Michael Smith, MD: Welcome to Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts on all things health and wellness. In today's episode, we're excited to welcome Dr. Nikita Singh, a Board Certified Pediatrician. Dr. Singh will guide us through Newborn 101, Everything You Need To Know In the First Month.

Dr. Singh, what are the most important things parents should do in the first 24 hours after bringing their newborn home? Because I know is the most nerve wracking part for new parents that first 24 hours. What do they need to be focused on?

Nikita Singh, MD: So it begins from right, having a rear-facing car seat. You want to make sure you have a rear-facing car seat, which is ideal for a newborn. If it's one of those that's actually going to grow and be used up until the two years of age, then you want to make sure you have a newborn insert in that car seat. Also you want to have a little bit of an idea about the feeding schedule, which the hospitals do a good job about.

If the lactation consultant of the hospital has not reached out to you, I would actually suggest you ask for a lactation consultant so that they can help you with the breastfeeding techniques and how you can be going ahead with your breastfeeding schedules. When you get home, it can be overwhelming, so you want to make sure you have some information before you get home and read some books or some information on newborn care before you actually have the baby home.

To begin with, feeding is one of the most important things because they are prone to jaundice in the first four days of life. So you want to make sure you learn the breastfeeding techniques and at least do 8 to 12 feeds as you reach home. I always suggest 15 minutes on each side of the breast, and then if you want to go ahead and pump after your breastfeeding sessions, you can go ahead and pump so that you build up a supply.

Other than that, make sure you have arrangements for safe sleep for the baby. So either a crib or a bassinet or an extension to the bed. The safest would be a crib or a bassinet. And anytime you're putting the baby to sleep, you want to make sure, always on the back and you don't have, you don't want to stuff the crib or the bassinet with soft toys or any extra cushions.

Just a light blanket would be enough. And if you're swaddling the baby, then that's not required either. So just two layers should be enough. So those two things are the most important when you get home.

Host: Fantastic. Very, very helpful. How do parents know, you know, speaking of feeding, right, how do they know if they're baby now, breastfed or not, like breastfed or formula fed, you know, either one. How do they know if the infant is eating enough?

Nikita Singh, MD: So the first cue will be you will get a good two-hour sleep. If you make sure the baby's comfortable with one layer of a body suit and a swaddle on top of it, then you will have a good nap of a two-hour that will, and the baby will be comfortable. So that's a cue that we are well fed. If the baby's sucking on her hand, or is rooting and is moving his head towards to find a nipple, or find the bottle, then at that point in time, it's the time to probably go ahead and feed the baby. In the first two days, three days, they're usually more tired and they don't really wake up every two to three hours. But you want to make sure you are not going beyond the stretch of four hours, even if they're not waking up, because that can lead to chances of hypoglycemia.

And also it can also increase the risk of jaundice in the first days of life. So you want to make sure every two to three hours it's a scheduled feed and usually they give you the signs. They will be finding the nipple or they will be actually rooting or they will be crying. So one of the signs, and you will learn the cue of your child as you spend more time with your child. So yeah, that's something that you will learn with time.

Host: Now every young parents are prepared for the crying. We all know babies cry, right? But what's considered normal amount of crying? And, once you answer that, help us to soothe the fussy baby to maybe bring down some of that crying.

Nikita Singh, MD: I know it can be overwhelming for a newborn parent actually at home. So if the baby is crying consistently for more than a two-hour stretch, and you've made sure that the baby's comfortable. We've swaddled well, there's nothing uncomfortable in the clothing. There's nothing stuck. Usually a hair stuck in their hand or foot.

Sometimes you want to check for that as well. You want to make sure there's no diaper area issue. We've done a good diaper change. The baby's diaper is not wet. And if you've taken care of all these things and you are sure that the baby is comfortable and well-fed at this point in time, more than two hours of crying is something I would get concerned about.

Less than that, sometimes we just need to get used to how to manage them. So I always suggest light swaddle, and some babies like it. Some babies don't like the swaddle, so if your child is not doing well with the swaddle and cries more, then probably don't do the swaddle. Just a body suit should be enough.

And the biggest help in this stage would be skin to skin. So I would suggest, like if in the nursing room, keep the lights dim as much as possible, maybe a white noise at the background, and do skin to skin with your child. That will help soothe the baby as well.

Host: So you, you mentioned over two hours though of continuous crying. That's a little bit more of a concern. Is that when they should call an expert like you, Dr. Singh?

Nikita Singh, MD: At that point in time, yes, I would reach out to the, either the office of the pediatrician and if the these, if the crying is also associated with like vomiting, diarrhea, or you're seeing any other signs, like maybe blood in stools, then at that point in time you don't even have to wait for the two hour stretch. Then you have to make sure you get the baby addressed at earlier than later.

Host: Now let's switch over to sleeping, right? We've covered the feeding and the crying. Now let's talk about the sleeping, and newborn sleep's confusing. So how much should the babies be sleeping? And give us some of those. Um, I know you talked about some of them, but some more of these safe sleep practices.

Nikita Singh, MD: Yes. So babies sleep, most of the day it's 16 to 20 hours sometimes they actually, as they come home, that's the amount of stretch you will be seeing them sleep. So I always suggest that sleep when your baby's sleeping for the mothers to have enough rest and they don't have the idea of day and night at this point in time.

So yes, you will be having to get up at night as well and it's going to be a lot. Make sure we've talked about the safe sleep practice. Make sure you have a bassinet crib, something that is making sure that we have a safe space for the child. Parents tend to think that maybe I'm not going to fall asleep and I'm just going to breastfeed in the bed and let me just do that.

And then you cannot gauge at that point in time, you are equally tired. So you want to make sure even if you trust yourself that you're not going to fall asleep, you keep the baby back in the bassinet once the breastfeeding is done. That will prevent any co-sleeping and the chances of SIDS are higher with co-sleeping and specifically in the earlier stages of life.

So you want to make sure that we are keeping the baby back in the bassinet. I suggest that, as we talked about, just one light swaddle, a one body suit and one light swaddle on top of it should be enough. For the first few times your baby might cry as you keep the baby in the bassinet, but it has to be about training the child and making sure you're doing it persistently so that they get in the habit of actually sleeping in the crib or the bassinet.

So it's about just keep, it's just about building the habit. So for the first three, four days, they're going to be fussy, they're going to be crying, they'll not want to stay in the crib. They'll want to be doing as much skin to skin. But if you assure that the baby is comfortable, then I would suggest keep the baby back in the bassinet and always on the back.

No pillow is needed at this stage. No inclination of the bed as well. Just a flat. Not even a very soft bed. I would suggest a firm mattress for a newborn and not a lot of toys or any kind of disturbances in the crib or the bassinet.

Host: We talked a little bit about when to be concerned about crying. Let's talk about some other things. When should parents call their pediatrician with things like fever, jaundice, or maybe just as they learn more about their baby, maybe just something unusual, so unusual behavior going on.

Nikita Singh, MD: So, I mean, there's a lot of, newborn things that parents might think is unusual. A lot of them actually call us about the umbilical stump being attached, and sometimes they get concerned about the umbilical stump. Usually the umbilical stump is attached when you come home from hospital and around day of week, one to three weeks after the birth, that dries out and falls off by itself. Until it falls off, always fold your diaper and then put the diaper on so that we are not affecting the area of the umbilical stump. The other thing they get concerned about is newborn rashes. There are certain rashes which are novel in newborn. It's called, Nevis Simplex. If you see a red dot on the forehead, on the nape of the neck, it's just basically blood vessels clumped up together and it goes away with time.

Those are also called angel's kiss and stork bite. So those rashes are normal. But the most important in the first 28 days of life is a fever in a newborn. A fever is any temperature, above 100.4 degree Fahrenheit, and any temperature above that in a less than one month old child is an emergency. At that point in time, I would also suggest you don't even have to place a call to your pediatrician. I would take the baby to the ED. Because any infection in the first one month of life can actually go directly to the brain because the blood brain barrier is not really formed at this point in time. So you want to make sure the baby is seen as soon as possible by either the emergency department, and I would suggest as soon as possible if you have a temperature.

So the other thing we come to on that is make sure nobody's sick around the baby, at least in the first one month of life. Nobody, even with a sniffle, is not around the baby.

Host: Very good. Now, you touched on some rashes we don't have to worry about, but what are some other common newborn health concerns that are really just normal and parents don't need to really worry about?

Nikita Singh, MD: So a little bit of jaundice is normal in every child. Now, parents sometimes get concerned if they see a little bit of yellowing of the face. When the yellowing actually gets really bad, if you see the full body is yellow, even below the umbilicus level, at that point in time, the jaundice is something that gets concerning for us. Jaundice in the first few days is normal, and specifically in breasted infants is normal because mom takes about four days to have her breast milk come in and they get rid of the jaundice from how much ever they pee and the stool, they will get rid of the jaundice from the pee and the stool. So if the mom has the breast milk come in earlier, the chances of jaundice are lower.

If the mom have the breast milk, has the breast milk come in later, sometimes the jaundice can get concerning. So, you want to make sure you get your baby seen for the newborn well child check. What they do at the newborn well child check is they see how much percent of weight has been lost in the first 14 days.

And about 14% of weight loss in the first 14 days is allowed. That's how much we allow the baby to have. Just that it should not be affecting the jaundice level. So you want to make sure you take the baby for the newborn, well child check. And sometimes the pediatricians might actually ask you to come back for a weight check or a jaundice check after that, if the jaundice is concerning, but some amount of jaundice is seen in all kids. If the jaundice level goes higher, it can go into the brain and affect the hearing and the brain. At that point in time, it gets concerning and that level, the pediatrician can assess better. So I would take the baby for the newborn well child check for sure.

Host: What's one piece of advice you wish every parent knew before their baby arrived?

Nikita Singh, MD: I mean, there's a lot of advices they will get before the baby comes. But I would, I always tell, it can be overwhelming. So if someone you trust offers you to help you during a newborn phase, accept the help. Don't take the guilt of it. Just accept the help. Even if that help will allow you to have a bath or will allow you to just have a meal for yourself, just accept the help because it can be overwhelming in the first few days.

You will not have enough time for yourself, and you need to be taking care of yourself as well. So accept help if someone is offering you help.

Host: That was great advice for the one of many things you could have said. Fantastic, Dr. Singh, this was a great interview. Thank you for sharing all of your expertise. I know this is going to help a lot of parents kind of calm down as they kind of go into that first few days with their newborn.

Thank you for tuning into this episode of Wellness First. We hope Dr. Nikita Singh's insights have provided you with valuable tips and reassurance as you care for your newborn in these precious early weeks. For more guidance on pediatric care, please visit St. Joseph Hospital Pediatrics. Don't forget to subscribe, rate and review the podcast to stay up to date on all of our latest episodes. See you next time on Wellness First.