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A Guide For First Time Parents


You've survived 9 months of pregnancy. You've made it through the excitement of labor and delivery, and now you're ready to head home and begin life with your baby. Once home, though, you frantically realize you have no idea what you're doing!

Brushing up on these tips can help first-time parents feel confident about caring for a newborn in no time.

Getting Help After the Birth
Consider recruiting help from friends and family to get through this time, which can be very hectic and overwhelming. While in the hospital, use the expertise around you. Many hospitals have feeding specialists or lactation consultants who can help you get started nursing or bottle-feeding. In addition, nurses are a great resource to show you how to hold, burp, change, and care for your baby.
For in-home help, you might want to hire a baby nurse or a responsible neighborhood teenager to help you for a short time after the birth. Your doctor or the hospital can be a good resource for find information about in-home help, they may even be able to make a referral to home health agencies. In addition, relatives and friends can be a great resource. They may be more than eager to help, and although you may disagree on certain things, don't dismiss their experience. But if you don't feel up to having guests or you have other concerns, don't feel guilty about placing restrictions on visitors.

Handling a Newborn
If you haven't spent a lot of time around newborns, their fragility may be intimidating. Here are a few basics to remember:
  • Wash your hands (or use a hand sanitizer) before handling your newborn. Young babies have not built up a strong immune system yet, so they are susceptible to infection. Make sure that everyone who handles your baby also has clean hands.
  • Be careful to support your baby's head and neck. Cradle the head when carrying your baby and support the head when carrying the baby upright or when you lay him or her down.
  • Be careful not to shake your newborn, whether in play or in frustration. Shaking that is vigorous can cause bleeding in the brain and even death. If you need to wake your infant, don't do it by shaking — instead, tickle your baby's feet or blow gently on a cheek.
  • Make sure your baby is securely fastened into the carrier, stroller, or car seat. Limit any activity that would be too rough or bouncy.
  • Remember that your newborn is not ready for rough play, such as being jiggled on the knee or thrown in the air.
The First Day Of Life
You've been waiting for this day for months: Finally you get to meet your new baby. But like many new parents, you might not have a clear idea of what that meeting will be like.
Wondering how your baby will look and what he or she will do after arriving? Read on.

What Your Newborn Looks Like
Although you may have visions of a robust bouncing baby, reality may not match that image. Many newborns are tiny, wet creatures when they first emerge. Often their heads are slightly pointed as a result of passing through the birth canal. This is only temporary — the head will take on a rounded appearance within a few days. It may surprise you that a newborn's head is so big compared with the rest of the body.
Your baby also may look scrunched up since the legs and arms have been kept bent at the knees and elbows while in the womb. After months of growing in ever-tightening close quarters, this is perfectly normal. The limbs will straighten out as your baby grows.
Look at your baby's tiny fingers and toes. You'll notice the paper-thin — and sometimes long — nails.
Your baby's skin may have one of several possible appearances, looking somewhat red, pink, or purple at first. Some babies are born with a white coating called vernix caseosa, which protects their skin from the constant exposure to amniotic fluid in the womb. The vernix is washed off with the baby's first bath. Other babies are born very wrinkled. And some, especially premature babies, have a soft, furry appearance because of lanugo, a fine hair that develops while in the womb. Lanugo usually comes off after a week or two.
Rashes, blotches, or tiny white spots also are common on newborns. These generally clear up over the first few days or weeks after birth. The doctor will examine your baby within the first 12-24 hours of birth and make sure that any rashes or spots are normal.
Remember, your baby's appearance will change dramatically over the next weeks as he or she grows. The limbs will extend, the skin tone will probably change, and the blotches will disappear.

Bonding With Your Baby
Bonding is the intense attachment that develops between parents and their baby. It makes parents want to shower their baby with love and affection and to protect and nourish their little one. Bonding gets parents up in the middle of the night to feedtheir hungry baby and makes them attentive to the baby's wide range of cries.
Scientists are still learning a lot about bonding. They know that the strong ties between parents and their child provide the baby's first model for intimate relationships and foster a sense of security and positive self-esteem. And parents' responsiveness to an infant's signals can affect the child's social and cognitive development.

Why Is Bonding Important?
Bonding is essential for a baby. Studies of newborn monkeys who were given mannequin mothers at birth showed that, even when the mannequins were made of soft material and provided formula to the baby monkeys, the babies were better socialized when they had live mothers to interact with. The baby monkeys with mannequin mothers also were more likely to suffer from despair. Scientists suspect that lack of bonding in human babies can cause similar problems.
Most infants are ready to bond immediately. Parents, on the other hand, may have a mixture of feelings about it. Some parents feel an intense attachment within the first minutes or days after their baby's birth. For others — especially if the baby is adopted or has been placed in intensive care — it may take a bit longer.
But bonding is a process, not something that takes place within minutes and not something that has to be limited to happening within a certain time period after birth. For many parents, bonding is a byproduct of everyday caregiving. You may not even know it's happening until you observe your baby's first smile and suddenly realize that you're filled with love and joy.

Sleep Of Your Newborn
Newborn babies don't know the difference between day and night yet — and their tiny stomachs don't hold enough breast milk or formula to keep them satisfied for very long. They need food every few hours, no matter what time of day or night it is.

How Long Babies Sleep
A newborn may sleep as much as 16 hours a day (or even more), often in stretches of 3 to 4 hours at a time. And like the sleep all of us experience, babies have different phases of sleep: drowsiness, REM (rapid eye movement) sleep, light sleep, deep sleep, and very deep sleep. As babies grow, their periods of wakefulness increase.
At first, these short stretches of 3 to 4 hours of sleep may be frustrating for you as they interfere with your sleep pattern. Have patience — this will change as your baby grows and begins to adapt to the rhythms of life outside the womb.
At first, though, the need to feed will outweigh the need to sleep. Many pediatricians recommend that a parent not let a newborn sleep too long without feeding. In practical terms, that means offering a feeding to your baby every 3 to 4 hours or so, and possibly more often for smaller or premature babies. Breastfed infants may get hungry more frequently than bottle-fed babies and need to nurse every 2 hours in the first few weeks.

Growth Of Your Newborn
In their first year, newborns grow a big way, with most tripling their birth weight and increasing their length by about 50%.
From your baby's first day, health care providers will keep track of weight, length, and head size. Growth is a good indicator of general health, and babies who are progressing well are generally healthy, while poor growth can be a sign of a problem.

What Newborns Weigh

Just like adults, newborns come in a range of healthy sizes. Most full-term babies (born between 37 and 40 weeks) weigh somewhere between 5 pounds 8 ounces (2,500 grams) and 8 pounds, 13 ounces (4,000 grams).
A newborn who is lighter or heavier than the average range is probably perfectly fine but might receive extra attention from the doctors and nurses after delivery just to make sure there are no problems.
A number of things can affect a baby's size at birth. The length of the pregnancy is important. Babies born at their due date or later tend to be larger than those born earlier. Babies born prematurely are often smaller than full-term babies.

Other factors include:
  • Size of parents. Tall parents may have larger-than-average newborns; short parents may have smaller-than-average newborns.
  • Multiple births. If you're having twins, triplets, or more, you can count on your babies being relatively small. Multiples not only have to share their growing space in the uterus, they also are often born early, which leads to small size at birth.
  • Birth order. First babies are sometimes smaller than brothers or sisters born later.
  • Gender. Girls tend to be smaller, boys larger, but the differences are slight at birth.
  • Mother's health during pregnancy. Factors that can lead to a lower birth weight include a mother's high blood pressure, heart problems, or use of cigarettes, alcohol, or illegal drugs during the pregnancy. If the mother has diabetes, the baby may have a higher birth weight. All conditions that can affect a baby's weight should be closely monitored by the mother's doctor. In addition, women should not smoke, drink alcohol, or use illegal drugs during pregnancy.
  • Nutrition during pregnancy. Proper nutrition is essential for a baby's growth in the uterus and beyond. A poor diet during pregnancy can affect how much a newborn weighs and how the infant grows.
  • Baby's health. Medical problems, including some birth defects and certain infections acquired during the pregnancy, can affect a child's birth weight and later growth.
Your Childs Immunistions
Babies are born with protection against certain diseases because antibodies from their mothers were passed to them through the placenta. After birth, breastfed babies get the continued benefits of additional antibodies in breast milk. But in both cases, the protection is temporary.
Immunization (vaccination) is a way of creating immunity to certain diseases by using small amounts of a killed or weakened microorganism that causes the particular disease.
Microorganisms can be viruses (such as the measles virus) or they can be bacteria (such as pneumococcus). Vaccines stimulate the immune system to react as if there were a real infection — it fends off the "infection" and remembers the organism so that it can fight it quickly should it enter the body later.

Types of Vaccines
There are a few different types of vaccines. They include:
  • Attenuated (weakened) live viruses are used in some vaccines such as in the measles, mumps, and rubella (MMR) vaccine.
  • Killed (inactivated) viruses or bacteria are used in some vaccines, such as in IPV.
  • Toxoid vaccines contain an inactivated toxin produced by the bacterium. For example, the diphtheria and tetanus vaccines are toxoid vaccines.
  • Conjugate vaccines (such as Hib) contain parts of bacteria combined with proteins.
The American Academy of Pediatrics (AAP) recommends that kids get combination vaccines (rather than single vaccines) whenever possible. Many vaccines are offered in combination to help reduce the number of shots a child receives.

What Vaccines Your Child Needs
The following vaccinations and schedules are recommended by the AAP. Please note that some variations are acceptable and that changes in recommendations often occur as new vaccines are developed. Your doctor will determine the best vaccinations and schedule for your child.

Recommended vaccinations:
  • Chickenpox vaccine
  • Diphtheria, Tetanus & Pertussis vaccine (DTaP)
  • Hepatitis A vaccine (HAV)
  • Hepatitis B vaccine (HBV)
  • Hib vaccine
  • Human Papillomavirus (HPV) vaccine
  • Influenza vaccine
  • Measles, Mumps & Rubella vaccine (MMR)
  • Meningococcal/Meningitis vaccine
  • Pneumococcal vaccines (PCV, PPSV)
  • Polio vaccine (IPV)
  • Rotavirus vaccine
Vaccine Concerns
Some parents may hesitate to have their kids vaccinated because they're worried that the children will have serious reactions or may get the illness the vaccine is supposed to prevent. But because the components of vaccines are weakened or killed — and in some cases, only parts of the microorganism are used — they're unlikely to cause any serious illness.
Some vaccines may cause mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare. The risks of vaccinations are small compared with the health risks associated with the diseases they're intended to prevent.

Immunizations are one of the best means of protection against contagious diseases.

Newborn Screening Tests:
About Newborn Screening
Newborn screening is the practice of testing every newborn for certain harmful or potentially fatal disorders that aren't otherwise apparent at birth.
Many of these are metabolic disorders (often called "inborn errors of metabolism") that interfere with the body's use of nutrients to maintain healthy tissues and produce energy. Other disorders that screening can detect include problems with hormones or the blood.
In general, metabolic and other inherited disorders can hinder an infant's normal physical and mental development in a variety of ways. And parents can pass along the gene for a certain disorder without even knowing that they're carriers.
With a simple blood test, doctors often can tell whether newborns have certain conditions that eventually could cause problems. Although these conditions are considered rare and most babies are given a clean bill of health, early diagnosis and proper treatment can make the difference between lifelong impairment and healthy development.

Screening: Past, Present & Future
In the early 1960s, scientist Robert Guthrie, PhD, developed a blood test that could determine whether newborns had the metabolic disorder phenylketonuria (PKU). People with PKU lack an enzyme needed to process the amino acid phenylalanine, which is necessary for normal growth in kids and for normal protein use throughout life. However, if too much phenylalanine builds up, it damages brain tissue and eventually can cause substantial developmental delay.
If kids born with PKU are put on a special diet right away, they can avoid the developmental delay the condition caused in past generations and lead normal lives.
Since the development of the PKU test, researchers have developed additional blood tests that can screen newborns for other disorders that, unless detected and treated early, can cause physical problems, developmental delay, and in some cases, death.
The federal government has set no national standards, so screening requirements vary from state to state and are determined by individual state public health departments. Many states have mandatory newborn screening programs, but parents can refuse the testing for their infant if they choose.
Almost all states now screen for more than 30 disorders. One screening technique, the tandem mass spectrometry (or MS/MS), can screen for more than 20 inherited metabolic disorders with a single drop of blood.