WelcometotheWorld Royal Baby!

Yesterday, with his own twitter hashtag #welcometotheworld and worldwide media coverage, a healthy baby boy was born to proud parents Prince William and Duchess Kate. In celebration of the as-of-yet nameless heir to the British throne, we wanted to highlight some of our posts specifically about newborns. If you happen to see William or Kate in the next few days, be sure to pass them on. :)

• Baby Science: The First 24 Hours
• Baby Science: Days 4 and 5
• New Babies, Growing Families, and Fitting In
• Newborn Development: Reflexes Rule
• Sometimes Newborns Good Behavior Can Be Misleading

Swaddling Safely: Reducing Risk for Hip Dysplasia

By Jennifer Goldbronn, MAS, RD

Swaddling can be an effective tool for helping newborns to rest because they have so little control over their sometimes flailing arms and legs. However, a possible adverse effect of swaddling that has gained attention recently (though it has been known for centuries) is the increased risk for the development of hip dysplasia related to swaddling with the baby's hips and legs extended. Today we’ll explain what hip dysplasia is and how it is related to swaddling, and share tips for hip-healthy swaddling.

What is Hip Dysplasia?

Hip dysplasia is simply looseness or instability of the hip joint, which in its severe form results in hip dislocation. About 1 in 20 infants are born with some hip instability, though most (about 90%) are mild and resolve over time with normal development. Tight swaddling of the legs, however, is one factor that can interfere with the hips developing normally.

How are Hip Dysplasia and Swaddling Related?

Young babies’ hip and knee joints naturally flex into the fetal position (curled with legs and arms pulled toward the body) from their time spent developing in the womb. After birth, normal development of these joints will allow their legs to straighten over time. However, when a baby’s legs are not free to bend and flex, there is an increased risk of abnormal development of the hips. This is where tight swaddling of the legs can impact hip health. A 2007 review showed that the incidence of hip dysplasia is highly associated with “traditional” swaddling techniques that force extension of the hip and knee. (van Sleuwen 2007) Studies show that cultures using cradleboards, which force the hips and knees into full extension, have higher incidences of hip dysplasia.

Recommendations for “Hip-Healthy Swaddling”

Here are a few tips for swaddling that promote healthy joint development (based on American Academy of Pediatrics (AAP) and The International Hip Dysplasia Institute (IHDI) recommendations). When swaddling your baby:

• Do not straighten your baby's legs or bring them close together

• Make sure the blanket is loose around your baby’s hips and legs; your baby’s legs should be able to bend up (flex knees) and out

• Always make sure your baby is placed on his back to sleep and that there are no loose blankets near him

Keep in mind that other parents and caregivers who swaddle their young infants may not have information about safe swaddling techniques. Please pass this on! For more information about healthy swaddling and hip dysplasia explore the resources below.

References and Resources

The International Hip Dysplasia Institute Web site: www.hipdysplasia.org,

The American Academy of Orthopaedic Surgeons Web site: http://orthoinfo.aaos.org/topic.cfm?topic=A00347

Van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TWJ, L'Hoir MP. Swaddling: A Systematic Review. Pediatrics. 2007;120: e1097-e1106.

Secrets of Baby Behavior: Overstimulation

 My 3 year old, Olivia, just started gymnastics. Her class is held at 6 pm in a large warehouse-like building that includes a gymnastics area, where several classes are conducted concurrently, and a hockey rink. Olivia was so excited for her first class, so our whole family (me, my husband, and 7-month-old Charlotte) came to watch. As you can imagine, the sounds of squealing toddlers, giggling pre-teen gymnasts, and hockey practice echoing through the inadequately air conditioned building quickly became overwhelming for Charlotte. While I helped with Olivia’s class, my poor husband spent the entire hour trying to keep Charlotte calm. This week, we decided that Charlotte should stay home, so I took Olivia alone. As I sat in the waiting area, watching Olivia do her first summersault, I heard some fussing and saw a mom rocking her baby. I watched as she tried bouncing and singing, walking around, and even feeding her 3 month-old son, but nothing seemed to help him calm down. Finally, after about 20 minutes, the baby fell asleep. The mom looked relieved as she sat down next to me and said “I think he should stay home next week.”


After seeing another mother experience exactly what we went through just a week before, I was reminded how easily babies become overstimulated. Over the last 2 years, we’ve posted a lot of information about overstimulation. So, today I thought it would be good to provide links to previous posts that may be useful to parents going through the same thing.

Baby Behavior Basics Part 2: The Many Moods of Babies (June 2009) – In one of our original posts, we describe the 4 infant states babies move through when they are awake (drowsy, quiet alert, irritable, and crying). For each state, we explain what you will see that will tell you that this is the state your baby is in and what you can do to help your baby be calm and happy.

Baby Behavior Basics Part 3: Learning and Creating Your Baby’s Special Language (June 2009) – Babies give 2 types of cues to tell caregivers what they need. Engagement cues are given when they want to interact and disengagement cues mean they need something to be different. This post describes both types of cues and explains how each can be related to overstimulation.

Baby Behavior Basics Part 4: Crying: Your Baby’s Super Power (June 2009) – Babies can’t tell us with their words when they are overstimulated, so crying is an important way they tell us they need a break. For information about why babies cry, recognizing when a crying baby is overstimulated, and using repetition to help calm your baby, read this post!

Reader Question: How to keep your baby from being grumpy while grocery shopping (March 2010) – Like the gymnastics class, the grocery store can be a very overwhelming place for a young baby. The sights, sounds, smells, and even temperature change from aisle to aisle and can overload babies’ senses. In this post we provide tips to make the shopping experience a little easier on everyone!

Part 1: The Phenomenon of Late Afternoon/Early Evening Infant Crying (July 2010) –Many babies tend to get fussy in the late afternoon or evening and overstimulation is usually the reason. This post provides research about crying and why it tends to be more common later in the day. In Part 2, we provide tips to deal with late afternoon and early evening crying.

Too Much Fun: Preventing Overstimulation in Infants and Toddlers (December 2010) – In this post, we provide tips for minimizing meltdowns that can occur when our kids have had too much excitement. Although it isn’t possible to prevent your baby from ever getting overwhelmed, these tips can help!

Baby Science: The First 72 Hours (February 2011) – This post was written to provide the “baby science” behind what I experienced during the first few days after Charlotte was born. We explain why many newborns are very sleepy on day 1, how overstimulation can lead to fussiness on day 2, and why babies don’t always breastfeed perfectly the first time.

If you have questions about overstimulation, please send us a comment!

Baby Science: Days 4 and 5

In our last "Mommy Science" post, we discussed the science behind Jen B’s early postpartum experiences at home. As promised, now we’ll take a closer look at her daughter Charlotte’s development and experiences during those early days.

As Charlotte entered her 4th day of life, she was still struggling to maintain an alert state for more than a few minutes. Her situation is a common one, especially for a baby born by c-section. Sleepy babies can be particularly challenging for new parents if they require a lot of work to wake up. Sometimes babies are sleepy because of exposure to medications, sometimes because their bodies are still not able to effectively move from one state to another. Other babies are challenging to wake because they are spending so much energy trying to tune out the world when they are trying to rest and recover from birth. While parents with sleepy babies may enjoy the extra shut-eye, sleeping too long or failing wake up enough to feed effectively, can result in babies' losing weight, becoming dehydrated, or even jaundiced. It is important to follow your health care providers' guidelines about how often to feed your baby and how best to wake your baby to feed.

Even when they are awake, newborns may have some trouble getting feedings started. Learning to latch and coordinating breathing and sucking are sometimes tricky even when all the reflexes and instincts are in place. Fortunately, babies are born with innate abilities to learn quickly and after the first few days, nearly all babies are feeding champs. If not, a trip to the doctor, nurse, or lactation consultant can help get things back on track. The very best way to make sure that your baby improves in his ability to feed is to practice every time you see your baby use hunger cues.  

Some of you will be surprised about how much your baby moves during those first few days. He may twitch and flail his arms and legs, especially when you put him down on his back. He may even move around quite a bit when he's sleeping. Newborns have little control over their muscles and some (but not all) will move around so much that they startle themselves. Swaddling can be useful for newborns to minimize movement and keep your baby a bit more relaxed until he gets more control over his body (within the first few weeks).

One last thing, newborns are tenacious in their desire and ability to connect with and learn from the world around them. It may not be obvious, but each time your newborn looks at your face, he is working hard to learn and duplicate what he sees. When you smile or move your lips to speak to him, his brain is making connections that will someday let him smile back at you. At first, your newborn won't be able to look at you for very long but when he does, you will notice that looking at you calms him. In fact, he will find your face to be one of the most wondrous things in his brand new world.

Next time: A New Baby Quiz! 

More Mommy Science: Days 4 and 5

By Taryn Barrette, RD

Today, we continue our posts about the “Mommy Science” behind the events surrounding Jen B’s postpartum experience with her daughter Charlotte.

In her last post, Jen described her struggles with sleeplessness and breastfeeding during days 4 and 5. Keeping in mind that not all of Jen’s experiences are typical, we’ll share some of the biology lurking in the background.

The Tiredness Continues
In our last mommy science post, we talked about the emotional and physical demands of recovering from a C-section and the onslaught of hormones that induce the “stress response.” Stress causes forgetfulness, irritability, and for Jen B and many other women like her, an alert and awake state – leading to a frustrating inability to sleep. Though these hormones are decreasing on days 4 and 5, the resulting lack of sleep persists through the next few days.

Milk Onset
About 85% of moms ‘feel’ changes in their bodies between 24-72 hours postpartum signalling that their milk supply is increasing (otherwise known as "milk coming in" or "milk onset"). The other 15% feel those changes later (and may need some assistance from the doctor or lactation consultant to get things going). Typically, first time moms feel the increase in milk supply near the end of day 3. Mothers who have already had children often feel the changes at the end of day 2, give or take a few hours. Jen B noted that she felt the changes on day three – which is well within the normal range. Though colostrum (the very important early milk) is already being produced during pregnancy, mothers notice fullness and tightness in their breasts as the milk supply rapidly increases (more than 10 fold) during the first week after the baby has been born. For some mothers, the milk comes in well after the third day (this may happen to some but not all of moms who have had c-sections). In this situation, it is important that both mom and baby are seen by a health care provider. The good news is that for most moms, a delay in milk onset can be addressed with help from the lactation consultant and/or health care provider.

Hungry Babies on Days 4 and 5!
Newborns tend to have the highest number of feeds on days 4 and 5 (we’ll talk more about the science behind this in our next post) and if moms do not expect this increase in feeding, they may think there is something wrong or they may worry that the frequent feeds will go on forever. This added stress combined with fears “doing it wrong” can be very discouraging for new moms, But, this peak in feeding helps mom and baby to get plenty of practice breastfeeding and keeps the mom from being engorged by too much milk when the milk supply is increasing so rapidly. All babies will feed frequently on days 4 and 5 as they become more alert and active. New families need a lot of help during that first week.

Newborn Challenges
Despite the fact that bringing home her newborn was a new experience, Jen B was confident that her training and experience would make breastfeeding and understanding her baby’s needs easy. Unfortunately, Charlotte didn’t get that memorandum. Charlotte’s early cues were confusing and her attempts to latch resulted in fussy frustration or sleep when she should have been eating. As Jen B became more overwhelmed, the hospital staff was able to step in at the right time and support her efforts to keep breastfeeding.

Next time: We’ll get back to the Baby Science of that tough first week!

Baby Science: The First 72 Hours

Recently, Jen B described the first 72 hours she and her husband shared with her new baby, Charlotte, Afterward, we shared the "mommy science" behind the experiences she described.  This time, we review the "baby science" related to those early days. Using Jen B's posts as a guide, we'll ask and answer some of the questions that many parents have about newborns. As usual, we have to remind you that not all babies will follow the timelines we describe but many will follow a similar pattern.

Why are newborns so sleepy on the first day?
I'm sure it is obvious that both babies and mothers are exhausted after their birth experience. After the first hour or so when adrenaline and excitement may keep babies relatively alert, they typically sleep for 2 to 4 hours before starting to wake more frequently. A few hours of deeper sleep on the first day helps mom recover and helps baby conserve calories while feeding is still being established. Most babies struggle staying awake on the first day, falling asleep off and on, even while they are feeding. That's why it is important to practice feeding during the first couple of hours and each time the baby becomes alert.

Why are newborns so fussy on the second day?
Many parents are surprised by the sudden behavior shift in their quiet sleeping newborns that comes along on the second day. Babies' alert periods are still very short but they are also likely to be fussy, even a bit frantic, when they are awake. While we know how hard it is to listen to your baby's crying, it is one of his most important baby-skills. Crying is an extremely effective mechanism to alert parents when they are needed. Without this skill, newborns would not be able to wake their caregivers when they need to be fed, diapered, warmed, or calmed. Babies cry out whenever they become uncomfortable or distressed and a quick response will minimize but not eliminate crying, especially during the first few weeks.

Brand new baby-tummies are so small that newborns typically consume only about a teaspoon of milk during a feeding. An average milk volume for the first 24 hours is about 50 ml (or a little over 3 tablespoons). During the second day, babies become more alert and they work hard to give cues (including hunger cues) to their parents. Being more alert means they are more likely to feed frequently enough to grow and stimulate mom's milk supply, But being alert also means they will be sensitive to all the discomforts of the new world they have entered. Some babies are better than others with dealing with stimulation and calming down when their parents try to soothe them. So, some babies will cry more than others independently of how they are cared for but all newborns do better when their parents are careful not to let them get overstimulated. Limiting visitors and using repetition to calm the baby can help new parents get through that tough second day.

Why don't babies breastfeed perfectly the first time?
In her sleep-deprived state, Jen B was frustrated that Charlotte seemed so "stubborn" about breastfeeding. She would cry out for feeds, not latch very well and then, when she did latch, fall asleep almost immediately. It is easy for parents to imagine their babies thinking like older children (like being stubborn) but Charlotte was only using instincts and reflexes that just weren't quite ready for her new world. Her body was overreacting to the world around her and her sucking reflex was sending her to sleep. She needed a few days to get better control over her responses to stimulation and to use all of her reflexes for feeding at the right time and in the right order. With practice, babies get better at feeding very quickly and by the time mom's milk supply is increasing rapidly (typically when babies are between 2 and 4 days old), they are ready to take in a much larger volume.

Next time: Jen B will share more of her early experiences

Life with a Newborn: Days 2 & 3

Last week, I wrote about my experience during the first 24 hours after giving birth to my new baby, Charlotte. Today, I’ll describe days 2 and 3.

Days 2 & 3

• Even though Charlotte was more alert than she had been on the first day, she still slept a lot. On day 3, she seemed irritable, crying more than she had the 2 days before. She’d wake up about every 2 hours to eat and would be awake for up to an hour before dosing off again. Just like the day before, I was having trouble sleeping. Once I was able to shower and change into my own clothes, I was much more comfortable.

• I remember saying “She is just so stubborn!” It wasn't until my friend laughed that I realized that I was projecting behaviors of an older child onto my newborn daughter. Even though it really felt that way at times, Charlotte wasn't being stubborn, she was just being a newborn baby, adjusting to a whole new world. When I kept that in mind, I wasn't nearly as frustrated!

• Our hospital has a “rooming-in” policy, which means that the infants stay with the moms and are not taken to a nursery unless there is a medical need. Even though my husband and I saw this as one of the benefits of the hospital, there were times in the middle of the night that we found ourselves wishing we could send her to the nursery while we slept. Even though we were so tired, I noticed that we seemed to have the best feeding sessions in the middle of the night and those times helped boost my confidence about breastfeeding.

• Charlotte had trouble latching well, so we met with the lactation consultant several times. When she did latch on, she would fall asleep soon after. I started to get discouraged and despite my professional experience, I still needed help.

Charlotte and her big sister!

• Our older daughter, Olivia, enjoyed coming to the hospital to visit. Even though I was happy to see her, it was hard having her there for more than 20 or 30 minutes. The room was small, but there was a lot for a 2 ½ year old to mess with and I noticed that it was easy for the adults to lose track of time paying attention to the baby. I recommend working out a system ahead of time to ensure that the sibling visits aren't stressful.

Next Time: Days 4 & 5

Life with a Newborn: Day 1

In December, we posted a special announcement! Charlotte is now almost 10 weeks old and we are getting used to being back to work. That’s right, I said we. Charlotte comes with me to the office a few days a week (watch for a post about bringing baby to the office in the near future)!

Charlotte Isabel Citlali Banuelos
7 hours old

Before I left, we introduced a new series that would chronicle Charlotte's behavior as it was happening. The plan was to take notes about her behavior (sleeping, crying, cues, etc) and how my family interacted with her and, in my spare time, post what we observed. Well, as many of you may have predicted (and as we mentioned in a previous post), I haven't had much spare time! We did take notes though, so now that I am back in the office, I am going to share our experiences. It is important to note that, unlike many of our research-based posts, this post is just an account of my family's personal experiences.

Day 1

• The first thing both my husband and I noticed was how much more calm this day was compared to the day our first daughter was born. This time, I was 39 weeks along and had no complications that affected the delivery. It was such a relief to have a "typical" experience this time!
  
  
• Charlotte spent most of her first 24 hours sleeping. Even though she wasn't awake often, we noticed her moving through the states that we've described on this blog many times. As I watched her move in and out of Quiet Alert, the state when babies are awake and ready to learn and interact, I noticed that she had about a 3 minute limit before she would either begin to fall asleep or start to fuss. It was so amazing to see her focusing on our faces so soon after she was born!
  
  
• Even though Charlotte was sleeping so much, I found it hard to sleep in the first 24 hours. I noticed that I could sleep only about 20 minutes before waking up.
  
  
• When we weren't sleeping (or in my case trying to sleep), we were trying to breastfeed. From the beginning, Charlotte had a strong suck and was anxious to eat, but she had trouble latching. When she would latch onto the breast, she'd quickly fall asleep, so we spent A LOT of time practicing! JenG's Tips for Successful Breastfeeding after a C-section really came in handy.
  
  
• The nurse gave Charlotte her first bath several hours after she was born. While getting her hair and face washed, she was happy and calm, but when the nurse washed her body in the little basin, we got our first chance to hear how loud she could scream. As terrible as it was to hear her scream, we learned something that was very useful. She was calmed by us touching her face and made more alert when we touched her body. Over the next few days, when she was really upset, we would use a washcloth on her head and face to help her calm down and when we needed her to wake up, we would use it on her body!
  
  
• We had very few visitors on the first day and the visitors we did have only stayed for a few minutes. I think this was very helpful in keeping everyone as calm and rested as possible. Although everyone was very anxious to spend time with Charlotte, we needed that time alone to recover and get to know our baby. I would definitely recommend limiting the number of visitors on the first day.
  
  

Next Time: Life with a Newborn: Days 2 & 3

New Babies, Growing Families, and Fitting In

Because babies are so small and needy, we tend not to think of them as needing to adapt to “fit in” to their new families. Instead, parents think of all the adjustments that they have to make to meet their babies’ needs. Yes, we know how hard it is to care for a new baby, but try to imagine early life from the baby’s perspective. Babies must adapt to a whirlwind of new experiences and learn how to communicate with no words and very little control over their own bodies. They must rely on adults to meet their needs and teach them everything about life. The relationships babies build with their parents, siblings, grandparents, and other family members provide the foundation they need to grow and develop into happy, successful people. As we wrap up this series and babies' relationships, we'll take a close look at the critical role that the family plays in babies' lives.

The Foundation of Family

Sixty years ago, developmental psychologists thought that the only relationship that mattered for a baby was the one he had with his mother. These days, researchers realize that many people are involved in helping babies socialize and learn. Of course, the first and most influential group in a baby's life is his family. In today's diverse world, "family" is defined more in terms of members' emotional ties and responsiblities rather than by genetics or roles in more formal or traditional structures. For our purposes, a baby's "family" refers to the group of people who interact with and care for him.

The Family "System"

As scientists have learned more about infants' social development, they've come to understand that family influences on babies don't work in isolation from each other. Families form networks with each member playing a special role in the baby's life. As mentioned in an earlier post, family members' relationships with a baby are influenced by the temperament and behavior of the baby. But, these relationships are also influenced by family members' relationships with each other. The whole family works together as a "system" as they interact with the baby and with one another. In secure and happy families, this "system" creates a safety net for each member to deal with the inevitable ups and downs of childrearing. When families are uncooperative or in direct conflict, the safety net breaks down and everyone, including the baby, is challenged.

For many new parents and family members, the physical and emotional stress of dealing with a new baby is overwhelming. No one ever seems to be doing enough to help. Ties between family members that may be already strained can snap, and caregivers can turn against one another. Fortunately, no family "system" is inevitably stuck in one pattern. Familes have the capacity to change and develop just like their children. For many familes, this development happens naturally as babies get older and easier to care for, but others may need help, and even professional support, to work together.

Baby Behavior and a Lighter Burden

Babies need consistent loving care from those around them. Even when they are not exhausted, family members who don't understand what the baby wants or why the baby is crying are far more likely to avoid or resent having to care for the baby. As more family members learn to understand babies' behaviors and cues, more individuals are ready to confidently support babies' efforts to "fit in." Sharing the basics of baby behavior might help lessen the burden on everyone.

In our first post in this series, we asked "where is that village" that is supposed to be needed to raise a child? For some, that village is already close by and family members are ready to work together. For others, help is needed from trusted friends or professionals to get family members to see how working together is best for themselves as well as the baby. Still, others may need to build their village from scratch, reaching out to trusted friends and making a family "system" all their own.

Next time: We'll answer some of your questions!

Quiz Answers

Earlier this week, we posted a quiz to see how much you know about babies. Here are the answers:

1. The answer is True - Babies are born with 2 types of cries, a basic cry and a pain cry. A basic cry is a generic cry newborns use when they aren't getting what they need, but a pain cry is different. When babies are in pain, they start by holding their breath before letting out an intense scream. As babies get older, their vocal cords mature and they develop different kinds of cries. For more information about crying, read Baby Behavior Basics Part 4: Crying: Your Baby's Super Power.

2. The answer is False - Babies all over the world develop behaviors and achieve milestones at the same pace! For example, babies in the United States, China, and France all develop social smiling around 6 weeks of age. For more information read Newborn Development: Reflexes Rule and Two to Four Weeks: A Whole New World. Next week we'll continue our series on infant development.

3. The answer is 3000 - The average baby goes through about 3000 diapers in the first year of life. That is a lot of diapers (and even more wipes)!

4. The answer is True - Babies can copy facial movements within the first hour of life. When a newborn is in the quiet alert state, she is ready to interact, so it's a great time to try this out. Hold the baby close to you (remember, newborns can only see about 12 inches away) and pucker your lips. It may take a little while, but she will try to pucker hers too!

5. The answer is 4 days old - Babies can identify their native language from a foreign language by the time they are 4 days old! This is just further proof that babies develop very quickly! More information about language development is available in the From Cues to Conversation: How Babies Learn To Talk.

We hope you enjoyed this little quiz! Do you have questions about baby behavior? We would love to give you the answers, just send us a comment or an email!

Next Time: We'll continue our series on infant development with 6-8 weeks of age.

Two to Four weeks: A Whole New World

By Jennifer Banuelos

Even after several years of studying and working with infants (and having one of my own), I am still amazed at how quickly babies grow and develop. Within just a few weeks, they rapidly develop more skills to help them interact more effectively with the people around them. Although some of these skills won't be obvious to strangers, you will see your baby maturing right before your eyes!

Senses
By 4 weeks, babies' senses are sharpening. They are captivated by faces (especially of other babies) and love high contrast (like black & white) patterns. You can find board books with baby faces and/or contrasting patterns that babies enjoy. Newborns are calmed by the sight of the human face. Consider adding "face time" to your routine, maybe before and after feeding to help your baby's senses develop!

By one month, babies start to explore more objects by mouth, beginning to recognize different objects by their mouth-feel.

Cognitive Development
As mentioned in the last post, newborns are often unable to control their states or moods. By 4 weeks, babies may begin to have more predictable patterns of behavior. For example, some 1-month-old babies will start to spend more time looking around after feedings, become visibly drowsy after some social time and fall asleep without crying or becoming irritable. As your baby continues to become more aware of the world around her, you may notice that she gets fussy at the the same time every day, often in the evening. This may be due to over stimulation from a long day of play and may coincide with the time of day that parents get home from work, siblings arrive home from school, and dinner is being made. All the new sights, sounds, and smells are just too much for baby!

By 4 weeks, babies have learned to interact in special ways with different caregivers. For example, with her mother, a baby's body movements and facial expressions may be smooth and rhythmic, mimicking the mother's low-key, gentle demeanor. With her father, a baby's facial expressions may be more animated. Her arms and legs may become tense as if she has already learned that fathers are for playing!

Physical Development
By 3-4 weeks, your baby may lift her head briefly and possibly move it from side to side when she's lying on her stomach. This is a great time to start "Tummy Time." Placing your baby on her tummy (in a safe stimulating place) for a little while each day is important for her development. At first, your baby will be able to handle only a few minutes of tummy time, but over time, her muscles will strengthen and she will enjoy more time on her tummy. Remember - tummy time is only appropriate when your baby is awake. Babies should always sleep on their backs. Babies this age also begin learning that their arms and legs are attached to their bodies. Try gently moving her hands in front of her face so she can see and feel them at the same time.

The first weeks of your baby's life are hard work and you may forget (or be too tired) to notice the wonderous changes in your baby's abilities to communicate and move. Even bigger changes are ahead! We'll share more about infant development in upcoming posts.

Next time: We're going to give you a fun little quiz to see how much you know about babies!

Newborn development: Reflexes rule!

By Jennifer Goldbronn

Just yesterday, my daughter, now 2, and I were looking through her baby clothes and we came across a newborn-sized diaper. Amazement swept over me as I tried to imagine my toddler ever having fit into something so small. I clearly remembered how tiny and fragile she seemed the first time I held her in my arms; yet, they let us take her home from the hospital, her survival dependent on us, her new, rather clueless parents!

Newborns are not born fully developed, but they are equipped with a few essential survival skills. At first, newborns are very disorganized and uncoordinated. Their arm and leg movements may appear jerky for awhile. Their sleep patterns and behavior can be erratic, but bear in mind that a newborn has just left the warm, safe confines of his mother’s womb. Suddenly voices and sounds are louder, lights are brighter, and he is experiencing many new sensations and smells. The outside world takes some getting used to, but with the help of his caregivers, he will grow and develop, adapting to his new environment. Infant brain development depends a lot on what babies see, hear, touch, smell and taste.

Senses
Babies are born with all 5 senses, but some are more developed than others. Vision is probably the least developed sense; newborn babies can only see objects about 8-12 inches away. They prefer looking at bright shiny objects, or even better, at mom or dad’s face! When babies are in the quiet alert state , they are ready to interact with you and will respond to your voice or an object you show them. Newborns can also pick up their moms’ smell and distinguish it from others. Babies listen to their mothers’ voice even before they are born and will turn their heads toward the sound of it. Breastfeeding is the culmination of many sensations in an infant: taste, touch, smell and sight. The distance between a mother and her baby while breastfeeding just happens to be the exact distance a newborn can see! But a newborn needs to coordinate several motor skills to breastfeed successfully.

Reflexes
Babies are also born with a set of reflexes that help them react to the world around them. One example: newborns are born with the ability to move their arms and legs in a swimming motion and lift their heads when placed on their stomachs. There are 3 main sets of reflexes present at birth that are important for a baby’s survival:

Feeding: the rooting (head turns toward cheek that is stroked), sucking and swallowing reflexes allow infants to take in nourishment.
Breathing: the breathing reflex, hiccups, sneezes, and moving arms and legs when something is covering the face all protect an infant’s ability to get oxygen.
Body temperature: infants can maintain their body temperatures by shivering, crying, and tucking their legs into their bodies to stay warm. To cool off, they will automatically push off blankets and decrease their movement.

Brain Development and Sleep
Newborns spend 70-75% of their sleep time in active sleep. During active sleep, babies dream and their brains are growing and developing. While infants dream, blood flows to their brains and neural connections are made. Because it is so important for their development, newborns may dream 30 minutes before they fall into deeper sleep. Research also shows that newborns need to wake up to be healthy. They need to wake easily if they are too hot or too cold, hungry, lonely, or need a caregiver’s help.

Newborns are amazing creatures who grow and change daily. Parents can help their newborns grow and develop by holding them close, talking to them, and learning their babies’ cues so that they can better understand and respond to their babies’ needs. While their erratic behavior and sleep patterns makes caring for newborns extremely challenging, the newborn period lasts a very short time.

Thinking back, I realize that at times I was too sleep-deprived to revel in my daughter’s early development. One thing I can picture, as clearly as if it were yesterday, is the first time I held her to my chest as she instinctively rooted around for her mommy’s milk. Aided by her acute sense of smell, she finally found her target and latched on. Listening to the subtle sound of her suck and swallow I sighed with relief: maybe I could take care of this new little being.

Next time: 2-4 weeks: By this age babies are able to follow their parents’ voices and begin to develop a distinct temperament.

Key Resources: Berger (Worth 2003) The Developing Person Through Childhood and Adolescence and Brazelton (De Capo 2006) Touchpoints: Birth to 3 years

Tips for Successful Breastfeeding After a C-Section

Here are a few tips that can help you achieve a positive breastfeeding experience, even if your birth "plan" doesn't include a c-section.

Communicate with the hospital staff about your decision to breastfeed.
Plan ahead by letting hospital staff know that you plan to breastfeed before your baby is born. Ask that no bottles, supplements, or pacifiers be given to your baby unless medically necessary, and ask for your baby to be brought to you as soon as possible after delivery. Inquire if the hospital has a rooming-in policy, meaning they let the baby stay in your room for your entire hospital stay. This will give you time to get to know your baby's cues and let you practice breastfeeding. In case you are not able to be with your baby immediately post partum, be sure that your partner (or other support person) is aware of your feeding choices and ready to talk to hospital staff about them.

As soon as you can, put your baby skin-to-skin.
In most cases, you can start skin-to-skin contact with your baby in the delivery room, while the doctor is completing your procedure. Your partner or a nurse can hold your baby against your bare chest until you are ready to be transported to the recovery room. Keep your baby skin-to-skin as much as possible during the first few days postpartum. Skin-to-skin contact enhances bonding and ensures that your breast is readily available when baby needs to feed. It also helps regulate your baby's temperature and heart rate. If your baby is taken to the nursery, encourage your partner to stay with your baby and practice skin-to-skin contact with him until you are reunited.

Be patient, your milk will come in.
There may be a bit of a delay in your milk "coming in" after a c-section, but that does not mean that you can't breastfeed. Put your baby to the breast soon after delivery and as often as possible to stimulate your milk production. Your newborn needs 8-12 feedings in a 24-hour period. Before you start to produce larger volumes of milk, your body will produce colostrum. Colostrum is produced in very small amounts because your baby's tummy is also small. Colostrum is all that your baby needs in his first days of life. You will notice that things change quickly by day 3-5 after delivery. Your milk will change in consistency and color and the volume will increase. If for some reason you do have to supplement temporarily with formula, you can go back to exclusive breastfeeding. Be sure to talk to your doctor, nurse, or lactation consultant about the steps you'll need to take to reduce the amount of supplementation when your baby is ready.

Get some help. Your incision will make it challenging to position your baby to breastfeed comfortably.
Get help with positioning your baby at the breast to feed. A lactation consultant or nurse can show you the most comfortable positions to breastfeed that won't irritate your incision. Usually the side lying position or football hold puts less pressure on your abdomen. It can also be painful to get out of bed and pick up your baby the first few days postpartum. For the first week or so after delivery, have someone bring your baby to you and help you get into a position that is the most comfortable for you and your baby to breastfeed. Use pillows to protect your incision and keep you comfortable while breastfeeding. Also, you may have received a lot of fluid during and after your surgery. This extra fluid may make it harder in the first few days for your baby to latch onto your breast.

Tell your doctor that you plan to breastfeed, many medications are safe to take while breastfeeding.
After your surgery, your doctor will prescribe medications to control your pain. These days, many pain medications are safe to take while breastfeeding. Ask your doctor about the safety and compatibility of all medications you take while breastfeeding.

Make sure your baby is awake enough to feed. Your baby will be drowsy.
Because of the pain medications given during labor and delivery, your baby will be drowsy. It could take several days for the medication to completely leave your baby's system. A drowsy baby may fall asleep early in a feeding and thus, not feed effectively. See the next section for the best way to wake a sleepy baby to feed. Call your doctor or lactation consultant if your baby is sleeping all of the time and feeding less than 8-12 times per day.

Use a variety of ways to wake your sleepy baby.
In our last post, we told you the best way to wake a sleepy baby is to use a VARIETY of stimulation. Use different positions, touch, or words. Removing your baby's clothing is another way to change his environment (temperature or touch) to help wake him. Keep in mind that sometimes it can take up to 10-15 minutes for sleepy newborns or premature infants to fully awaken enough to feed effectively. Be patient!

With a little extra support and patience, you can successfully breastfeed your baby after a c-section. I did it, along with thousands of other mothers. That's not to say it was easy, but knowing what to expect will give you the confidence you need to achieve your happy (breastfeeding) ending.

Next time: Just when you thought the worst was over, waking up again with an older infant.

Sometimes Newborns’ “Good” Behavior Can Be Misleading

I was speaking at a conference the other day and a nurse told me that she worries when she calls a mom during the first week after hospital discharge and she hears that the newborn is a “good baby” who sleeps all the time, never cries, and is consistently “content.” She’ll ask about feedings and diapers and more often than not, there are lots of red flags and she’ll ask the mom to bring the baby in to see the doctor.

During pregnancy, most first-time moms don’t learn about what it is like to care for an infant and they expect that newborns should behave like the older babies they see in public or on television shows. Normal chaotic newborn behavior can lead some parents to panic while parents of quiet, sleeping babies believe they have won the genetic jackpot.

Newborns Take a Lot of Work
Newborns are born with tiny stomachs, developing brains, and very limited physical ability. While healthy newborns shouldn’t be “persistent criers” (see:http://www.secretsofbabybehavior.com/2009/07/whats-difference-between-crying-and.html ), they should wake fully, demand and sustain good feedings, and have short periods of alertness during the day and night. Sometimes, when sleepy babies gain strength and stamina, parents are shocked that their “good babies” are suddenly so demanding. Soon enough, babies settle down, lengthen their feeds, and sleep longer, but in the first few weeks, they need frequent feedings, fresh diapers, and lots of rest. When things are going well, newborns keep their parents busy!

Most newborns need to eat 10-12 times per day, almost every 2 hours. If babies are not waking to feed or fall asleep immediately after they start feeding, parents may need to work harder to wake their babies. How do they do that? Remember how “repetition, repetition, repetition” calms babies down? Using a variety of stimulation is the key to waking sleepy babies. For example, parents can try undressing the baby, changing the baby’s diaper, gently changing the baby’s position, and talking or singing to the baby using different sounds and voices. All the variety will wake the baby more fully for better feeds.

When is Good “Too Good?”
“Good” babies who don’t wake to feed, aren’t showing interest in feeding, have a weak suck, or don’t have frequent wet or dirty diapers need to get checked out by the doctor. Any time newborns go more than a few hours without a good feed, parents should check in with their doctor or the advice nurse. Most of these “good” babies will get back on track once things are figured out. Just be ready for that “not so good” but “oh, so healthy” baby to take over for a few weeks.

Did you have a sleepy baby? How did you get your baby to wake up enough to feed?

Next time we’ll share some ideas about how moms can work with their employers both before and after their babies are born.