Scary New Babies

This week's guest columnist is Dr. Elizabeth Hunter, a Family Practice resident at the University Hospital and Clinics here in Lafayette. It's 10 pm and Sarah is pacing the floor, holding newborn Charlie.  Charlie seems to be spitting up more, and sometimes he coughs.  She worries: is this normal?  Is Charlie sick?  Is he eating enough?  When Charlie coughs he occasionally gags and chokes, and this scares Sarah the most.  Should I take him to the ER, or wait to see the doctor tomorrow? We see many new parents in the pediatric ER with these concerns and more.  Let's discuss common feeding worries first.  Babies often spit up after feeds, sometimes freaking out moms, who worry that if baby vomits while lying on his back, he will choke to death.  The good news is that coughing, gagging, and swallowing reflexes clear babies' airways to prevent bad things.  And despite all that spitting up, just about all newborns hold down enough calories to grow. Parents can also be alarmed by how baby breathes, especially with so much talk about Sudden Infant Death Syndrome (SIDS).  Many newborns have light snoring, since they breathe through their noses.  That noise can get worse with some dried mucus in the back of the throat, and baby can gag on that mucus too.  All that noise can really freak mom out- is she going to stop breathing!? More good news- gagging on vomit or mucus, and noisy breathing, don't cause SIDS.  Again, babies are designed to handle these.  What they can't handle is the real cause of many SIDS deaths- smothering in thick blankets, pillows, mattresses, or against adults in bed with them.  When baby's face gets covered by heavy bedclothes, or ends up face down on a soft surface, baby doesn't have the ability to roll over or use his arms to clear his face. Thus babies shouldn't sleep on mattresses, couches, pillows, or with parents, siblings, or animals (live or stuffed).  They should sleep face-up on thin mattresses with thin blankets. Sometimes even doctors who aren't pediatricians get freaked out by things newborns do.  Dr. Hamilton tells of a phone call from an outlying ER, the doctor saying "Scott, I've got a real 'fascinoma!'"  Fascinoma is doctor-talk for an interesting, weird problem- literally a "fascinating lesion."  The doctor had a newborn with apparent breast development.  "Then when I squeeze the breast, milk comes out!" he exclaimed. Dr. Hamilton reassured the doctor that this was normal.  Pregnant women make a hormone called prolactin, which starts their milk production.  Babies get some prolactin through the placenta before delivery, and for some weeks after can make milk themselves, before the hormone washes out of their system. Parents can get weirded out by more mundane things, like stooling.  Lots of moms wonder if baby poops enough.  Baby may skip a day or two of pooping, seem to get fussy, and then mom worries that baby is in pain from constipation. However, not all babies poop daily.  Some may go 3-4 days without stooling and that's normal.  If the stool comes out soft when baby finally does go, that's not constipation.  And babies at that age fuss for lots of reasons- wet diapers, gas pain or colic, hunger, or just wanting to be swaddled and held.  It's important to know that breast feeding decreases the chances of colic and days without stooling, besides being generally healthier for infants. The umbilical cord also concerns many parents.  First, it looks gross, initially gelatinous, then drying up like a piece of jerky.  Sometimes when it falls off, there's blood and wetness underneath- normal!.  Parents are afraid to touch it, afraid to pull on it. No worries- it won't tear off and guts come sliding out. It's also not necessary to put any special lotions or creams on it.  Plain water is the best thing to wash it with, and fold the front of the diaper down so it won't get irritated or pooped and peed on. Worrying about newborns is normal for new, or even experienced parents.  Second babies can do different odd things than first ones, upsetting parents who thought they saw it all the first time.  Read up on babies, with books or reliable on-line sources recommended by your doctor.  Knowledge helps keep normal babies at home, and out of the ER.