It's not easy for a new parent to be certain when an infant is ill. Sometimes a parent's concerns can be treated as a casual inquiry by medical workers who are accustomed to soothing new-mother nervousness. It's enough to make a mama doubt her own instincts.
It will come as a relief to know that there IS a way to objectively measure a baby's health.
THE FIRST SEVEN DAYS
From the start, newborns will need to nurse for no less than 15 minutes, 8 times per day during the first week of life. Listen and you should hear the baby swallowing milk. Baby's first sticky-black stool - called meconium - should pass. You should see it progress from greenish-black to a brown soft play-dough consistency. By the fourth or fifth day, this will appear yellow. During the first two days of life, a child should begin to have wet diapers. The number of wet diapers will increase to two or three each day be the end of the week.
That first week will also give you clues if a baby isn't doing well. Nursing for less than fifteen minutes fewer than 8 times per day, showing no desire to eat and having a sucking reflex that is week are all signs for a parent to be concerned. Something is likely wrong if there is a clicking sound when a baby nurses, the cheeks dimple when the baby sucks, or the baby falls asleep before nursing for 15 minutes. When the baby's diapers don't show stools progressing as they should and you don't see wet diapers within 48 hours after birth, there is something out of the ordinary. Two days of these symptoms indicate that you should seek medical help.
THE INITIAL 30 DAYS
The signs that your baby is healthy will be pretty much the same throughout the next month. For weeks 2 through 4, the baby will continue to nurse at least eight times a day and have 2 to 4 yellow bowel movements per day. Urine should be clear, not yellow, 6-8 times per day. Along with observing some milk and hearing your baby swallow during nursing, you should see a strengthening of the suck reflex. Your baby's alertness will increase as well as his size.
Take special note of anything out of the ordinary: infrequent feedings, small stools or missed stools, decreased urination or bright yellow urine. Measure your baby's length and weight; these should increase. You'll know something is not right if your baby's sucking becomes weak, you can't hear swallowing at feedings, the baby becomes lethargic and slow to respond or stops sleeping between feedings. Should you observe these behaviors for a couple of days in a row, seek out a health care provider.
THE 5TH THROUGH THE 10TH WEEK
In the second month of life, a baby might reduce the number of feedings to seven times per day. This is because he is growing and can take in more milk. Again, you will notice a change in bowel movements to either several small stools per day or a large one as infrequently as every couple of days. This is normal for a breastfed baby as the body is able to assimilate much of mama's milk with little waste. The wet diapers (6-8 per day) will continue in frequency, but check to be sure the urine isn't a yellow concentrate. Expect increased alertness, strengthened suck, audible swallows and a little milk dribbling at feeding time.
During the 5 to 10 week mark a baby that doesn't nurse at least seven times a day and produce the right amount of wet diapers (without dark yellow color) should be watched carefully. Make a note if your child stops gaining weight or doesn't grow in length. A baby that isn't getting enough nourishment may have a weak sucking reflex and may nurse without an audible swallow. If your baby becomes slow to respond, sluggish and stops sleeping between feedings, contact a health care provider. A couple of days in a row of these indicators mean that something is not well with your baby.
MONITORING YOUR BABY
A well-rested person would be hard-pressed to know when and how often an infant ate. Expecting a new, sleep-deprived mama to do this can be overwhelming. Have note paper and a pencil near the baby's bed. Write down the time of each feeding and changing along with your notes. An example might be: “2:00 a.m., Nursed 20 minutes, wet diaper/clear, bm - greenish yellow." For clarity, you may want to start a new page each day with the date written at the top.
Your detailed list will be of great value to you and your doctor should your little one become ill. This is also a good bonding tool for a new mama. You may be too tired to figure out why your baby is crying, but a quick check of your notes will tell you if it's been too long since he ate (hunger) or if he hasn't had a bowel movement that day (constipation). This helps mama learn the different sounds of her baby's cries. This list will then encourage a mother to trust her instincts as she learns to identify her baby's different cries and meet those needs.
Yet, BEST advice is often the most common advice, and it comes from the not-so-new mothers. Don't take for granted any of those first weeks. There's nothing more important than getting acquainted with your new baby. They aren't little for long.
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