Kids' Wellness Matters Podcast Ep. 24: Is This Normal? Your Newborn Questions Answered

Lurie Children’s pediatricians Dr. Nina Alfieri and Dr. Rob Sanchez discuss important insights and advice for new parents navigating their first month with a newborn. From safe sleeping practices and feeding options, to understanding baby’s growth and development and bowel movements, the conversation aims to equip new parents with the knowledge needed to confidently care for their newborns.

“All different colors of poop can be normal. I had a pediatrician friend who tells families that if you look at the colors of the fall trees other than red, all of those are fair game. I had a chief resident who liked to teach the residents that, since we live in Chicago, anything but the Chicago Bulls colors are okay. So, you don't want poop to be white, black or red, and otherwise it's all good. I think those are great pieces of advice.” 

-Dr. Nina Alfieri  

Show Notes

• When preparing to bring your newborn home, the most important thing parents need to have is a safe place for the baby to sleep, such as a crib or bassinet.  

• It’s important to watch for behavioral changes in the pets when bringing home your newborn. Watch for any signs of discomfort or anxiety and be sure to give your pet its own space. 

• Parents can limit visiting hours for guests to avoid feeling overwhelmed and decrease risk of infection that could be brought into the home by visitors.  

• The first doctor visits are centered around the baby’s growth. It’s normal for newborns to lose 10% of their birth weight in the first few days and gain it back within two weeks. 

•  Tummy time is the basis of all the other motor movements that babies achieve later in life and is recommended to be started very early.  

• Exclusive breastfeeding is recommended for the first six months of life, however formula, which is modeled after breastmilk and is highly nutritious and also recommended.  

• Newborns will urinate and produce wet diapers as often as every one-to-three hours. It is normal for bowl movements to dramatically change within the first few days from a dark thick meconium to yellow seedy stool. 

• Safe sleep is one of the most important aspects parents need to consider for their newborns. Avoid the risks that lead to infant deaths by giving babies their own crib or bassinet, placing them on their back to sleep, and keeping soft toys and blankets out of the bed. 

• Newborns will sleep up to 17 hours a day, but only one-to-two hours at a time. In the first weeks of life, babies shouldn’t sleep more than four hours at a time to ensure hydrations and nutrition needs are met. 

Transcript  

[00:00:00] Nina Alfieri: Welcome to Kids' Wellness Matters. I am Dr. Nina Alfieri 

[00:00:07] Rob Sanchez: and I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann & Robert H. Lurie Children's Hospital of Chicago. 

[00:00:15] Nina Alfieri: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adults because kids' wellness matters. 

[00:00:31] Rob Sanchez: The first month of life, Nina. I just saw a newborn last week, my first time parents in clinic. So it's such a great visit and, as we know, it can be so blissful, but can also be really stressful. Especially for parents who are welcoming a baby home for the first time. 

[00:00:48] Nina Alfieri: Absolutely. I have this thing in clinic where every time I walk by a newborn being weighed, even if it's not my patient, I just like to stop and just, mesmerized because it's so exciting to look at a newborn. You think about the life it has ahead and what a beautiful change it is for the family. And of course the things that go along with it, it's exciting. 

[00:01:05] Rob Sanchez: Yeah. Which is why, today we really wanna go more into that, right? You know, just kind of talk about all the common questions that we get. All the things that come up during this newborn period, and just really focus on that first month of life. 

 [00:01:17] Nina Alfieri: I'm excited to do this episode because there is just so much to know about newborns, and oftentimes at that first visit, there's just so much to cover, so it's nice to have a space to unpack a little bit. Let's start with a few things to consider before coming home from the hospital. From the very beginning Rob, we're expecting a baby. What do you tell families about preparing their home for a new baby? 

[00:01:38] Rob Sanchez: Yeah, so I oftentimes will relate myself. I was definitely the big nester. Like I really wanted to get everything ready, and many people do. They wanna have a nursery ready to go, they wanna have the colors picked out or just how they wanna design it. And I remember feeling like, oh, I gotta get this all ready. But you know, truly at the day, in most cases, you really just need a safe crib or bassinet or even a pack and play that's next to the parent bed. That's really what's most important, especially during that first month of life, because that's where the baby's gonna sleep. And if you have that setup, you're already getting some of the most important things outta the way. Would you agree? 

[00:02:10] Nina Alfieri: That's so true. I feel like the baby market is inundated with all these things and gadgets you think you need, but you could change a diaper anywhere, like on a towel on your bed. You really just need a safe place for your baby to sleep in, something to feed it. So I totally agree with that. 

[00:02:24] Rob Sanchez: And when you think about the other parts of preparing the home? Yes, there's a few other things that you wanna maybe change up that'll be new when you have a new baby around. So kind of watching out for things like everyday products that might be in your home. So harsh chemicals might wanna push those out. So there could be different types of cleaners, insect sprays. Things that you would have done when there were just adults living in the house that you might want to get out of there . And then kind of sticking to gentle non-toxic products when possible. And that includes things like detergents or other common things around the home. Just remember there's no need to overdo it and having that expectation that this is gonna be a new born, this is gonna be a new baby and it's really gonna change a lot of stuff. As fun and exciting as it will be. it will be some challenging, sleepless you know time period during that. And so it's ok to have things get a little less spotless, a little less neat along the way. 

[00:03:12] Nina Alfieri: Totally. Yes. I feel like my motto, and it still is the same motto, is just like Frozen, "let it go, let it go". If you have dishes that pile up, the home isn't totally perfect. It's all good. People are coming to see you and the baby. The dishes can just be a part of your family. But I agree. 

[00:03:28] Rob Sanchez: Absolutely, I don't know if this is the same for you, Nina, but you know, when our first born came home, we had a dog and it was this big special moment when, we brought the baby home, to meet the dog for the first time. And, so that's another thing that families might wanna get prepared with. So how do you like to talk about pets? 

[00:03:43] Nina Alfieri: This is actually one of my favorite topics to talk about and one that I feel like I never have enough time to talk about in the office. We actually did an episode on this way back in the beginning. So if people are interested in a deep dive, check out the episode on introducing dogs and babies. That was actually recorded by a veterinary behaviorist, so it was really cool. But the high points from that are basically, you don't need to banish your pets. And most people would never want to but of course , you wanna make sure that there's a safe way to introduce the pet and the baby. So you know your animal the best. It can be helpful to watch for behavioral changes, so look for signs of discomfort or anxiety in your pet. Space is everything, so giving your dog or your cat space if they're showing signs of nervousness can be very helpful. In the episode we talked about protecting the pet's sleep space. That's a common trigger. Never letting the baby crawl onto the pet's sleep space. Using gates and physical barriers to keep babies and pets separate. There's also some cute ideas like introducing the baby scent first before it comes home. Like bringing a blanket or clothing item with the baby sent on it before the baby arrives. But using common sense can be really helpful here and just really being a great advocate for your baby but also for your pet. 

[00:04:54] Rob Sanchez: First of all, yeah, that was a great episode. And those are all really great tips, especially the cute stuff about how you wanna introduce. It's a really special moment and I think it's just a good reminder that if you do have questions, it's a good opportunity to talk about it with your pediatrician in those first visits about if you do have any concerns especially after you're kind of making the transition home too. 

[00:05:12] Nina Alfieri: Absolutely. Let's talk about visitors because this is something that's really fun. What do you advise families on visitors and how to regulate that and how to think about infection risk in the early newborn time. 

[00:05:23] Rob Sanchez: My children were both born in the wintertime and so there was always a particular concern for us as well . But it's also just about us and making sure that you and your partner are on the same plan in terms of who you want to visit when you visit. And also prioritizing time for y'all to connect with your newborn as well. And so I think there's a few things definitely to keep in mind. Sometimes you can use calendars to keep track of when visitors are coming. That helps to make sure that you're not too overwhelmed. I dunno about you. I always feel like I have to be a good host, right? But know that is ok. You can say "yes" to help or folks who want to be supportive but you don't have to feel like you're entertaining or hosting. So making sure that you're prioritizing your needs as a parent is so important. And that know that it's okay to limit visitors during different times, especially during that first month of life when babies immune systems are still developing Especially if there's anyone who might be under the weather, cousins who are like school age, and if they're gonna visit, making sure that you're having plenty of hand sanitizer, encouraging washing hands. All those things are things to help keep your baby safe, and make sure that they're not getting any unnecessary exposures while also making sure that you're taking care of yourself as well. 

[00:06:23] Nina Alfieri: These are great points. So definitely fevers in young babies up up to three months at least, and even beyond can be a big deal. And of course if they get sick, their lungs are a lot less strong than a bigger kid. So of course, you want your baby to meet everyone. But also just having some ground rules about making sure people are healthy, I think makes a lot of sense. 

[00:06:41] Rob Sanchez: And making sure folks are vaccinated are really key, right? So things like making sure that folks as parents, your TDAP vaccines are up to date is really key. And, I acknowledge that sometimes those conversations with other family members can be a little challenging. So I usually talk and relate to my families that if they need something, that you can say, oh, it was doctor's recommendations that we wait a certain amount of time until we have so many visitors and things like that. And to make sure again, that you're prioritizing time with your child and also, making sure that you're prioritizing their health and safety too. 

[00:07:08] Nina Alfieri: Let's talk about what to expect in the first days after you leave the hospital. So, lots of changes. It of course includes a lot of eating and sleeping and a lot of diapers, but there's a lot of other things to be prepared for with the first days alone with your newborn baby. Tell me a little bit about weight and growth milestones that you think about in the first few weeks to months of life. 

[00:07:28] Rob Sanchez: Yeah, absolutely. It's one of the biggest things that we look at on those first visits. How they're growing, what their growth curve is like, and a couple of things that always come up when I have conversations with parents, especially first time parents. During those first few days, weight loss is totally normal. Most newborns would lose somewhere around 10% of their birth weight. They hit that drop and then they start to climb back up there. And that's one of the reasons why we like to see them soon after so we can track that and make sure that they get back to their birth weight. For most babies, we give them about two weeks of life to get back to that birth weight and then they continue to grow from there. And I usually let folks know that sometimes that might come with cluster feeding, so during the first couple of days, babies might not eat quite so much. They tend to sleep a lot. But then sometime between those first three to five days of life, they kind of go into big growth spurt mode , where they're just showing hunger cues very frequently. You're probably waking up a lot during the nighttime, I know my children were and it's a lot. And I usually tell families that it doesn't last forever. They will go back to kind of a more every two to three hour process and then kind of go from there. But it's that growth spurt where they're coming back to their birth weight and going from there. And so, a lot of feeding, time but that's why it's always good to check with your pediatrician, making sure that the growth charts are being followed and showing that they're staying on that curve that we like to see them. 

[00:08:45] Nina Alfieri: I think that's such a great point. One of the biggest things I learned in pediatric residency is that the growth curve is a big collection of data from a ton of babies, and someone is gonna be on the third percentile, someone's gonna be on a hundred percentile. And so what we look for as pediatricians is that babies track in a consistent way on whatever line they're on. So it's okay to move around a little bit, and I try not to knee jerk reflex too much. Obviously the growth curve is important, but unless a baby is crossing percentiles or is actually losing weight or not gaining at all, if they're following their own growth trajectory, but they're on a lower percentile, that's probably where that baby belongs. And parents can feel really great about how their baby is growing. 

[00:09:27] Rob Sanchez: As you mentioned, it's not just that we're tracking their weight, but we're also tracking their length and their head circumference or their head size. But along with all of the feeding changes and growth that they're doing, their bodies are changing and their movement is changing, especially during those first several weeks. So what are those things that you like to share and talk about with families, especially with infants and their development during those first months of life? 

[00:09:48] Nina Alfieri: Motor development in babies is so important. Movement is actually the basis for all other development and babies. So they need to be able to hold their head up in order to look around and see things. They eventually crawl to approach objects so they can explore and touch things. They need to bring their hands to their mouths. So starting on tummy time very early is the core and the basis of all the other motor movements that babies achieve later in life. So I recommend tummy time right away. Tummy time can look a million different ways, but it can start very simply with just putting the baby on your chest. And babies who do more tummy time, achieve their milestones earlier and are able to learn how to lift up their head, roll, crawl, walk, all of those things. Tummy time also doesn't have to be fancy. It could just be on the floor. it can be if you're laying down, on the floor, it can be on your chest. So there's a million different ways to do it on a bouncy ball. There's a lot of really good examples actually from pathways.org, they have a website and an app that has videos on how to have fun and connect with your baby through tummy time. And the CDC milestones are also great too. For movement, babies when they're born, they're very flexed. They're kind of rolled in a ball. They're so cute. Their fist and their toes are kind of curled over and their arms are kind of to their chest. And when they grow up a little bit, they start to stretch out, and extend a little bit more. So you might see a little bit of arching of the back, which can be normal. But can also be a sign of reflux that parents can be concerned about too. and then in older babies, you can get a little bit of bow legging appearance and that can be common. And it usually self-corrects by, one or the toddler ages. But I would talk to your pediatrician if you're noticing that there's bow legging only on one leg or if it looks really severe, in your baby, because there's things we can do to help with that. 

[00:11:28] Rob Sanchez: I love it and I love tummy time. I remember with my boys, doing it, I felt like I was their coach or like their personal trainer, like trying to really encourage 'em to keep it up. My favorite thing to do was like, as I was warming up a bottle, for them I would use it as the perfect time to put 'em on their tummies. because they would last a little bit and then they'd start crying because they usually only last about a minute or so. And so, after they were done getting their workout in they'd get a little reward of having a nice feed. 

[00:11:52] Nina Alfieri: That's so cute. 

[00:11:53] Rob Sanchez: Yeah. And it usually meant that they were getting a few feeds during the daytime when I was caring for 'em. So it meant that, yeah, they were getting a few workouts in a day, like two a days, three a days. I thought that was always really helpful just to kind of think of it that way as like, yeah, this is a really helpful time for the development and also really good bonding. Because oftentimes if it was on my chest or if it was on the floor I was oftentimes getting down with them too. You know, trying to get down at their eye level and having a lot of fun with them. 

[00:12:16] Nina Alfieri: That's so fun. I'll give one more tip. It can be hard when you're worried about your baby's development. But from an optimistic perspective, what's so cool about babies is that their brains have something called neuroplasticity, which means that they have a special ability to learn things in such a rapid way that adults don't. So if you notice that your baby maybe isn't meeting milestones or is having trouble with moving, and not interacting with the world the way that you expected to with therapies, your baby can learn so much early on and you can prevent your baby from learning patterns that are atypical. So it's really important to keep an eye on development and to practice tummy time and to reach out to your pediatrician and get into therapies early if you're worried about your babies. So let's move on a little bit too, some appearance changes that parents might notice about their baby. Tell me a little bit about some physical exam findings that we see in normal babies. 

[00:13:10] Rob Sanchez: So there's a few things. One oftentimes is, the head shape. A lot of times the head shape can be affected by the birthing process , right? So if it happens to be a vaginal birth, or for example, requires any type of vacuum assisted device that could adjust the shape of the head. So they might have a small amount of, kind of misshape in it. or sometimes, they can have something called overlying sutures which is where the kind of soft spot on the head isn't quite as noticeable. And that's just because some of those, parts of the skull, are kind of overriding each other until the baby's head gets too nice to open up and continue to grow. So those are some common changes that you might see in those newborn babies. A couple other smaller things that can happen is that there might be some swelling around the area. Sometimes there's something called a cephalohematoma that can occur on babies' heads . You know, your pediatrician will point it out to you. And sometimes some babies can have very tiny red spots in the whites of their eyes. That can sometimes happen during that delivery process. So all really common things that happen, that you might notice during that first visit that you have with your pediatrician, that will improve with time. There's a lot of skin and hair changes that happen too. And I know this happened with some of my boys, their hair will fall out, sometime in the first few weeks oftentimes. So depending on how much hair they have, it might not be all that noticeable from my boys. It was very noticeable, and so they lost almost all the hair on the top of their head, and then right around that same time around a month of life they're gonna get baby acne. And that just looks like it is, and they'll just have these tiny little white acne looking spots that can present on the face, actually sometimes on the body and other parts of the arms and legs, that you'll notice and that will typically go away by around two months of life. But, maybe not the most appealing look for them at around a month of life because they might be losing some hair, they might be having some acne. Know that all those things are normal. They will resolve over time and they typically don't need anything else big at that time as well. And then, a common thing that often happens too is, skin changes. So, as babies adjust from the nice, very moist area in the womb, to the dry air outside of it. They'll often have skin peeling. They might have some other skin changes, in terms of some changes to the colors of their hands. All those things. Again, resolve with time, can be reassuring. But if you ever have questions about it, feel free to talk about it with your pediatrician. It's something that I'm always happy to talk with my parents about and things to know. So, but Nina you know, I'm sure you probably experienced this yourself as a parent, but also get a lot of those questions too from your families that you see in the clinic. 

[00:15:27] Nina Alfieri: absolutely. I feel like the skin changes, the rashes, all of these are so common. It's almost a rite of passage around a month of life to have all this happening at the same time. So really common. 

[00:15:38] Rob Sanchez: Another big thing that happens around that time or a little sooner is we talk about the umbilical cord right, so the umbilical stump. Does that come up for your families a lot and what are things. You like to talk to them about? 

[00:15:48] Nina Alfieri: All the time. So the umbilical stump falls off between a few days of life and around three weeks of life. Usually it's on the earlier side. If it's not fallen off by around two weeks or so, definitely let your pediatrician know. When it falls off I tell parents, don't be alarmed. You'll see a couple, spots of blood and sometimes you can see a little bit of white gooey stuff in there, but there should not be lots of bleeding or copious white stuff that comes out. That could be a sign of obviously bleeding or infection. The other thing to look out for is if there's redness that's around the belly button that's spreading that sign of infection of the umbilical stump that's kind of spreading to the skin. I usually advise parents to keep an eye on it and try to fold the diaper underneath it. Let it do its thing by falling off. After it falls off, it takes a few days, but then it does dry up completely usually. and we recommend keeping that area just clean and dry. Don't submerge the baby underwater for their first bath until the stump has fallen off, completely dried up. A lot of times in the past, parents were told to use alcohol to help it dry up faster or to like tape a coin on it. We don't recommend doing any of that. We just recommend leaving it alone. In rarer cases, sometimes it doesn't completely dry up and there's treatments we can do in the office, to help that stump dry up. 

 [00:16:59] Rob Sanchez: We've talked a lot about everything from growth and appearance changes, but we know some of the biggest things that come up are about feeding, right? So whether you're a chest or breastfeeding or using formula, feeding the baby is a 24/7 job. And you and I, we know this in our own families but also in counseling and talking with families about this for sure. Nina, I know this is a big passion for you. What are some of the things that you really like to talk about especially, in the realm of breastfeeding and providing nutritional support for the babies? 

[00:17:26] Nina Alfieri: Feeding is totally a full-time job, and I remember being struck with both of my babies about how sleepy they were right after delivery. And then of course when we came home it was like they were partying at night up every hour. They were so hungry. So it is a very normal pattern for babies to be pretty sleepy the first day or two. They should, of course, be feeding, but the baby's nutritional needs become really high after the first few days at home. And they're higher in the newborn period than at any other time in their life. And of course, feeding, like you said, isn't just about the food, it's about cuddling, eye contact, bonding. There's a lot of things all wrapped up into feeding that are. Breast milk. is agreed on by multiple sources as the ideal food for infants. Exclusive breastfeeding is recommended for the first six months of life, followed by offering solids and other forms of nutrition when babies are older. Formula is wonderful too and it's modeled after breast milk. We always, as pediatricians, wanna support what's best for the family. So I usually ask what parents' plans are. With proper support most parents can successfully breastfeed, but it's really hard. I think that it's really important that parents are given a lot of information and support around breastfeeding. It's a very dynamic process, as you know, it takes time for the milk supply to be established and then there's maternal and baby conditions that can affect breastfeeding. So it is actually very complicated. And as I've become a parent and a pediatrician I've grown just such a respect for how complex it's and how challenging it is. But definitely reach out for help. It can be a really meaningful and beautiful relationship, but it isn't easy. Definitely recommend people have a lactation consultant or a pediatrician. and then, reach out for support as needed.So when breastfeeding isn't possible or when a family doesn't wish to breastfeed, infant formulas are safe, nutritious, amazing alternatives and all basic infant formulas are great. Can you talk a little bit about formulas? 

[00:19:12] Rob Sanchez: Yeah, I have those same conversations with my family about what works for them, whether it's breast milk or formula. It's really important that babies don't have any solids or water at all until four to six months. And really, formula or breast milk is going to be the primary nutritional source for babies. With Formula it is always important to make sure that you're mixing it properly. Almost all of them will come with directions on the cans that they come in. Make sure that you follow that and if you have any questions be sure to ask your pediatrician. Really important resources that can be available are programs such as WIC or other types of things that you might have at your pediatrician's office. Like we have a small amount of food pantry and other resources that we can offer to families. And so that's really key. If that is a challenging thing to find, reaching out for help is really helpful. I wanna acknowledge though Nina that you're right in terms of the breastfeeding process, it's really hard. And being a dad myself and a non breastfeeding parent, you kind of wanna figure out exactly how you can support during this really important process. I wanted to promote the paternal health episode that we did earlier featuring Dr. JJ Parker, one of our colleagues in our division. Who talked a lot about some of the things that could be helpful and that could be supporting the breastfeeding parent. Making sure that they're staying hydrated, finding other ways to be helpful during that, but also looking for opportunities to feed the baby themselves. And as you mentioned It's an important bonding experience too, because that's how you can pick up on hunger cues. So when the baby is rooting or smacking their lips, or sucking, things that they do before they cry. Those are things or that you can also pick up on and make sure that you have that so that you know we can provide those support for babies before they get overly hungry. Really helping make things easier for both of y'all as you're going through this process. And again, leaning on those resources from pediatricians, lactation consultants, or other folks who can provide support and guidance for you too. Nina, do you have some good breastfeeding tips? If you like, talk with parents who are breastfeeding their children early on. 

[00:21:01] Nina Alfieri: If I had to pick my top breastfeeding tips, it would be to put the baby to breast early, and then be patient. It takes a while for supply to develop, and in the beginning, just a few drops of colostrum, which is that really thick almost honey looking breast milk is all babies need. So babies don't need like ounces and ounces of formula in the beginning. So if you're putting the baby to the breast, and they're sucking, latching, and they're making wet and dirty diapers, you can be confident that your supply is coming in. And that's why we check the baby's weight so often in the first couple days because we really can be patient as long as the baby's not losing weight too fast and they're making wet and dirty diapers. We recommend parents breastfeed around 8 To, 12 times a day. Especially in the beginning. And that can either be, pumping or, direct feeding and that breast stimulation can really help encourage and build the supply that's gonna come in the next few days. A couple other tips. I've come to appreciate how important latch is and how latch issues underlie almost all breastfeeding problems. So, if a parent is having nipple pain or supply concerns, the first thing I do is, ask if I could do a latch evaluation, or recommend that they see a lactation consultant. And then the last thing is that there's so many different ways to feed a baby. Some families wanna do a mix between a bunch of different modalities, which is direct breastfeeding or pumping and feeding or formula. So I think really just trying to figure out what works best for families and then providing resources for making it work for families is the way to go. And then last tip that all breastfed babies need vitamin D because it's the only thing that breast milk doesn't have. So those would be my top tips. 

[00:22:34] Rob Sanchez: Great tips overall totally. All really great things to keep in mind. 

[00:22:38] Nina Alfieri: Okay, Rob, I can't wait. Let's talk about poop and pee. Tell me yeah, normal urination and newborns. 

[00:22:45] Rob Sanchez: Yeah. I'll take the pee. Maybe you can take the poop. We'll talk a little bit about it. sounds great. We can flush it out together. So good. So with urination and newborns , they're gonna pee a lot. Frequency, every one to three hours can be common. Sometimes up to four to six hours. That can still be normal. and there's obviously different things that can affect it as well. Babies might have a little bit less output, if it's really hot out, you know, if they're a little bit older it might be during an illness. It's natural for sometimes that pee frequency to be a little bit less. But there's a few things that aren't normal. Pain with urination is really not normal. So please talk to your pediatrician if they seem really distressed as they're peeing, that would be something to talk with them about because that wouldn't be expected during that time. A lot of folks might wonder about the color and different things that can come out. Urine is typically gonna be light to dark yellow, sometimes darker urine can be. A little bit more concentrated which means they may not be getting quite as much fluid. There's a couple things that can commonly happen during this first month of life, that we sometimes get questions about in the clinic. So little pink or red stains in the diaper, during the first week especially, is often due to just concentrated urine and is often not blood, but it is something that can happen. Always, if you have questions. You can talk about it with your pediatrician, but it is a common occurrence that we can see as well. With young, infant girls, they might have a small amount, slight vaginal bleeding in that first week. It's often due to the maternal hormones that they still have during the pregnancy process, and that this is entirely normal but after the first week any kind of blood in combination with poor feeding or especially with fever, please contact your pediatrician those could be things that we wanna talk about. About especially as you are spending all that time kind of looking at the diapers and checking that and changing all those diapers too. Alright that's all I have about pee let's talk about poop Nina. 

[00:24:23] Nina Alfieri: Awesome. So, meconium is the first type of poop that babies have, and it's like thick tarry looking. It's very dark and normal for the first couple of poops. We usually expect babies to stool within the first, 24 hours of life. And then as babies start to feed the stool color and consistency really starts to change and it really transitions into this yellow, seedy stool. And I just can't go to the grocery store and look at that like seedy yellow mustard anymore because it reminds me exactly of dirty diapers. 

[00:24:52] Rob Sanchez: Yep. Yep. 

[00:24:53] Nina Alfieri: But you know, all different colors of poop can be normal. I had a pediatrician friend who tells families that if you look at the colors of the fall trees other than red, all of those are fair game. Um, I 

[00:25:05] Rob Sanchez: Yeah. had a chief 

[00:25:05] Nina Alfieri: resident who liked to teach the residents that, since we live in Chicago, anything but the Chicago Bulls colors are okay. So you don't want it to be white, black or red, and otherwise it's all good. I think those are great pieces of advice. We often see green poop, and that's not concerning. Hard or dry stool isn't very common in babies, but if you're seeing that, it might indicate that your baby isn't getting enough fluid or the formula might not be mixed correctly. So, make sure that you're checking on that. And then of course, you know, the red flags look for if there's tons of mucus or water or blood in the stool, or if it seems like the baby in pain definitely call your pediatrician. Trust your instincts. If you think your baby looks sick, definitely check with your pediatrician. Rob, tell me about poop frequency. I feel like this is a common question we get. 

[00:25:47] Rob Sanchez: Yeah, super common for it to change. These patterns for babies can vary widely. A couple of general principles. Breast fed babies tend to vary a little bit more on how frequently they . poop. Some breastfed babies will go multiple days without pooping and can be totally normal. Formula babies will typically poop at least once a day. and then less than that, they might have some straining with it. And that could be a little bit of sign of constipation which you can talk with your doctor about, but it can be a little common thing that happens. But the big thing to know is that the pooping patterns are gonna vary widely and that you'll just kind of get a sense of how your baby poops. And if you have questions, you can talk about it with your doctor. So we've talked about so many different things, getting them home from the hospital, feeding them, taking care of them, all those kinds of things. But we also, most importantly, wanna keep them safe. What are some of the big things that we like to talk about with our families, especially during the first month of life about safety? 

[00:26:39] Nina Alfieri: Absolutely. I think the number one, two, and three safety things are safe sleep for babies. You know, it's really hard because of the levels of exhaustion and because I think biologically we're wired to be connected to our babies at all times, and so it feels so odd to put them to sleep away from you. But there is mountains of research about the dangers of co-sleeping and how it can lead to infant death. So safe sleep is one of the most important things that you can do to keep your baby safe. And to make it really simple, I usually recommend families follow the abc's So. A) Babies should be alone, sleeping by themselves. B) they should sleep on their back. And C) they should sleep in a crib or a bassinet, so alone, on their back, in a Crib. So we recommend no soft things in the bed, like blankets. The receiving blankets actually can be dangerous to sleep with because babies can run swaddle overnight. So we recommend just being sure that you're following safe sleep recommendations from the very start to decrease the risk of infant death from sleep. Other than that, making sure your baby has a car seat that's rear facing, and that it's properly clipped is really important. The most common issues I see with car seats are the clip being too low. It should be at the nipple or the armpit line on the baby, and it should be pretty snug on the baby. So only one or two fingers should be able to fit underneath the clip. There's a ton of info on car seat safety for families who are interested. And then a couple other things to think about for safety. For infant choking, actually, one of the common reasons we see is that older siblings who are just trying to play and be loving with their siblings can sometimes put toys and little things in baby's mouth, which is a choking risk. So make sure that you're keeping an eye on your baby. Unfortunately, we do see shaken baby syndrome. This is obviously a really serious topic with no levity here, it's never the intention, but colic and very severe crying in babies can be an extreme stressor for caregivers. So if you're a parent of a baby who cries a ton, or if being a parent is more than just a little stressful , like if it's impacting your ability to care for your baby, reach out for help. We totally understand that this is something that happens and there's resources like the Fussy Baby Network. Asking for family and friends to help give you some respite and talking with your pediatrician. And then lastly, when older babies start to move, that's a really common time where we hear a lot with our parent pager that a baby has fallen off a bed or a surface. This is really common. It can actually happen even as early as two or three months when babies can't fully roll, but they can start to twist. So I always recommend parents from birth get in the habit of placing the baby on a floor or in a crib when they're stepping away, just even for a second. So those are my top safety tips for babies. 

[00:29:13] Rob Sanchez: Really important stuff and great tips to keep in mind, especially during those first few weeks of life. As you're getting used to setting up your home and keeping your child and your family safe. 

[00:29:22] Nina Alfieri: Awesome, Rob, we've saved the holy grail topic for last. Tell me about one of the most precious parts of life, sleep. Tell me about normal infant sleep and what do you recommend for sleeping? 

[00:29:33] Rob Sanchez: The reality is, especially during that first month of life and probably beyond, parents are not gonna get a lot of it. And it's important to acknowledge that, and I talk about it with parents in clinic visits too. And it does get better. So let's talk about what some of the typical things that newborn sleep patterns will go through. So newborns do sleep a lot. It's important to remember that up to 16 To 17 hours a day , but it's broken into short stretches of time, typically. So especially during those first couple of weeks, it might only be about one to two hours at a time and then gradually might increase over time. Their sleep cycles are not yet regular, so they might sleep in very unpredictable patterns. In general, especially during those first few weeks of life we don't want babies to sleep too long. Four hours is probably the maximum amount. We wanna make sure that they're waking up to feed, make sure that they're getting that hydration and nutrition that they need as well. And that, when they sleep, we're following those safe sleep guidelines that you talked about. So on a firm flat surface, like a crib or bassinet, and keeping that crib free of any loose blankets, pillows, or toys, those are all things that are really important for them as well. For some babies, pacifiers could be really helpful, especially during nap time and bedtime. It's been shown to sometimes reduce the risk of SIDS or sudden infant death syndrome. And even if it falls out during sleep, it can be helpful for that as well. Oftentimes folks will have questions about breastfeeding and bottle feeding and how that works with pacifier use. With pacifiers if you're breastfeeding it's recommended probably to wait a little bit until you feel like nursing is going well, baby's gaining weight you have good latch. With bottle feeding. Totally okay to start a pacifier whenever you like. And some babies are just not into pacifiers. That's totally okay. My firstborn loved his passie, the second one just wasn't into it. And there's no need to force it. You can try and offer, see if it's something that offers them, that soothing, that comfort, and helps with that sleeping process. But other babies you know, again, everyone's unique and so for some it might just not be their thing. It's important to remember though, with pacifiers not to attach to the baby's neck or clothes during sleep, just because it's not as safe. So you can just keep that free flowing, and go from there. But sleep can fluctuate a lot, especially with feeding and everything like that. How do you kind of put those things together when you talk to families? 

[00:31:37] Nina Alfieri: I usually recommend thinking about the baby's day in little cycles. So babies kind of eat, sleep and play, and that's all that they have time for. So, usually the baby will wake up, get a diaper change, and do some tummy time. And then they'll tire out and sleep and then feed again. And so I usually think of their life in these little cycles. It tends to arrange itself more into a structured nap schedule as babies get a little bit older, but at least for the newborn time, it's rinse and repeat for all of those things. 

[00:32:05] Rob Sanchez: Yeah and for us, we're always just gonna tell them It does get better and we'll support you through it. Really important to kind of have that expectation. Know about that, especially as you're coming into it. 

[00:32:14] Nina Alfieri: Yeah, absolutely. So we've covered a lot today. We covered feeding and diapering and sleep and everything in between. And we hope that it gives families some guidance for that first month with the newborn. It can be really hard though. So lean on family and friends and your pediatrician and remember to have fun. Sing, read books, take lots of pictures. It goes by so fast. 

[00:32:35] Rob Sanchez: And remember, you know, there's no such thing as a perfect parent. You are learning, your baby is learning, and together you're gonna figure out what works best for you and your family. So trust your instincts. You know, I'm reminded I recently heard on NPR they had this feature called My Unsung Hero and it talked about a dad who was so nervous and got this advice, I think in the delivery room from one of the docs who I think sensed just how anxious he was being a dad for the first time. And they said, this line that really stuck with me, it said, just make sure they're fed, clean, warm, and loved, and the rest will take care of itself. 

[00:33:06] Nina Alfieri: That's so beautiful. And I think that quote also applies to parents too. It's a time where you're taking care of a baby, but also you gotta take care of yourself too. It's really hard to be a newborn parent, so make sure that you're loved and fed and clothed and take a break and sleep when you need to. And yes, we just wish all the best for our families out there and it's been fun recording this episode. with you today. 

[00:33:27] Rob Sanchez: Thanks for listening to Kids Wellness Matters. 

[00:33:32] Nina Alfieri: For more information on this episode and all things kids wellness, please visit luriechildrens.org.