Amanda Wilde (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. In this episode, we’re focusing on pediatrics and newborn care with pediatrician, Dr. Soren Johnson from Novant Health. We’ll talk about what happens at that very first visit, how to know your baby is thriving, and what new parents really need to know in those first few weeks. I’m Amanda Wilde, your host. And Dr. Johnson, welcome. Thank you so much for being here.

Soren Johnson, MD: Yeah. Thank you. I'm glad to have the opportunity and thanks for having me.

Host: Well, I don't know the answer to this very first question that I'm going to ask you. When should that first appointment take place exactly? In other words, how quickly after birth should a newborn be seen by a pediatrician?

Soren Johnson, MD: Yeah, I mean, it's pretty universal. We generally want kids right out of the hospital to see their pediatrician either the next day or maybe at most two days later, just because it's a kind of a vulnerable period. And, don't worry, we're not going to leave you hanging very long.

They'll tell you in the hospital, with your baby, they'll say, "Look, we really want you to be seen tomorrow" or, "Go ahead and schedule for two days from now." They'll give you some guidance. But that would be a reasonable expectation. Sometimes rare cases, you know, it's going to be a holiday in there or something, you might have to stretch it a day more. But most of the time, one or two days.

Host: So, kind of right away. And that's actually reassuring, I think, especially for new parents. What are the key things you check during a newborn's first pediatric visit?

Soren Johnson, MD: There's kind of two main parts in my mind. One is just establishing that connection of what's hopefully going to be a great long-term supportive relationship. And it's why pediatricians go into pediatrics, is to watch kids grow and to get to know families and to get that bond going.

And it's important the other way. You want to have somebody you trust. So, just building that relationship is really key from the get-go. So, it's a little bit of get to know you. So, expect some questions, some personal questions probably. You know, "Hey, what do you do for work? How long is your maternity leave or paternity leave?" You know, just getting a sense of the lay of the land at home and getting to know the family structure.

And then, the second piece is more the medical oriented towards the baby. You know, what do we need to be focused on? What concerns do you have as a parent already? What's come up in the hospital? There'll be some work done ahead of time, before I even meet the family of reviewing the records and seeing what was the pregnancy course, were there any issues, things discovered on prenatal ultrasounds and whatnot.

And the hospital's going to be really good about sending communication in most cases about what specifically needs to be followed up. So, the parents generally don't need to, you know, be really, really rigorous about keeping track of everything because they're overwhelmed, and we know that. It's a new experience, and you're kind of deer in the headlights with most of the time your first baby. So, don't worry, a lot of this is happening behind the scenes. But then, in the room with the family, that's the other aspect of it that I'm assessing in my head is, "How's baby doing? How's mom doing? What are the mechanics of making sure everything's making the transition to the real world?

Host: So, thinking about that piece, how do you assess whether a baby is eating well, feeding well, and gaining enough weight in those first few days?

Soren Johnson, MD: The biologic questions, number one, yeah, how is feeding going? And that's generally one of my first kind of medical questions. And so, really the subjective experience is important. Obviously, the big choice there and, you know, you can do both. But it's are you formula feeding or are you doing breastfeeding? So, there's going to be a different sets of questions with each of those. And they're not mutually exclusive. Sometimes, you know, you do a bit of both until the breastfeeding really takes off if that's your desire. And breastfeeding takes a lot of work. So, a lot of times we make sure we connect you with support kind of regardless. If it's your first time breastfeeding, we're going to make sure you have lactation support and kind of know what to expect along the way or other tips. So, that's a big piece of it. We want to be sure you're feeding regularly. That's universal, no matter how you're feeding, every three hours, at a kind of minimum interval is pretty standard recommendation. And yeah, we just take it as it comes.

I think probably the most important thing to know ahead of time is that weight loss is normal. That's how Mother Nature designed the system. And for whatever reason, babies come out after delivery and they're going to lose some weight. So, that's not a failure. You're not doing anything wrong. That is just supposed to happen. And then, mom's milk might not really be coming in till day four, you know, maybe day three at the earliest if you're lucky with a first baby. And then, it's going to continue to come in stronger from there. So, just knowing that expectation that things are not necessarily going to go like gangbuster, you know, fire hydrant at the breast right out of the gate on day one.

Host: So besides support and resources, which are so important, you also help parents manage those expectations. I think eating and sleeping are usually the main concerns about a newborn, but what else do you check? Do you check physical features, reflexes? Do you have some ways to check neurological development?

Soren Johnson, MD: Yeah, absolutely. I mean, we're going to do a head-to-toe exam on that first day as well. And the baby will already have had that in the hospital, but it's good to have a new pair of eyes, a new brain, you know, looking for any issues that might present challenges down the road.

Listening to the heart and lungs, is everything sounding correct? The anatomy of the blood circulation takes a lot of—there are a lot of changes from being a fetus in the womb to how the blood circulates through the heart, then out of the womb in breathing in room air. So, we want to make sure that process is going fine and everything sounds good. Neurologically, it's kind of intuitive. Is your baby crying? Do they have a strong suck? Are they able to latch on, whether that's to a breast or a bottle or even a finger in the mouth?

Do they have kind of your typical baby reflexes, which are they should kind of do this instinct to reach out their arms and grasp, if they have the sensation of falling? And don't drop your baby. That's important. Don't do that. But that's part of our exam, and sometimes that makes babies cry, and we want to see them cry. We want a vigorous baby that will make a little noise and move all their arms and legs. And then, generally, just their strength and tone and, you know, are all the muscles seem appropriately strong.

Host: So, just a little more detail on that. What developmental milestones or behaviors do you expect to see, not only in those first few days and the first visit, but the first few weeks of a baby's life?

Soren Johnson, MD: Yeah. Initially, it's just kind of an instinct to suck, so you want the suck reflex there. And they're going to be sleeping a lot. So, they're not necessarily going to do a ton. But it's the key vital functions, you know, are you eating? Are you sleeping? Are you peeing? Are you pooping? How are you breathing? All these vital functions of life that should all be happening.

And the transition of, like, milestones along the way, they should periodically open their eyes and you should have the sense that they're looking at you or, you know, looking at things. Babies can't see very far and their vision's probably a little bit blurry, so they're not going to necessarily track as well as a bit of an older infant. But some sense of, "Okay, when I'm holding them in my arms, you know, they're looking at my face," is key. We don't really get smiles necessarily till closer to a month or two old. I mean, sometimes you'll get it really young, but don't expect that right out of the gate. Same with laughter, that's going to come a little bit later. So, those are probably the key things.

Host: Do you discuss vaccinations and schedules for vaccinations on that first visit?

Soren Johnson, MD: Yeah, absolutely. I think a lot of times it's already come up. So in the hospital, we generally recommend for all infants a hepatitis B vaccine. And so generally, that parents will have either already gotten that. Sometimes they prefer to wait until they get it in the pediatrician's office.

But if there's hesitations or questions, absolutely, this is a great time to talk about it, bring it up. And I think it just goes to that one of those fundamental, kind of foundational things that we do in pediatrics, is we want to do things to anticipate health challenges, anticipate risk. And vaccines are a huge part of that. I mean, it's one of the best tools we have to give someone a medicine that could prevent potentially something that might be deadly. So, you want to be sure you're seeing eye to eye and have trust in the information that you're getting from the pediatrician, but also that that pediatrician is respecting and supporting your values and hopes for how you want to go on that process.

So, it's a great time to ask those questions and make sure you have alignment there. If the pediatrician is saying things that are way off base from what you kind of as parents want for your child, then it's a good time to figure that out early rather than, you know, six months down the road.

Host: Yeah. Are there things parents should think about to get the most out of that visit, that first visit?

Soren Johnson, MD: I generally would say just bring your baby and all your questions. And we'll take it from there. I don't think you necessarily need to come with a huge checklist of things. There are always some logistic questions that you might have answers about, and you can ask the pediatrician those.

You might also be able to ask the office, when you make the appointment or when you check in some of the logistic questions like, "What are your hours?" You know, "Do you have weekend hours? What do I do if I have a question? Who do I call?" You know, "Who's going to answer my call?" Those kind of things. And so, that's going to be handled a little bit differently at every office

Host: So Dr. Johnson, what other areas or topics do you typically discuss? The medical health of the baby obviously, and some questions the parents may have. You mentioned the logistical ones. Are there any other topics you cover? I'm thinking, "Well, parents have a lot of anxiety, or there may be postpartum depression, or maybe they're just dealing with that lack of sleep that comes for all parents." Do you advise people on those topics?

Soren Johnson, MD: Absolutely. I mean, you know, the baby is not like an independent being yet, you know? So, I have to make sure and get a sense of what's the whole family support structure and how are you guys doing as parents, how are you adjusting? It's all important. So yeah, you may get some questions about that type of thing, like, "Who else lives at home? Tell me about that." Because yeah, I want to do everything I can to make sure that baby's going to thrive and do great and not in a judgmental way, just in a like, you know, do you need any extra support?

And so, you mentioned postpartum depression. That's certainly a great thing to be aware of that is super common and there shouldn't be guilt or shame associated with admitting like, "Wow, the hormone shifts have been crazy after delivery and I'm having anxiety," or "I'm feeling really down and depressed and I don't know why." Those are great opportunities to bring up those things. And sometimes everything's just a whirlwind in the first visit. So, maybe some of those things don't pop up until a couple weeks down the road or even a couple months down the road, but just knowing that that's normal and common.

Feeding ties in a little bit with jaundice, which is when babies can get kind of a yellowish hue to their skin, because right at delivery you get typically a bit of a transfusion, a bit of an extra kind of salvo of blood from the placenta into the baby's circulation. And that's great because it helps you give, you know, more fluid, but also transport oxygen well for the baby. But that blood that kind of transfers at that time doesn't last very long and it breaks down in the body fairly quickly. And as those red blood cells break down, they kind of get metabolized into this yellow pigment. And a little bit is normal, but too much is not good and can be dangerous for the developing brain. So, that's another kind of really common thing that we're keeping a close eye on in the first few days, first few weeks sometimes. So, that'll be something on your pediatrician's mind.

And, along with weight and feeding and jaundice, those are the two biggest factors that dictate when I'm going to tell that family to come back. So, sometimes I'm saying, "Hey, you need to come back tomorrow because I'm worried the baby's weight is a little bit too low," or, "Oh wow, your jaundice level is a little bit higher than maybe I would like at this age. Let's keep a close eye on that." So, those are common issues.

Fatigue and how to kind of just still be a human and try to function on what little sleep you're going to get, because the baby's going to be waking up and feeding every three hours is exhausting. But don't worry, it doesn't last forever. You know, it is a time-limited thing. It's generally only for a week or two that families are having to maintain that schedule.

Host: And pretty soon, they'll be in high school and you won't be able to get them out of bed.

Soren Johnson, MD: That's right. That's right. And then, other safety stuff, like a fever is a huge deal. You really don't want to take that lightly in a newborn. They do not have great immune systems in terms of they're kind of immunosuppressed a little bit, if you could think of it that way. Because otherwise, the baby's immune system would attack mom's immune system in the womb and vice versa.

So, that's kind of why that is the way it is, and it takes time to develop the immune strength and the immune response. But that's why we take any fevers really seriously. So, anything over 100.4 is the magic number, or 38 degrees centigrade Celsius. Those would be reasons to go right to the emergency room. Do not give Tylenol, do not give ibuprofen, do not give other medicines. It's not a, "Hey, wait 24 hours and call me tomorrow." It's a right now issue. Just trying to keep the baby safe from an infection standpoint. Just kind of some of those risks and safety concerns are things that we try to bring up just in case there's other questions or concerns.

Anyone who's sick should not be around the baby. I don't care if it's grandmom or your neighbor or a friend from work or whatever. If they're sick, they can wait to meet him or her. There's no point in taking a risk for just a social hello.

Host: Those are really important reminders to keep our babies safe and healthy, especially as newborns. And I think, Dr. Johnson, I get the impression from our conversation that the pediatrician is really the parent's medical resource, but also partner in care and telling us what is normal and what to be concerned about and what to know to expect as well. How rewarding do you find it to, as you mentioned at the beginning of our interview, connect with families and be able to watch the children grow and develop over time? As a pediatrician, you may follow them from birth to adulthood.

Soren Johnson, MD: Yeah. I mean, it's the best. It's absolutely the most rewarding part of the job. And, you know, hopefully, we don't run into issues, but trying to anticipate problems before they happen is great. Yeah, and absolutely don't hesitate to use your pediatrician as a resource.If you have questions, call. If you're a new parent, you haven't done it before by definition, and that's why your pediatrician is there to help support. So, don't feel like you're burdening the office if you have questions. Just fire away. And if we think, "Okay, well, that seems like it needs a visit," hey, we're going to tell you that over the phone and come on in.

You know, in regards to feeding too, I feel like I have to say this, like we're always pro-breastfeeding because there's that extra benefit of immune support and there's, you know, some good evidence to support that. But I also feel like moms really just get hit over the head with the guilt of like, "This is the most important thing that you can do for your baby," et cetera.

And while we support it, it's not the definition of parenthood or of motherhood. Your baby needs your love and attention and care, and you have that in spades. So, if breastfeeding is just a major challenge and it's not going well, it is okay. Like, formula works really great too. So, I don't want people to go into it just feeling like they're a failure if that doesn't just take off.

So again, I'm pro-breastfeeding, don't get me wrong. But I also have faced a lot of families that just are really upset when it's not going well. So, I like to just preempt that with saying, "Look, it's okay."

Host: Yeah. The anxiety only makes things much worse for the parent, and the baby's going to pick up on that as well. As you said, it's love and support that they need. And in the case of breastfeeding, bottom line, nutrition is what they need. So, if it's too difficult to do breastfeeding, it's just nice to have someone there, a medical professional, to take that weight off of a parent's mind.

Soren Johnson, MD: And it is. It is so special to be invited into these young families' lives. And, as you said, consult with them. I really do view myself there for coaching and guidance and consultant more than, you know, the directive like, "You have to do this this way," or whatever. That's not my style and probably not most pediatricians' style.

Host: And you give parents resources as well so that we have other pillars to rely on. Dr. Johnson, thank you so much for all this important information and just the consistent support and care you give babies and their families

Soren Johnson, MD: Yeah, my pleasure. Thanks for having me on the podcast

Host: That was pediatrician Dr. Soren Johnson from Novant Health. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Meaningful Medicine, a Novant Health podcast.