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Joy and anxiety – at the same time!

A newborn is adjusting to a world that is very different from the warmth and security he knew in his mother's womb. Parents need time to adjust, too.

Contents:

• Head-to-Toe look at Your Baby/ First Year Development – Month By Month
• Common Problems for Babies – Jaundice/ Spitting up/ Rashes/Diaper Rash/ Dehydration/ Diarrhea
• SIDs

Your Newborn - A Head-to-Toes Look
at Your Astonishing New Arrival

The SKULL has two soft spots, or fontanels. One is on the forehead, above the brow line. The other, where you may be able to see or feel your baby's pulse, is close to the crown of the head. These soft spots will grow smaller as your baby's skull bones grow together.

The HEAD, which takes up about a quarter of the baby's length, may seem very large. Most babies' heads are lopsided or elongated because the soft bones were compressed during birth. In a few days the head will start to become more rounded. A bald head, a full crop of hair, or anything in between is normal.

The HANDS are usually held in tight fists. When opened, they reveal finely lined palms, tissue-paper-thin nails, dry, loose-fitting skin, and deep creases.

The SKIN is often covered with vernix, the cheesy, white coating that protected it in the uterus. Until babies start breathing well, they often look purple-tinged. Veins may be visible through the skin, which is thin and dry. Peeling, particularly on the hands and feet, is normal.

The EYES may appear swollen and bloodshot due to the pressures exerted on them during birth. A baby's true eye color won't become apparent for as many as six months; in many cases, the color at birth is lighter.

The FACE could startle you. The nose may be flattened and the chin asymmetrical or pushed in from being squeezed through the pelvis. Often the skin of the brow is loose and wrinkled, giving the baby a "worried old man" look.

The GENITALSof both sexes usually appear large and swollen. Girls may have a vaginal discharge, which can be bloody. It will clear up in a couple of days.

The LEGS are often drawn up against the abdomen in the fetal position. When extended, the may appear short and bowed.

The FEET have only one bone (at the heel). The rest is cartilage, which will form future bones. It's common for the feet to be turned in.

The BODY may surprise you with its short neck, small sloping shoulders, large rounded abdomen, umbilical stump, and narrow hips. Fine hair called lanugo may cover the forehead, temples, shoulders, and back but will disappear sometime in the first few weeks. When a newborn cries hard, a deep flush spreads over the body, and veins on the head may swell and throb.

First Year Development: Infant Development

Perhaps your six month old has not rolled over yet, but the child development chart shows that some babies start rolling over at five months. Or possibly your neighbor's eleven month old is walking, but your thirteen month old has not attempted to walk. Maybe you are worried that your baby's development is not where it should be and wonder what this means for his or her future. Comparing your baby's development to other infants or to norms on developmental charts should be avoided. Instead it is important to know that babies develop at different rates and should only be compared to their individual milestones from the previous week or month.

Your Baby's Development Month by Month:

The following milestones are listed under the FIRST month in which they may be achieved. However, remember that babies develop at different rates, so if your baby has not reached one or more of these milestones, it does not mean that something is wrong. He or she will probably develop these skills within the next few months. If you are still concerned, consider discussing this with your baby's pediatrician. The delay could indicate a problem, but more than likely it will turn out to be normal for your baby. Premature babies generally reach milestones later than others of the same birth age, often achieving them closer to the adjusted age and sometimes later.

The First Month:

• Can lift head momentarily
• Turns head from side to side when lying on back
• Hands stay clenched
• Strong grasp reflex present
• Looks and follows object moving in front of them in range of 45 degrees
• Sees black and white patterns
• Quiets when a voice is heard
• Cries to express displeasure
• Makes throaty sounds
• Looks intently at parents when they talk to him/her

The Second Month:

• Lifts head almost 45 degrees when lying on stomach
• Head bobs forward when held in sitting position
• Grasp reflex decreases
• Follows dangling objects with eyes
• Visually searches for sounds
• Makes noises other than crying
• Cries become distinctive (wet, hungry, etc.)
• Vocalizes to familiar voices
• Social smile demonstrated in response to various stimuli

The Third Month:

• Begins to bear partial weight on both legs when held in a standing position
• Able to hold head up when sitting but still bobs forward
• When lying on stomach can raise head and shoulders between 45 and 90 degrees
• Bears weight on forearms
• Grasp reflex absent
• Holds objects but does not reach for them
• Clutches own hands and pulls at blankets and clothes
• Follows objects 180 degrees
• Locates sound by turning head and looking in the same direction
• Squeals, coos, babbles, and chuckles
• "Talks" when spoken to
• Recognizes faces, voices, and objects
• Smiles when he/she sees familiar people, and engages in play with them
• Shows awareness to strange situations

The Fourth Month:

• Drooling begins
• Good head control
• Sits with support
• Bears some weight on legs when held upright
• Raises head and chest off surface to a 90 degree angle
• Rolls from back to side
• Explores and plays with hands
• Tries to reach for objects but overshoots
• Grasps objects with both hands
• Eye-hand coordination begins
• Makes consonant sounds
• Laughs
• Enjoys being rocked, bounced or swung

The Fifth Month:

• Signs of teething begin
• Holds head up when sitting
• Rolls from stomach to back
• When lying on back puts feet to mouth
• Voluntarily grasps and holds objects
• Plays with toes
• Takes objects directly to mouth
• Watches objects that are dropped
• Says "ah-goo" or similar vowel-consonant combinations
• Smiles at mirror image
• Gets upset if you take a toy away
• Can tell family and strangers apart
• Begins to discover parts of his/her body

The Sixth Month:

• Chewing and biting occur
• When on back can lift chest and part of stomach off the surface bearing weight on hands
• Lifts head when pulled to a sitting position
• Rolls from back to stomach
• Bears majority of weight when being held in a standing position
• Grasps and controls small objects
• Holds bottle
• Grabs feet and pulls to mouth
• Adjusts body to see an object
• Turns head from side to side and then looks up or down
• Prefers more complex visual stimuli
• Says one syllable sounds like "ma", "mu", "da", and "di"
• Recognizes parents

The Seventh Month:

• Sits without support, may lean forward on both hands
• Bears full weight on feet
• Bounces when held in standing position
• Bears weight on one hand when lying on stomach
• Transfers objects from one hand to another
• Bangs objects on surfaces
• Able to fixate on small objects
• Responds to name
• Awareness of depth and space begin
• Has taste preferences
• "Talks" when others are talking

The Eighth Month:

• Sits well without support
• Bears weight on legs and may stand holding on to furniture
• Adjusts posture to reach an object
• Picks up objects using index, fourth, and fifth finger against thumb
• Able to release objects
• Pulls string to obtain object
• Reaches for toys that are out of reach
• Listens selectively to familiar words
• Begins combining syllables like "mama" and "dada" but does not attach a meaning
• Understands the word no (but does not always obey it!)
• Dislikes diaper change and being dressed

The Ninth Month:

• Begins crawling
• Pulls up to standing position from sitting
• Sits for a prolonged time (10minutes)
• May develop a preference for use of one hand
• Uses thumb and index finger to pick up objects
• Responds to simple verbal commands
• Comprehends "no no"
• Increased interest in pleasing parents
• Puts arms in front of face to avoid having it washed

The Tenth Month:

• Goes from stomach to sitting position
• Sits by falling down
• Recovers balance easily while sitting
• Lifts one foot to take a step while standing
• Comprehends "bye-bye"
• Says "dada" or "mama" with meaning
• Says one other word beside "mama" and "dada" (hi, bye, no, go)
• Waves bye
• Object permanence begins to develop
• Repeats actions that attract attention
• Plays interactive games such a "pat-a-cake"
• Enjoys being read to and follows pictures in books

The Eleventh Month:

• Walks holding on to furniture or other objects
• Places one object after another into a container
• Reaches back to pick up an object when sitting
• Explores objects more thoroughly
• Able to manipulate objects out of tight fitting spaces
• Rolls a ball when asked
• Becomes excited when a task is mastered
• Acts frustrated when restricted
• Shakes head for "no"

The Twelfth Month:

• Walks with one hand held
• May stand alone and attempt first steps alone
• Sits down from standing position without help
• Attempts to build two block tower but may fail
• Turns pages in a book
• Follows rapidly moving objects
• Says three or more words other than "mama" or "dada"
• Comprehends the meaning of several words
• Repeats the same words over & over again
• Imitates sounds, such as the sounds dogs and cats make
• Recognizes objects by name
• Understands simple verbal commands
• Shows affection
• Shows independence in familiar surrounding
• Clings to parents in strange situation
• Searches for object where it was last seen

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Common Problems for Babies

Jaundice

Jaundice, identified by yellowish skin and whites of the eyes, occurs in half of all newborns, typically around day two or three. It's caused when bilirubin, a yellow pigment in bile — the fluid produced in the liver — builds up in the baby's bloodstream. Normally, the liver filters bile from the blood and sends it to the gallbladder, where it's released into the intestines or absorbed into the bloodstream and disposed of. But, just as with nearly every other organ of a days-old baby, the liver is immature and not fully developed. Often, the bilirubin builds up and gets stored in the layer of fat just underneath the skin, which causes the yellowish, or darkish, cast. Another form of jaundice, found in about two out of every 100 breast-fed babies, is caused by a component in breast milk that interferes with the absorption of bilirubin. Also, breastfed babies may be jaundiced if they're not getting enough milk. In rare instances, jaundice occurs because the mother and baby's blood types are incompatible, or because there is some infection, or a blood or liver disease. Generally, though, jaundice goes away without any special treatment. Your health care provider may tell you to lay the naked baby in a patch of sunlight for a few minutes a day, or, if it's more serious, order a course of phototherapy, in which the infant lies under a blue or white fluorescent lamp that radiates ultraviolet light. The light changes the bilirubin so it moves into the bloodstream, where it can be excreted. You don't want the bilirubin to build up; in high levels it can cause brain damage. Another suggestion is to try feeding your baby more often. Whether you're breast- or bottle-feeding, the more you feed the baby, the more bowel movements he will have, which helps clear out the bilirubin.

If you think your baby might have jaundice, check his or her skin in natural daylight for any signs of yellowing or darkening. As mentioned here, it shouldn't be a big deal if your baby is a newborn. Jaundice in an older baby, however, could be a sign of something serious. Call your care provider if this occurs.

Spitting Up

It often seems that as soon as you've finished feeding your baby, everything you worked so hard to get down comes right back up — all over your shirt. Spitting up is as endemic to newborns as the soft spot on the top of their heads. Also called reflux or regurgitation, these "wet burps" usually occur shortly after feedings.

Babies spit up because, in about half of all infants, the valve at the upper end of the stomach (the esophageal sphincter) hasn't closed properly. This should change by the end of the first year. Until then:

• Try smaller feedings - try nursing on one side and pumping the other. Wait at least two hours between feedings to give the baby's stomach time to empty. Also, don't feed a crying baby. The air gulped in crying may lead to a post-meal spit up.
• Avoid putting pressure on the abdomen. This means not wrapping the diaper too tightly, especially when baby is in a sitting position.
• Pay attention to position. Forget burping over the knee; that's a sure way to get your shoes covered. Instead, try to keep baby upright just after feeding in a front pack.

If your baby is vomiting frequently and not gaining weight, call your care provider. She may have a condition called pyloric stenosis, a narrowing of the outlet from the stomach to the intestines. If the vomit is brown, green or tinged with blood, call your care provider.

Rashes

So you're considering showing off the baby and her face erupts with the worst case of acne you've seen since high school.

Just as you did then, you can blame it on hormones. More than 30 percent of newborns develop baby acne of the face mainly small red bumps, with some whiteheads interspersed. It's caused by exposure to your hormones just before birth. Wash your baby's face gently with warm water two or three times a day. It will clear up — only to reappear in about 13 years! You may also see a red rash on her chin as she starts teething. With teething comes drooling, which, particularly in winter months, can lead to dry, chapped skin. Keep your infant's skin clean with warm water, and change her sleeping position and sheets regularly.

Diaper Rash

No matter how careful you are, whether you use disposable or cloth diapers, it's nearly inevitable that at some point your baby will get diaper rash. At least you're not alone; up to 35 percent of all babies get diaper rash. Even if you've escaped it for the first six months, you may encounter it as you introduce new foods to your baby's diet. The key is catching it early and treating it immediately — or preventing it completely.

Each of these preventatives also works as a treatment:

• Change diapers often to prevent skin contact with urine and feces.
• Forget the diaper wipes. They simply aren't enough after a poopy diaper, and they can actually dry out baby's skin. Use lots of warm water and a soft wash- cloth. And be thorough — any speck of poop left on your baby could turn into a skin ulcer or diaper rash.
• Expose your baby's bottom to air each day. Put her on a blanket naked to play for 20 minutes. She'll love it, and the air will help prevent and treat the rash.
• Avoid plastic pants. If you use cloth diapers, use diaper liners instead and terrycloth diaper covers.
• Use a protective cream or ointment. There are several available, including petroleum jelly, A & D or Desitin . If the rash doesn't disappear in three days, it may be a yeast infection. Certain over-the- counter creams are specially formulated to treat yeast infections. But don't use boric acid or talc, both of which can be dangerous for baby. Try cornstarch instead.

Dehydration

One of the most important things to watch out for with very young babies is dehydration. It can happen suddenly and without much warning. Common causes include diarrhea, vomiting or simply not getting enough formula or breastmilk.

Signs to watch for:

• Crying without shedding any tears
• Dry mouth, often ringed with white
• Cool, dry, pale skin
• Excessive thirst
• Listlessness, rapid pulse
• Sunken eyes
• Urinating less than once every 8 hours
• Sunken soft spot

If your baby has any of these symptoms, call your care provider immediately.

Diarrhea

There you are, holding baby with one arm, trying to fix dinner with the other, when you hear an explosive sound coming from the nether regions, smell something awful and feel something wet all over your hand. OK, a diaper blow out, you think. You bathe the baby, put her in clean clothes, pick her up and boom! There she goes again. She's got diarrhea, and not only will you need to stock up on diapers for the next two days, you've also got to watch for dehydration.

There are numerous causes of diarrhea in a baby, from food allergies, changes in diet and reactions to medications to viruses and other infections. The most common virus is the rotavirus, particularly prevalent among children in day care. It usually hits during the winter. Some children have no symptoms, while others may have severe vomiting, watery diarrhea and fever, maybe a cough or runny nose. It lasts about four to six days and is highly contagious.

The best defense - Wash your hands often before touching your child and make sure any caregiver does the same. And always wash your hands — with soap — after changing a diaper.

The best treatment is time and fluids, particularly oral rehydration solutions such as Ceralyte, Pedialyte or Oralyte.

Call your care provider if your baby is less than 6 months old and, in addition to the diarrhea, has a fever, bloody stools, prolonged vomiting and signs of dehydration as described above.

Breast-fed babies bowel movements tend to be softer and looser than bottlefed babies. They may even be watery for the first few weeks of life. This is normal, not a sign of diarrhea.

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SIDS stands for Sudden Infant Death Syndrome

It occurs among infants who are 1 month to 1 year old. The death is sudden and unpredictable. In most cases the baby seems healthy. Death occurs quickly, usually during sleep. Unfortunately there is no way to predict or prevent SIDS.

Make sure your baby sleeps on his or her back. This is the best protection against SIDS.

Follow these simple guidelines and enjoy being a new parent. Share this information with family and friends who may also be taking care of your baby.

So, how can you decrease the risk of SIDS to your baby?

• Early and regular prenatal care. This includes proper nutrition and regular check-ups. Prevent premature birth, a major risk factor for SIDS.
• Avoid smoking during pregnancy, using drugs or alcohol.
• No one should smoke around your baby, or in your home. The exposure to tobacco smoke increases the risk of SIDS.
• Consider breastfeeding your baby. Breastmilk keeps your baby healthy. Human milk contains substances that aid infant growth and development necessary for optimal brain development. And, breastmilk contains antibodies that protect babies from many illnesses.
• Your baby should sleep on a firm mattress. No stuffed animals, fluffy blankets or comforters, or toys in the crib. No waterbeds, pillows or sheepskin. These can cause your baby to become smothered.

What else can you do?

Prevent overheating. Babies should be kept warm, but not too warm. Don't overdress. Keep the room comfortable for you.

• An overheated baby is more likely to go into a deep sleep, and may be difficult to wake.
• Regular pediatrician visits are encouraged, including immunizations on schedule.
• If your baby seems ill see a doctor.

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