Scott Webb (Host): There is perhaps no more joyous time than when we're expecting a newborn, but when it's your first newborn, you're likely to have more questions than answers. And I'm joined today by a guest who always has the answers parents need. Pediatrician, Dr. Nivedita More, is here again. And today, she's going to help parents prepare to bring that bundle of joy home.

This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Dr. More, it's always a pleasure to have you here. And I know that it's an exciting time, right? Having a baby, bringing a baby home, but parents want to be prepared. And that's why we have experts like you to help us be prepared. So, let's just talk about that. Like what should parents have prepared at home when they welcome that cherished, lovely, awesome newborn?

Dr. Nivedita More: You know, it's definitely nerve-wracking when there's so much out there to be bought for a newborn baby. And especially with the first time parents, they want to get everything that there is out there. In terms of what they absolutely need, they definitely need to make sure there's a nursery set up, a safe sleep area, which will start off in the parent's room really. We want the baby sleeping next to the mom, next to her bed, in a bassinet, in a safe sleep area. But they do need the nursery set up before bringing the newborn home. They need diapering supplies, they need clothing supplies, some feeding stuff, some bathing and grooming supplies. You know, health and safety supplies too, in terms of car seat, thermometers, clippers. They need comforting, soothing supplies like pacifiers and blankets just to make sure the baby stays warm. They need laundry and cleaning detergents for the baby clothing, which are hypoallergenic so that baby doesn't get rashes and things like that.

And definitely, not to forget the mother with the postpartum supplies. There's a ton of stuff out there, but moms frequently forget to buy stuff for their own needs. So, I want to make sure that the moms are prepared for healing appropriately after the baby's born. You know, having these essentials ready can help ease the adjustment to life with a newborn and allowing the parents to focus more on bonding and less on the last-minute shopping.

Host: Yeah. Just bringing a smile to my face, remembering back all of this and, you know, me primarily being the one out shopping. And it was truly, Doctor, one of the few times in my life where I just sort of spared no expense. Whatever it costs, I want the best, I want the most, I want everything, you know? So when we think about baby gear, right? And yes, I want to ask you what's required, but of course, you know, I bought things that weren't required. And my wife was like, "You're never going to use this." I said, "I know, but it's so adorable." And we were having a girl and I just have to have it. But from the required perspective, doctor, what's actually required?

Dr. Nivedita More: Absolutely. In this day and age, it's so much easier now to shop online. So luckily, parents don't have to get out of their homes to get stuff delivered anymore. So, that's taken a little bit of the edge off of most parents. And a lot of parents do shop ahead of time, which is good, but some of them, you know, have to scramble last minute.

First things first, to take the baby home from the hospital, parents do need to have a car seat that is required by the hospital before discharge. So, ensuring a rear-facing correctly installed car seat is key before parents take the baby home. This can be done at most police stations, and they can also be fitted at most fire stations in most cities and in your own neighborhood. So, make sure that the car seat's taken to the fire station or the police station if need be to fit it correctly in your car before the baby arrives. You can also do it after the baby arrives, but there's just a lot going on after that.

In terms of other safety supplies, we need safe sleep supplies, so we need a bassinet, we need appropriate swaddle blankets, and sleep sacks. For feeding supplies, American Academy of Pediatrics recommends breastfeeding all babies exclusively till six months of age. But we want all mothers to be set up for success right when they deliver their babies. So, for all mothers who are unable to exclusively breastfeed and for the working mothers, it may be best to be prepared with bottles and breast pumps to adequately nourish their newborn. Most insurances will cover breast pumps, and most OBGYN doctors will write a prescription, so it is covered through your insurance. Sometimes we need extra bottles, extra formula, for those moms who are unable to breastfeed. We need diapering supplies, so appropriate-sized diapers, wipes, diaper rash creams, just so that we don't get the nasty diaper rashes as a newborn. You know, we're dealing with a whole lot of stuff and then now we have a rash, and we don't want those things happening. So, it's best to be prepared.

We need bathing supplies after the umbilical cord falls off. We want to make sure that the babies are given a bath at home and we need gentle baby soaps and shampoos, which are again, hypoallergenic, which don't cause any rashes or drying of the baby's skin. We need some pacifiers for soothing, and any wrap or baby carrier for the babies ahead of time, just so that you can pacify the baby and hold them a lot as a newborn.

Host: Yeah. Well, that was the best, that new baby smell, doctor. You were talking about the and things. I always volunteered. I'm like, "I'll take her as soon as she gets out of the bath, because I just want to smell her head. I want to smell that new and clean baby. Just such a joy.

And, you know, Doctor, my experience at least being a dad twice here was that babies change, newborns change so much. So, maybe you can discuss that. Like, what do we need to be prepared for in those first three months?

Dr. Nivedita More: Babies change a lot, as you just said, you know, in the first three months, physically, emotionally, cognitively. The sleep changes, they develop differently. So in terms of physical growth, initially, they lose about 10% of their body weight in the first week, and then they gain it back by two weeks of life. They typically gain about an ounce a day after the first two weeks of life. And a lot of parents don't know this. So, they worry a lot and they're like, "Oh my gosh, my baby, you know, lost weight." But that's why there's pediatricians like myself who are there to reassure them about the baby's growth. They elongate very quickly, they grow in spurts and, you know, often, around three to six weeks of life and again at three months. So physically, there's a lot of growth to be achieved as a newborn.

Emotionally, they become more connected to their caregivers and may express joy or frustration more clearly by about two or three months of age. Cognitively, they become more aware of their environment and their abilities increase as they learn to track objects and react to stimuli. They also begin to understand basic cause and effect. So when they cry, they know they're getting picked up or when they cry, they know they're getting fed. So, they're really smart beings, so to say. I really enjoy that part of it, obviously. And the parents are still learning as to what cues are leading to what next.

In terms of sleep, they sleep a lot, as you know, as newborns, like anywhere from 14 to 18 hours a day in 24-hour period. And I always say they come out jet lagged from the womb, so don't call me if they're not sleeping at night because that's the normal newborn. They don't know what's day and night yet for the first six weeks. So, be prepared for that. By about three months, they start sleeping a little longer hours at night, anywhere from five to seven hours stretches. And then, they'll establish more of a routine between three to six months of age.

Developmentally, most babies spend their time sleeping, as I said, and feeding and having brief awake moments as newborns. They can't focus their eyes well, but are attracted to faces and high-contrast patterns like black and white stuff. They know black and white, but nothing else really. By three months, they're cooing, they respond to faces, voices, they start smiling socially. You know, they may try to reach for objects at that point. They grab things, bring them to their mouths. They have much better head control by three months, and tummy time definitely helps build stronger muscles for future milestone development, like rolling over and things like that. That happens about four months of age.

Host: Sure. So, what are some of those milestones that we should be on the lookout for and/or be concerned about if we're not seeing those things?

Dr. Nivedita More: Yeah. As a newborn, you know, we're not seeing a whole lot of milestone development. But a variety of primitive reflexes are seen more so in the newborn period. And the most important of which is the rooting reflex and the sucking reflex, which allows them to eat from the mother or from the bottle to be able to grow. You know, other reflexes include like a startle reflex or a grasp reflex. They have poor control, as I said, over their bodies, leading to poor neck control, head control. They have jerky hand and leg movements. And that's to be expected. I mean, parents worry, does my baby have a seizure? Do they have convulsions? I say, "No, no, no, don't worry. This is normal. These are jerky movements of the hands and legs. These are primitive reflexes. This will pass. Not to worry." Most of these reflexes disappear after the newborn period, allowing for babies to advance in their developmental milestones beyond that period.

Host: So, doctor, let's talk then, in terms of visits, what are your recommendations about bringing newborns to the pediatrician?

Dr. Nivedita More: Most newborns require regular checkups to monitor their growth, their development, and their overall health. However, there are also specific situations when it's important to bring a newborn to the doctor immediately. Some of those situations include a fever or, by definition, rectal temperature over 100.4 is considered a fever in newborns. And if that's happening, we want to know about it, especially in the first 90 days of life. So, the first 90 days are crucial in terms of, I call it the fourth trimester for the babies, because it's like an adjustment period to this whole new world that they are in. And at that time, we worry about a fever. We need to make sure that the parents are aware of this when they get discharged from the hospital and that they call us right away about it, because there are conditions from the mom, from the womb, from the pregnancy that can transfer over and manifest in these babies in the first three months of life.

If there's any sort of difficulty breathing, we want to know about it. There is something called periodic breathing that newborns do all the time where they breathe fast or they breathe slow, and that's normal. But if they are really gasping for air, if they're turning blue around their nose or lips or their face, little bluing of the tips of their fingers and toes is normal, but if I have a newborn who is blue on their face or their lips and they have trouble breathing, that's a baby we want to see right away or call 911 if need be.

Most babies get jaundiced. They get yellow, that's called jaundice. But some babies get more yellow than others, and they need more attention. This is why our first pediatrician visit is on the third to the fifth day of life, since that is when the jaundice levels peak for most newborns.

So, we have about six well-visits spread out throughout the first year of life. And the first one should be happening on the 3rd to the 5th day for a newborn. The next one happens at one month, then at two months, four months, six months, nine months, and then the last one is after the first birthday. And those are all tied around, you know, routine newborn care, routine baby care, vaccines, stuff like that.

Some of the other things that we want to be notified right away about are poor feeding or lack of weight gain. Babies lose 10% of their body weight, as I said earlier, in the first week of life, and then they gain it back up. They double their birth weight by five months of age, and they triple it by one year of age. So, there's rapid weight gain in the first five months, and then a little bit of a slowdown after that in terms of how much gain they have per day, so to say, you know, in the last half of the first year.

If they're crying excessively or are extremely irritable, especially during the first couple of weeks of life, it is most likely hunger. And I want to make sure that the parents are aware of it and they're not looking for other reasons for the crying or the irritability. So, making sure that the baby is well fed and that the parents are aware of the baby's needs helps with adequate weight gain, especially in the newborn period.

So if the baby is like colicky and unconsolable after the first couple of months, I'm not as worried. If they're gassy, if they're throwing up, these are not huge concerns for me. But in the newborn period, if they're vomiting excessively, they're crying excessively, they are irritable, unconsolable in the first few days of life, that is a huge concern for us and needs immediate attention.

Host: Yeah. And, you know, it's always great to have your expertise here, of course. I'll Just Give you a chance here as we wrap up, you know, final thoughts, takeaways, but really what you want families to know about those first few months.

Dr. Nivedita More: While there's a lot of advice out there, every baby is different. And I always encourage parents to trust their basic instincts. If something feels off with their baby, or if they have any concerns, it's always better to check in with their pediatrician, even if it turns out to be nothing. I always say just message us or call us. If you think something needs to be checked out, please don't hesitate to reach out.

Practicing safe sleep is of prime importance because we have something called sudden infant death, and we do not want babies to be placed on their tummies for sleeping. We emphasize placing them on their backs to sleep on a firm mattress without any loose blankets or pillows or stuffed animals in their bassinets or cribs. Room sharing is recommended, but bed sharing is not advisable at all for safe sleep.

Keeping up with routines and checkups and vaccinations is important. We encourage families to stick to the schedule for well-baby visits and immunizations periodically. We always set up appointments for their future visits, ahead of time in the newborn period so that way they're not scrambling at the last minute or they don't forget.

Taking care of themselves is extremely important. A lot of times, parents forget themselves and newborn care can be all-consuming, but I always remind parents that their well-being is very important. If they can't take care of themselves, they can't take care of the baby. Encouraging them to take breaks when possible. Eating well. Talking about how they're feeling with each other. Postpartum depression and anxiety are common, and we do screen parents for postpartum depression. In my practice, we also screen the fathers for postpartum depression. One in four moms can get depressed. One in 10 fathers can get depressed. I always let them know that milestones, they offer guidance. Babies develop at their own pace. And as long as the baby is growing and thriving, variations in milestones are often normal.

Host: Yeah, it's always a pleasure to speak with you. And I've appreciated this sort of stroll on memory lane, if you will. I'm sure we'll speak again soon. So, thank you so much.

Dr. Nivedita More: Thank you so much for having me on.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.