As if 40 weeks of pregnancy and chocolate-covered-strawberry cravings -- and enduring a labor -- weren't enough of a challenge, now comes the real test: raising that little baby. There's no shortage of early-on issues, especially for first-time parents. You've got concerns about what goes in one end, how often it comes out the other, when baby will finally sleep through the night, and why in the world you can't get that ESPN-watching lug to fold a bodysuit every once in a while.
While many of the issues below are complex enough to warrant deeper discussion, this serves as a quick and easy stress-busting guide.
Really, how much better is breast milk?
You've heard it from docs, from nurses, from lactation consultants, from everyone: natural nectar rules. "Breast milk provides immunity that even the best formulas don't offer," says Ellen Rome, MD, pediatrician at Cleveland Clinic Children's Hospital. "Plus, it comes in handy-dandy carrying packages at just the right temperature." It has many other advantages: it's free, it helps Mom burn up to 500 extra calories a day, and studies show that breastfed babies may have higher IQs. But, Dr. Rome says, if you can't breastfeed or choose not to, leave the guilt at the door. After all, formula contains most of the same important nutrients as breast milk. "Breastfeeding doesn't work for everyone," Dr. Rome says. "And generations of us were raised perfectly fine after being bottlefed."
Why is breastfeeding sometimes so awkward and painful?
The mouth-to-nipple union isn't always a smooth one. In fact, the most common nursing problem for new moms is when baby can't latch on. "Sometimes it just takes trial and error with different positions -- and a ton of patience," Dr. Rome says. Try the classic cradle hold or even a football grip (hold him to your side like a football). To detect a good latch, listen for a change of sounds -- from short, quick sucks to long, slow gulps (his jaw will move up and down when he's getting milk). If it hurts, and it shouldn't after a few days, make sure his mouth covers your entire areola, says Mehmet C. Oz, MD, coauthor of YOU: Having a Baby. Cracked nipples? Try a lubrication cream from Lansinoh or Mustela. For any troubles, talk to a lactation specialist.
How in the world do I get my partner to help out more?
Before I had kids, I remember having a debate with a new mom (and friend) I worked with. She was breastfeeding her infant and thought that her husband (also my friend) should wake up for every feeding, change the child, and bring the baby to her so she could feed him while half asleep. I defended the husband (we were on the same softball team, after all), arguing it didn't make sense to make both parents lose sleep when he was working in the morning and, really, baby needed only one set of nipples: Mom's milk-producing ones.
I don't think most men take a backseat maliciously; it isn't that they're too lazy to help or that they think baby can get a clean diaper right after the Packers score. It's just that most need a nudge. Women may think that a man should help just because. But if you explain what you need and why -- as obvious as it probably seems to you -- it stimulates the problem-solving center of his brain. After a few (hundred) times, he may catch on. Make his chores a habit early, and he'll start working as your copilot, not as a passenger along for the ride.
What about poop -- how much is too much?
Turns out, a baby's poop patterns are about as varied as weather cycles. After the first few weeks of life, it's perfectly normal for a breastfed baby to go seven times a day or once every seven days; formula-fed babies often poop somewhere between several times a day to once every two days, says Michael Steiner, MD, a pediatric expert at N.C. Children's Hospital at the University of North Carolina, at Chapel Hill. An infant's poop can be many different colors, but you should get it checked out if it's white or bloody. White can mean that the liver is having trouble metabolizing food, although this is not a common problem. And bloody stool can be caused by a number of things, such as an anal tear, allergens, even blood from Mom's cracked nipple.
Spit-up and reflux: what's the difference?
You surely expect your shirt to occasionally play the role of bull's-eye for baby's digestive arrows. It's normal for some of baby's milk or formula to come back the way it went down, and the truth is that reflux and spit-up are different names for the same thing. Spitting up is dangerous only if it prevents a baby from gaining weight and growing normally. (That's when spit-up becomes GERD, or gastroesophageal reflux disease, and you should seek a doctor's input.) One cause: more milk than baby's stomach can hold. So slow down, burp baby often, and experiment with feedings -- some kids do better with less milk spread out over more feedings. "Reflux usually starts and can worsen any time from birth to 4 months; then it slowly starts getting better," Dr. Steiner says. That's because certain stomach muscles become stronger, and baby's spending more time upright than vertical. In 99 percent of kids, it will be totally gone by 11/2 years.
Are there any times when doctors don't want me to call?
Nope. "Doctors always want parents to call if they're worried about what's going on," Dr. Steiner says. Always pick up the phone if you feel something needs immediate attention (high fever, breathing issues) -- even if you reach an on-call doc, a nurse, or the after-hours clinic that your pediatrician is affiliated with. But if the issue doesn't require immediate attention (hello, runny nose), most docs prefer you wait until regular office hours or even until the next visit, in some cases.
What's the bottom line on vaccines?
The Centers for Disease Control and Prevention and the American Academy of Pediatrics have a standard vaccination schedule(find it at aap.org). Most pediatricians support this schedule as a way to protect children against diseases. "It's safe to immunize your child," Dr. Rome says. "There's no data that says vaccines are going to cause autism in your child. That's a popular myth." But that doesn't mean the issue is without controversy. Some parents prefer alternative schedules to spread out certain vaccines: some wish to postpone the MMR until after age 2 because they think it may lower the risk of autism; others believe that the Hepatitis B vaccine, typically given at birth, isn't necessary until later if the child doesn't have a high risk of contracting Hep B. (One downside is that alternative schedules are harder to manage because most doctors don't follow them.) If you have concerns about the timing of your child's vaccine schedule, talk with your pediatrician.
Originally published in the September 2009 issue of American Baby magazine.
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