Growth and Development, Newborn

Overview

What kinds of development occur in your baby's first month?

Amazing changes are happening in your newborn's development. Babies' brains develop quickly, as they begin to think, learn, and remember. Newborns listen to and learn the sounds of language. They can communicate with sounds and facial expressions. Newborns also start to develop motor skills. They have all their senses, like hearing, smell, and touch.

How can you help your newborn grow and develop?

The most important way to help your baby grow and develop is to communicate with them. Use a high-pitched voice, gentle touch, hugs, and kisses. An environment that is rich in stimulation, comfort, and loving attention helps your baby develop. Research shows that babies who are talked to throughout their first few years usually learn language skills more easily than those who are not. Newborns are more interested in their caregivers than they are in toys or other objects.

How do you know if you are caring for your newborn correctly?

You may feel overwhelmed during your baby's first month and wonder "Am I doing this right?" No previous life experiences prepare first-time parents for this new role. It is completely normal to be confused and frustrated by your newborn.

You'll become familiar with your newborn's needs by paying attention to their behavior. For example, a fussy cry and turning away usually means "Change what we are doing." And an alert, bright-eyed look means "I'm interested in what's going on." Trusting your instincts—to cuddle and rock a crying baby or to talk to your baby in a high-pitched "baby talk" voice—is usually the "right" thing to do. You will start to develop a rhythm with your baby, where you will be able to read each other's needs and moods.

What checkups will your newborn have?

Your baby's first checkup starts in the hospital right after birth. The first tests your baby will have are:

• Apgar scores. This test checks certain physical traits to help find out if your newborn needs any treatments or special monitoring right away.
• Temperature and vital signs.

Soon after birth, your baby may also have:

• A physical exam. This will check your baby's breathing and heartbeat. Your baby will also be checked to make sure they can pass urine and stool.
• Measurements of length, head circumference, and weight.
• Antibiotic eyedrops or ointment. Newborns can get eye infections from bacteria in the birth canal. These drops are required in some states.
• Screening tests. These can include hearing tests and tests that check for diseases. These diseases may include congenital heart disease, jaundice, and genetic diseases, like sickle cell disease and cystic fibrosis.
• Injections. These can include vitamin K and immunizations, such as hepatitis B.

What to Expect

Although your newborn sleeps a lot, powerful changes are occurring in the five major areas of development.

Physical development.

Watching your baby grow in size is part of the fun of being a new parent. Don't be alarmed if your newborn loses some weight shortly after birth. Most babies regain the weight within 10 to 12 days. Most newborns gain about 4 oz (113 g) to 8 oz (227 g) a week and grow about 1 in. (2.5 cm) to 2 in. (3.5 cm) in the first month.

Cognitive development.

Cognition is the ability to think, learn, and remember. Your newborn's brain is developing rapidly. You promote healthy brain growth every time you interact in a positive way with your baby.

Emotional and social development.

Newborns quickly learn to communicate. They seek interaction with you and express how they feel with sounds and facial expressions. At first, instinctual behaviors, such as crying when uncomfortable, are your baby's ways to signal their needs. Soon your newborn starts to subtly communicate and interact with you. For example, your baby's eyes will track your movements. And your baby's face will brighten when you cuddle and talk soothingly. Even at a few days old, your baby may try to mimic you sticking out your tongue.

Language development.

Your newborn is listening to and absorbing the basic and distinct sounds of language. This process forms the foundation for speech.

Sensory and motor skills development.

Newborns have all five senses. Your newborn quickly learns to recognize your face, the sound of your voice, and how you smell. Your newborn's sense of touch is especially developed, particularly around the mouth. Your baby also has a strong sense of smell. After a few days, your newborn hears fairly well and responds most noticeably to high-pitched and loud sounds. Your baby recognizes and prefers sweet tastes to sour, bitter, or salty tastes. Vision is developing quickly but is believed to be the weakest of the senses. Motor skills develop as your baby's muscles and nerves work together. Movements are mostly controlled by reflexes, such as the rooting reflex. This occurs when a newborn's head turns and their mouth "reaches" toward a touch. Hands are tightly fisted when the baby is alert.

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Common Concerns

You may feel prepared for your baby. But the reality of the constant care a newborn needs can shock many parents. A newborn affects your life in ways that you simply can't expect. Only through experience can you fully understand the impact of these new responsibilities and how your roles will change. Many parents shift between feeling confident and ecstatic one minute, and drained, scared, and unsure the next.

When you realize that your baby is physically completely dependent on you, you may worry whether you are giving your baby the best care. Common concerns in this first month include:

Umbilical cord care.

Basic care of your baby's umbilical cord is keeping it clean and dry. To keep the cord dry, give your baby a sponge bath instead of bathing your baby in a tub or sink. Keep your baby's diaper folded below the stump. If that doesn't work well, before you put the diaper on your baby, cut out a small area near the top of the diaper to keep the cord open to air. The stump usually falls off within a couple of weeks.

Your newborn's sleepiness.

In the first few days after birth, your baby may sleep a lot and only be awake to eat or have a diaper change. Your baby will become gradually more alert throughout the month. By the end of the first month, your baby will likely start to form sleeping and eating patterns. In general, your baby will likely have periods where they're awake for 2 or 3 hours straight. Around 3 months of age, the patterns will become more predictable.

Your exhaustion and sleep deprivation.

Newborns sleep a lot. But they also wake up a lot for brief periods and need feeding, diapering, and attention. Nights of long, restorative sleep can seem a foggy memory to parents. This may be especially true for those who start with a deficit after the physical exertion of and recovery from giving birth. Be sure to ask for help when you need it. Ask a family member, friend, or neighbor to help you with daily tasks, such as laundry, cleaning, or making meals. This can help you to nap instead of doing chores while your baby sleeps.

Worry over whether your baby is getting enough to eat.

This is especially a common concern among breastfeeding parents. As long as your baby feeds regularly (every 1 to 3 hours in the first few weeks, then every 2 to 4 hours over the next few weeks), your baby should be fine. Sometimes you may need to wake a sleepy baby to eat. It's good to check your baby's diaper for signs that your baby is getting enough breast milk. For example, your baby may have about 3 wet diapers a day for the first few days. After that, expect 6 or more wet diapers a day throughout the first month of life. During well-child checkups, the doctor will track your baby's weight gain and growth.

Urine color.

The urine should be yellow. Don't be alarmed, though, if you notice a pink color to the urine during your newborn's first 3 days of life. It's common for newborns to pass crystals in the urine (highly concentrated urine) which makes the urine look pink. If the pink color lasts, or if at any time your baby seems to be in pain while urinating, call your doctor.

Newborn jaundice.

Many babies get jaundice (also called hyperbilirubinemia) in their first few days of life. Jaundice is a condition in which the skin and the whites of a baby's eyes appear yellow because of a buildup of bilirubin in the blood. Bilirubin is a yellow-brown substance produced by the breakdown of red blood cells. Jaundice should be monitored by your baby's doctor. But it most often doesn't need medical treatment. Usually, increasing the number of feedings helps reduce jaundice. Phototherapy, in which a baby is placed under special lights or fiber-optic blankets, may be used if bilirubin levels are too high. Keep your baby's well-child appointments with your doctor, and call anytime if you're concerned about jaundice or your baby's skin.

Skin care.

In general, use mild shampoo or soap when you bathe your baby. Avoid lotions and other skin care products unless your doctor tells you to use them. Newborns have sensitive skin, and healthy newborn skin doesn't need skin care products applied.

A misshapen head.

Right after birth, especially after lengthy vaginal deliveries, your baby's head may look misshapen. This is normal, and your baby's head will most likely take on a more normal shape within a few days to weeks after delivery. In rare instances, a misshapen head can be a sign of an abnormal condition, such as craniosynostosis (say "kray-nee-oh-sih-noss-TOH-sus"). After your baby is born and during your baby's well-child checkups, your doctor will track your baby's head shape and skull growth. If you're concerned that your newborn's head hasn't gone back to a normal shape within several weeks, talk with your doctor.

It's common to question your feelings for your baby. A bond doesn't always happen the moment you set eyes on your child. But you will develop stronger feelings and love for your baby every day. For some parents, it takes time to build this bond, especially when the baby's physical demands take a great deal of time and energy. Talk to your doctor if you don't feel that you are bonding with your baby in the first week or two.

Also keep in mind:

• Your baby will soon be able to engage with you. But in this first month, your baby may seem to be in a semi-conscious state. Sleeping and eating are a newborn's main activities. Your baby will gradually emerge from this groggy state. And you can rest assured that your loving care will be rewarded with interaction very soon.
• Gradually within the first month, your newborn will start to look more "baby-like." Many parents don't like to admit it, even to themselves. But they may feel disappointed that their baby isn't as cute as they had hoped. If you feel this way, don't despair. Labor and delivery takes its toll on your baby's appearance. Your baby may have an odd-shaped head, swollen or squinty eyes, blotchy skin, and a flattened nose in the first few weeks. Soon, these irregularities will fade away. Your baby will start to have more normal-looking features.
• Your baby may have a birthmark that you notice at birth or during the first month. Most birthmarks need no treatment. They often fade as a child grows older. But sometimes a birthmark needs treatment or close monitoring. Talk to your doctor if you have concerns.

You will go through some major adjustments to this new little person in your life. But your baby's first month is also a period of amazing growth and change. Treasure these first weeks as you slowly introduce your baby to the world.

Your newborn's daily patterns

You may wonder if your baby's daily patterns are typical. During your baby's first few weeks, most of your time will be spent simply making sure that your baby is fed every few hours, comforted, and held, and that your baby's diaper is changed. Pay attention to cues. You'll start to learn your baby's own needs and preferences.

Here's an idea of what you can expect from your baby in these areas:

Reflexes.

Babies are born with a number of automatic physical responses that help them handle their world.

Sleeping and eating patterns.

A newborn's main routines center around these two activities. But by about 3 weeks of age, babies start to socialize more.

Diaper habits.

You can expect to change your newborn's diaper often. How many times a day varies. It depends in part on whether you feed your baby breast milk or formula.

Crying.

Newborns cry when they are hungry, tired, overstimulated, or otherwise uncomfortable. They may also cry for no clear reason and may be hard to console.

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Promoting Healthy Growth and Development

For healthy growth and development, newborns need physical and emotional care. You enhance development and give your newborn a sense of security and being loved. Here are some ways you can do that.

• Feed on demand.

  Respond to your baby's hunger cues, no matter how frequent.

• Encourage emotional bonding.

  Your baby needs to be close to you and to expect that you will respond to their needs.

• Stimulate learning and communication.

  Your newborn learns through bonding and interaction.

• Create a safe place for your newborn.

  Your baby's needs are basic. But it's important to respond promptly to your baby's cues and to recognize safety issues.

Keeping your baby safe

You can take steps to protect your child from everyday dangers.

• Practice healthy habits.

  For example, wash your hands often, keep toys clean, and take your baby for well-child visits. Make sure your child is immunized. Be sure that all visitors are up to date with their vaccinations. And keep your baby away from crowded places where there are a lot of people.

• Keep your baby safe around the home.

  For example, use sliding gates in front of stairs. Keep small objects, like toys parts, out of reach. Keep plastic bags away from your baby. Be aware of things in your home that could burn your baby, such as hot coffee or a hot stove.

• Give your newborn sponge baths until the umbilical cord falls off.

  After that, bathe your baby in warm water, not too hot. Never leave a baby alone in the bathtub, even for a moment. Always keep the baby within arm's reach.

• Never leave your baby unattended in high places.

  This includes tabletops, changing tables, beds, and sofas.

• Be safe in the car.

  For every car ride, securely strap your baby into a car seat. Always read and follow the guidelines and instructions provided by the maker of your car seat. Never leave your child alone in the car (even if it's just for "a second").

• Don't put sunscreen on newborns.

  Sunscreen can be used for babies older than 6 months. Keep your baby covered and in the shade when you go outside. Keep your baby in a cool place, wearing a single layer of loose clothing, when the weather is hot.

• Don't smoke around your baby.

  And don't let visitors smoke in your home or around your baby.

• Always place your baby to sleep on their back.

  This is the safest way for your newborn to sleep.

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When to Call a Doctor

Call your doctor right away if you notice anything that concerns you. You are the expert on your baby. Although usually everything is fine, don't be afraid to contact your doctor for any reason.

Physical problems to watch for in your newborn include:

• An umbilical cord stump that looks infected. You may see pus or reddened skin at the base of the cord.
• Signs of dehydration, such as having no wet diapers for 6 hours.
• Not having regular bowel movements.
• Jaundice that has not improved by 4 days after birth.

Be sure to call your doctor if your newborn:

• Cries in an odd way or for an unusual length of time.
• Has circumcision problems. Signs may include greater-than-expected bleeding at the circumcision site, a bloodstained area larger than the size of a grape on the diaper or wound dressing, or signs of infection (such as swelling and redness).
• Has a rectal temperature that is less than 97.5°F (36.4°C) or that is 100.4°F (38°C) or higher.
• Is rarely awake and does not wake up for feedings, or seems too tired or uninterested to eat.

Talk to your doctor if you are concerned about the following:

• Your baby seems to be acting odd, even though you can't identify exactly what concerns you.
• You feel that you are unable to nurture your newborn.
• You feel that you can't emotionally connect with your newborn. It's normal to feel some distance at first. But you should develop increasing feelings for your baby during the first week or two.
• You think you might be depressed (postpartum depression).

Routine Checkups

Your baby's doctor will likely recommend a specific schedule of routine newborn visits. These visits are important. They let the doctor check for problems and make sure that your child is growing and developing as expected.

Don't be afraid to call your baby's doctor anytime you have concerns about your newborn's health or general care. It's normal and expected for parents of newborns to have questions and to make frequent visits and calls to the doctor.

Birth exam

Your baby's first checkup starts in the hospital right after birth when a nurse assesses the baby's Apgar scores. This test checks certain physical traits to help find out if your newborn needs any treatments or special monitoring right away. Temperature and vital signs are always closely watched during the baby's first 6 hours. Your baby may also have the following soon after birth:

• A thorough physical exam. Within 24 hours of birth, a doctor will examine your baby. The doctor will check your baby's breathing and heartbeat and make sure the baby can pass urine and stool.
• Measurements of length, head circumference, and weight.
• Antibiotic eyedrops. Newborns can get eye infections from bacteria in the birth canal. So some states require that antibiotic eyedrops or ointment be given.
• Screening tests, such as hearing tests and tests that check for genetic diseases like phenylketonuria.
• Injections, such as vitamin K, and maybe some immunizations, such as for hepatitis B.

Well-child visits

In the first weeks after birth, your baby starts a series of health exams, sometimes called well-child visits. Doctors have their own approaches to the timing of these appointments. During one or more of these visits, your baby will have:

• Length, weight, and head circumference measurements taken. These measurements are plotted on a growth chart. Then they are compared to previous and later markings to make sure that the baby is growing as expected.
• A physical exam. The doctor examines your baby thoroughly for any problems. The doctor also assesses the baby's reflexes and general development and sees how you and your baby interact. You are asked questions about how the baby and the rest of the family are doing, how the baby is eating and sleeping, and whether you have noticed any changes in behavior.
• Immunizations. Your doctor can give you a schedule so that you know how many vaccines to expect at each visit.
• Screening test follow-up, if needed.

Routine checkups are a good time for parents to ask about what to expect in the weeks to come. You may find it helpful to go to your baby's checkups with a prepared list of questions.

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