Thursday, October 4, 2007

Your Baby's First Year

When your baby first arrives, you may feel a bit overwhelmed by the job of caring for her. Even such routine tasks as diapering and dressing her can fill you with anxiety–especially if you've never spent much time around babies before. But it doesn't take long to develop the confidence and calm of an experienced parent, and you'll have help. While you are in the hospital, the nursery staff and your pediatrician will give you instructions and support your needs. Later, family and friends can be helpful; don't be bashful about asking for their assistance. But your baby will give you the most important information–how she likes to be treated, talked to, held, and comforted. She'll bring out parental instincts that will guide you quite automatically to many of the right responses, almost as soon as she's born.

The following sections address the most common questions and concerns that arise during the first months of life.

Day to Day

Responding to Your Baby's Cries

Crying serves several useful purposes for your baby. It gives him a way to call for help when he's hungry or uncomfortable. It helps him shut out sights, sounds, and other sensations that are too intense to suit him. And it helps him release tension.

You may notice that your baby has fussy periods throughout the day, even though he's not hungry, uncomfortable, or tired. Nothing you do at these times will console him, but right after these spells, he may seem more alert than before, and shortly thereafter may sleep more deeply than usual. This kind of fussy crying seems to help babies get rid of excess energy so they can return to a more contented state.

Pay close attention toyour baby's different cries and you'll soon be able to tell when he needs to be picked up, consoled, or tended to, and when he is better off left alone. You may even be able to identify his specific needs by the way he cries. For instance, a hungry cry is usually short and low-pitched, and it rises and falls. An angry cry tends to be more turbulent. A cry of pain or distress generally comes on suddenly and loudly with a long, high-pitched shriek followed by a long pause and then a flat wail. The "leave-me-alone" cry is usually similar to a hunger cry. It won't take long before you have a pretty good idea of what your baby's cries are trying to tell you.

Sometimes different types of cries overlap. For example, newborns generally wake up hungry and crying for food. If you're not quick to respond, your baby's hunger cry may give way to a wail of rage. You'll hear the difference. As your baby matures his cries will become stronger, louder, more insistent. They'll also begin to vary more, as if to convey different needs and desires.

The best way to handle crying is to respond promptly to your infant whenever he cries during his first few months. You cannot spoil a young baby by giving him attention; and if you answer his calls for help, he'll cry less overall.

When responding to your infant's cries, try to meet his most pressing need first. If he's cold and hungry and his diaper is wet, warm him up, change his diaper, and then feed him. If there's a shrieking or panicked quality to the cry, you should consider the possibility that a diaper pin is open or a strand of hair is caught around a finger or toe. If he's warm, dry, and well fed but nothing is working to stop the crying, try the following consoling techniques to find the ones that work best for your baby:

• Rocking, either in a rocking chair or in your arms as you sway from side to side

• Gently stroking his head or patting his back or chest

• Swaddling (wrapping the baby snugly in a receiving blanket)

• Singing or talking

• Playing soft music

• Walking him in your arms, a stroller, or a carriage

• Riding in the car

• Rhythmic noise and vibration

• Burping him to relieve any trapped gas bubbles

• Warm baths (Most babies like this, but not all.)

Sometimes, if all else fails, the best approach is simply to leave the baby alone. Many babies cannot fall asleep without crying, and will go to sleep more quickly if left to cry for a while. The crying shouldn't last long if the child is truly tired.

If your baby is inconsolable no matter what you do, he may be sick. Check his temperature (see Taking a Rectal Temperature, page 78). If it is over 100 degrees Fahrenheit (rectally), he could have an infection. Contact your pediatrician.

The more relaxed you remain, the easier it will be to console your child. Even very young babies are sensitive to tension around them and react to it by crying. Listening to a wailing newborn can be agonizing, but letting your frustrations turn to anger or panic will only intensify your infant's screams. If you start to feel that you can't handle the situation, get help from another family member or a friend. Not only will this give you needed relief, but a new face can sometimes calm your baby when all your own tricks are spent. No matter how impatient or angry you feel, do not shake the baby. Shaking an infant hard can cause blindness, brain damage, or even death.

Above all, don't take your newborn's crying personally. He's not crying because you're a bad parent or because he doesn't like you. All babies cry, often without any apparent cause. Newborns routinely cry a total of one to four hours a day. It's part of adjusting to new life outside the womb.

No mother can console her infant every time he cries, so don't expect to be a miracle worker with your baby. Instead, take a realistic approach to the situation, line up some help, get plenty of rest, and enjoy all those wondrous moments with your child.

Helping Your Baby Sleep

Initially, your infant doesn't know the difference between day and night. Her stomach holds only enough to satisfy her for three or four hours, regardless of the time, so there's no escaping round-the-clock waking and feeding for the first few weeks. But even at this age, you can begin to teach her that nighttime is for sleeping and daytime for play. Do this by keeping nighttime feedings as subdued as possible. Don't turn up the lights or prolong late-night diaper changes. Instead of playing, put her back down after feeding and changing her. If she's napping longer than three or four hours, particularly in the late afternoon, wake her up and play with her. This will train her to save her extra sleeping for nighttime.

Positioning for Sleep

For many years it has been recommended that infants, particularly in the age range from birth to four months, be placed on their stomachs for sleep. This was thought to be the best way to avoid aspiration (sucking food into the trachea or windpipe) in case of vomiting or spitting up. Recent information, however, indicates that the back is a safer position, particularly as it relates to Sudden Infant Death Syndrome (SIDS). Therefore, the American Academy of Pediatrics recommends that healthy infants be placed on their backs for sleep. The exact reason for this finding is not certain, but it may be related to the stomach-positioned infant getting less oxygen or eliminating less carbon dioxide because she is "rebreathing" air from a small pocket of bedding pulled up around the nose. Although sleep position is probably not the only reason for SIDS, it seemed to be so strongly related that the Academy felt obligated to make this recommendation. Please note that there are some exceptions to this new recommendation, which your pediatrician can discuss with you.

This recommendation applies to infants throughout the first year of life. However, the recommendation is particularly important for the first 6 months, when the incidence of SIDS is the highest.

It is also important to avoid placing your baby down for sleep on soft, porous surfaces such as pillows or quilts. Her airway may become blocked if her face becomes burrowed in such surfaces. A firm crib mattress covered by a sheet is the safest bedding.

As she gets older and her stomach grows, your baby will be able to go longer between feedings. In fact, you'll be encouraged to know that more than 90 percent of babies sleep through the night (six to eight hours without waking) by three months. Most infants are able to last this long between feedings when they reach 12 or 13 pounds, so if yours is a very large baby, she may begin sleeping through the night even earlier than three months. As encouraging as this sounds, don't expect the sleep struggle to end all at once. Most children swing back and forth, sleeping beautifully for a few weeks, or even months, then returning abruptly to a late-night wake-up schedule. This may have to do with growth spurts increasing the need for food, or, later, it may be related to teething or developmental changes.

From time to time you will need to help your baby fall asleep or go back to sleep. Especially as a newborn, she probably will doze off most easily if given gentle continuous stimulation. Some infants are helped by rocking, walking, patting on the back, or by a pacifier in the mouth. For others, music from a radio or a record or tape player can be very soothing if played at moderate volume. Even the sound of the television, played quietly, can provide comforting background noise. Certain stimulation, however, is irritating to any baby--for example, ringing telephones, barking dogs, and roaring vacuum cleaners.

There is no reason to restrict your baby's sleeping to her crib. If, for any reason, you want her closer to you while she sleeps, use her infant seat or bassinet as a temporary crib and move it around the house with you. (She'll be perfectly happy in a padded basket if you don't have an "official" bassinet.)

Excerpted from
Your Baby's First Year
Copyright © 2004 by American Academy of Pediatrics
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