Baby girls are precious and soft, but your daughter is far sturdier than she first appears. Still, she does need you to look after her health and give her continued medical care and checkups.Keeping your newborn healthy is a top priority in the first few months. The best way to do that is to limit your daughter’s exposure to illness. The immune system of newborns is less mature and developed than that of older children and adults. Because of this immature immune system, it’s a good idea to limit your daughter’s exposure to lots of visitors in the first weeks.Ask your daughter’s doctor when it is appropriate to take the baby into crowds, such as the mall. Stuffy stores and crowded spaces are breeding places for germs, so it’s usually best to stay far away for the first few weeks. Also, if friends or relatives have a cold or infection, ask them to delay visiting until they are better. If you, your partner, or a sibling becomes ill, of course it is harder (or impossible) to keep the baby from being exposed. But, if possible, limit the sick person’s contact with your daughter so this person doesn’t cough in her face or kiss the baby until they’ve recovered. Everyone in the household should practice good hygiene by washing their hands thoroughly before touching the baby. Keeping your baby girl healthy is very important in these first three months. To do this, you’ll need to give her ongoing professional medical care, so make sure you keep those doctor appointments for her checkups. Stephen Muething, M.D., associate director of clinical services for the division of General Pediatrics at Cincinnati Children’s Hospital Medical Center, says that babies generally receive routine medical checkups twice in their first three months: often at one week and then again at two months. To get the most out of these visits, Dr. Muething recommends that you prepare in advance. “I’m a big believer in the assertive parent,” he says. “Write down your questions and concerns. You’re probably going to be feeling tired. The baby may start crying during the exam. The doctor may be rushed, and with all that’s going on, it’s hard to remember what information you want to take home with you. Don’t just go with the doctor’s agenda during the visit and remain passive. Families who get more bang for their buck go in saying, ‘This is what we need to know during this visit: We have these three questions and we need to talk to you about this.’ ” One-week exam: When you take your daughter for her first medical checkup, consider it a good opportunity to learn more about your child’s health and to begin to get to know her doctor. Either before or during this visit, you’ll be asked a long list of questions that will help the doctor better care for your newborn. The first group of questions will pertain to prenatal history. The doctor may ask questions such as: What was the pregnancy like? Did you have any health problems? Did you get regular prenatal care? Did you take any prescription medications or over-thecounter drugs? Did you drink alcoholic beverages (including beer or wine) and if so, how much? Did you smoke during pregnancy? Did you use any drugs like marijuana or cocaine? (Don’t feel insulted by any of these questions. You should doubt the competency of a doctor who doesn’t ask them.) You will then be asked about the birth experience. The doctor may ask: Was the baby full-term or premature? If premature, how many weeks early was she born? How much did she weigh? Were there any signs of fetal distress during birth? How was she delivered (vaginally, by cesarean, with forceps, or a vacuum extractor)? How long did labor and delivery take? At birth, did the baby need any help breathing? Did she need to spend any time in a special care unit or the neonatal intensive care unit (NICU)? Did she need treatment for jaundice? How long did she stay in the hospital? Did the doctor who examined her in the hospital tell you of any problems? (If you did not give birth to your daughter—if she is adopted or you are providing foster care—the doctor will ask you for any information you have about her birth and prenatal history, and about the biological family’s medical history.) The doctor may also want to know about the baby’s life at home. He may ask: How is the baby doing with the main newborn activities—eating, sleeping, pooping, and peeing? When does she sleep and for how long? Where does she sleep? Do you always put her to sleep on her back, the safest position to prevent SIDS? How many wet diapers does she have each day? How often does she have bowel movements? How is the rest of the family doing? Do you feel comfortable taking care of the baby? Are you and your partner having any conflicts over her care? Are you getting any sleep? How is your mood (happy, elated, stressed, depressed, etc.)? Do you get support from family, friends, or hired caregivers? And so on. With this information in mind, the doctor will turn his attention to your daughter and give her a complete going over. He will double-check to make sure that nothing unusual was missed in the hospital such as a cleft lip, ear abnormalities, or heart murmur. He will also take a bit of blood to see if the baby has jaundice. (Jaundice gives the skin a yellowish color; it is caused by excess bilirubin, a by-product of old red blood cells.) The doctor will then begin the physical exam. He or the nurse will weigh your daughter and measure her length and head circumference. He may also take her vital signs (heart rate, breathing rate, and temperature) and record them on her medical chart. Then the doctor will give your daughter a thorough physical.He listens to the baby’s heart and lungs with a stethoscope. He examines her abdomen, checking to see that the umbilical cord is not getting infected and that the naval (belly button) is healing well. A few days after the cord has fallen off, normal skin should have grown over the navel. If not, the doctor may swab on some silver nitrate to help it heal. He feels your daughter’s abdomen to be sure that it is soft, not tender, and has no unexpected masses. While feeling her belly, he checks that her liver, kidneys, and spleen are not enlarged. He makes sure her hip joints are developing properly. He looks to see that the skin creases on both thighs are the same. Then he pushes the baby’s hips down into the table and rotates them, moving the knees outward and down toward the table. If he feels the joints slip, she may have a condition called developmental dysplasia of the hip. He checks your daughter’s femoral pulses (the pulses between the thigh and the abdomen) to make sure there is good blood flow from the heart to the lower half of the body. He examines her legs, feet, and overall skin color and condition. He examines the genitals. He checks to see that the labia (the folds of skin surrounding the opening of the vagina) are normal. He will also reassure you that if you see a mucosy vaginal discharge and sometimes a small amount of bleeding from the vagina that it is nothing to worry about. This discharge that may last for a week or so is due to the effects of hormones transferred from the mother before birth. He examines the head, noting the shape and feel of the fontanels, the “soft spots” where the bony plates of the skull have not yet joined. He checks her suck and gag reflexes. (Your daughter should suck when something is placed in the front of her mouth and gag when something is placed toward the back of her throat.) He examines her eyes to see if they are aligned, checks the position of the ears, and looks inside at the eardrums. At this first visit, the doctor will also focus on your daughter’s feeding. He may ask questions such as: How often does she eat? How long does she nurse at the breast, or how much formula does she take? Have you had any nursing problems? Does she seem satisfied after eating? The doctor will also want to make sure that you’re comfortable with your chosen method of feeding, be it breast or bottle. Two-month visit: In addition to a thorough physical, the doctor may also check your daughter’s reflexes at the two-month visit. Some that may be examined include: The startle (or Moro) reflex. A loud or sudden noise should make your daughter stretch her arms and legs out, then draw her arms back into her chest.The step and place reflex. If held as if she’s “standing” on a flat surface, your daughter will lift her legs as if taking steps. If held so the tops of her feet are dragging against a surface (such as the underside of a table), she’ll lift her legs as if to step up onto the surface. The Babinski reflex. If the sole of the foot is stroked from heel to toe, your daughter stretches her toes up and fans them out (the opposite of what older children and adults do, which is to curl their toes down). The doctor also checks how your daughter is developing. He does this by asking you questions, watching the baby, and interacting with her. He may check her development while doing the physical exam, or he may do a developmental exam separately. He is checking things such as: Does she watch people’s faces? Can she make eye contact? Does she move both arms and both legs equally? Does she make any sounds besides crying? Does she follow an object with her eyes as it moves from the side of her visual field to the midpoint? If she is placed on her stomach can she raise her head? If so, how far? Again, at the two-month-checkup, be sure to come prepared to ask questions and tell the doctor about your concerns. Most doctorvisits last less than 12 minutes, so being organized can help you get the most out of that time. Many doctors have phone hours when you can call with routine questions. In some practices, a nurse or nurse practitioner may handle most of these calls unless you specifically want or need to talk to the doctor. Don’t hesitate to call with your concerns, no matter how small they may seem. Of course, if you suspect your daughter is ill and may need prompt attention, don’t wait for phone hours—call your doctor immediately. Calls for Emergencies: If your daughter has any of the following conditions, call 911 or your doctor immediately, or go to the emergency room: trouble breathing head injury with loss of consciousness, vomiting, or blue or pale skin color bleeding that won’t stop poisoning seizures sudden loss of energy or ability to move high feverbloody urine bloody diarrhea any fever or abnormal behavior in a child under three months In the first three months of life, your infant daughter will give you plenty to wonder and worry about. The health concerns that many parents fret over include jaundice, hemangiomas, colic, and SIDS. Here are the facts: Jaundice: Jaundice, which causes yellowing of the skin and whites of the eyes, is quite common in newborns. It is caused by a buildup of bilirubin in the blood, a substance produced by the normal breakdown of red blood cells. Usually bilirubin passes through the liver and is excreted as bile through the intestines. But sometimes it builds up faster than a newborn can pass from her body. If bilirubin levels begin to climb too high after birth, and if the baby is born in a hospital, treatment with phototherapy begins right away before dangerous levels are reached. The baby is placed unclothed under blue or broad-spectrum white light until bilirubin levels fall. The light alters the bilirubin so that it is more rapidly excreted by the liver. If your daughter is already home when it emerges, she may be treated with a portable light unit or she may need to return to the hospital. Hemangiomas: Hemangiomas are large, noncancerous, bloodfilled, usually red birthmarks that affect about 10 percent of all infants by age one and are more common in infant girls. They are especially common in low birth weight, premature infants. Hemangiomas are caused by an abnormality in the blood vessels and occur most frequently on the face and neck. They usually donot pose a major threat to the child’s health, but because the birthmarks are prominent and may be unsightly, you may find them very upsetting. Only a small portion of hemangiomas require treatment, and most will resolve themselves before your daughter reaches school age. Colic: Some babies cry much more than others. There is no calming them, no rocking them to sleep, no relief for the parents. If your daughter is a crier, check with your doctor. She may have colic. Colic is the extreme end of normal crying behavior in a baby between three weeks and three months of age. In a baby with colic, the crying lasts longer (more than three hours a day), occurs more often (more than three days a week), and is more intense than expected for the baby’s age. As I quickly learned with my colicky middle baby, it is very difficult to console a baby once an episode of colic has started. The baby may seem to be in pain, flailing and screaming, with tense legs drawn up to her belly. But the crying is not due to hunger, a wet diaper, or other visible causes, and the child cannot be calmed down. Why do these babies cry so much? Your parents and grandparents may tell you that colic is caused by gastrointestinal problems such as stomach pain due to gas in the intestine and digestive problems such as milk allergies. But modern medicine now says it is not a disease. Today, evidence suggests that colic is due to the baby’s temperament and an inability to regulate crying. A baby’s temperament may make her extremely sensitive to the environment, and she reacts to the environment or changes to the environment by crying. The baby’s nervous system is immature, which results in her being unable to calm down once the crying starts. Although the parents of every crying baby suspect colic, only approximately 10 to 30 percent of babies actually cry long and often enough to wear the medical term. It is equally common among male and female babies, and in those who are breast-fed and bottle-fed. Fortunately, babies with colic grow and develop normally. They are just as likely as other children to be healthy and happy. (It’s my own sanity I came to worry about!) In most cases, colic goes away on its own in about three months. Dealing with colic. If your daughter’s doctor has confirmed that she is perfectly healthy and has no physical reason for her frequent crying, the best you can do is to use a trial-and-error method to find ways to calm the screams. When she is fed, rested, and diapered, you can try any of the calming strategies mapped out earlier in this chapter. In addition, you might find, as I did, that there is peace in constant motion: walk or rock her; put her in the swing or infant seat; sing songs and dance around the room; place her across your lap on her belly and rub her back while you sway your legs; put her in the car or stroller and take her for a ride—anything is worth a try. Often, despite your best efforts, your colicky baby will continue to cry. When that happens, it’s sooooo frustrating—enough to make you wonder why you ever thought it would be a good idea to have this baby in the first place. That’s when it’s time to step back and try to salvage your sanity. Here are a few strategies that worked for me:
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