Newborn baby activities are all about getting you and your baby to bond and get to know each other during the first weeks of baby's life.

It's a new life for all of you; and what a rollercoaster it is!

Feeding, colic, lack of sleep and trying to figure out what baby needs every minute of the day can be overwhelming for mom and dad.

Some babies are so good... sleeping wonderfully, feeding like little angels and looking as though butter wouldn't melt in their mouth.

Others drive us to distraction by wailing all night, refusing to feed and looking downright dismal all day!

And of course, if you're ever worried about your newborn baby's development, do check with your healthcare provider, and get your mind put at rest; meanwhile, here are some activities that I hope will help you and your newborn baby have some calm, fun time together.

• Move your baby around with you - from room to room, in the car, going out to the park etc.

• Sing a song - either just you or sing along to a CD. Nursery rhymes, Ella Fitzgerald, anything you like - my husband liked some lively rock 'n roll for baby's bathtime :)
• Lie next to your baby and show him or her some toys. Pick one up and talk about it, hug it, let your baby touch it.
• Sit down with a book, have a cuddle and read a story - the sound of your voice will soothe your baby, and you too! If reading children's stories is a new experience for you, get prepared to be an expert!

• Rub your baby's feet and say "feet, feet, feet!" Do the same with their hands and nose, ears and toes!
• Look at your baby, stick out your tongue, open your eyes wide, open your mouth, smile.

• Let your baby follow sounds - a rattle, shaker, squeaky toy or little bell. Move them from side to side or from further away getting nearer.
• Have a dance - a slow rocking dance or a faster (but still careful!) movement. Lift baby up, then move him down, then pop him gently onto the bed. Then slow lift-off... another dance - and back down again.
• In a warm room, let baby lie with just a diaper on, and let him have a good kick!
• Stroke your baby's feet, head, hands. Count fingers and toes. Tap gently on the end of their nose, one, two three!

OK, here are some more ideas for newborn baby activities.

You may already have a kind of sketchy routine that seems to be forming, but you're at perfect liberty to change things around now and again - if it doesn't interrupt your baby's sleep or feeding habits!

This is a good calming method with all young children up to toddlerhood. Carry baby from room to room around your home, talking quietly about what you can see.

Show baby pictures on the wall, take a look in the mirror, look at the sink and turn on some taps, play a few notes on the piano, open and close cupboard doors, or look out of the windows.

You need to make sure baby doesn't get too cold... or too hot - and the sun is not a newborn's best friend.

I hope these newborn baby activites have given you some ideas!

It is exciting for new parents to watch their newborn's behaviors and activities. However, in some cases, the absence or presence of a behavior or activity may indicate a problem. Listed in the directory below you will find additional information regarding a normal newborn's behaviors and activities, for which we have provided a brief overview.

Reflexes are involuntary movements or actions. Some movements are spontaneous, occurring as part of the baby's usual activity. Others are responses to certain actions. Reflexes help identify normal brain and nerve activity. Some reflexes occur only in specific periods of development. The following are some of the normal reflexes seen in newborn babies:

• root reflex

• suck reflex

• Moro reflex

• tonic neck reflex

• grasp reflex

• Babinski reflex

• step reflex

The average newborn sleeps much of the day and night, waking only for feedings every few hours. It is often hard for new parents to know how long and how often a newborn should sleep. Unfortunately, there is no set schedule at first and many newborns have their days and nights confused - they think they are supposed to be awake at night and sleep in the daytime.

Generally, newborns sleep about eight to nine hours in the daytime and about eight hours at night. Most babies do not begin sleeping through the night (six to eight hours) without waking until about three months of age, or until they weigh 12 to 13 pounds. Newborns and young infants have a small stomach and must wake every few hours to eat. In most cases, your baby will awaken and be ready to eat about every three to four hours. It is not necessary to wake a baby for feedings unless you have been advised to do so by your baby's physician. However, do not let a newborn sleep longer than five hours at a time in the first five to six weeks. Some premature babies need more frequent feedings and must be awakened to eat.

Watch for changes in your baby's sleep pattern. If your baby has been sleeping consistently, and suddenly is waking, there may be a problem such as an ear infection. Some sleep disturbances are simply due to changes in development or because of overstimulation.

Never put a baby to bed with a bottle propped for feeding. This is a dangerous practice that can lead to ear infections and choking.

Babies, like adults, have various stages and depths of sleep. Depending on the stage, the baby may actively move or lie very still. Infant sleep patterns begin forming during the last months of pregnancy - active sleep first, then quiet sleep by about the eighth month. There are two types of sleep:

• REM (rapid eye movement sleep)

• Non-REM sleep:

• Stage 1 - drowsiness - eyes droop, may open and close, dozing
• Stage 2 - light sleep - the baby moves and may startle or jump with sounds
• Stage 3 - deep sleep - the baby is quiet and does not move
• Stage 4 - very deep sleep - the baby is quiet and does not move

A baby enters stage 1 at the beginning of the sleep cycle, then moves into stage 2, then 3, then 4, then back to 3, then 2, then to REM. These cycles may occur several times during sleep. Babies may awaken as they pass from deep sleep to light sleep and may have difficulty going back to sleep in the first few months.

Babies also have differences in how alert they are during the time they are awake. When a newborn awakens at the end of the sleep cycles, there is typically a quiet alert phase. This is a time when the baby is very still, but awake and taking in the environment. During the quiet alert time, babies may look or stare at objects, and respond to sounds and motion. This phase usually progresses to the active alert phase in which the baby is attentive to sounds and sights, but moves actively. After this phase is a crying phase. The baby's body moves erratically, and he/she may cry loudly. Babies can easily be overstimulated during the crying phase. It is usually best to find a way of calming the baby and the environment. Holding a baby close or swaddling (wrapping snugly in a blanket) may help calm a crying baby.

It is usually best to feed babies before they reach the crying phase. During the crying phase, they can be so upset that they may refuse the breast or bottle. In newborns, crying is a late sign of hunger.

Babies may not be able to establish their own sleeping and waking patterns, especially in going to sleep. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on his/her own, and providing the right environment for comfortable and safe sleep.

Your baby may show signs of being ready for sleep when you see the following signs:

• rubbing eyes
• yawning
• looking away
• fussing

Although it is surprising, not all babies know how to put themselves to sleep. When it is time for bed, many parents want to rock or breastfeed a baby to help him/her fall asleep. Establishing a routine like this at bedtime is a good idea. However, be sure that the baby does not fall asleep in your arms. This may become a pattern and the baby may begin to expect to be in your arms in order to fall asleep. When the baby briefly awakens during a sleep cycle, he/she may not be able to go back to sleep on his own.

Most experts recommend allowing a baby to become sleepy in your arms, then placing him/her in the bed while still awake. This way the baby learns how to go to sleep on his own. Playing soft music while your baby is getting sleepy is also a good way to help establish a bedtime routine.

For many years in the United States, babies have been put to bed on their stomachs. In most other countries, babies sleep on their backs. Research has found a link between sudden infant death syndrome (SIDS) and babies who sleep on their stomachs (in the prone position).

Experts now agree that putting a baby to sleep on his/her back is the safest position. Side-sleeping may also be used, but this also has a higher risk than back sleeping. Other reports have found soft surfaces, loose bedding, and overheating with too many blankets also increase the risk for SIDS. When infants are put to sleep on their stomachs and they also sleep on soft bedding, the risk for SIDS is even higher. Smoking by the mother is also a major risk for SIDS, as are poor prenatal care and prematurity. Since the American Academy of Pediatrics (AAP) made the "back-to-sleep" recommendation in 1992, the SIDS rate has dropped more than 40 percent.

Back sleeping also appears to be safer for other reasons. There is no evidence that babies are more likely to vomit or spit up while sleeping on their back. In fact, choking may be more likely in the prone position.

A task force of The US Consumer Product Safety Commission (CPSC), the American Academy of Pediatrics (AAP), and the National Institute of Child Health and Human Development (NICHD), offer the following recommendations for infant bedding:

• Place your baby on his/her back on a firm, tight-fitting mattress in a crib that meets current safety standards.
• Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib.
• Consider using a sleeper as an alternative to blankets with no other covering.
• If using a blanket, put your baby with his/her feet at the foot of the crib. Tuck a thin blanket around the crib mattress, only as far as the baby's chest.
• Make sure your baby's head remains uncovered during sleep.
• Do not place your baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.

According to the task force report, bed sharing or co-sleeping may be hazardous for babies in certain conditions. The report advises the following:

• Parents should consider placing the infant's crib near their bed for more convenient breastfeeding and parent contact.
• If a mother chooses to have her infant sleep in her bed to breastfeed, care should be taken that the baby sleeps in a non-prone position, soft surfaces or loose covers are avoided, and the bed is moved away from the wall and other furniture to avoid the baby becoming entrapped between them.
• Adults other than the parents, children, or other siblings should not share a bed with an infant.
• Parents who choose to bed share with their infant should not smoke or use substances such as drugs or alcohol that may impair their ability to awaken.

To prevent overheating, the report recommends that the infant should be lightly clothed for sleep and the room temperature kept comfortable for a lightly clothed adult. Avoid over bundling and check the baby's skin to make sure it is not hot to the touch.

Additional research has found that infants should not be put to sleep on a sofa, alone or with another person, as this practice increases the risk for SIDS.

While babies should sleep on their backs, other positions can be used during the time babies are awake. Babies can be placed on their stomachs while awake to help develop muscles and eyes and to help prevent flattened areas on the back of the head.

Babies are born fully equipped with all the necessary senses of sight, hearing, smell, taste, and touch. However, some of these senses are less precise than others. Below are some of the ways newborn babies express their senses:

• Vision

• Hearing

• Taste

• Smell

• Touch

The first cries of a newborn baby are often music to the ears of parents. However, over the next weeks and months this "music" can become grating and painful. This is especially true when all attempts fail to stop the crying.

Surprisingly, crying does not produce tears until after the first month or two. Crying is the way babies communicate. They cry because of hunger, discomfort, frustration, fatigue, and even loneliness. Sometimes, cries can easily be answered with food, or a diaper change. Other times, it can be a mystery and crying stops as quickly as it begins.

You will soon learn differences in cries, from a cry of "I'm hungry" to "I've been overstimulated." It is important to respond to your baby's cries. Contrary to old wives' tales, young babies cannot be spoiled by being picked up when crying. Being held is reassuring and comforting when a baby cannot express him/herself any other way.

Some techniques to help console a crying baby include the following:

• Take care of physical problems first - hunger, diaper change, need to burp.
• Walk with baby in a sling or in a stroller.
• Rock your baby in a rhythmic, gentle motion.
• Try a baby swing or rocking cradle.
• Gently pat or stroke on the back or chest.
• Try swaddling the baby.
• Go for a ride in the car.
• Turn on some white noise (such as a washing machine or vacuum cleaner).

No matter how frustrated you may become, NEVER SHAKE A BABY. This can cause severe injury to the baby's fragile brain. If you become angry or frustrated, allow someone else to take over for a while. If you are alone, put the baby down in a safe place, such as the crib, and go to another room for a few moments. This will give you time to collect yourself. Then you can return to your baby and try a different tactic to comfort your baby.

acne neonatorum (baby acne) - pimples on newborn skin common in the first month.

Apgar test - A scoring system to evaluate the condition of the newborn immediately after birth.

areola - the pigmented (darkened) ring around each nipple.

bilirubin - substance formed when red blood cells break down and are excreted by the liver. Too much bilirubin in the blood causes jaundice.

biotinidase deficiency - an inherited disorder characterized by a deficiency of the biotinidase enzyme needed to metabolize a B vitamin.

bonding - process of falling in love with a newborn baby.

brachial palsy - birth injury to the nerves that supplies the arms and hands.

candidiasis - a fungal (yeast) infection, often in the mouth, called thrush, or in the diaper area.

caput - a severe swelling of the soft tissues of the baby's scalp that develops as the baby travels through the birth canal.

cephalohematoma - an area of bleeding underneath one of the cranial bones that appears as raised lump on the baby's head.

circumcision - a surgical procedure to remove the skin covering the end of the penis.

cleft lip - an abnormality in which the lip does not completely form. The degree of the cleft lip can vary greatly, from mild (notching of the lip) to severe (large opening from the lip up through the nose).

cleft palate - occurs when the roof of the mouth does not completely close, leaving an opening that can extend into the nasal cavity. The cleft may involve either side of the palate. It can extend from the front of the mouth (hard palate) to the throat (soft palate). The cleft may also include the lip.

clubfoot - also known as talipes equinovarus, clubfoot is a foot deformity that is detected at birth. It affects the bones, muscles, tendons, and blood vessels and can affect one or both feet. The foot is usually short and broad in appearance and the heel points downward while the front half of the foot, or forefoot, turns inward. The heel cord (Achilles tendon) is tight. The heel can appear narrow and the muscles in the calf are smaller compared to a normal lower leg.

colic - a condition in an otherwise healthy baby characterized by excessive crying.

cyanosis - a blue coloring of the skin.

developmental dysplasia of the hip (DDH) - a condition of the hip joint that is congenital (present at birth). The hip joint is created as a ball-and-socket joint. In DDH, the hip socket may be shallow, letting the "ball" of the long leg bone, also known as the femoral head, slip in and out of the socket. The "ball" may move partially or completely out of the hip socket.

diaper rash - an irritation of the skin in the diaper area.

erythema toxicum - a common red rash on the skin of newborns.

eye prophylaxis - eye drops or ointment containing an antibiotic medication that are placed in a newborn's eyes.

facial paralysis - impairment of movement of the muscles of the face due to birth injury.

galactosemia - an inherited disorder in which the baby is unable to metabolize galactose, a milk sugar.

grunting - a sound made by a baby who is having difficulty breathing.

harlequin color change - a normal change in a newborn baby's color due to immaturity of the circulation.

homocystinuria - an inherited disorder caused by a deficiency of an enzyme necessary to digest an amino acid.

hyperbilirubinemia - the build-up of bilirubin in the blood.

hypoglycemia - a condition in which the amount of blood glucose (sugar) is lower than normal.

hypospadias - a birth defect in which the male urethral (urine tube) opening is not located at the tip of the penis.

hypothyroidism - a condition in which the baby is born with too little thyroid hormone.

immunization - vaccine to prevent diseases.

jaundice - a yellow coloring of the skin and/or eyes that is caused by too much bilirubin in the blood.

lactation consultant (IBCLC - International Board Certified Lactation Consultant) - a nurse or other healthcare provider specially trained to help women with breastfeeding.

lanugo - soft, downy hair on a baby's body.

maple syrup urine disease - an inherited disorder caused by an inability of the body to properly process certain parts of protein called amino acids.

meconium - a sticky, greenish-black substance that forms in the intestines during fetal development and is the first bowel movement of a newborn.

milia - tiny, white, hard spots that look like pimples on a newborn's nose.

mongolian spots - blue or purple-colored splotches on the baby's lower back and buttocks common in dark-skinned babies.

Moro reflex - Movement of arms and legs that occurs when a newborn is startled by a loud sound or movement.

moulding - elongation of the shape of a baby's head due to delivery through the birth canal.

neonatal intensive care unit (NICU) - a special care nursery that uses advanced technology and trained health professionals to care for sick and premature newborns.

phenylketonuria (PKU) - an inherited disease in which the body cannot metabolize a protein called phenylalanine.

phototherapy - special lights used to treat jaundice.

port wine stain - a flat, pink, red, or purple colored birthmark.

reflux - when stomach contents back up into the esophagus (the tube that connects the mouth to the stomach).

REM (rapid eye movement) sleep - this is a light sleep when dreams occur and the eyes move rapidly back and forth.

retracting - when the baby is pulling the chest in at the ribs with breathing.

rooming-in - when mothers and newborns remain together in the same room through the hospital stay.

rooting - when a newborn turns his/her head toward touch near the mouth.

sickle cell disease - an inherited disorder that occurs primarily in African-Americans and causes a severe form of anemia.

stork bite or salmon patch - small pink or red patches often found on a baby's eyelids, between the eyes, upper lip, and back of the neck.

strawberry hemangioma - a bright or dark red, raised or swollen, bumpy area on the skin of a baby or child.

subconjunctival hemorrhage - the breakage of small blood vessels in the eyes of a baby.

sudden infant death syndrome (SIDS) - the sudden and unexplained death of an infant under 1 year of age.

thrush - a yeast infection in the mouth and throat of babies.

transient tachypnea of the newborn (TTN) - a mild respiratory problem of babies, characterized by rapid breathing, that begins after birth and lasts about three days.

tyrosinemia - an inherited disorder that causes severe liver disease in infancy.

umbilical hernia - a weakness in the abdominal muscles.

vernix - a white, greasy, cheese-like substance that covers the skin of many babies at birth.

vitamin K - an essential component of blood clotting produced by intestinal bacteria. Babies normally have low levels of this vitamin.

As parents of a new baby, you want to know everything about this little person. Your baby is wonderful to look at! His inquiring eyes and chubby cheeks make him especially appealing. As you spend time admiring him, you will have many opportunities to discover his abilities and to interact with him.

Seeks to bond with you.

Communicates through behavior (crying, turning toward you, turning away).

Molds his body to yours when held.

Has well developed senses.

Seems to have no identifiable schedule.

Has six states of consciousness.

Sleeps 90% of the time.

Displays automatic movements called reflexes.

Hiccups a lot.

May dislike being undressed.

Needs both nutritive sucking (feeding) and nonnutritive sucking (comforting).

Being held and spoken to.

Rocking and gentle rhythmic movements.

Being swaddled.

Gazing at bright simple pictures.

Being talked to during feeding, changing, and bathing. Listening to nursery rhymes (rhythmic language).

Adjusting to a new baby can be an overwhelming task. You are still recovering from the birth. The baby requires "24 hour-around-the-clock care," and you may be exhausted from late night feedings. You are filled with a new sense of anxiety and you may experience depression. These are all understandable and normal feelings. Limiting visitors and other outside demands may enable you to cope with the challenge of being a new parent.

Your baby, as a newborn, comes very well equipped to "speak" a special language. This special language is her behavior. She sends signals to you to make her needs and wants known. These signals will come through in every behavior she demonstrates as you care for her. She is a good "teacher" and will let you know whether you are right or not.

As a new parent, you may find it difficult to imagine playtime with your newborn who sleeps 90% of the time. Everyday activities offer opportunities for play.

Feeding provides a wonderful time to interact with your baby. During feeding she will start with a short burst of constant sucking. Very quickly, she changes to a burst-pause pattern. A burst of sucks will be followed by a pause: suck-suck-suck-pause. These pauses are a signal that your baby wants to communicate as well as eat. She is waiting for you to talk gently or touch her. This may make the pauses longer and feeding time more pleasurable for both of you. In response to the question "May I feed my baby by propping a bottle?," Dr. Brazelton responds with a resounding "absolutely not!" Every baby deserves to be held for feeding. Communication and closeness at feeding time are as important as the food.

Diapering is another opportunity for you to interact with your baby many times a day. She will enjoy looking at something interesting and listening to your voice during diapering.

Bathing can be another important time for communication. Many babies do not like to be undressed. You can swaddle your baby in a cloth diaper or hand towel after he is undressed to help him feel safe. Then lower him into a warm tub, holding his head up with one hand. The diaper or towel can then be taken off. While he kicks and moves about, talk and sing to him!

Reciting Nursery Rhymes can serve two purposes. It is a fun way to interact with your baby and to introduce him to language and literature. It is also a relaxing activity for both baby and you. Rhythm is comforting!

You will spend much time and energy trying to figure out exactly how to comfort your baby. She will have her own special way to be held or moved in which she is comforted. Most babies need a self-comforting pattern. They will need a way to fall apart and to relax. Sucking is a part of this self-comforting pattern.

There are two kinds of sucking: (1) nutritive sucking, which your baby uses for feeding, and (2) nonnutritive sucking, which she uses to keep herself comforted and under control. Babies comfort themselves with either a pacifier or thumb. You will need to decide which you want to encourage her to use as part of her self-comforting pattern.

All babies cry. Many babies (85%) cry long and often. Sometimes this crying is a fussy period at the end of the day. The baby is still trying to organize all the stimulation he is receiving each and every day. Crying is your baby's way of adjusting to this new world. It is one of your baby's normal six states of consciousness. Crying is not a sign of failure. IT IS NOT YOUR FAULT OR YOUR BABY'S FAULT.

• Keep calm.
• Pick up your baby.
• Check his diaper.
• Offer a feeding.

• If your baby has not calmed down, lay him down in a safe place, and let him cry for 10-15 minutes to let off steam.
• Pick up your baby; offer warm water to burp.
• Let him have another cycle of letting off steam. (crying)
• Repeat this cycle 3 or 4 times; your baby will be more organized and probably will sleep better.

• Swaddling: wrap baby snugly in a blanket or hold her close to your body.
• Lay baby across your knees; rub or pat her back.
• Rock baby at 60 rocks per minute--infant swing.
• Walk with her tucked under your arm, with your hand under her tummy.
• Hold baby so she can look around to see things. Try changing her bath to evening.
• Burp her well to get air out of her tummy.
• Offer a pacifier or help her to find her thumb. Sucking helps relax her stomach.
• Sing to her or play soft music. Sometimes a continuous sound such as a fan or radio tuned to static may help calm her.
• Go for a ride in the car, putting her in a car seat.
• Remember: If your baby cries excessively, see your doctor. He or she may have other ideas to help your baby.

Your newborn baby is equipped with a magnificent map of behaviors. He has all the skills needed to begin to discover and understand his new world. Your observation and understanding of these behaviors will enhance your enjoyment of these first few weeks. Understanding these behaviors will start you on the journey of a loving relationship with your baby.

Newborns seem to drift in and out of sleep with no order or sense to their daily pattern. Actually, there is a cycle of behavior in which your baby may exhibit six different states of consciousness: deep sleep, light sleep, drowsiness or transition, wide-awake alert, fussy or active alert and crying. By watching for your baby's particular cycle you can predict his behavior and know whether he will be ready for feeding, sleeping, or play. Understanding this can help you plan your day.

Face relaxed and eyelids closed and still

No body movements

Breathing is very regular

Body in curled-up position

Unreachable by outside stimuli

Half of baby's sleep is in this state

Deep sleep and light sleep are alternated every 30-45 min.

Eyes usually closed, but will flutter

Can see eyes move under lids

Occasional body movements Breathing is irregular

Often makes funny faces (grimace, smile, frown).

May make chewing or sucking movements

More vulnerable to the outside world.

May be roused to awaken sleepily and fussily or struggle to sink into deep sleep

Usually occurs just before or after sleep.

May continue to move

Sometimes smiling, frowning or pursing lips

Eyes have a dull glazed appearance

Eyes do not focus

Eyelids are droopy

Just before closing, eyes may roll upward

Eyes are open wide, bright and shiny

State in which a newborn may have a prolonged period right after birth

Will look at mother's or father's face and eyes

Very little motor activity

All energy seems to be used for seeing and hearing

Best time to interact and play with baby

His signals will tell you when he is ready for play and when he has had enough. During these wide-awake alert moments, he will go through four stages:

1. becomes alert
2. increases attention
3. a gradual decrease in interest
4. turns away and eventually cries

Anytime your baby has had enough of an activity or play, he will turn away from the activity. He is letting you know that his system is overloaded for the moment and needs time to regroup or move to a different activity.

Frequent jerky movements every one-two minutes

Looks all around

May make small sounds

Usually appears before eating or when baby is fussy

Breathing is irregular

Unable to control himself

Infants' communication--different cries for different needs Eyes may be open or tightly closed

Face contorted and red

Arms and legs move vigorously

May change into wide-awake alert state by changing position

Vision
Can my baby see? Yes, at birth your baby's eyesight is well developed. When you first lift your newborn to come face-to-face, his eyes will open and search your face, almost saying "Is it really you?" This is the beginning of a wonderfully special relationship.

• Your baby can focus on objects 8-14" away from her Oust about the distance between her eyes and your face as you hold or feed her).
• Your face, more than any other object, holds a very special attraction for your baby. Babies enjoy exploring human faces. They usually scan the outline and then move to the eyes and mouth. Eyes are particularly stimulating!
• Your baby enjoys objects with sharply defined outlines and bold contrasting colors. Examples of this are your face, board books and anything black and white.
• Your baby is best able to focus when she is calm and alert. She can become "locked in" or hooked on what she is looking at and will stare at an object or face for periods of up to ten minutes.
• Movement or change in her surroundings will also capture her attention. She is able to follow an object or face in an arc from one side of her body to another.
• A reflex that presents itself from birth is called tonic neck reflex or "fencer's pose." When a baby's head is turned to one side, the arm on the face side extends and the other arm flexes near the face in a fencing position. Take advantage of this reflex by propping stimulating objects at baby's side.

Newborns prefer human to nonhuman sounds. They also prefer high-pitched voices. Mothers and fathers instinctively raise the pitch of their voices when they talk to their babies. You will find talking to your baby rewarding as he alerts and "tunes in" to your voice and face.

Babies are comforted by rhythmic sounds. These sounds probably remind them of being in the womb and hearing the rhythm of their mothers' heartbeat. Examples of rhythmic sounds are Mother Goose rhymes, music, a vacuum cleaner and a fan.

Touch is an important area of communication between you and your baby. He likes to be cuddled and will often nestle and mold to your body. Both you and your baby enjoy the experience of holding, stroking, and rocking.

One of the most comforting activities for your newborn is sucking on his fingers. As he develops, touch will be an important way to explore his world and initiate contact with you. Your baby also responds to other aspects of touch: different temperatures, texture, moisture, pressure, and pain. He will let you know when he is uncomfortable!

Newborns have a highly developed sense of smell. Your baby can distinguish between appealing (sweet) and unappealing odors (vinegar). By the age of six days, a breast-fed infant can even recognize the smell of her mother's nursing pad!

Taste is also highly developed in newborns. Your baby will show pleasure with sweetness and displeasure with slightly salty, acidic, or bitter liquids.

Your baby is born with a group of automatic movements called reflexes. These are responses to specific stimuli. They have aided him in the birthing process and will be useful to him in the first weeks of life.

Tonic neck--This is produced when a newborn's head is turned to one side. The baby arches away from the face in a "fencing-like" response. The baby's arm on the face side stretches out, and the other arm flexes up by his head.

Moro--These "startles" consist of his throwing out his arms, arching his back, grimacing, and then crying out. When there is nothing to grab and hold, or no one to hold the baby, each startle sets off more startles.

Rooting--This appears if you touch a newborn on either side of his mouth. He will turn in the direction of the touch, searching for the breast or bottle with his mouth.

Grasping--A newborn's hands are usually clenched in a fist. Once unfolded his fingers will grasp any small object placed high in the palm. His hands and feet will grasp objects with some strength. The hold may last for a few seconds or possibly a few minutes.

Walking--While properly supported, a newborn will begin to step first with one foot, then the other, in a kind of slow jog.

Gallant--If you stroke along the side of the newborn's spine while he is held by your hand under his belly, he flexes his whole body to the side that is stroked; when you switch to the other side, he flexes to that side.

Crawling--When the newborn is placed on his abdomen, he flexes his legs under him and starts to crawl, picking his head up to turn it and to free it from the bedclothes.

Babkin--When you stroke a newborn's cheek or put your finger in his palm, he will bring his fist up to his mouth and try to insert a finger. This hand-to-mouth reflex will serve him later to suck on his fist or finger.

Babinski--When you stroke the baby's inner sole, he grasps your finger in his toes. Stroke the outer side of his sole, he spreads his toes out.

Protective--Reflexes to keep his airways clear. If your baby thinks his airway is obstructed, he will arch his head turning it from side to side. He will also bring one hand up and then the other, swiping across his face, to try to keep his airways clear.

Congratulations on the birth of your new baby. This is a glorious time in your life. Whether this is your first baby or your fifth, you will find this a time of recovery, adjustment, sometimes confusion and frustration, but -- most wonderfully -- of falling in love.

During the early months of your baby's life, he sleeps when he is tired, it's really that simple. You can do very little to force a new baby to sleep when he doesn't want to sleep, and conversely, you can do little to wake him up when he is sleeping soundly.

A very important point to understand about newborn babies is that they have very, very tiny tummies. New babies grow rapidly, their diet is liquid, and it digests quickly. Formula digests quickly and breast milk digests even more rapidly. Although it would be nice to lay your little bundle down at a predetermined bedtime and not hear a peep from him until morning, even the most naive among us know that this is not a realistic goal for a tiny baby. Newborns need to be fed every two to four hours -- and sometimes more.

You have probably heard that babies should start "sleeping through the night" at about 2 to 4 months of age. What you must understand is that, for a new baby, a five-hour stretch is a full night. Many (but nowhere near all) babies at this age can sleep uninterrupted from midnight to 5 a.m. (Not that they always do.) A far cry from what you may have thought "sleeping through the night" meant!

What's more, while the scientific definition of "sleeping through the night" is five hours, most of us wouldn't consider that anywhere near a full night's sleep for ourselves. Also, some of these sleep-through-the-nighters will suddenly begin waking more frequently, and it's often a full year or even two until your little one will settle into a mature, all-night, every night sleep pattern.

It is very natural for a newborn to fall asleep while sucking at the breast, a bottle, or a pacifier. When a baby always falls asleep this way, he learns to associate sucking with falling asleep; over time, he cannot fall asleep any other way. I have heard a number of sleep experts refer to this as a "negative sleep association." I certainly disagree, and so would my baby. It is probably the most positive, natural, pleasant sleep association a baby can have. However, a large percentage of parents who are struggling with older babies who cannot fall asleep or stay asleep are fighting this natural and powerful sucking-to-sleep association.

This is a time when you need to focus your instincts and intuition. This is when you should try very hard to learn how to read your baby's signals. Here's a tip that is critically important for you to know. Babies make many sleeping sounds, from grunts to whimpers to outright cries, and these noises don't always signal awakening. These are what I call sleeping noises, and your baby is nearly or even totally asleep during these episodes. I remember when my first baby, Angela, was a newborn. Her cry awakened me many times, yet she was asleep in my arms before I even made it from cradle to rocking chair. She was making sleeping noises. In my desire to respond to my baby's every cry, I actually taught her to wake up more often!

You need to listen and watch your baby carefully. Learn to differentiate between these sleeping sounds and awake and hungry sounds. If she is awake and hungry, you'll want to feed her as quickly as possible. If you respond immediately when she is hungry, she will most likely go back to sleep quickly. But, if you let her cry escalate, she will wake herself up totally, and it will be harder and take longer for her to go back to sleep. Not to mention that you will then be wide awake, too!

A newborn baby sleeps about sixteen to eighteen hours per day, and this sleep is distributed evenly over six to seven brief sleep periods. You can help your baby distinguish between nighttime sleep and daytime sleep, and thus help him sleep longer periods at night.

Begin by having your baby take his daytime naps in a lit room where he can hear the noises of the day, perhaps a bassinet or cradle located in the main area of your home. Make nighttime sleep dark and quiet. You can also help your baby differentiate day naps from night sleep by using a nightly bath and a change into sleeping pajamas to signal the difference between the two.

I've yet to hear a parent tell me that she or he loves getting up throughout the night to tend to a baby's needs. As much as we adore our little bundles, it's tough when you're woken up over and over again, night after night. Since it's a fact that your baby will be waking you up, you may as well make yourself as comfortable as possible. The first step is to learn to relax about night wakings right now. Being stressed or frustrated about having to get up won't change a thing. The situation will improve day by day; and before you know it, your little newborn won't be so little anymore -- she'll be walking and talking and getting into everything in sight during the day, and sleeping peacefully all night long.

You and Your Newborn Baby: a guide to the first months after birth - by Linda Todd

Regardless of whether labor is long or short, whether it is hard or easy whether a baby is born vaginally or by cesarean, most parents recall the first hours and days after birth as crystal-clear images surrounded by haze. It is in this haze that you first take in your baby and make a giant leap from pregnancy to parenting.

Despite all the anticipatory parenting done before conception and during pregnancy, despite weeks of feeling movement within and fantasizing about your baby, despite months of having strange dreams, worrisome thoughts, and musings about what kind of parent you will be, the first time you hold your baby in your arms and call yourself mother or father, mama or papa, mommy or daddy, an awareness floods over you that life will never be the same again. Another human being is now dependent upon you for survival. More than anything else, you want to be the best parent possible.

Your awareness of your baby's dependency and your desire to be a good parent will together be a great source of energy and a great source of stress. Both are part of being a parent.

Becoming a good parent means much more than knowing a lot about babies. Ask pediatric doctors or nurses what it was like for them to be new parents. They will tell you that all their knowledge about babies was not enough to keep them from being over whelmed by their own babies. All new parents feel the same way. All new parents work at knowing, understanding, and loving their babies. Your baby will work just as hard at learning to know, understand, and love you. This is the process of attachment-the work that parents and babies do together to form a deep and lasting love. It is what becoming a family is all about.

This book is written to give you some help as you make the transition from pregnancy to parenting. It offers ideas on things you can do to make this time of change easier. It is written as much to encourage as to teach you. Besides providing the information you need about taking care of yourself and your baby, it can help build your confidence in your own wisdom about your family's needs. You will find the postpartum period easier if you know what to expect during this time, if you actively participate in health-care decisions, and if you build a network of support that nurtures your growing family.

New families in the United States face some challenges that families in most other countries do not. In the United States, where nearly 99 percent of women give birth in hospitals, the average hospital stay after childbirth is two days for a woman who has given birth vaginally, three to four days for a woman who has given birth by cesarean. In many communities, new families are discharged from the hospital within twenty-four hours of birth. Such early discharge will probably become the norm by the year 2000.

In most other countries, both industrialized and developing, the postpartum period is seen as being at least as important as the prenatal period. Because of this, women giving birth in hospitals have longer stays. More importantly, services are brought to the homes of new families. No matter how long the stay in a hospital or birth center, the family's transition to home-and to sole responsibility for the newborn-is overwhelming. in many countries all new families are visited at home by midwives, nurses, or other trained personnel who teach parenting skills, assess the mother's and baby's health, and provide moral support (and sometimes, as in the Netherlands, government-paid helpers do the housekeeping!). In the United States, such services are now provided to only a small minority of women.

The day after birth, you may ache all over from the work you did in labor. Your arms and legs may be sore from pulling back on your legs while pushing out the baby.

Although achy legs are normal, tenderness, pain, or warmth in your calves and swollen or reddened veins are warning signs that you should report to your doctor or midwife immediately. These signs could indicate thrombophlehitis, an inflammation of a vein that can result in formation of a blood clot. Postpartum women are at slightly increased risk of this because the vein walls normally relax somewhat in pregnancy. To reduce the risk of thrombophlebitis, increase circulation in your legs by doing foot rotations (see page 2 1) and by getting up and walking soon after birth. Thrombophlebitis is treated with bed rest, elevation of the affected leg, hot packs, and the use of elastic stockings. Medications may also be needed to prevent infection and clot formation. The affected leg should not be massaged.

Joints that relaxed in pregnancy to allow for the baby's growth and birth will return to their pre-pregnancy condition within several weeks of birth. Many women, however, feel that the rib cage and pelvis remain slightly expanded for the rest of their lives.

Abdominal muscles are relaxed after birth, so the abdomen is soft and still rounded. All women have some degree of separation of the abdominal muscles, which lessens with exercise.

Any stretch marks you have will seem more obvious after birth than before. Although stretch marks never completely disappear, they fade to silvery white lines in the months after childbirth. Darkened areas of the skin, such as the areola and the linea nigra, a dark line from the belly button to pubic bone, may tighten but may not completely fade.

Many women note changes in their hair after birth-most commonly, profuse hair loss. This is because pregnancy hormones stimulate hair growth. With the drop in these hormones, the extra hair that grew in pregnancy will fall out. This begins around three months after birth and usually ends within a couple of months.

Perhaps the most common feeling of new mothers after childbirth is that of being bone-tired. This seems especially true of women who have just had their first babies. Often, fatigue is combined with such excitement in the first days that sleep is difficult. The usual aches and pains of the early postpartum period can make it even harder to sleep. But beyond the first few days after birth, most women find daily naps are essential to their well-being.

Each woman recovers in her own unique way after cesarean birth, just as after vaginal birth. Pain medications can help during the first few days (the medications given are considered safe during breastfeeding). The nurses will assist you in getting up the first time, learning to cough or huff to keep your chest clear, dealing with the gas that can follow surgery, and learning to hold your baby in ways that are comfortable for you. If assistance is not available when you need it, press your call button and ask for help.

All new parents can benefit from assistance at home after childbirth, but for a woman who has had a cesarean birth such help is essential for at least the first week. Not only are you undergoing a transformation to a nonpregnant state and learning to care for your new baby, you are recovering from major surgery. Adequate help, allowing you to rest often during the day, can make a great difference in how quickly you feel strong and well. Taking care of yourself and your baby should be your only duties until you feel ready to take on more.

These activity restrictions are usually recommended:

• Limit stair climbing as much as possible.
• Don't lift anything heavier than your baby for the first two weeks.
• Ask your mate or a friend to do laundry, vacuuming, and other tasks that require bending, lifting, or pushing for at least the first few weeks after birth. Then resume such work gradually.
• Do not drive a car for the first two weeks.

Take showers instead of tub baths until the incision is completely healed and dry. Ask your doctor or midwife for specific instructions on the care of your incision.

Like her labor, a woman's initial response to her baby is something she remembers for a lifetime. Women greet their babies in as many ways as there are mothers. Before they give birth, most women anticipate a rush of loving feelings, or even tears of joy. others anticipate instantly "feeling like a mother." Some women actually experience these things. Many do not.

Sometimes, a woman experiences a temporary holding back from the baby whose birth caused pain or emotional trauma. A new mother may have a feeling of distance-which in retrospect may seem like disinterest. Or she may feel a strong need to attend to herself, pain and exhaustion compete with interest in the baby. in retrospect, she may see herself as selfish. Coolness, distance, self-centeredness-none of these fit with any woman's conception of a "good mother." Because of this, many women say they feel guilty about their initial responses to their babies.

Many women speak of feeling outside of themselves after labor. It is as though one's personal boundaries are hazy. Is it any wonder that women feel they are not taking their babies in-"as they should?" They can hardly take themselves in! This is to be expected. Most women say it takes days to come back into themselves. This is the natural rhythm of things. Something amazing is going on. As boundaries are reclarified, they are also redefined. You are now a mother. Your baby is no longer one with you, as in pregnancy. But the new boundaries are extended, to connect you for a lifetime to this other person. This connection is the essential work of the first months of parenting. You may have all the loving feelings you anticipated, but if you do not, give them time to evolve, as you do the work of taking on your new role.

Many parents doubt whether they will recognize if the baby is sick. When you have no experience with babies, being told that a sick baby behaves differently from a well baby is of little comfort. if everything about your baby seems unfamiliar, it is hard to have confidence that you can and will recognize changes that indicate your baby is ill. Besides, healthy babies can cry for a couple of hours each day. Crying does not tell you as much in the first weeks as it will when your baby is older. So how will you know if your baby is sick? Asking yourself these questions may help:

• Is there a change in the baby's behavior? Is the baby crying more than usual? Has the tone of the cry changed? Is the crying at a different time of day than usual? Is the baby more irritable than usual? Is the baby sleeping more or less than usual? Does the baby seem lethargic or listless?
• Has the baby's appetite or digestion changed? Is the baby eating less than usual? Has the baby vomited more than once? If the baby is vomiting, is the vomiting forceful? (This is called projectile vomiting.) Are there signs of constipation? That is, are the stools hard or more solid than usual? Are there signs of diarrhea? That is, are the stools watery, or more runny than usual? Are they more frequent than usual? Is the baby urinating less frequently than usual? Has the color of the urine changed?
• Has there been a change in the baby's breathing? Does the baby seem to have trouble breathing? Does the baby sound congested? Does the baby have a runny or stuffy nose? Is the baby coughing?
• How does the baby look? Is the baby's skin pale or flushed? Is there a rash anywhere on the baby's body? Do the baby's eyes look glassy or dull? Is there any discharge from the eyes?
• Does the baby have a fever?

Any of these changes could indicate illness. if you notice any of them, or other worrisome changes in Your baby, call your baby's care- giver. When you call the office, be prepared to describe:

• The signs of illness about which you are concerned.
• How long the signs have been present.
• What you need: to have the caregiver return your call; to speak to the caregiver immediately, if you feel this is an emergency; or to arrange for the baby to be seen as soon as possible.

• Make sure it has no corner posts. older infants can catch clothing on these.
• Check that the crib slats are no more than 2 3/8 inches apart. Never put a baby in a crib that has missing slats.
• Make sure that the mattress is firm, and that it fits tightly within the crib rails, with no more than a 1-inch space (two fingers width) between the rails and the mattress.
• Assure yourself that all guide rods and support brackets are firmly in place and secure, and that no screws are missing.
• Check the locks and latches on the crib. They should be smooth, and tight enough to prevent accidental release.
• Be certain the paint used on the crib is lead-free. If it isn't, the old paint should be removed. if you're pregnant or nursing, have someone else do the stripping, preferably away from your home, or at least outside the house and away from any play or garden area. New paint should be a high-quality, lead-free enamel recommended for children's furniture. Some babies do chew on their cribs, and ingesting lead can cause brain damage.
• If your crib is new, remove and discard all plastic packaging materials, including the thin plastic mattress cover. As with a used crib, check the guide rods, support brackets, locks, and latches, and make sure no screws are missing.
• With any crib, new or old, place the crib out of reach of any cords, electrical sockets, or other hazards.
• Keep crib rails up at all times when the baby is unattended.
• As soon as your baby can pull himself or herself up, move the mattress to the lowest position. There should be at least 22 inches between the mattress and the top of the rail.

If you plan to use a bassinet or cradle instead of a crib, many of these same safety tips will still apply.

Expectant parents know they will have a lot to learn after their babies arrive. They know it will take time to feel confident about diapering, bathing, and soothing a baby. Most have been told that feeding, too, will be a learning experience. It is not until after the birth, however, that the true meaning of this is dear. Parents often say they had not anticipated that the baby, too, would need to learn to feed. Also unanticipated is the profound concern parents have that their babies be adequately nourished.

Even as adults, many people are greeted by their mothers with the questions "Are you hungry? Do you want to eat?" These are questions you will find yourself asking your baby. It is natural for you to feel somewhat anxious when the baby's answers are not as clear as you might like. Following are some basics about feeding that can guide you as you gain experience.

Feelings after Birth. Fathers who are present at birth are, more often than mothers, captured by the baby immediately. Whereas women may need minutes, hours, or a few days to feel connected to the baby, fathers often feel the power of this connection at the moment of birth. Unless the mother or baby is in some danger just after birth, the father is likely to find these moments life-changing and exquisite. These feelings are often blended with a sudden awareness of exhaustion.

A father also experiences new feelings about his mate. He may speak of his amazement at her courage, strength, and endurance during labor. He now faces the task of integrating his memory of her in labor with his previous knowledge and feelings about her.

A father may have to work through feelings he experienced while supporting the mother in labor. One of the most common feelings fathers speak about after labor is that of helplessness. Unless he is told, a man may not know how much his presence and emotional support really meant to the laboring woman.

A man may also feel that the labor experience has altered his whole life view. He may have gained a sense of the miraculous and spiritual, of a deeper meaning to life.

Not all fathers, of course, are able to share the birth experience. A lot of fathers who missed their babies' births worry that not having been there will affect their relationships with their babies. Birth is a special moment in the parent-child relationship, but it is only one moment. The years of child rearing provide many other shared moments that are just as important in the development of a relationship between father and child.

Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. Throughout the hospital stay, physicians, nurses, and other healthcare providers continually assess a baby for changes in health and for signs of problems or illness. Assessment may include:

• Apgar scoring:

• Birthweight and measurements:

1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1000 grams = 1 Kg.

• vital signs:

• temperature - able to maintain stable body temperature 98.6° F (37° C) in normal room environment
• pulse - normally 120 to 160 beats per minute
• breathing rate - normally 30 to 60 breaths per minute

• general appearance - physical activity, tone, posture, and level of consciousness
• skin - color, texture, nails, presence of rashes
• head and neck:

• appearance, shape, presence of molding (shaping of the head from passage through the birth canal)
• fontanels (the open "soft spots" between the bones of the baby's skull)
• clavicles (bones across the upper chest)

• face - eyes, ears, nose, cheeks
• mouth - palate, tongue, throat
• lungs - breath sounds, breathing pattern
• heart sounds and femoral (in the groin) pulses
• abdomen - presence of masses or hernias
• genitals and anus - for open passage of urine and stool
• arms and legs - movement and development

• Gestational assessment:

• Physical maturity:

• skin textures (i.e., sticky, smooth, peeling).
• lanugo (the soft downy hair on a baby's body) - is absent in immature babies, then appears with maturity, and then disappears again with postmaturity.
• plantar creases - these creases on the soles of the feet range from absent to covering the entire foot, depending on the maturity.
• breast - the thickness and size of breast tissue and areola (the darkened ring around each nipple) are assessed.
• eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue.
• genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled.
• genitals, female - appearance and size of the clitoris and the labia.

• Neuromuscular maturity:

• posture - how does the baby hold his/her arms and legs.
• square window - how far the baby's hands can be flexed toward the wrist.
• arm recoil - how far the baby's arms "spring back" to a flexed position.
• popliteal angle - how far the baby's knees extend.
• scarf sign - how far the elbows can be moved across the baby's chest.
• heel to ear - how close the baby's feet can be moved to the ears.

When the physical assessment score and the neuromuscular score are added together, the gestational age can be estimated. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and postmature babies.

All of these examinations are important ways to learn about your baby's well-being at birth. By identifying any problems, your baby's physician can plan the best possible care.

Learning to care for your baby is an exciting time, but may come with many questions. Listed in the directory below is some information that twill assist you in caring for your baby after birth.

The birth of a baby is one of life's most wondrous moments. Few experiences can compare with this event. Newborn babies have amazing abilities, yet they are completely dependent on others for every aspect - feeding, warmth, and comfort.

Amazing physical changes occur with birth. When the baby is delivered, the umbilical cord is cut and clamped near the navel. This ends the baby's dependence on the placenta for oxygen and nutrition. As the baby takes the first breath, air moves into the lung airways. Before birth, the lungs are not used to exchange oxygen and carbon dioxide, and need less blood supply. The fetal circulation sends most of the blood supply away from the lungs through special connections in the heart and the large blood vessels. When a baby begins to breathe air at birth, the change in pressure in the lungs helps close the fetal connections and redirect the blood flow. Now, blood is pumped to the lungs to help with the exchange of oxygen and carbon dioxide.

Some babies have excess amounts of fluid in their lungs. Stimulating the baby to cry by massage and stroking the skin can help bring the fluid up where it can be suctioned from the nose and mouth.

A newborn baby is wet from the amniotic fluid and can easily become cold. Drying the baby and using warm blankets and heat lamps can help prevent heat loss. Often a knitted hat is placed on the baby's head. Placing a baby skin-to-skin on the mother's chest or abdomen also helps keep the baby warm.

Health assessments of the new baby begin immediately. One of the first checks is the Apgar test. The Apgar test is a scoring system designed by Dr. Virginia Apgar, an anesthesiologist, to evaluate the condition of the newborn at one minute and five minutes after birth. The physician and nurses will evaluate the following signs and assign a point value:

A score of seven to 10 is considered normal. A score of four to six may indicate that the baby needs some resuscitation measures (oxygen) and careful monitoring. A score of 3 or below indicates that the baby requires immediate resuscitation and lifesaving techniques.

A brief physical examination is performed to check for obvious signs that the baby is healthy. Other necessary procedures will be done over the next few minutes and hours. These may be done in the delivery room or in the nursery, depending on several factors, including the condition of the baby. Some of these procedures include the following:

• temperature, heart rate, and respiratory rate
• measurements of weight, length, head circumference

• cord care

• Bath

• Footprints

Footprints are often taken and recorded in the medical record.

Before a baby leaves the delivery area, identification bracelets with identical numbers are placed on the baby and mother. Babies often have two, on the wrist and ankle. These should be checked each time the baby comes or goes from your room.

Healthy babies born in a vaginal delivery are usually able to stay with the mother. In many cases, immediate newborn assessments including weight, length, and medications, and even the first bath are performed right in the mother's room. As quickly as possible, a new baby is placed in the mother's arms.

In the first hour or two after birth, most babies are in an alert, wide awake phase. This offers a wonderful opportunity for parents to get to know their new baby. A baby will often turn to the familiar sound of the mother's voice. A baby's focus of vision is best at about eight to 12 inches - just the distance from baby cradled in a mother's arms to her face.

This is also the best time to begin breastfeeding. Babies have an innate ability to begin nursing immediately after they are born. Although some medications and anesthesia given to the mother during labor and delivery may affect the baby's sucking ability, most healthy babies are able to breastfeed in these first few hours. This initial feeding helps stimulate breast milk production. It also causes contraction of the mother's uterus which can help prevent excessive bleeding.

If your baby is born by a cesarean delivery, chances are good that you can be awake for the surgery. Only in rare situations will a mother require general anesthesia for delivery. This means she is not conscious for the birth. Most cesarean deliveries today are done with a regional anesthesia such as an epidural or spinal. With this type of anesthesia, only part of the body is numbed for surgery. The mother is awake and able to hear and see her baby as soon as he/she is born.

Babies born by cesarean are usually checked by a nursery nurse or pediatrician right after delivery. This is often done right near you in the operating room. Because babies born by cesarean may have difficulty clearing some of the lung fluid and mucus, extra suctioning of the nose, mouth, and throat are often needed. Occasionally, deeper suctioning in the windpipe is required.

Once a baby is checked over, a nurse will wrap the baby warmly and bring the baby to you to see and touch. In some cases, babies born by cesarean will first need to be watched in the nursery for a short time. All of the usual procedures such as weighing and medications are performed there. Usually, your baby can be brought to you while you are in the recovery area after surgery.

Many mothers think that they will not be able to breastfeed after a cesarean delivery. This is not true. Breastfeeding can begin in the first hours right in the recovery room, just as with a vaginal delivery.

Plan to have someone stay with you during your hospital stay after a cesarean delivery. You will have quite a bit of pain in the first few days and will need help with the baby.

All the baby's body systems must work together in a new way after birth. Sometimes, a baby has difficulty making the transition. Health assessments, including the Apgar test performed right after birth, can help determine if a baby is doing well or having problems.

If there are signs the baby is not doing well, treatment can be given right in the delivery room. The physician and other members of the healthcare team work together to help the baby clear excess fluid and begin breathing.

Babies who may have difficulty at birth include those born prematurely, those who experienced a difficult delivery, or those with birth defects. Fortunately for these babies, special care is available. Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained healthcare professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but need specialized nursing care. Some hospitals do not have trained personnel or a NICU and babies may need to be transferred to another hospital.

Having a sick baby can be distressing. Few parents expect complications with pregnancy or their baby to be sick or premature. It is quite natural for parents to have many different emotions as they try to cope with the difficulties of a sick baby. But, it is reassuring that today's advanced technology is helping sick babies get better and go home sooner than ever before. And it helps to know that although separation from a baby is painful, it does not harm the relationship between the mother and baby.

While each baby is a unique individual there are certain characteristics and behaviors that are common to newborns. This section will describe some of the physical and behavioral traits you may notice in your baby during the first few weeks of life.

The average baby weighs between six and nine pounds, and is between 18 to 21 inches long. Infants may lose up to five to ten percent of their birth weight during the first week of life, due mainly to loss of extra fluid accumulated by the mother and baby as the pregnancy nears term.If the baby is approaching a ten percent weight loss we will advise you as to frequency and type of feedings to ensure proper regain of weight.

Shape: Because of pressure before or during birth, your baby’s head may be temporality misshapen. Normal head shape usually returns by the end of the first week. Babies delivered by Cesarean usually don’t have as much of this head molding.

Soft spots: Your baby has two obvious soft spots or fontanelles. One is on the top of the head and the other is near the back of the head. Both the fontanelles are covered by a tough membrane and with normal handling care, you can’t damage the soft spots when shampooing, brushing, or stroking your baby’s head.

Color, tears, and swelling: Caucasian infants usually have grayish-blue eyes at birth. Infants of other ethnic backgrounds may have grayish-brown or brown eyes. However, an infant’s true eye color may not be known for several months. Tears are usually not produced in noticeable amounts with crying until your baby is one to two moths of age. Swollen and puffy eyelids or red hemorrhages on the white conjunctivae are normal after birth and result from pressure during birth. Swelling and inflammation usually go away in a few days.

Eye discharge: Occasionally, a baby may have irritation from the antibiotic ointment given at birth. You may notice a small amount of yellow discharge from your baby’s eyes during your hospital stay. This usually clears within 24 hours. If you notice a small amount of yellow discharge form your baby’s lids or lashes after you get home, just gently wipe it away with a warm moist cloth or cotton ball. If the discharge is purulent (yellow or green), in large amounts and accumulates frequently, please notify us; this can be a symptom of an infection or a blocked tear duct in need of antibiotic drop therapy.

Newborns have a wide variety of ear sizes, shapes, and positions that are normal. At birth your baby’s ears may bend easily. In time, the ear will feel firmer.

Ear Discharge: It is normal for a baby’s ears to produce wax. It is not normal for them to produce any other kind of discharge. If you think the discharge from your baby’s ears is not wax, please call us. Cotton swabs should not be used in your baby’s ears at any time; one can inadvertantly be tamping wax down into the canal deeply without realizing it. Ears can be cleaned well with the corner of a clean, damp washcloth. Just clean what you can see.

Swollen breasts: During the first days after birth, it is normal for both boys and girls to have swollen breasts. This swelling is caused by hormones a baby gets from the mother during pregnancy. Occasionally a baby may produce a small amount of milk. If your baby does produce milk or have breast swelling, do not attempt to squeeze out the milk, as this might cause infection. The swelling will go down as the baby’s body metabolizes the mother’s hormones. If the breasts are markedly swollen, tender or reddened, please call us so that we can evacuate the child for the possibility of mastitis.

Color: The skin is thin and dry. You may see some veins through it. The skin is the Caucasian newborn is a pink or reddish color. As babies cry, they may become a deeper red. In the Black infant, the skin color appears as a reddish-black color that darkens as the baby gets older. In Asian babies the skin is a tea rose color. Frequently, dark bluish spots may appear on the lower portion of the back or buttocks of babies of Black, Asian, or Mediterranean descent. These are called Mongolian spots. They are caused by a temporary accumulation of pigment under the skin and they fade without treatment during preschool years. Despite the names, these spots have nothing to do with Mongolism or Down’s Syndrome. In the newborn it is common for the baby’s hands and feet to appear bluish. This is called acrocyanosis. This is common in the first few days of life a decreases gradually.

Milia: These are tiny white spots often seen on the nose and chin. They are caused by obstruction of oil or sebaceous glands. You should not squeeze these spots. They usually disappear in several weeks.

Lanugo: your baby’s body is covered with fine downy hair. This hair is most noticeable on the back, shoulders, and ear lobes. It will fall out in time.

Vernix: A white, cheese-like substance called vernix at one time covered your baby’s skin to protect it while in the bag or waters. Traces of it are usually found in the body’s creases. It is not necessary to scrub this off.

Peeling: Most babies’ skin peels after birth because they have been in fluid for many months. This generalized peeling is completely normal and requires no treatment, including oils or lotions.

Rashes: A temporary rash, called erythema toxicum, may occur during the first few weeks. It is small areas of redness with raised yellowish-white centers and it may resemble a flea bite or hives. This rash requires no treatment. Washing clothing with a mild detergent, such as Dreft or Ivory, omitting fabric softeners and double rinsing if necessary, will help minimize rashes.

Red blotches: Many babies have reddened areas of skin on their upper eyelids and forehead. These are areas of dilated blood vessels. These areas usually fade with time (months to years) as the blood vessels contract and as the baby’s skin grows thicker and less transparent. Redness may reappear when your baby cries. These are often called Stork Bites or Angel Kisses and are distinct from the deeper purple Port-Wine stains which are permanent. they are areas of tangled capillaries. As the baby gets older ,these vessels contract and the visible redness fades.

Diaper rash: Diaper rash is often caused by irritants in the urine or stool. To minimize diaper rashers, be sure to change your baby’s diaper frequently (every two to three hours during the day). Always wash the diaper area with plain water at each change. If you launder your own diapers, double rinses with one-half cup of vinegar per rinse load may help eliminate any soap and neutralize the ammonia. If your baby develops a rash in spite of these precautions, try to change diapers more frequently and expose the reddened area to the air several times a day. A diaper rash ointment (vaseline or A&D) applied to the rash area after air-drying may be helpful. Occasionally babies develop a yeast infection of the diaper area. This is usually a deep red colored rash covering a continuous area and with accentuation in the skin folds and satellite lesions at the outer edge. If you suspect this, use Lotrimin AF ointment (clotrimazole) which is available over-the-counter or call us for further guidance.

Genitals- Swelling & Vaginal Discharge: The genitals of both boys and girls are usually large and swollen from hormones passed from the mother through the placenta. Girls may also have a white, mucoid, and sometimes blood-tinged vaginal discharge. As your baby metabolizes your hormones, these changes will disappear.

Moro (Startle): The Moro reflex is a sudden reaction to a loud noise or change in position. It appears as jerky, generalized muscular activity with a flinging out of your baby’s arms and legs, then bringing them back in towards the body.

Rooting: When an object touches your baby’s cheek, your baby turns his head toward the side touched, opens his mouth and begins to suck.

Sucking and Swallowing: Touching your baby’s lips will trigger the sucking reflex which is followed by the swallowing reflex.

Gag: The gag reflex helps your baby get rid of mucus in his stomach that he swallowed during birth or to regurgitate excess milk taken at a feeding.

Hiccups: Hiccups are a common occurrence. They do not bother your baby and will go away without any special treatment.

Cough & Sneeze: These reflexes help your baby remove irritating substances from him nose and throat. They are not necessarily signs of a cold.

Blinking: Your baby’s eyes will blink when they are exposed to bright light. Blinking also protects the eyes from foreign objects.

Walking: When you hold your baby around the chest in an upright position with his feet touching a hard surface, he will make prancing movements with his feet.

Grasping: This reflex is present in both the hands and the feet. Your baby will grasp any object put into his hands, hold it briefly and then drop it.

Deep Sleep: In this state your baby is nearly still except for an occasional startle or twitch. Breathing is regular. There are no eye movements and few facial movements. It is very difficult to arouse your baby in this state.

Light Sleep: In this state your baby shows some body movement. Breathing is irregular. You can see rapid eye movements beneath the eyelids and your baby may smile or briefly fuss. This state usually comes just before awakening or you may be able to awaken your baby to feed at this time.

Drowsy: In the drowsy state you baby’s activity level varies. The eyes may open and close occasionally and seem heavy. Breathing is also irregular in this state. Your baby may go back to sleep or awaken more.

Quite Alert: When your baby is in the quiet alert state, his eyes are wide open, his breathing is regular, and he is very attentive to what is going on around him. During this time, your baby is most interested in eating and learning about his new world.

Active Alert: In this state your baby becomes very active and may fuss. His breathing is again irregular and he is increasingly sensitive to stimulation or personal needs such as hunger, discomfort, fatigue, etc. At this time it is best to comfort your baby and bring him to a lower state.

Crying: Crying is your baby’s way of telling you that he needs something or that something is bothering him. Some causes of crying include hunger, physical discomfort, fatigue, boredom, needing to be burped, being over stimulated, or needing close physical contact. As you live with your baby, you will learn to tell the difference in his cries and discover what works best to soothe him.