102 - The First Week

02/23/22 • 22 min

The first week of having a new baby is full of surprises, but it's important that you know what to expect. In this episode, Dr. Carole Keim MD talks about what she wishes she knew the first week of having a new baby. She walks you through what is normal and what can be scary for a new mom. She also goes into detail on what moms can expect for themselves after welcoming home their adorable little one!

Dr. Carole Keim MD covers hormones, postpartum depression and the use of the Edinburgh Postnatal Depression Scale. From the first diaper change, breastfeeding, skin care, right up to your baby's first doctor's visit, there is a lot of information in this episode. However, you are going to be glad to have it to make that first week less scary. Also, remember that it’s normal to feel a little sad, overwhelmed, and exhausted.

At this age, your baby is doing a lot of things that seem scary but are actually normal.

Emotions: (00:32)

Bonding with baby
Baby blues
Signs of postpartum depression

Pooping: (01:33)

Meconium
Transitional stool colors
Seedy yellow - what are the seeds?
Number of poops: 1 in first 48h of life, a few times on days 3-4, then every feed once milk surges

Peeing: (02:35)

Brick dust / rusty pipes
Pee once in the first 24h, 2-4x until milk surges, then by 1 week of age with each feed
Concentrated urine x 3 days
Normal pee

Eating / breastfeeding: (03:22)

Painful x 2 weeks
Takes baby 2 weeks to really learn how to do it
Tongue ties, lip ties, cheek ties - when to fix them, baby has to re-learn how to eat
- Fix if W shaped tongue, can’t stick out tongue past lips, inadequate weight gain. Some people fix due to nipple pain

Skin: (07:10)

Bath x 9 mos, they’re going to peel
Can use aquaphor/vaseline/unscented baby lotion
Normal newborn rash

Diaper rash: (08:32)

Uncommon at first but can happen
Use wipes for poop only, not for pee
If baby has a rash, could be irritation from wipes or diaper brand

Baby girls vs. boys: (09:11)

Pseudomenses
Circumcision after care
Intact care

Breathing patterns: (12:03)

Fast then slow

Belly button care and when it falls off: (12:30)

The first two checkups: (13:19)

Typically 2-3 days after going home, or DOL 3-5, f/up 1 week (earlier if concern for weight or jaundice)
First Hep B vaccine if they didn’t get it in the hospital
Check weight; often down from BW
Check if mom’s milk is in yet and what color poops are to assess jaundice risk
Check for signs of PPD
PE: Look at skin for jaundice, rashes (some normal, some deadly). Heart, lungs, organs, eyes, genitals, sacral dimple, spina bifida, hip clicks, fontanels, sutures mobile
Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, turns towards parents voice, communicates needs (hungry/wet), fixes briefly on faces, lift head when prone / on parent’s chest

Anticipatory guidance: (18:15)

Eating - nothing but breast milk or formula for 4-6 months
Mom should eat a wide variety of foods and take PNV while breastfeeding
Supplement with 400 IU of vit D daily, or mom can take 6400 IU
Sleep: back to sleep, nothing else in the crib. ABC = Alone, on Back, in Crib
Fever and how to take temp
Jaundice precautions, why jaundice happens, when it’s dangerous
Never leave baby on high surface
Rear facing car seat til age 2
Avoid secondhand smoke
Bathing baby - wait til umbilical stump falls off; then once/wk
Skin care / peeling skin
Tummy time

Resources discussed in this episode:

The Baby Manual - Available on Amazon
Edinburgh Postnatal Depression Scale - Downloadable

Dr. Carole Keim MD: linktree | tiktok | instagram

At this age, your baby is doing a lot of things that seem scary but are actually normal.

Emotions: (00:32)

Bonding with baby
Baby blues
Signs of postpartum depression

Pooping: (01:33)

Meconium
Transitional stool colors
Seedy yellow - what are the seeds?
Number of poops: 1 in first 48h of life, a few times on days 3-4, then every feed once milk surges

Peeing: (02:35)

Brick dust / rusty pipes
Pee once in the first 24h, 2-4x until milk surges, then by 1 week of age with each feed
Concentrated urine x 3 days
Normal pee

Eating / breastfeeding: (03:22)

Painful x 2 weeks
Takes baby 2 weeks to really learn how to do it
Tongue ties, lip ties, cheek ties - when to fix them, baby has to re-learn how to eat
- Fix if W shaped tongue, can’t stick out tongue past lips, inadequate weight gain. Some people fix due to nipple pain

Skin: (07:10)

Bath x 9 mos, they’re going to peel
Can use aquaphor/vaseline/unscented baby lotion
Normal newborn rash

Diaper rash: (08:32)

Uncommon at first but can happen
Use wipes for poop only, not for pee
If baby has a rash, could be irritation from wipes or diaper brand

Baby girls vs. boys: (09:11)

Pseudomenses
Circumcision after care
Intact care

Breathing patterns: (12:03)

Fast then slow

Belly button care and when it falls off: (12:30)

The first two checkups: (13:19)

Typically 2-3 days after going home, or DOL 3-5, f/up 1 week (earlier if concern for weight or jaundice)
First Hep B vaccine if they didn’t get it in the hospital
Check weight; often down from BW
Check if mom’s milk is in yet and what color poops are to assess jaundice risk
Check for signs of PPD
PE: Look at skin for jaundice, rashes (some normal, some deadly). Heart, lungs, organs, eyes, genitals, sacral dimple, spina bifida, hip clicks, fontanels, sutures mobile
Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, turns towards parents voice, communicates needs (hungry/wet), fixes briefly on faces, lift head when prone / on parent’s chest

Anticipatory guidance: (18:15)

Eating - nothing but breast milk or formula for 4-6 months
Mom should eat a wide variety of foods and take PNV while breastfeeding
Supplement with 400 IU of vit D daily, or mom can take 6400 IU
Sleep: back to sleep, nothing else in the crib. ABC = Alone, on Back, in Crib
Fever and how to take temp
Jaundice precautions, why jaundice happens, when it’s dangerous
Never leave baby on high surface
Rear facing car seat til age 2
Avoid secondhand smoke
Bathing baby - wait til umbilical stump falls off; then once/wk
Skin care / peeling skin
Tummy time

Resources discussed in this episode:

The Baby Manual - Available on Amazon
Edinburgh Postnatal Depression Scale - Downloadable

Dr. Carole Keim MD: linktree | tiktok | instagram

Previous Episode

101 - Essential Information Before The Baby Arrives

In this episode, Dr. Carole Keim MD explains what you should expect when going into labor. Why she, as a pediatrician, recommends having your baby at the hospital vs a home birth. She also goes into great detail on what to expect from a c-section or vaginal birth. It's all here in this episode to make your life easier pre and post-delivery in an unfamiliar environment where you may feel overwhelmed by your new responsibilities.

Knowing the right questions to ask and having the right answers before your baby arrives will decrease your stress during your labor and delivery. Why is a vitamin K injection important and how erythromycin ointment protects your newborn from pink eye. She even gives you advice and tips for breastfeeding success. Good luck with your new baby. You are going to do awesome!

How to tell you’re in labor: (00:42)

Water breaks
Contractions
When to go to the hospital
How long you’re going to be in labor

What happens at the hospital: (01:59)

Delivery options (vaginal, c-section)
Delivery staff
What the pediatrician does, APGAR score
Newborn screen

What I recommend while still in the hospital: (08:41)

Feeding: only breastfeed, push through the pain because it gets better. Start pumping while in hospital. Work with the nurses to check baby’s latch, learn how to listen for milk movement/swallowing
Write down every time your baby starts and stops eating, and every time they pee and poop. You’re going to be asked this by everyone who walks in the room so one less thing to have to remember.
Vitamin K shot
Erythromycin ointment
Hep B vaccine: get it in the hospital if you want your baby to have it. (explain why it’s safe for newborns)
Bilirubin/jaundice checks: all babies get screened before discharge (either visually or with TCB or blood test)
Blood sugar testing - for babies who are LGS or SGA; pros/cons
Catch up on your sleep because this might be your only chance
Buy a copy of The Baby Manual on Amazon so it’s waiting at home for you

Discharge instructions: (17:49)

Jaundice precautions
Fever
Car seat safety
Followup appointment
Baby development / what to expect before the next appt (weight loss and weight gain, length changes, sleep deprivation)
Who to call if you need help

Resources discussed in this episode:

The Baby Manual - Available on Amazon

Dr. Carole Keim MD: linktree | tiktok | instagram

Next Episode

103 - Two Weeks Old

Your baby is now two weeks old and they are changing so fast! In this episode, Dr. Carole Keim MD walks you through what to expect during your baby’s two-week check-up. Your baby will now be keeping their eyes open longer and the nighttime feeding schedule will change. She talks about tummy troubles that usually start to pop up over the next few weeks.

There is so much happening in that little body. Your baby is learning to use their muscles and oh wow that ceiling fan is so wonderful to look at. From tummy time to bicycle legs and what is safe to give your baby to help them along.

Baby is starting to be awake more during the day - awkward age: (00:23)

Parents / emotions: (00:53)

You’re getting a little more sleep - baby’s consolidating feeds, more awake during day, sleeping at night
Don’t overstimulate
Narrate your day

Eating: (01:54)

8-12x per 24h; formula or EBM should be 12-24 oz per day (350-700ml)

Peeing/pooping: (02:20)

Baby pees and poops every time they eat

Tummy troubles: (02:55)

gas, colic, reflux
Gas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic drops
Reflux: Explain LES, normal spit ups. Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)
Pyloric stenosis: getting progressively worse, turns green (grass green)
Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillows

Skin: (08:25)

Umbilical stump is off - start baths. Once or twice per week, unscented soap or just plain water, pat them dry rather than rubbing, use lotion/cream/ointment right after the bath
Diaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.
Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID. Treat the whole family - nails and nose.

Checkup: (12:42)

Check weight, should be above birth weight now
Ask about any feeding difficulties; should be better now
Jaundice should be gone
Screen for PPD
PE: same head to toe exam as the first checkup
Neuro/devel: Reflexes (grasp, suck, moro), calms to parents’ voices, communicates needs, lifts head in tummy time

Safety: (15:37)

Fever over 100.4 (38c)
Back to sleep, alone, in a crib or bassinet. Ok to stop swaddling and start sleepsack. NO blankets til age 1 and no pillows til age 2.
Never leave baby on high surfaces
Avoid secondhand smoke
Rear facing car seat til age 2 years
Breastfeeding moms should be taking PNV
Supplement baby with 400 IU vitamin D
Tummy time: 2x per day 15-30 mins

What to expect in the next 2 weeks (before the 1mo checkup): (17:53)