clench the fist of the extended arm.

 Smiling. In the first few weeks of life, most of a newborn’s smiles are involuntary, but it won’t be long before the baby begins smiling in response to a person or situation.

If you’re observant, you may notice some of these reflexes, but don’t worry if you don’t notice them. Your baby’s care provider may check for them during physical examinations.

You can encourage your baby’s movement by gently cycling the arms and legs as he or she lies on his or her back. Or you might let the baby kick at your hands or a squeaky toy.

Senses It’s a new world for your baby, and all of his or her senses are coming alive to explore and make sense of it. You’ll notice when an object, light, sound, smell or touch engages your baby. Watch for him or her to settle down or become quiet when something new is introduced.

Sight Your newborn is nearsighted and sees best at 12 to 18 inches. That’s the perfect distance for seeing the most important things to babies — their parents’ faces as they hold or feed them. Your baby will love to fixate on your face, and it will be the favorite entertainment for a while. Give your newborn plenty of face-to-face time to get to know you.

In addition to being interested in human faces, newborns are also engaged by brightness, movement and simple, high-contrast objects. Many toy stores sell black-and-white and brightly colored toys, mobiles and nursery decorations.

Because newborns can’t fully control their eye movements, they may appear to be cross-eyed at times, or their eyes may briefly diverge and look walleyed. This is normal. Your baby’s eye muscles will strengthen and mature during the next few months.

When your baby is quiet and alert, provide simple objects for him or her to look at. Try slowly moving an object to the right or left in front of him or her. Most babies will briefly follow moving objects with their eyes and sometimes with their heads. But don’t overload your child — one item at a time is plenty. If your baby is tired, hungry or overstimulated, he or she won’t want to play this game.

Hearing Once baby is born, new sounds will capture his or her attention. In response to noises, babies may pause in sucking, widen their eyes or stop fussing. They may startle at a loud noise such as a dog barking, and they may be soothed by the hum of the vacuum cleaner or the whirring of the clothes dryer. But babies can easily adapt and tune out noises, so they may react to a particular sound only once or twice.

Newborns can tell the difference between human voices and other sounds. Babies are most curious about their parents’ voices. Your baby will learn quickly to associate your voice with food, warmth and touch. He or she will listen carefully when you talk to him or her — even infants enjoy being read to. Talk to your baby whenever you can. Even though he or she won’t understand what you’re saying, the sound of your voice is reassuring and calming.

Improvements in hearing tests have made newborn hearing screening possible. Many hospitals now routinely test every newborn’s hearing. If this testing isn’t offered where you give birth, ask your baby’s care provider to refer you to an audiologist for the screening. This is particularly important if someone in the family has hearing problems.

Touch Infants are sensitive to touch and can detect differences in texture, pressure and moisture. They respond quickly to changes in temperature. They may startle when cold air blows across their skin and become quiet again when they’re wrapped warmly. Your touch provides comfort and reassurance to your baby and can rouse a sleepy baby for feeding.

Smell and taste Infants have a good sense of smell. Even when very young, they can recognize their mothers by scent. They may show interest in a new smell by a change in movement or activity. But they easily become familiar with a new smell and no longer react to it.

The sense of taste is closely related to the sense of smell. Although newborns aren’t exposed to many tastes beyond breast milk or formula, research shows that from birth, babies prefer sweet tastes over bitter or sour tastes.

Crying Crying is the first and primary form of communication that newborns use. And they do plenty of it — young babies typically cry on average from one to four hours a day. It’s a normal part of adjusting to life outside the womb.

Common reasons for crying include:

 Hunger. Most babies eat six to 10 times in a 24-hour period. For at least the first three months, babies usually wake for night feedings.

 Discomfort. Your baby may cry because of wet or soiled diapers, gas or indigestion, and uncomfortable temperatures or positions. When babies are uncomfortable, they may look for something to suck on. But feeding won’t stop the discomfort, and a pacifier may help only briefly. When the discomfort passes, your baby will probably settle down.

 Boredom, fear and loneliness. Sometimes, a baby will cry because he or she is bored, frightened or lonely and wants to be held and cuddled. A baby seeking comfort may calm down with the reassurance of seeing you, hearing your voice, feeling your touch, being with you, being cuddled or being offered something to suck on.

 Overtiredness or overstimulation. Crying helps an overtired or overstimulated baby to shut out sights, sounds and other sensations. It also helps relieve tension. You may notice that your baby’s fussy periods occur at predictable times during the day, often between early evening and midnight. It seems that nothing you do at these times can console him or her, but afterward baby may be more alert than before and then may sleep more deeply. This kind of fussy crying seems to help babies get rid of excess energy.

As your baby matures, you’ll be able to distinguish the different messages in your baby’s cries.

Calming a crying baby In general, during the first few months of life, it’s best to respond promptly to your infant when he or she cries. You won’t spoil your baby by doing so. Studies show newborns who are quickly and warmly responded to learn to cry less overall and sleep more at night.

When your baby’s crying seems prolonged, run down a simple list to determine what might be needed:

 Is baby hungry?

 Does baby need a clean diaper?

 Does baby need to be burped?

 Is baby too warm or too cold?

 Does baby just need to suck, whether on a finger or a pacifier?

 Does baby need some tender care — walking, rocking, cuddling, stroking, gentle talking, singing or humming?

 Does baby need to be moved to a more comfortable position? Is something pinching, sticking or binding him or her?

 Has there been too much excitement or stimulation? Does baby just need to cry for a while?

Try to meet your baby’s most pressing needs first. If hunger seems to be the problem, feed him or her. If the crying is shrieking or panicky, check to make sure nothing is poking or pinching your baby. If your baby is warm, dry, well-fed and well rested but still wailing, these suggestions may help:

 Try swaddling baby snugly in a blanket, as shown at the end of this chapter.

 Gently talk to or sing to your baby face to face.

 Gently stroke baby’s head or rub or pat his or her chest or back.

 Offer your baby your finger or a pacifier to suck on as you rock or rhythmically walk him or her.

 Use a gentle motion, such as rocking your baby in your arms, walking with him or her against your shoulder, or carrying him or her in a front carrier.

 Play soft music.

 Hold baby tummy down on your lap.

 Hold baby in an upright position on your shoulder or against your chest.

 Put baby in his or her car seat and go for a drive.

 Give baby a warm bath or put a warm — not hot — water bottle on his or her stomach.

 Go outside. Take your baby for a walk in a stroller or carriage.

 Reduce the noise, movement and lights in the area where your baby is. Or try introducing white noise, such as the continuous, monotonous sound of a vacuum cleaner or a recording of ocean waves. This can relax and lull babies by blocking out other sounds.

If your baby is dry, full, comfortable and wrapped snugly but is still crying, he or she may just need a 10- to 15-minute period alone. Stay within earshot, and check on the baby every few minutes from a distance. Although many parents find it difficult to let their babies cry, it may give the infants an opportunity to unwind and let off steam.

Remember that you won’t always be able to calm your baby, especially when the fussing is simply a way to release tension. Babies do cry; it’s a normal part of being a baby. Rest assured that the crying won’t last forever — the amount of time your baby spends crying usually peaks at about six weeks after birth and then gradually decreases. By three to four months, there is often a marked improvement.

It’s also a normal part of parenting to find excessive crying frustrating. Make arrangements with family, friends or a baby sitter for needed breaks. Even an hour’s break can renew your coping strength.

If your baby’s crying is making you feel out of control, put your baby in a safe place, such as a crib. Then contact your care provider, your hospital emergency room or a local crisis intervention service. No matter how impatient or angry you get, never shake a baby. And never let anyone else shake a baby. Shaking an infant can cause blindness, brain damage or even death.

COPING WITH COLIC

Every baby is fussy at times, but some babies cry much more than do others. If your baby is healthy but has frequent fussy episodes, especially during the evening, or has prolonged, inconsolable crying for three or more hours a day, chances are your baby has colic. It’s not a physical disorder or disease — colic is just the term for recurring bouts of crying that are difficult to relieve.

A colicky baby’s crying is not simply due to hunger, a wet diaper or any other apparent cause, and the baby can’t be calmed down. Experts aren’t sure what causes the condition. Colic typically peaks at about six weeks after birth and usually goes away by three months.

For parents of a baby with colic, it may seem that the baby will never outgrow this phase. It’s common to feel frustrated, angry, tense, irritable, worried and fatigued.

What to do No treatment consistently provides relief to infants with colic. Experiment with various methods to calm your baby, and try not to get discouraged if many of your efforts seem futile. Remember that your baby will eventually outgrow colic. And just because you have a fussy newborn doesn’t mean that he or she will develop into a child that whines a lot. Many colicky babies turn out to be happy, smiling, easy-going toddlers and children.

During your baby’s crying spells, the more relaxed you can stay, the easier it’ll be to console your child. Listening to a newborn wailing can be agonizing, but your own anxiety, frustration or panic will only add to the infant’s distress.

Take a break and allow others to watch your baby so that you can relax. Sometimes a new face can calm the baby when you’ve used up all your tricks.

When it may not be colic Sometimes it can be difficult to determine if your baby has colic or if his or her crying is related to something else. Call your baby’s care provider if:

 Your baby seems to cry for an unusual length of time

 The cries sound odd to you

 The crying is associated with decreased activity, poor feeding, or unusual breathing or movements

 The crying is accompanied by other signs of illness, such as vomiting, fever and diarrhea

 You or someone else in your household is having trouble dealing with your crying baby

Eating and sleeping Two important items on a newborn’s agenda are eating and sleeping. Because most of a baby’s energy goes into growing, many nonsleeping hours are spent eating.

Eating patterns During the first several weeks, most babies will want to eat six to 10 times a day. Their stomachs don’t hold enough breast milk or formula to satisfy them for long. That means you could be feeding your baby every two or three hours, including during the night. However, there’s tremendous variation among infants in how often and how much they eat.

Your baby probably won’t have a feeding routine at first. Although you can roughly estimate the amount of time between feedings, the baby’s schedule will be erratic. During growth spurts, feedings will be more frequent for a day or two.

You’ll soon learn to read the signals that your baby is hungry, such as crying, opening its mouth, sucking, putting a fist in its mouth, fidgeting and turning toward your breast. Babies will also let you know when they’ve had enough by pushing the nipple or bottle out of their mouths or turning their heads away.

Sleep patterns and cycles As with eating, it takes awhile for newborns to get on any kind of schedule for sleeping. During the first month, they usually sleep and wake around the clock, with relatively equal periods of sleep between feedings.

In addition, newborns don’t know the difference between night and day. It takes time for them to develop circadian rhythms — the sleep-wake cycles and other patterns that revolve on a 24-hour cycle. As a baby’s nervous system gradually matures, so do his or her phases of sleep and wakefulness.

Although newborns don’t usually sleep for more than about 4½ hours at a stretch, altogether they sleep 12 or more hours a day. They generally stay awake long enough to feed, or for up to about two hours, before falling asleep again. By the time your baby is 2 weeks old, you’ll likely notice that the periods of sleeping and wakefulness are lengthening. By 3 months, many babies shift more of their sleep to nighttime, much to the relief of their parents.

You can help adjust your baby’s body clock toward sleeping at night by:

 Avoiding stimulation during nighttime feedings and diaper changes. Keep the lights low, use a soft voice, and don’t play or talk with your baby. This reinforces the message that nighttime is for sleeping.

 Establishing some kind of bedtime routine. This might be singing, having a quiet time or reading for an hour before putting your baby to bed.

DEVELOPING GOOD SLEEPING HABITS

Drooping eyelids, rubbing the eyes and fussiness are the usual signs that a baby is tired. Many babies cry when they’re put down for sleep, but if left alone for a few minutes, most will eventually quiet themselves.

If your baby is not wet, hungry or ill, try to be patient with the crying and encourage self-settling. If you leave the room for a while, your baby will probably stop crying after a short time. If not, try comforting him or her and allow the baby to settle again.

In the first few months, it’s common for a pattern to evolve in which a baby is fed and falls asleep in a parent’s arms. Many parents enjoy this closeness and snuggling. But eventually this may be the only way the baby is able to fall asleep. When the baby wakes up in the middle of the night, he or she can’t fall asleep again without being fed and held.

To avoid these associations, put your baby in bed while he or she is drowsy but still awake. If babies fall asleep in bed without assistance when they’re first laid down, it’s more likely that they’ll fall asleep on their own after waking in the middle of the night.

Keep in mind that young babies who stir during the night aren’t necessarily distressed. Infants typically cry and move about when entering different sleep cycles. Parents sometimes mistake a baby’s stirrings as a sign of waking up, and begin unnecessary feeding. Instead, wait a few minutes to see if your baby falls back to sleep.

‘BACK’ TO SLEEP

Always place your baby on his or her back to sleep, even for naps. This is the safest sleep position for reducing the risk of sudden infant death syndrome (SIDS). Sometimes called crib death, SIDS is the sudden and unexplained death of a baby under 1 year of age.

Research shows that babies who are put to sleep on their stomachs are much more likely to die of SIDS than are babies placed on their backs. Infants who sleep on their sides also are at increased risk, probably because babies in this position can roll onto their stomachs. Since 1992, when the American Academy of Pediatrics began recommending the back-sleeping position for infants, the incidence of SIDS in the United States has declined significantly.

The only exceptions to the back-sleeping rule are babies who have health problems that require them to sleep on their stomachs. If your baby was born with a birth defect, spits up often after eating, or has a breathing, lung or heart problem, talk to your baby’s care provider about the best sleeping position for your child.

Make sure that everyone who takes care of your baby knows to place the infant on his or her back for sleeping. That may include grandparents, child care providers, baby sitters, friends and others.

Some babies don’t like sleeping on their backs at first, but they get used to it quickly. Many parents worry that their baby will choke if he or she spits up or vomits while sleeping on his or her back, but doctors have found no increase in choking or similar problems.

Some babies who sleep on their backs may get a flat spot on the backs of their heads. For the most part, this will go away after the baby learns to sit up. You can help keep your baby’s head a normal shape by alternating the direction your baby lies in the crib — head toward one end of the crib for a few nights and then toward the other. This way, the baby won’t always sleep on the same side of his or her head.

Other tips that may help reduce the risk of SIDS include:

 Breast-feed your baby. Although it’s not entirely clear why, breast-feeding may protect babies against SIDS.

 Dress your baby in a kimono or sleep sack. By doing this you don’t need to use a blanket and worry about the blanket interfering with breathing.

 Select bedding carefully. Use a firm mattress. Avoid placing baby on thick, fluffy padding, which may interfere with breathing if baby’s face presses against it. For the same reason, don’t leave pillows, fluffy toys or stuffed animals in your infant’s crib.

 Don’t smoke or expose baby to household smoke. Infants whose mothers smoke during and after pregnancy are three times as likely to die of SIDS as are infants of nonsmoking mothers.

 Keep the temperature at a comfortable level. If your baby is sweating around the neck or face, it probably means he or she is too warm.

Feeding a sleepy baby You’ll no doubt have times when your baby signals that he or she is hungry, only to doze off when you begin feeding. Try these tips to feed a sleepy baby:

 Watch for and take advantage of your baby’s alert stages. Feed at these times.

 A sleeping baby may squirm and root around or fuss when hungry. If your baby naps for more than three hours, watch for these subtle signs. If your baby is partially awake, gently wake him or her and encourage eating.

 Give your baby a massage by walking your fingers up his or her spine.

 Partially undress your baby. Because your baby’s skin is sensitive to temperature changes, the coolness may wake him or her long enough to eat.

 Stroke a circle around your baby’s lips with a fingertip a few times.

 Rock your baby into a sitting position. The baby’s eyes often open when he or she is positioned upright.

Peeing and pooping New parents often wonder what’s normal when it comes to their baby’s urination and bowel movements. By the time a baby is 3 or 4 days old, he or she should have at least four to six wet diapers a day. As your baby gets older, he or she may have wet diapers with every feeding.

In a healthy infant, urine is light to dark yellow in color. Sometimes, highly concentrated urine dries on the diaper to a pinkish color, which may be mistaken for blood. Actual blood in the urine or a bloody spot on the diaper is cause for concern, however.

As for stools, the range of normal is quite broad and varies from one baby to another. Babies may have a bowel movement as frequently as after every feeding, as infrequently as once a week, or in no consistent pattern.

If you’re breast-feeding, your baby’s stools will resemble light mustard with seed-like particles. They’ll be soft and even slightly runny. The stools of a formula-fed infant are usually tan or yellow and firmer than those of a breast-fed baby, but no firmer than peanut butter. Occasional variations in color and consistency are normal. Different colors may indicate how fast the stools moved through the digestive tract or what the baby ate. The stool may be green, yellow, orange or brown.

Mild diarrhea is common in newborns. The stools may be watery, frequent and mixed with mucus. Constipation is not usually a problem for infants. Babies may strain, grunt and turn red during a bowel movement, but this doesn’t mean they’re constipated. A baby is constipated when bowel movements are infrequent, hard and perhaps even ball-shaped.

FIRST BOWEL MOVEMENTS

Your baby’s first soiled diaper — which will probably occur within 48 hours of birth — may surprise you. During these first few days, your newborn’s stools will be thick and sticky — a tar-like, greenish black substance called meconium. After the meconium is passed, the color, frequency and consistency of your baby’s stools will vary depending on how your baby is fed — by breast or bottle.

BABY-CARE BASICS

Once your son or daughter is home, you may wonder about even the little things. Am I holding him or her right? Is this outfit too tight or too hot? Is the bath water too cold? It’s normal to feel a little nervous or anxious.

But it won’t take long until you’re a pro. You’ll soon become a whiz at everything from changing diapers to giving your little one a bath.

Holding your baby At first you may feel a little awkward or nervous about holding and carrying your baby. Over time you’ll feel more comfortable. And you’ll soon learn what positions your baby likes — all babies have their own preferences. Newborns generally love being held close, soothed by the warmth of your body. They also feel secure and calm when they’re cradled in the crook of an elbow, with their head, legs and arms firmly supported.

During the first few months of life, babies differ in their ability to control their neck muscles and heads. Until you’re sure your baby can hold up his or her head quite well, lift baby gently and slowly so that his or her body is supported and the head doesn’t flop back. When putting your baby down, gently support the head and neck with one hand and the bottom with the other.

With experience you’ll discover the best position for calming and comforting a fussy baby. You might try holding him or her along the length of your arm, facedown, with the baby’s head at the bend of your elbow and his or her crotch at your hand. Or you can hold the baby facedown across your lap, with his or her tummy lying against your thigh. Another comforting position is to lie on your back and put baby facedown on your chest while gently rubbing his or her back.

Your baby will probably also develop a preference for how he or she wants to be carried. Some infants enjoy facing outward, looking at the world, and others prefer the security of snuggling close to your body. Your baby may like being carried with arms and legs tucked in, or he or she may prefer a more relaxed position with just the body and head supported.

Changing diapers To parents of young babies, life often seems to be an endless round of changing diapers. Indeed, the average child goes through about 5,000 diaper changes before being toilet trained. That statistic is daunting, but it may help to think of this necessary task as an opportunity for closeness and communication with your baby. Your warm words, gentle touches and encouraging smiles help make your baby feel loved and secure, and soon your infant will be responding with gurgles and coos.

Because newborns urinate frequently, it’s important to change your baby’s diapers every two or three hours for the first few months. But you can wait until your baby wakes up to change a wet diaper. Urine alone doesn’t usually irritate a baby’s skin. However, the acid content in a bowel movement can, so change a messy diaper soon after your baby awakens.

Get equipped To make diaper changing more comfortable for you and your baby, make sure you have on hand:

 Diapers. Stock an adequate supply of diapers. You can buy cloth or disposable diapers, or you can use a diaper service, most of which use cloth diapers. If you use disposable diapers, be sure to get the size corresponding to your baby’s weight. You’ll need 80 to 100 disposable diapers a week. If you plan to buy cloth diapers, the number you’ll need depends on how often you plan to wash them. For example, if you have three dozen diapers, you’ll probably need to wash them every other day. Even if you use disposable diapers, you’ll find it helpful to have a dozen cloth diapers on hand in case you run out of disposables. Cloth diapers are also handy to drape over your shoulder or to put on your lap while burping your baby.

 Plastic pants. You will need these if you’re using cloth diapers.

 Pre-moistened baby wipes. Although a moistened cloth also works, it’s hard to beat the convenience of pre-moistened baby wipes. Choose wipes for sensitive skin to prevent irritation.

 A diaper pail. Various types of diaper pails are available. Look for a pail that’s convenient, sanitary and holds in odors.

 Baby lotion. It’s not necessary to use lotion at every diaper change, but it may come in handy if your baby develops diaper rash.

 A changing table. Choose a table with a wide, sturdy base that has compartments for storing diaper-changing supplies.

Diaper-changing basics When changing a diaper, use a flat surface — a changing table, a changing pad on the floor or a crib. If you’re using a changing table, be sure to use the safety belt or keep one hand on your baby at all times.

Your baby may urinate when you’re changing the diaper. If your baby is a boy, you can avoid being sprayed with urine by covering his penis loosely with a diaper or cloth while cleaning the rest of the diaper area.

After you’ve removed the soiled diaper, take time to thoroughly clean your baby’s bottom:

 During the cleaning, carefully grasp and hold baby’s legs at the ankles with one hand.

 Use either a cotton cloth dampened with warm water or a pre-moistened baby wipe to wipe your baby’s diaper area. Use alcohol-free and fragrance-free wipes to avoid drying or irritating the baby’s skin.

 In case of a bowel movement, use the unsoiled front of the diaper to remove the bulk of the stool. Wipe down and away from the genitals, folding the waste inside the diaper.

 Gently finish cleaning with a cloth or wipe, using a mild soap as needed. You needn’t apply lotion, unless your baby tends to develop rashes.

 Lift your baby’s lower body by the ankles and slide the new diaper underneath. Fit the diaper snugly around your baby’s waist and fasten the tabs on either side. For newborns, fold the top of the diaper down.

If you use cloth diapers, you can fold them several ways. Experiment with different techniques for best absorbency and fit. Fold the side edges in, making shallow folds for a larger baby and deeper folds for a smaller baby. For boys, you may want to create extra padding in the front. Folding the front narrower than the back may allow diaper pins to sit flatter on the stomach and bring the diaper around the legs more tightly.

If you’re using diaper pins, you can avoid accidentally poking the baby by keeping the fingers of one hand between the diaper pin and your baby’s body until the point of the pin is securely locked in the pin’s hood. Cloth diapers should fit snugly because they tend to loosen as your baby moves around. Tuck the edges of the cloth into plastic pants to keep wetness inside.

DIAPER RASH

All babies get a red or sore bottom from time to time, even with frequent diaper changes and careful cleaning. Diaper rash may be caused by many things, including irritation from stools or from a new product, such as disposable wipes, diapers or laundry detergent. Sensitive skin, a bacterial or yeast infection, and chafing or rubbing from tightfitting diapers or clothing also can cause a rash.

Diaper rash usually is easily treated and improves within a few days. The most important factor in treating diaper rash is to keep your baby’s skin as clean and dry as possible. Thoroughly wash the area with water during each diaper change. While your baby has a diaper rash, avoid washing the affected area with soaps and disposable, scented wipes. Alcohol and perfumes in these products can irritate your baby’s skin and aggravate or provoke the rash.

It’s also important to allow baby’s bottom to air-dry before putting on a new diaper. If possible:

 Let your child go without a diaper for short periods of time.

 Avoid using plastic pants or tightfitting diaper covers.

 Use larger sized diapers until the rash goes away.

In addition, use a soothing ointment such as Desitin, Balmex, or A+D any time pinkness appears in the diaper area. Many diaper-rash creams and ointments contain the active ingredient zinc oxide. These products typically are applied in a thin layer to the irritated region several times throughout the day to soothe and protect the baby’s skin. If the rash doesn’t improve within a few days, check with your baby’s care provider.

Don’t use talcum powder or cornstarch on a baby’s skin. An infant may inhale talcum powder, which can be very irritating to a baby’s lungs. Cornstarch can contribute to a bacterial infection.

To help prevent diaper rash, avoid using superabsorbent disposable diapers because they tend to be changed less frequently. If you’re using cloth diapers, be sure to wash and rinse them thoroughly. To improve circulation, select snap-on plastic pants, instead of those with elastic bindings. In addition, try using absorbent liners with cloth diapers.

Bathing Your infant doesn’t need much bathing. During the first week or two, until the stump of the umbilical cord falls off, give your newborn sponge baths. After that, a complete bath is necessary only one to three times a week for the first year. More frequent baths can dry out baby’s skin.

Once the umbilical area is healed, try placing your baby directly in the water. The first baths should be as gentle and brief as possible. If your infant resists baths, give sponge baths, cleaning the parts that really need attention, especially the hands, neck, head, face, behind the ears, under the arms and the diaper area. Sponge baths are a good alternative to a full bath for the first six weeks.

UMBILICAL CORD CARE

After your newborn’s umbilical cord is cut, all that remains is a small stump. In most cases, it will dry up and fall off one to three weeks after birth. Until then, keep the area as clean and dry as possible. It’s a good idea to give sponge baths rather than full baths until the cord falls off and the navel area heals.

Traditionally, parents have been instructed to swab the cord stump with rubbing alcohol. But some research indicates that leaving the stump alone may help the cord heal faster, so some hospitals now recommend against this practice. If you’re unsure about what to do, talk to your baby’s care provider.

Exposing the cord to air and allowing it to dry at its base will hasten its separation. To prevent irritation and keep the navel area dry, fold the baby’s diaper below the stump. In warm weather, dress a newborn in just a diaper and T-shirt to let air circulate and help the drying process.

It’s normal to see a bit of crusted discharge or dried blood until the cord falls off. But if your baby’s navel looks red or has a foul-smelling discharge, call your baby’s care provider. When the stump falls off, you may see a little blood, which is normal. But if the navel continues to bleed, have it examined by your baby’s care provider.

Bathing basics Find a time for bathing your baby that’s convenient for both of you. Many people give their baby a bath before bedtime, as a relaxing, sleep-promoting ritual. Others prefer a time when their baby is fully awake. You’ll enjoy this time more if you’re not in a hurry and not likely to be interrupted.

Most parents find it easiest to bathe a newborn in a bathinette, sink or plastic tub lined with a clean towel. Have all of your bathing supplies ready and try to have the room warm — about 75 F — before you undress your baby. In addition to the basin of water, you’ll need a washcloth, cotton balls, a towel, diaper-changing supplies and clothing to put on after the bath. Plain water baths are fine most of the time. If needed, you can use mild baby soap and shampoo that are free of fragrances and deodorants, which can irritate baby’s delicate skin.

Before filling the tub or basin, test the water temperature with your elbow or wrist. The water should feel warm, not hot. Fill the tub with a couple of inches of warm water. Undress your baby, removing the diaper last. If the diaper is dirty, clean your baby’s bottom before setting him or her in the bath. Use one hand to support your baby’s head and the other to guide him or her in, feet-first, then gently lower the rest of the body in. It’s important to support the head and torso, to provide safety and a sense of security.

It’s not necessary to shampoo your baby’s hair with every bath — once or twice a week is plenty. Massage the entire scalp gently. When you rinse soap or shampoo from the baby’s head, cup your hand across his or her forehead so that the suds run toward the sides, not the eyes. Or tip your baby’s head back a bit.

Use a soft cloth to wash your baby’s face and hair with clear water. Use a damp cotton ball to wipe each eye from the inside to the outside corner. Gently pat the face dry. Wash the rest of the body from the top down, including the inside folds of skin and the genital area. For a girl, gently spread the labia to clean. For a boy, lift the scrotum to clean underneath. If he’s uncircumcised, don’t try to retract the foreskin of the penis. Let your baby lean forward on your arm while you clean his or her back and bottom, separating the buttocks to clean the anal area.

Be careful handling your infant when he or she is slippery and wet. As soon as you’re done bathing, wrap the baby in a towel or a baby towel with a built-in hood and gently pat him or her dry.

Skin care Many parents expect their newborns’ skin to be flawless. More commonly, you’ll see some blotchiness, bruising from birth and skin blemishes that are unique to newborns, such as baby acne (milia). Most young infants have dry, peeling skin, especially on their hands and feet, for the first few weeks. Some blueness of the hands and feet is normal and may continue for a few weeks. Rashes also are common.

Most rashes and skin conditions are treated easily or clear up on their own. If your baby has pimples, place a soft, clean receiving blanket under his or her head and wash the face gently once a day with a mild baby soap. If the baby has dry or peeling skin, try using an over-the-counter, unscented lotion.

CRADLE CAP

Your baby may develop scaliness and redness on his or her scalp. This condition is called cradle cap (seborrheic dermatitis), which results when oil-producing sebaceous glands produce too much oil. Cradle cap is common in infants, usually beginning in the first weeks of life and clearing up over a period of weeks or months. It may be mild, with flaky, dry skin that looks like dandruff, or more severe, with thick, oily, yellowish scaling or crusty patches.

Shampooing with a mild baby shampoo can help with cradle cap. Don’t be afraid to wash your baby’s hair more frequently than before. This, along with soft brushing, will help remove the scales. If the scales don’t loosen easily, rub petroleum jelly or a few drops of mineral oil onto your baby’s scalp. Let it soak into the scales for a few minutes, and then brush and shampoo your baby’s hair. If you leave the oil in your baby’s hair, the scales may accumulate and worsen cradle cap.

If cradle cap persists or spreads to your baby’s face, neck or other parts of the body, especially in the creases at the elbow or behind the ears, contact your baby’s care provider, who may suggest a medicated shampoo or lotion.

Nail care Your baby’s nails are soft, but they’re sharp. A newborn can easily scratch his or her own face — or yours. To prevent your baby from accidentally scratching his or her face, you may need to trim the fingernails shortly after birth and then as often as a few times a week after that.

Sometimes you may be able to carefully peel off the ends with your fingers because baby nails are so soft. Don’t worry — you won’t rip the whole nail off. You can also use a baby nail clipper or a small scissors. Here are some tips to make nail trimming easier for you and your baby:

 Trim the nails after a bath. They’ll be softer, making them easier to cut.

 Wait until your baby is asleep.

 Have another person hold your baby while you trim his or her nails.

 Trim the nails straight across and keep them short.

Clothing When you’re buying clothes for your newborn, choose a 3-month size or larger so that the baby doesn’t immediately grow out of the clothes. In general, look for soft, comfortable clothing that’s washable. Select sleepwear that’s labeled flame resistant or flame retardant, which can be either a synthetic fiber or cotton treated with flame-retardant chemicals. Avoid buttons, which are easily swallowed, and ribbons or strings, which can cause choking. Don’t buy garments with drawstrings, which can catch on objects and strangle a child.

Because you’ll likely be changing your baby’s clothing several times a day, or at least changing diapers, make sure the outfits are uncomplicated and open easily. Look for garments that snap or zip down the front, have loosefitting sleeves, and are made of stretchy fabric.

During the first few weeks, babies are often wrapped in receiving blankets. This keeps them warm, and the slight pressure around the body seems to give most newborns a sense of security.

Dress for the weather New parents sometimes overdress their infants. A good rule of thumb is to dress your baby in the same number of layers that you would feel comfortable wearing. Unless it’s hot outside, you might put the baby in an undershirt and diaper, covered by pajamas or a dressing gown, and wrapped in a receiving blanket. In hot weather — over 75 F — a single layer of clothing is appropriate, but a cover is needed when the baby is in air conditioning or near drafts.

Remember that your baby’s skin will sunburn easily. If you’re going to be outside for any length of time, protect your baby’s skin with clothing and a cap. Keep the baby in the shade to avoid overexposure to the sun. You can use sunblock after your baby is six months old, but don’t rely on it as the baby’s only sun protection. Babies don’t sweat easily and can become overheated.

TWINS, TRIPLETS OR MORE

Every year, thousands of moms bring home more than one newborn — twins, triplets or even more. Life changes for any new parent, but for parents of multiples the changes are — multiplied!

Having more than one new baby at once can be exciting. It’s also extremely demanding. Sometimes just getting through the day can seem impossible. And multiples often are born early, which increases the risk of complications. This means you need to spend more of your time at doctor appointments than you would with a single baby.

What are some of the changes that you can expect with multiples? You’ll often be tired because you’ll be getting a lot less sleep, and your household standards will probably have to relax for a few years. If you have other children, the arrival of multiples can trigger more than the usual sibling rivalry. Multiple babies require an enormous amount of your time and energy, and they attract extra attention from friends, relatives and strangers on the street.

You may have some negative or difficult feelings from time to time. Having less time for each baby can make you feel guilty or sad, and those feelings may become even more pronounced if you already have another child or children. However, the joy and excitement your multiples bring will soon cancel out all of those negative moments.

Getting through the first weeks Here are some tips for dealing with the challenges of caring for multiples:

 Recruit help and accept all offers of help. Even though this may be difficult to do, it can make a big difference. Some families hire help, some rely on extended family, and some get help from friends, neighbors, their church or organizations for parents of multiples.

 Establish a list of priorities. The list generally focuses on babies’ needs, such as feeding, bathing, sleeping and cuddling. Rest and breaks for you also should be on the list.

 Recognize your babies as individuals from the beginning. Select different-colored clothing for your babies, which helps you identify each one at a glance. Avoid referring to the babies as “the twins” or “the triplets.” Use their names. Be sure to take pictures of each child separately.

 Use charts or checklists. This is helpful for documenting feedings and keeping track of who has been cared for and when.

 If you have older children, encourage them to be an active, helpful part of the experience. Ask them to help with the baby chores and tell them how special it will be to be a big sister or big brother. It’s also important to regularly set aside time to spend alone with your other children. Older children may also enjoy time alone with grandparents, aunts, uncles, or other family members or friends.

 Use disposable diapers or a diaper service unless you have extra household help. If you use disposable diapers, keep at least a dozen cloth diapers on hand for emergencies.

 Gather practical advice, information and support. Feeding, bathing and dressing multiples may require some special strategies. Consider attending a local support group for parents of twins or other multiples. You’ll likely get many invaluable ideas from other parents. Read books and magazines, visit websites and get involved in social media dedicated to advice on parenting multiples.

 Don’t neglect your relationship with your partner. Talk to each other about your feelings and problems. Try to give each other breaks when you can, and do what you can to have some time alone as a couple.