Overview

Welcoming a newborn comes with its share of surprises, and this episode aims to help you navigate and troubleshoot some common challenges. While most of these issues are not serious, trusting your instincts is essential. Don’t hesitate to contact your pediatrician if something doesn’t feel right. This episode explores the research on topics like jaundice, diaper rashes, baby acne, cradle cap, scratching, colds, fevers, gas, vomiting, and colic. Thankfully, there are many effective remedies and strategies to manage these concerns. While these may not be the most glamorous topics, understanding them will better equip you to navigate caring for your newborn.

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Article and Resources

Understanding Jaundice

Jaundice is a common condition in healthy newborns that causes a yellowish tint to their skin and eyes. It results from a buildup of bilirubin, a substance produced when red blood cells break down. Normally, the liver processes and removes bilirubin from the bloodstream, but a newborn’s liver might not be fully efficient yet, leading to this temporary condition. Neonatal jaundice is the most frequently encountered medical condition in the first two weeks of life and a common cause of hospital readmission. According to the American Academy of Pediatrics, More than 80% of newborn infants will have some degree of jaundice.

Mild jaundice is typically harmless and resolves on its own. However, if bilirubin levels become too high, it can lead to more serious complications. Jaundice is more common in breastfeeding newborns, especially if they’re not nursing effectively. Ensuring your baby nurses 8–12 times per day can help keep bilirubin levels in check.

Another risk factor for jaundice is Rh incompatibility, which occurs when the mother’s blood type is Rh-negative and the baby’s blood type is Rh-positive. This mismatch can cause the mother’s immune system to produce antibodies that attack the baby’s red blood cells, leading to increased bilirubin levels. If you have a negative blood type, your doctor or midwife may recommend a medication called RhoGAM during the third trimester to prevent these complications. For more information on Rh-negative blood types and the RhoGAM shot, refer to this episode that dives into the evidence on this topic.

If you suspect jaundice, monitor your baby closely. It often starts on the face and then progresses to the chest, abdomen, arms, and legs. The whites of the eyes may also appear yellow. The doctor will check for jaundice during your baby’s first pediatrician visit. They may order a skin or blood test to confirm the diagnosis if necessary.

Jaundice typically peaks at 3–5 days old. If treatment is required, options include phototherapy, where your baby is placed under special lights while undressed, with their eyes protected. This can be done in the hospital or at home. Frequent breastfeeding and monitoring are key to managing and preventing jaundice effectively.

Navigating Breastfeeding Challenges

If you encounter any breastfeeding challenges, such as difficulty with your baby latching or concerns about milk supply, seek help right away. Don’t wait to address breastfeeding concerns. Getting help early can prevent minor issues from becoming major challenges and ensure a smoother breastfeeding journey for you and your baby. You can see all of the Pregnancy Podcast breastfeeding resources here, including a dedicated episode on troubleshooting common breastfeeding issues.

There are many resources available, and many are free. A great starting point is La Leche League, which provides excellent resources and support groups at no cost. A lactation consultant can also be invaluable. While their rates vary, their expertise in solving breastfeeding issues is often priceless and well worth the investment. If cost is a concern, check with your hospital or birth center, and they may offer free resources.

Recognizing and Preventing Diaper Rash

Diaper rash appears as red, irritated skin in the diaper area. The good news is that not every baby will get a diaper rash, and this affects between 16-65% of infants. The number one way to prevent diaper rash is to change soiled diapers as soon as possible. The most common type of diaper rash is irritant dermatitis. This is caused by prolonged contact of the skin with urine and stool. This appears as pink or red patches on the skin and usually not in the groin folds.

Effective Ways to Treat Diaper Rash

If your baby develops a diaper rash, it is most likely contact dermatitis, and there are several effective ways to treat it. You should be extra diligent about changing soiled diapers immediately to keep the area clean and dry. Cloth diapers tend to be less absorbent than disposable. If you use cloth diapers and your baby develops a rash, you may consider temporarily using disposable diapers until the rash clears up.

Use water and a soft washcloth or baby wipes that are alcohol- and fragrance-free to clean the area gently. A squirt water bottle can be a gentler alternative to wiping for severe rashes. You should also allow the area to air dry completely before putting on a new diaper. Giving your baby some diaper-free time can also help their skin heal quicker.

Diaper rash cream with zinc oxide or petroleum acts as a barrier between your baby’s skin and the contents of a dirty diaper. This can be used proactively to help prevent rashes or allow the skin to heal if irritated. Apply diaper cream as a thick layer on your baby’s skin.

If you address diaper rash early and follow these steps, it will clear up quickly. Most diaper rashes do not require medical attention. Contact your pediatrician if a rash does not go away or worsens after two to three days of treatment.

Other Rashes and When to Call Your Pediatrician

Other rashes can result from bacteria, allergies, or, in rare cases, other conditions that may initially appear as a rash. A rash can also result from a yeast infection, which appears as shiny, bright red or pink patches with sharp edges and may have little pink bumps or pimples. This is usually in the folds of the groin. Yeast infections are most commonly linked to antibiotic use, which can disrupt the gut microbiome and lead to an overproduction of candida. If your baby takes an antibiotic and develops a yeast infection, contact your pediatrician. Other indications to contact your doctor are if the rash includes pimples, peeling skin, blisters, pus-filled or oozing or crusty sores. If the rash is especially painful or your baby has a fever.

Managing Baby Acne

Baby Acne Baby acne typically appears as small red or white bumps on a baby’s cheeks, nose, and forehead. It usually develops within the first two to four weeks after birth and resolves on its own within three to four months. This condition is completely harmless and very common. While it might bother you to see, it should not bother your baby.

To care for baby acne, gently wash your baby’s face daily with warm water and mild baby soap, then pat it dry. Avoid pinching or scrubbing the bumps, which can cause irritation or infection. Additionally, do not use lotions or oils on your baby’s face, as these can worsen the condition. With proper care, baby acne will usually clear up naturally without medical intervention.

Dealing with Cradle Cap

Seborrheic dermatitis is a mild skin condition that appears as crusty or oily scaly patches. This can appear on a baby’s face, armpits, neck crease, or diaper area. When it appears on the scalp, it is known as cradle cap. Cradle cap usually appears between 3 weeks and 2 months old and affects around 70% of babies. The exact cause of this is unknown, and it is likely due to a combination of overproduction of sebum in the oil glands and hair follicles and a type of yeast found on the skin. While it may look unpleasant, this condition is completely harmless and is not painful or itchy for your baby. The scales may be thick, white, or yellow and are often tough to remove.

The good news is that cradle cap typically resolves on its own within a few months. To help manage the cradle cap, wash your baby’s scalp daily with a mild shampoo. You can utilize gentle massage, a soft brush, or a baby comb to loosen and remove the scales. For tougher scales, you may consider applying mineral oil, coconut oil, or petroleum jelly overnight and then washing your baby’s hair in the morning. Do not scratch the affected areas, which can cause irritation or infection. If the condition persists or seems severe, consult your pediatrician.

Caring for Your Baby’s Fingernails

Babies’ fingernails grow quickly and can be very sharp, making it easy for them to scratch themselves. To prevent your baby from scratching themselves, keep their nails trimmed. There are clippers and nail files specifically marketed for babies. These tend to be safer and have less risk of accidentally cutting your baby as you trim their nails. If your baby resists nail trimming or is squirming, try doing it while they are eating or sleeping.

Another solution to prevent your baby from scratching themselves is to cover their hands with mittens. One cue your baby may be hungry is when they clench their fists and bring them towards their face. If your baby is wearing mittens, you will not see when their fists are clenched. There is also an argument that babies are comforted by their hands and that mittens may limit your baby’s ability to explore their environment through touch. After all, they have had nine months of being able to explore with their hands. Thankfully, if your baby does scratch themselves, their skin will heal quickly.

How to Handle Baby Colds

At some point, your baby will likely catch a cold, a viral infection of the nose and throat. Common symptoms include congestion, a runny nose, sneezing, coughing, and possibly a low-grade fever. Other signs might include irritability, difficulty sleeping, or a decreased appetite. Young infants are more susceptible to colds developing into something serious, so monitor their symptoms closely and consult your doctor if you’re concerned.

Unfortunately, there is no cure for the common cold. Most medications are not recommended for infants and you would always want to run any medications by your pediatrician, even if they are available over-the-counter. You can ease your baby’s discomfort by keeping them hydrated with frequent feedings and using a humidifier to maintain moisture in the air.

If your baby has a stuffy nose, saline drops, and a suction bulb can help clear mucus. The best tool for clearing your baby’s nasal passages is the NoseFrida, which allows you to suck the snot right out of their nose. This is intelligently designed and is not as gross as it initially sounds. Babies breathe through their noses while breastfeeding or drinking from a bottle, and a stuffy nose makes it difficult for your baby to eat. While a snot sucker may sound unappealing, it can be a lifesaver when your baby has a stuffy or snotty nose.

Vomiting vs. Spitting Up

Vomiting is quite different than your baby just spitting up. Spitting up during or after feedings is common for babies. This involves milk slowly free-flowing out of your baby’s mouth. Vomiting involves the forceful ejection of stomach contents. This can occur due to feeding difficulties or car sickness. If vomiting is persistent or accompanied by other concerning symptoms, contact your pediatrician.

Understanding Fevers in Newborns

Fevers are a natural part of the body’s defense against infection, as they help the immune system fight off bacteria and viruses. 14 out of every 1,000 healthy infants born full term develop a fever during the ages 8 days to 60 days old.

There are two ways to take your baby’s temperature: with a thermometer rectally (which tends to be the most accurate) or under their armpit. Tympanic thermometers, which measure temperature in the ear, are not recommended until your baby is at least three months old. Oral thermometers are best for children over age four. Infants tend to run warmer than older kids. The thresholds for what is considered a fever differ depending on how you take your baby’s temperature. A rectal temperature of over 38°C (100.4°F) is considered a fever, and a temperature taken in the armpit over 37.2°C (99°F) is considered a fever.

Overheating is the most common reason for fevers in newborns, as they are unable to regulate their body temperature effectively. If you suspect this is the reason for your baby’s fever, adjust your baby’s clothing or environment and monitor their temperature.

If your baby develops a fever, get in touch with your pediatrician right away. For younger infants, they will likely recommend you go to the emergency room. Even a mild fever can signify a more serious infection that can progress quickly. While this possibility can be scary, infants are also very quick to respond to treatment. The key is getting medical attention to identify and treat the underlying cause immediately.

You may breeze through the first few months without your baby ever getting a fever. As your baby gets older, fevers are not so scary, and you have more options for treating them prior to contacting your doctor. Talk to your pediatrician for their recommendation on fevers and when to contact them. When in doubt, always call your pediatrician.

Dealing with Gas

All babies experience gas as they digest food. If your baby is generally content and only fusses for a few seconds while passing gas, it shouldn’t be anything to worry about. As they get older and their digestive system matures, gas will be less of an issue. Gas can make your baby fussy, and signs of gas include burping, bloating, farting, or a firm tummy.

If you suspect your baby is gassy, there are several things you can do to help. You can place your baby’s belly down for tummy time, which may help put mild pressure on the stomach to relieve gas. You can also place them on their back and gently massage their belly or move their legs in a bicycle motion.

For breastfeeding moms, certain foods in your diet can cause gas. Pay attention to what you eat, observe your baby’s reactions, and make adjustments as needed, which may help relieve gas. If you give your baby formula and gas is a persistent issue, you may consider trying an alternative formula or one marketed to reduce gas.

There are a lot of things you can do to prevent gas in the first place. Ensuring your baby has a good latch on your breast or a bottle can minimize the amount of air they take in during feedings. If you bottle feed your baby, ensure you tilt the bottle at an angle so that milk fills the entire nipple to prevent your baby from sucking in the air. Burping your baby during and after feedings can get air out before it can travel through the intestinal tract.

What to Know About Colic

While crying is the primary mode of communication for a baby, some babies cry more than others. Colic is defined as a baby whose crying lasts for more than 3 hours a day at least 3 days per week for more than 3 weeks. Colicky babies usually tend to get fussy toward the end of the day, but it can really happen at any time. The cause of colic is unknown. Researchers have explored a number of possibilities, including allergies, lactose intolerance, changes in the normal bacteria found in the digestive system, a digestive system that hasn’t fully developed, anxious parents, and differences in the way a baby is fed or comforted. Yet it’s still unclear why some babies have colic, and others don’t.

Colic usually starts a few weeks after birth and tends to go away by 3 months. If your baby does have colic, it may clench its fists when crying, curl up its legs, or turn bright red. They can cry in bouts or seem like it is non-stop. A baby crying a lot may swallow more air, contributing to more gas. Their tummy may look swollen and tight, making them even more uncomfortable. Colic can be extremely frustrating for parents.

Techniques to Soothe Your Baby

The “5 S’s,” developed by pediatrician Dr. Harvey Karp, cover the basic techniques to soothe a crying baby. These techniques are designed to help recreate the comforting environment of the womb. They may be more effective for a baby who is not colicky, but they are worth trying if your baby is especially fussy. The 5 S’s include:

1. Swaddle: wrap your baby like a mini burrito with their arms snug and straight at their sides (hips loose). You can swaddle your baby in a swaddle blanket or use wraps specifically for swaddling. This is thought to recreate the gentle hug and security of the womb and decrease the startle reflex.
2. Side or stomach position: Hold your baby positioned on the side or stomach or even over your shoulder. This is only used for holding your baby; they should always be on their back to sleep.
3. Shush: make a “shhh” sound or play white noise to mimic the sound of blood flow in the womb.
4. Swing: swing or jiggle in fast, tiny movements while supporting your baby’s head and neck.
5. Suck: sucking on a pacifier, thumb, or breast helps soothe your baby.

Each baby is different, so it may take some time to determine which techniques work best or if a combination of these methods is most effective. A baby with colic may not respond to these soothing techniques.

The Importance of Never Shaking Your Baby

Babies who have colic can be hard to care for. If a baby is crying nonstop, it can be extremely frustrating, especially when it feels like nothing works to calm them down. Frustration with a baby’s crying is the number one trigger for shaken baby syndrome. Shaken Baby Syndrome/Abusive Head Trauma is a term used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child. Violent shaking for just a few seconds has the potential to cause severe injuries. Babies are vulnerable to injury from shaking because their heads are heavy and large in proportion to their body size; they have weak neck muscles and fragile, undeveloped brains.

I know what you are thinking: who would ever shake a baby? This seems like a ridiculous message you will hear over and over as a new parent. There is actually a National Center on Shaken Baby Syndrome dedicated to supporting and educating families, caregivers, and professionals to prevent shaken baby syndrome. There are about 1,300 cases of shaken baby syndrome every year in the United States. About 25% of babies die, and about 80% suffer lifelong disabilities.

As silly as it may seem to hear, never shake a baby. If at any point you feel overwhelmed and frustrated with your baby, take a break. If someone is available to care for your baby, ask them to watch your baby while you take a break. If that is not an option, you can safely put your baby down in their crib, check on them often, and step away for a few minutes. We are wired to want to soothe a crying baby, and it can be incredibly frustrating if your baby is crying non-stop without responding to any soothing techniques. You need to be calm and collected so you are not getting overly frustrated.

Should You Use Gripe Water?

Some products are marketed to help with colic. Gripe water is a liquid that can contain sodium bicarbonate to help neutralize stomach acid or herbs like ginger or chamomile that are thought to help calm the stomach. There is limited research on gripe water to relieve gas. One study actually found that vomiting and constipation were more common in babies who received gripe water than those who did not. Always check with your pediatrician before giving your baby any supplements. If you would like to try giving your bay gripe water, there are brands that are formulated without alcohol, dyes, or artificial sweeteners.

Exploring Probiotics for Babies

There are also probiotics for infants marketed to reduce crying and fussiness. Probiotics are live bacteria to support a healthy gut microbiome. For infants, probiotics are sometimes used to address digestive issues, such as gas, colic, or diarrhea, or to promote overall gut health. There is evidence supporting probiotic supplementation as an effective method to reduce colic. Research shows that lactobacillus reuteri effectively reduces infant colic in breastfed infants. However, the same results were not found for infants on formula. Talk to your pediatrician before giving your baby any supplements. Infant probiotics can be liquid, which you can give your baby directly; powders, which you can mix with milk; and some formulas, which include added probiotics. If you want to give your baby probiotics, look for one that contains lactobacillus reuteri.

As always, run any supplements, even over-the-counter supplements marketed for infants, by your pediatrician first. While there is no magic cure for colic, there is little downside to trying these.

When to Call Your Pediatrician

Your first pediatrician appointment should occur within three to five days of your baby’s birth, followed by visits at 1, 2, 4, and 6 months of age. Be sure to save your pediatrician’s contact information in your phone and know who to contact for assistance outside of normal office hours. While it’s a good idea to keep a running list of questions to address during regular check-ups, don’t hesitate to contact your pediatrician if any concerns arise between visits. Trust your instincts, and if something doesn’t feel right, call. If your concerns are ever dismissed, advocate for yourself and your baby to ensure your concerns are properly addressed.

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