Basic Baby Care: Caring for Your Newborn

Congratulations! Your baby is finally here. You may have attended a childbirth class, or perhaps you have been nannying or babysitting for years. However, feeding and caring for your own newborn around the clock can be quite a different experience. Here are some essential baby care tips to help you feel more confident as a new parent.

Baby’s Weight Loss after Birth

It is expected that baby will lose between 5-10% of his birth weight in the first five to seven days, as he adjusts to his new world. However, he should be back to his originally plump self within 10-14 days.

Breastfeeding Basics

Skip to the next section for bottle-feeding

• Expect a newborn to nurse every one-and-a-half to three hours, or eight to twelve times a day, for the first few months. Mark feeding intervals from the start time of feedings.
• Get comfortable first. If Mom is not comfortable, baby will not be comfortable feeding. Try to relax, and don’t worry about doing everything just right.
• Hold baby skin-to-skin and guide baby’s movements toward your breast. Bring baby to the breast, not the breast to baby, to avoid straining your neck and back.
• Line up baby’s body so that his nose is opposite your nipple. You will be supporting him with one arm and supporting your breast with the other. Gently stroke his lips with your nipple. Aim your nipple closer to the roof of baby’s mouth to encourage a better latch.
• Don’t worry if baby only sucks for a short time. Baby’s stomach is about the size of a teaspoon, and colostrum is thick, rich, concentrated milk.
• Recognize a bad latch. If your nipple is flattening, like a duck’s bill, you have a bad latch. When baby comes off the breast, your nipple should be round.
• If baby is sleeping at the breast, break the latch and burp him or switch breasts. If that doesn’t wake him, remove all warm blankets and clothes, rub his feet, or change his diaper.
• Loosely watch the clock while feeding. Newborns may breastfeed for 20 minutes or more per breast. However, baby can typically get all the milk she needs in the first 15-20 minutes of sucking.
• If you have a tight or clogged duct, put a warm washcloth on the sore area before feeding. Let baby feed on the sore breast first.
• Wash breasts with water only (no soap) and wear a supportive bra that does not restrict milk flow.

For more information on the benefits and challenges of breastfeeding (See: Breastfeeding Challenges, Support and Information). Get tips from lots of moms who have breastfed successfully.

Breastfeeding Positions

• Alternate breastfeeding positions, especially if you are developing tight ducts. Some feeding positions draw more milk from one side of the breast than the other.
• Four popular breastfeeding positions are:

Did You Know?

Drinking Alcohol and Breastfeeding

Alcohol does pass from your bloodstream into breast milk. If you drink alcohol while breastfeeding, wait at least three hours to feed after a drink or “pump and dump” your breast milk. Pumping does not clear the alcohol from your system faster, but it does keep your supply steady. 

Here are some other tips:

• If you pump just before drinking an alcoholic beverage, you will have milk to feed during the wait period.
• Time your drink with one of baby’s longer sleep stretches.
• Drink water to dilute alcohol levels.
• Definitely don’t stop breastfeeding because you want to have an occasional drink.
• To remove all the guesswork from the process, try Milkscreen test strips for detecting alcohol in breast milk.

Breastfeeding: Checking Your Progress

The first week: breastfeeding is going well if…

• Your baby is breastfeeding at least eight times every twenty-four hours.
• Your baby has at least three to four bowel movements every twenty-four hours by day four (mustard yellow with curds).
• You can hear your baby gulping and swallowing at feedings.
• Once your baby latches on, your nipples do not hurt when baby nurses.
• Your baby is gaining weight. By the end of the first week, you should be making 19 to 30 oz. of milk each day.

Count baby’s diapers, if you are concerned he is not getting enough milk.¹

Age	Mom’s milk	Wet diapers every 24 hrs	Dirty diapers every 24 hrs
1-2 days	colostrum	1-2	Green-black tarry meconium
2-6 days	milk comes in	5-6 disposable (6-8 cloth)	at least 3 yellow or green stools
6+ days	milk supply adjusts to baby’s needs	5-6 disposable (6-8 cloth)	at least 3-5 loose stools, yellow
6 weeks	milk supply established	5-6 disposable (6-8 cloth)	bigger, less frequent stools

Collecting and pumping breast milk

• Wash hands with soap and water.
• Wash all pump parts and accessories with hot, soapy water, or use microwave steaming bags. If baby was premature or has health issues, your doctor may require bottle sterilization.
• Wait three to four weeks before introducing a bottle to avoid nipple confusion, although some choose to have other caregivers feed at night when rest is critical for Mom. 
• If employed outside the home, begin storing pumped milk at least one to two weeks prior to returning to work. Breastfeed in the morning, evening, weekends, and days off to maintain your milk supply. Strive to pump three times during an eight-hour shift, or every three hours that you are away from baby (e.g., 10 minutes of pumping during two breaks and 15 minutes during lunch).

Storing freshly expressed breast milk

• Swirl warmed milk to mix the cream on top with liquid below. Stored milk may separate into layers.
• Avoid adding warm breast milk to cooled breast milk from the refrigerator.
• Freeze milk in single feeding portions (2 to 5 oz.). Label bags with a marker before pouring.
• Lay bags flat to freeze. Use the oldest milk first (first in, first out).

Storage guidelines (for healthy full-term babies) ^2-4

• Room temperature: four to six hours at 66-78°F (19-26°C)
• Cooler with three ice packs: 24 hours at 59°F (15°C)
• Refrigerator: three to eight days at 39°F or lower (4°C)
• Freezer: six to 12 months at 0-4°F (18-20°C)
• Thawed breast milk: use within 24 hours

Practical tips from real parents: Introducing a bottle (with breast milk)

• Try your first bottle around age three to four weeks when baby isn’t extremely hungry. He may get upset, if he is starving and Mom is not there to feed.
• Have someone other than Mom give baby her first bottle.
• Tell your spouse to skip any strong cologne when feeding baby. Raid your dirty laundry hamper. Wrap the bottle in a nursing bra to help soothe baby with a familiar, comforting smell.
• Squeeze a little bit of milk on baby’s lips and wait for baby to take to the nipple. Be patient. It may take a few tries before baby gets the hang of bottle feeding.
• Make sure that the nipple is a stage 1 or low-flow nipple. Otherwise, baby may get too much milk (and an upset tummy) or become too satisfied with his new quick-and-easy dispensing system. Ideally, you want baby to be comfortable with both the bottle and breast.

Bottle-Feeding Basics

• Do not use whole milk, goat’s milk, evaporated milk, or any other substitute for formula.
• Sterilize new bottles before first use by submerging them in boiling water for five minutes. Hot, soapy water and air-drying or a cycle through the dishwater should be sufficient for continued use, unless directed otherwise by your child’s doctor.
• Mix formula with filtered tap water. Some parents prefer to boil water for formula for the first six months. However, it is not necessary unless you have a well or non-chlorinated water. Do not use bottled water, if possible, due to concerns of BPA leaching from the plastic. The EWG gives most brands of water bottles grades of C to F. If you do use bottled water, make sure it is fluoride-free.
• Wash hands thoroughly before mixing bottles, and mix formula exactly as recommended by the manufacturer.
• Do not buy expired formula.
• Do not freeze formula or leave it unrefrigerated for more than four hours.
• Make a few bottles ahead of time to be used the same day. Store in the refrigerator. Feed to baby within twenty-four hours of preparation.
• Do not mix breast milk and formula. It changes the composition of breast milk and may concentrate the micronutrients in formula beyond a level that your newborn’s kidneys can handle. Feed baby breast milk first then follow up with formula, if desired.
• Do not warm formula in the microwave, since it heats unevenly and can lead to burns. Use warm water in a bowl or a bottle warmer for heating.
• Get baby used to room temperature formula as quickly as possible to ease the burden of chasing down warm water while on the go. In the meantime, a travel thermos can help tote warm water for feedings.
• Never put a baby to sleep with a propped bottle.

The first week: formula feeding is going well if…

• Your baby is drinking 1.5 to 3 oz. every two to three hours.
• You are changing five to six wet and three to four poopy diapers per day.
• Your baby’s stool is yellow to green by the end of week one.
• Your baby is satisfied after feedings.
• Your baby is gaining weight at a rate of four to seven ounces per week.

Choosing the right infant formula

• If baby seems fussy after feedings, take notes and talk to your child’s doctor.
• Know the symptoms of an allergy to the protein in cow’s milk: vomiting, diarrhea, blood in baby’s stool, a rash, and/or abdominal pain.
• Choose organic formula, if you can afford it, to avoid GMOs, antibiotics, and growth hormones.
• If your full-term infant must be fed soy-based formula, due to an inherited lactase deficiency (rare) or a preference for a vegetarian diet, choose a non-GMO soy formula, such as Baby’s Only Organic Soy Formula.

Talk to your doctor before switching to expensive, sensitive formulas. Formula makers are creating new versions every day for colic, reflux, lactose intolerance, and everything under the sun, mostly to charge a premium. If you have selected a sensitive formula, and baby likes it, it may be because the formula is sweeter. For example, the first two ingredients of Similac Sensitive Infant Formula are “Corn syrup and sugar”.

Practical tips from real parents: Feeding preterm infants (born before 37 weeks)

Premature infants face a higher risk of infection due to an immature immune system. The antibodies and protective live cells in breast milk cannot be found in formula, making breastfeeding even more important for premature babies.

• Even if your baby does not look premature, he is still at risk for more problems than babies born full term. Preemies need breast milk.
• Preterm babies do not eat or feed like full-term babies. They fall asleep at the breast a lot, they have to be wakened to eat, and they may not empty a breast like a full-term baby would.
• If you have a newborn in the NICU (Neonatal Intensive Care Unit), you might want to rent a hospital-grade pump to keep your supply up in the first few weeks.
• My doctor told me to subtract the number weeks of prematurity when thinking about baby’s developmental age. This means that if your baby is born at 33 weeks, you should expect her to meet the milestones of a two month old around the four month mark. 
• Our twins were born early, and they started out gavage (guh-vahj) feeding—a tube runs through the nasal passage to the stomach—because they both had issues preventing them from getting enough milk. The syringe that fed their tubes contained my pumped breast milk. Don’t be intimidated with breastfeeding just because you have multiples: just start pumping. It’s worth it, and your babies need it.   
• If your babies are in the NICU (I had twins), just bring your hospital pump right up next to them. You don’t have to go into another room and then feel torn about where you should be. The hospital staff will support you.
• I quit pumping too early with my eldest daughter, who was born at 35 weeks. I didn’t do my homework on breastfeeding, I had a bad attitude about pumping, and I basically let the stress and frustration of our NICU experience overwhelm me. For my next child, who was also preterm, I drank more water, relaxed, and had more self-discipline with pumping because I finally understood the benefits.  

Burping

• Pat baby on her back at regular intervals to help release air swallowed while feeding.  
  • For breastfeeding, burp every five minutes in the first few weeks. This time interval will increase as baby gets older and her digestive system adjusts.
  • For bottle feedings, burp every half ounce in the first few weeks, then every two ounces as baby matures.
  • Burp anytime baby is fussy while feeding.
  • Burp at the end of every feeding.
• Try multiple burping positions and see what works best.
  • Upright: Baby sits upright over your shoulder.
  • Sitting supported: Baby sits on your lap with one hand holding her chest (palm facing the sternum) and the other hand patting her back gently.
  • Across the knees: Baby lies stomach facing down across the tops of your legs while you are seated with one hand patting the back.
• Always have a burp cloth handy.

Diapering

• Expect baby’s first stool after birth, called meconium, to be odorless, thick, and tarry in consistency. Meconium, which is sometimes released into the amniotic fluid before birth, is composed of materials that were ingested by baby in utero: mucus, bile, lanugo or tiny hairs, amniotic fluid, water, and other tiny cells. Thankfully, Mom’s early milk, called colostrum (pronounced coh-LOSS-trum), has a laxative-type effect during the first feedings to help meconium clear from baby’s system.
• Check bowel movements. By day three or four, they should be brown, yellow, or green (thicker yellow-to-green for formula-fed babies and runny, seedy, and yellow for breastfed babies). Bad colors for stool are red (blood), black (digested blood), and white (blockage in the liver).
• Always put a clean diaper beneath baby before removing the dirty one.
• Be sure to let baby’s bottom air dry for a moment after using wipes or a wet washcloth. You can also pat with a dry cloth.

Learn all about your #1 or #2 expense for baby in these articles: Best Diapers and Diaper Supplies, and The Diaper Download.

Diaper Rash

• To prevent and minimize rashes, change diapers frequently and allow time for baby to have fresh air on her bottom. When baby’s urine mixes with bacteria in her stool, ammonia forms that can be harsh against delicate skin. Other factors that can exacerbate rashes are: fragrances and chemicals in disposable diapers and wipes; chaffing from an ill-fitting diaper; and acidic foods such as citrus, berries, and tomato sauces, eaten by a breastfeeding mom.
• If disposable wipes are too harsh for baby’s skin, try a soft cloth and warm water after pee diapers, and warm water and a sensitive soap after poop diapers. Some parents like to keep a spray bottle of natural diaper wash and clean washcloths near baby’s changing area.
• If baby has a bad rash, clean his bottom in a sink or tub after bowel movements. Dry baby’s bottom with a soft towel and let it air dry before applying diaper cream and securing a new diaper.

Yeast rash vs. regular diaper rash

If baby gets a beefy red, bumpy rash that lasts more than two to three days and doesn’t respond to rash treatments, he might have yeast rash that requires medicine.Yeast rashes occur in both boys and girls. Babies taking antibiotics and moms nursing while taking antibiotics are more susceptible to yeast rashes.If your baby has recently had thrush, the yeast infection that started in the mouth can pass through the digestive system and end up in the warm, moist diaper region. Some women with chronic yeast infections may choose to take an acidophilus supplement, or a probiotic, such as Culturelle or Florastor, to maintain balance of intestinal flora.⁵

• If you have confirmed a yeast rash with your baby’s doctor, apply a topical anti-yeast or anti-fungal cream, such as nystatin, clotrimazole, or miconazole, or a mild corticosteroid cream. Diaper barrier or rash creams do not relieve yeast rashes.

Did You Know?

Baby’s Skin

Baby’s delicate skin is 20-30% thinner and less acidic than adult skin with a surface pH of around 5.5 (the pH scale goes from 0 to 14, and pH factor represents the balance between acid and alkaline.) Look for “skin-neutral” or “pH balanced” baby products, and resist the urge to bathe baby too frequently.

Bathing

• Limit newborn bathing to sponge baths until the umbilical cord falls off, around fourteen days postpartum.
• After the cord falls off, give baby one to two tub baths per week lasting no more than ten minutes. Babies with darker skin should be bathed once a week since they are more prone to dryer skin and skin problems.  
• Before baby’s first bath, lay out all of your supplies: a pouring cup, washcloth, cotton balls, baby soap, towel, a fresh diaper, and pajamas. If your home is cold or drafty, you may want to heat the room before bathing. Some babies will love bathing, and some will scream from start to finish.
• Wash baby gently yet assertively. Dried formula and breast milk can be particularly foul-smelling, if left to hide in baby’s skin folds.
• Never stick a Q-tip into baby’s ear. Only clean the outer ear area.
• Do not worry about touching baby’s soft spot, or fontanel, when washing her hair. The fontanel can withstand some handling. It did make it through the birth canal.
• Consider folding a soft, thick towel on the kitchen counter, or using a baby bath cushion, to “catch” baby after her bath for drying. Apply baby lotion to moisturize skin when slightly damp.
• Let baby hang out on a waterproof sheet or towel for some bare-bottom time, especially if he is prone to diaper rashes.

Articles for bathing baby: Avoid Dollar Store rubber ducks in the bath! Bath toys go in baby’s mouth instantly. Learn more about Bathing Supplies for baby and why you want to “Go Green” in this area.

Eco Tip

Green Soaps and pH

Most adult soaps have a pH factor of 9 to 11, including green offerings such as castile soap. These soaps can strip baby’s skin of natural oils, leading to dryness and eczema.

Umbilical cord care

• Keep the umbilical cord clean and dry.
• To avoid drying it out excessively, doo not clean the area with alcohol.
• Expect the cord to progress in color from bluish to yellowish green to brown to black before falling off about two weeks from birth.
• Fold baby’s diaper beneath the umbilical cord stump, if possible.

Circumcised males

• Keep the area clean by bathing in warm water with a baby cleanser. You may notice swelling, redness, or a slight yellow discharge; however, this should decrease as the circumcision heals. This process takes about seven to ten days. You may be instructed by your doctor to apply a touch of petroleum jelly to keep the tip from sticking to the diaper.

Uncircumcised males

• Keep the area clean with warm water and a gentle baby cleanser.
• Never force the foreskin back to clean the tip of the penis. Gently tense the foreskin against the tip and wash with care.

Care of the vagina

• To care for your daughter, gently clean the genital area front to back with a soft cloth, using only water. You may see some bloody vaginal discharge during the first few weeks of life, typically caused by hormones from Mom.

Nail filing and clipping

• Clip and file baby’s nails after a bath, or while baby is feeding. Better yet, have someone else clip and file after a bath while baby is feeding.        
• Expect baby to fuss during nail clippings; however, complete your task. You will regret not clipping or filing baby’s nails as soon as she makes a giant scratch across her face.  

Pacifier use

The AAP recommends pacifiers during the first year of life, with the following guidelines.⁶

• Offer a pacifier at sleep and nap times to reduce the risk of sudden infant death syndrome (SIDS), if baby wants to suck beyond what nursing or bottle-feeding can provide.
• Do not force a pacifier into the mouth, or coat it with any sweet substance.
• Do not reinsert a pacifier after baby falls asleep.
• If a baby refuses a pacifier, he or she should not be forced to take it.
• If you are concerned about nipple confusion, introduce a pacifier three to four weeks after breastfeeding has been established.
• Do not use pacifiers to replace or delay meals. Offer a pacifier only when you are certain that baby is not hungry.

Tummy time

In 1992, the AAP began instructing parents to put babies to sleep on their backs. Babies have resisted tummy time ever since. Yet not spending enough time face-down is associated with delays in motor skills, such as pushing up, rolling over, crawling, and pulling up to stand. If your baby is miserable during tummy time, perhaps these strategies can help.

• Offer tummy time when baby is content. This can begin as soon as she is home from the hospital.
• Get down on the floor with baby. She might feel abandoned if you just leave her to face-plant.
• Make tummy time fun. Sing to baby, listen to music, and dance while looking eye-to-eye.
• Distract baby from her discomfort. It’s hard to hold your head up, especially when your skull is 25% of your total body length and you spend 95% of your day on your back. Place baby on a colorful mat. Use a mirror, board books, rattles, and toys to distract her from the process.
• Prop baby up on a nursing pillow or rolled towel, then gradually remove these aids.
• Try different tummy positions outside of her structured tummy time. Place baby on your chest for rest. Burp baby across your knees. Place baby on an exercise ball and roll back and forth. Fly baby around the house face down.
• If baby continues to cry during tummy time, put her on the floor for just a few seconds, then increase to minutes several times a day until she works up to a higher comfort level.

Practical Tips from Real Parents: Newborns and Baby Care

• Try not to stress too much over baby’s appearance. Newborns can be funny-looking with cone-shaped heads, unruly hair, birth marks, redness, rashes, bruising, baby acne, scratches, and other marks. Most of these are due to Mom’s hormones and the birth process, and other than permanent birth marks, should subside in a few months.
• Newborns have some funny quirks. Their eyes are crossed (this should go away in two to three months), their skin peels, they get startled easily, and they get the hiccups a lot. This is all normal. 
• Keep baby facing you as long as possible in the stroller, car seat, and front carrier. More bonding will occur if baby can see your face while you talk.
• If you are unhappy with your pediatrician or pediatric practice, don’t be afraid to switch.
• Don’t schedule your newborn’s well-baby visits on Mondays. That is when all of the sick children from the weekend pile into the doctor’s office.
• Trust your instincts. Don’t let anyone talk you into doing something with baby that makes you uncomfortable, such as supplementing with formula too early or not taking baby to the doctor for an issue. You know your baby better than anyone.
• Do not be so set on advice from books, or the opinions of doctors, that you disregard what you know about your baby.

Related content: For more high-quality baby research and practical tips from real parents, try the following articles:

• Colic and Crying
• Sleep Guide: Age Newborn to Three Years
• Baby Sleep Training: Putting Baby on a Schedule (Summary of all the Books)
• Breastfeeding Challenges and Support
• Breastfeeding Nutrition and Food Sensitivities
• Breastfeeding Grocery List
• Starting Solid Foods (AAP recommendations and practical advice)
• Starting Solid Foods: Food Allergy Awareness
• Anxiety, Depression, and Postpartum Depression
• New Mom Isolation
• New Mom Weight Gain (that isn’t from pregnancy)
• How to Dress Skinnier After Baby
• Baby Proofing and Child Safety Checklist
• Car Travel with Baby
• Air Travel with Baby
• Autism Signs and Awareness
• Top 10 Toxins Causing ADHD and Autism (Please read!!)
• Green Cleaning Products and Tips
• Keeping Baby Healthy During Cold and Flu Season
• Raising a Smart Baby

Sources

1.         La Leche League International, Is My Baby Getting Enough Milk? New Beginnings, 2008. 25(5): p. 44-45.

2.         Hamosh, M., et al., Breastfeeding and the working mother: effect of time and temperature of short-term storage on proteolysis, lipolysis, and bacterial growth in milk. Pediatrics, 1996. 97(4): p. 492-8.

3.         Academy of Breastfeeding Medicine (ABM), Academy of Breastfeeding Medicine (ABM) clinical protocol #8: human milk storage information for home use for full-term infants Breastfeed Med, 2010. 5(3): p. 127-30.

4.         Jones, F. and M. Tully, Best practice for expressing, storing and handling human milk in hospitals, homes and child care settings. 2005, Raleigh, NC: The Human Milk Banking Association of North America (HMBANA).

5.         Sears, W. Thrush. Ask Dr. Sears 2015; Available from: http://www.askdrsears.com/topics/health-concerns/childhood-illnesses/thrush.

6.         American Academy of Pediatrics. Nonnutritive Sucking: Pacifiers. April 28, 2014; Available from: http://www2.aap.org/ORALHEALTH/pact/ch8_sect1b.cfm.