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What Pediatricians Wish Every New Mom Knew

Seems as though babies are always giving their mothers something new to worry about. Yet, as any pediatrician will tell you, self-confident moms aren't born, they're made. But that doesn't mean you need to sweat out every minor crisis on your own. To give you a crash course in confident parenting, we've rounded up pediatricians' opinions on nerve-racking-but-normal newborn health problems. Here are the top ten things your doctor wants you to know.

Your baby might be a loser --

in the weight department, that is. Babies typically lose about 10 percent of their body weight by day three of life. (Breast-fed babies may lose a little more than bottle-fed ones because breast milk doesn't usually come in until the third day postpartum.) What's the skinny on a newborn's weight loss? Because babies are sleepy from the trauma of birth, feeding isn't high on their list of priorities. What's more, they're also shedding some of the fluids they were born with, which can lighten their load. But don't panic. "Babies enter the world with enough fluid on board to get them through the first three to five days, whether they feed or not," says Suzanne Corrigan, M.D., a spokesperson for the American Academy of Pediatrics and a pediatrician in Dallas. "By a week, they'll have started gaining weight again," adds Miriam Bar-on, M.D., a professor of pediatrics at Loyola University Stritch School of Medicine, in Chicago. If your baby hasn't regained her birth weight by her two-week checkup or she loses more than 10 percent of her body weight in those first few days, your doctor may suggest a strategy such as supplementing with formula if you're breast-feeding.

You should trust your instincts.

Everyone from your mother to the mailman will be giving you advice. Though they might have more experience than you in the child-rearing department, don't discount your own hunches. After all, you rock, bathe, cuddle, diaper, calm, and feed this baby every day. Who could know him better than you do? "Your own intuition will get you through a lot of situations," says Gwen Wurm, M.D., M.P.H., director of community pediatrics at the University of Miami School of Medicine. "Most parents have a sixth sense about what their child needs. I'm not suggesting that you ignore the symptoms of illness, but if you think everything looks fine, then it probably is."

Rash behavior is routine.

A newborn's skin may be soft, but it's often not clear. Baby acne -- which typically erupts in the first few days to weeks of life -- is a major but temporary skin spoiler. "It happens when the mother's estrogen is still circulating in the baby's body, and it will go away on its own," says Dr. Corrigan. The same goes for milia, tiny white pimples on the face caused by blocked oil glands. Erythema toxicum, small white or yellowish bumps surrounded by red, blotchy skin, "freaks everybody out," says Dr. Corrigan. "We usually see it in babies under 10 days old. We don't know what causes it, but it generally lasts three to five days and means nothing." Seborrheic dermatitis, or cradle cap, can also cause scaly, flaking skin on your baby's eyebrows, behind her ears, and on her neck. Again, no treatment is necessary -- just cleanse with a mild, hypoallergenic soap. Rashes that need prompt attention? Any that are oozing or accompanied by a fever (which can indicate infection) and those that seem to get worse with simple treatment.

Spit happens.

You no sooner finish feeding your baby than boom -- she's wearing her meal. What's going on? The muscle that closes the opening to the stomach is sometimes floppy and underdeveloped in newborns, allowing formula or breast milk to come right back up. But don't worry that your baby will go hungry. "Spill out a tablespoon of fluid, which is half an ounce, on the counter," suggests Dr. Bar-on. "See what a mess it makes?" Add in the mucus that also gets regurgitated and what a baby spits up is going to look like a lot more than it really is. To help stop spit-ups if you're bottle-feeding, feed your baby in a semiupright position and tilt the bottle so that she swallows milk (not air) from the nipple. With breast or bottle, burp her several times, and keep her upright for a few minutes after feeding her.

Coughing is common.

Babies cough and sneeze for the same reasons we do: to clear their nasal passages of something irritating, such as dust, or to move mucus or saliva out of their throats. "Coughing and sneezing are the only ways babies have of clearing their airways -- of lint, spit-up, whatever," says Dr. Corrigan. "It doesn't necessarily mean illness." When might it signal a problem? When it's accompanied by congestion or a fever or it interferes with your baby's eating and sleeping.

Weird poop is perfectly normal.

Nothing gets parents more worked up than their children's bowel movements. What's normal depends on your baby and her diet. Breast-fed babies often poop loose, yellowy, mustardlike stools with every feeding. Bottle-fed babies, whose stools have more of a mayonnaisey texture, may go only two or three times a day. "Newborns often have an active gastro-colic reflex," says Dr. Bar-on. "Eating relaxes the reflex, which makes them poop." But even if your baby isn't prolific, don't worry. "Breast-fed babies can have a stool with every feeding, every other day, or even every four days and then have a big blowout," says Dr. Corrigan. "All are normal. And bottle-fed babies can poop three to four times a day, then twice a day, and then just once a day. As their digestive systems mature, they tend to have fewer stools." How can you tell if your baby is constipated? Don't rely on the grunting sounds she typically makes when she passes a stool -- she's just creating pressure to help herself evacuate. "It's not the number of stools that makes you see the doctor, it's the consistency," says Chitra Reddy, M.D., an assistant professor of pediatrics at the University of Medicine and Dentistry of New Jersey, in Newark. If her stools are hard several times in a row, she's probably constipated. Also call your doctor if your baby's poop is more watery than usual or is tinged with blood. "These could be signs of an infection or a formula intolerance," notes Dr. Reddy.

Baby belly buttons don't feel pain.

It's blackish-purple. Shriveled. And all-out gross. But your baby's umbilical-cord stump has no nerve endings, so don't be afraid to handle it. To help it fall off in the recommended two to four weeks, doctors suggest that you wipe it with alcohol after each diaper change. Let your doctor know if the cord hasn't fallen off after four weeks. Some rare immune problems are associated with slow-to-fall-off cords.

Doctors don't mind phone calls.

No woman wants to seem like a hysterical mother, but sometimes calls to the doctor are warranted -- and no one knows this better than pediatricians themselves. "Most of us are parents too," says Dr. Corrigan. "We know what it's like to be up with a sick child in the middle of the night. We know you can't schedule emergencies." And don't fret about bothering the doctor. If something's wrong, they want to hear from you. And if you call with a basic question (how to bathe your baby, how to tell if she's eaten enough) during office hours, chances are you'll speak with a nurse or other knowledgeable person who can give you the information you need. "Use your common sense and do what feels right," says Dr. Bar-on. "If you have questions, call."

Babies cry. And cry. And cry.

Most pediatricians say you can count on about three hours of crying a day -- from whimpering to full-blown wailing. "And that's a minimum," says Suzanne Corrigan, M.D. "Crying is the only way a baby has to communicate -- that he's hungry or annoyed or afraid or tired, among other things. Each of those cries will probably have a different tone, and it will take you a while to sort them all out." So if crying is normal, how can you tell when it really indicates a problem? "The crying will seem different in some way," says Gwen Wurm, M.D. It may sound more shrill than usual, or persistent or uncontrollable. If it's easy to calm your baby down, however, the crying probably doesn't signal anything serious.

Moms need sleep too.

What new mother doesn't check her sleeping baby's breathing -- not once, not twice, but several times a night? But a cradle watch will only make you more exhausted. "There's no proof that being hypervigilant will prevent something like sudden infant death syndrome," notes Dr. Wurm. "In fact, there's little evidence that even apnea monitors, electronic devices that observe breathing, prevent SIDS unless there's a medical reason to use one." A more sensible strategy: Put your baby to sleep on her back, use a firm mattress, remove blankets, pillows, and stuffed animals from the crib, and don't overbundle her. "There are concrete things you can do to decrease the risk of SIDS," says Dr. Wurm. But watching your baby's every breath isn't one of them.

12-01-1999