Caring for Your Newborn

photos depicting newborn cues

[An audio version of this post is available on my podcast, episode 9.]

In this post, I’ll just offer a brief introduction to key ideas about understanding your baby’s needs, calming crying, infant sleep, and getting breastfeeding off to a good start. I include links to lots of related resources, including photos and videos to illustrate newborn appearance, cues a baby uses that communicate their needs, and skills for caring for your newborn. Click on those links to learn more!

Meeting Your Baby

In my article on Birth and Baby’s First Hour, (episode 7 of my podcast) I covered baby’s first golden hour, and topics such as Apgar scores, skin-to-skin contact with the parent, and the benefits of keeping baby with you in the first hour after birth.

When you first meet your baby, they may not look like the perfect baby you see in advertisements. A newborn may be covered with a creamy substance called vernix, they may have a rash or red marks or white dots on their face. Their genitals may be swollen, and they will have soft spots on their head. I encourage you to learn about what to expect by watching a video on YouTube about newborn appearance, such as the video from Together with Baby.

Your newborn may be crying, but I find that many newborns who are in skin-to-skin contact with their parent are very calm. They may have a relaxed body, calm breathing, and bright, wide open eyes that gaze around. Those signs are known as “engagement cues” – in a few weeks, baby will also add smiles to those engagement cues, and they’ll add reaching out and up for connection. Whenever your child shows engagement cues, that tells you they are ready to connect and to learn. Talk to them, sing to them, gently massage them.

Babies can only take in so much new information before they need a break to process it. So, when your baby starts to show disengagement cues, give them a break where you hold them quietly but don’t interact a lot – that helps you to avoid overstimulating your baby. Disengagement cues are when your baby looks away, turns their head away, “pushes” away with their hands, gets glassy-eyed or looks “spaced out” or just start squirming and wiggling around. If they’re over-stimulated, this can escalate up to a baby with a stiff body, fast choppy breathing, jerky movements, and crying.

Knowing about and being able to recognize baby’s instinctive behaviors can help you to understand what they need. I made a video about newborn cues that show babies displaying these behaviors. You can find it on YouTube – it’s titled Newborn Cues Narrated – What is Your Baby Trying To Tell You. I encourage you to check it out now, and bookmark it to refer back to after your baby is born so it can help you to interpret your baby’s needs.

When our oldest was a newborn, it always seemed like he went from zero to 60… like he was happy, happy, happy, and then screaming in misery. Years later, when I watch videos from these days, I can now see that he was using so many cues to communicate his needs, and we missed them all! And once a baby is screaming, it’s harder to see those cues and figure out what they need. For us, baby # 2 and 3 were so much easier to parent because we would see those cues and respond to them, and those babies just didn’t need to cry as much, because their needs were met before we reached that point.

Feeding

First Feeding

About 30 – 40 minutes after birth, your baby may become more active, and may initiate “the breast crawl.” They will shove themselves with their legs, pushing toward the nipple. Let them do the work to get there on their own. It works best if you are in the “laid-back breastfeeding position” – not flat on your back, but with the head of the bed elevated (or pillows behind your back) so your back is on a gentle slope. (Learn more.)

When they reach the nipple, they may sniff at it, lick it, knead the breast, and explore for a few minutes, then will latch on and begin nursing. I encourage you to watch on online video of the breast crawl, and ask your nurse or midwife to help you with this first feeding, especially if your baby has not initiated the breast crawl by about 45 minutes after birth. It’s important that baby feeds in the first hour of life. (Learn more about the first feeding.)

How to Breastfeed

You can nurse in that laid-back position, or you can hold your baby in a cradle position, where their head rests in the crook of your arm, and your hand supports their bottom, or in what’s called the football hold, where you hold the baby on your side, under one arm. Look online for videos that demonstrate breastfeeding positions or take a breastfeeding class to learn them. (This series of videos goes into detail on each position.)

Bring your baby so their belly is against your belly, and their nose and chin are right next to the nipple. Wait for him to open his mouth wide and latch on. If he’s slow to do so, then use your nipple to tickle baby’s upper lip till you activate the rooting reflex and he opens his mouth wide like a big yawn. Then pull him close to latch on. (Check out this video for a really clear illustration of a good latch and effective nursing.)

Check to be sure it’s a good latch – the baby’s mouth should be open wide, with the lips spread out, taking most of the areola into their mouth. Baby’s chin and nose are touching the breast. You’ll see swallowing motions. He begins feedings with lots of rapid sucks, then slows down to suck, swallow, suck, swallow.

When to Feed and How Much

How do you know when to feed your baby and how much to feed? Easy – watch your baby’s cues! When your baby is hungry, they will show hunger cues – lots of mouth movement – sticking their tongue out, licking, sucking on their hand or anything that is reach, or rooting – turning the head side to side or bobbing it up and down as if searching for a nipple. In the first six weeks, expect the baby to nurse every 1 – 3 hours, and feed whenever you see hunger cues. The minimum number of feeds for a newborn is 8 – 12 times in a 24 hour period.

Expect a breastfeeding newborn to take anywhere from 10 – 25 minutes to nurse. Nurse until you see full cues – the baby may fall asleep, let go of the nipple, or just slow down their nursing to just an occasional suck. They should feed for at least 10 minutes at each feeding, so if it’s been less than ten, burp them, or wake them back up and continue to feed. A bottle-fed baby will feed more quickly – watch the volume they take in – over the course of 24 hours, they should eat 2 – 2.5 ounces of breastmilk or formula per pound that they weigh. So, a ten pound baby would eat 20 – 25 ounces over the course of a day, so around 3 ounces each feeding if they had 8 bottles in a day.

Burping

A breastfed baby often may not need to burp after a feeding. A bottle-fed baby is more likely to need to. After a feeding, it’s always fine to give them an opportunity to burp: hold them so their belly is laying on your shoulder or across one knee – then rub their back firmly. You will know a baby needs to burp if they are showing gassy cues – creaking noises, grimacing, squirming, or pulling their legs up.

How You’ll Know Baby is Eating Plenty

At the end of the feed, baby will seem satisfied. (They’re no longer showing hunger cues.) You’ll keep an eye on their diapers – if they’re taking in enough, then you’ll know! In the first week, expect at least one wet or dirty diaper per day old – so a five day old should have at least five wet or dirty diapers. From 1 week to 6 weeks old, expect 6 – 10 wet diapers a day. A breastfed baby will poop at least three times a day, often more. A formula fed baby will poop at least twice a day. Each time your baby visits a health care provider, they’ll be weighed and measured to be sure they are growing as we expect them to. These are all good signs your baby is eating plenty.

If you have minor challenges with breastfeeding, look for a breastfeeding support group, such as La Leche League, or seek advice from parents you know who have successfully breastfed. If you need more support with nursing, your best source of support is a lactation consultant – they’re the breastfeeding professionals.

Diapers, Bathing, and Dressing

Diapers

Often during a feed, or shortly thereafter, your baby will have a bowel movement. You may hear it happening – babies are not subtle poopers! You can also watch for poop cues: baby has a serious expression, with a furrowed brow, and may be grunting. You can help him by holding him in “the poop position” sitting up, with his thighs supported like he’s sitting on a toilet. It’s much easier to poop in this position than lying flat on your back! Give him a few minutes, then change him as soon as he’s done. (Here’s a helpful guide to baby poop and what’s normal – even if it doesn’t seem normal!)

Bathing

You’ll be changing your baby’s diaper many times each day, and will clean their bottoms each time. You also end up doing lots of “spot cleaning” over the course of the day – wiping up spit-up, cleaning their drooly hands, and so on. When should you give baby a bath and how? It all depends on who you ask. Some cultures and some parents believe in daily baths. Some cultures don’t immerse a baby in water for the first year of life. Again… they’re “sponge bathing” all the time – that just means wiping a baby with a clean washcloth when he needs to be cleaned.

Doing a full tub bath may be something you choose to do every day, or may be something you do a few times a week when baby is calm and relaxed, and you have the time to make it a relaxing experience. To learn how to bathe a baby, just search on YouTube for “how to bathe a newborn baby” – there’s lots of helpful videos.

Now, I’m going to give a quick caution about getting baby care advice from the internet. There are lots of really great sources with lots of helpful information. First, try to figure out who wrote the information / made the video. What is their training or expertise? I prefer to get baby care info from people who have professional training and experience AND are parents themselves. Also – are they trying to sell something? If they’re trying to sell a product, then try to see if they also have useful information available and focus on that, rather than on their sales job – very few products are as necessary as their salespeople want you to think they are. On controversial topics, pay extra attention to what their biases may be – if they’re trying really hard to sell one idea, and to scare you into believing them, that’s not your best source of information.

Also, remember there’s no one right way to parent a baby – there’s lots of reasonable alternatives. If you asked ten parents for advice on one topic, you’d get 10 slightly different pieces of advice! 8 of them would seem helpful to you and a couple seem not reasonable. I personally have not found it possible in my lifestyle to feed my child only healthy, home-made whole foods at all times, so I prefer sites that advise me on how to make the best choices I can from other options to sites that make me feel guilty for failing to meet their ideal. So, seek out lots of advice – keep all the ideas that are useful and applicable, and let go of the ones that aren’t!

Dressing

Dress your baby in simple clothes that make it easy to change their diapers and to care for them throughout the day. (To learn how to dress them, watch this video on how to dress a newborn.)The general rule is to dress your baby like you are dressed, but add one more layer. So, if it’s summertime and you’re wearing a t-shirt, shorts and flip-flops, dress them in a onesie shirt, light leggings and socks. If it’s winter and you’re wearing heavier, warmer clothes, dress them in something similar and add a hat to keep the warmth in. You’ll know they’re dressed right if they pass the tummy-toes test – their tummies should always be warm, their toes may be cool. If their tummy is cool, add warmer clothes. If their toes hot, and their face is flushed or they are breathing quickly, they’re over-heated.

If you’re taking baby out in the car in the winter, it’s important to know that you shouldn’t bundle them in that giant puffy snow suit, and then buckle them into their car seat – you can’t possibly get a secure fit with the harness over all those layers. Instead, dress them in warm clothes like leggings and a sweater, then buckle them into the car seat, and lay a blanket or that snowsuit over them. (Learn more.)

Speaking of carseats, make sure you’re installing it correctly and using it correctly every time. Also, always check the height and weight requirements. Some parents are in a hurry, and they’ll move from rear-facing infant seat to front-facing toddler seat to booster seat the moment their child reaches the minimum age or size. But each level of carseat is a little less safe than the one that came before. So keep your child in each level of carseat as long as possible, till they reach the maximum height or weight.

Outings, Exploration, and Play

Once your baby is dressed, you’re ready to take them out to learn about their world! To help support your baby’s learning, it helps if you know some basic ideas about brain development. Neurons are brain cells – the raw computing power of the brain. Synapses are the connections between those neurons which help our brains to function well. Your baby has as many neurons as you do – that’s about 100 billion neurons! But, when they’re born, there’s not a lot of connections. Their strongest connections are in the brain stem, which is responsible for survival skills like breathing, digesting, and eliminating. The connections are weak in the parts of the brain that are responsible for balance, hearing, language. The connections are very immature in the areas that handle control of the emotions and thinking.

To build those synapses, babies need both novelty and repetition. They need exposure to new experiences to make the connection and they need to explore and experience the same thing over and over again to reinforce the connection. For a newborn baby, almost everything is a new experience! There’s so many new things to see, hear, feel, smell, and taste every day! Just a walk to the mailbox or a trip to the grocery store is an incredible world-broadening experience.

As you take them out in the world, remember how much new information they’re taking in and balance it out with the familiar. If you have them in your arms or in a carrier, where they can feel your breathing, hear your heartbeat, hear your voice, and smell your smell, that calms them and helps them be open to the new information. When we feel calm and safe and connected, oxytocin flows, and our brains have a high degree of neuroplasticity – we’re ready to learn. When we’re stressed, and the adrenaline flows, it’s hard to learn anything other than survival skills. So, hold your baby, soothe your baby, create loving rituals for how you interact with them to help them know that they are safe and loved. (This site and its companion videos have some really helpful information on how to provide good stimulation to baby without overstimulating. However, it is all a lead-in to encouraging you to take their classes. So please take the information in, but don’t think of it as an endorsement of their classes. I’m sure they’re fun and lovely, but no class is essential to a baby’s brain development.)

So, novelty and repetition build the connections – the synapses. Then comes myelination – as the brain matures, a dense fatty myelin sheath develops that insulates the nerve fibers. This helps the brain process information so much more quickly and act much more quickly. Myelin develops when we sleep – we need that period without new input to process all that we have seen. So, your baby’s learning depends on these things: novelty, repetition, down-time for rest or sleep, and feeling safe.

Some new parents miss this message – they only know that babies need novelty – lots of stimulation – to develop their brains. The challenge with newborns is that they are very easily overstimulated. Whenever we are exposed to something new, we have to put a lot of attention and energy into understanding it. Over time, as we’re exposed to it enough, we master an understanding of it, so it doesn’t take as much energy from us… we filter out so much stimuli every day – I wrote this piece sitting in a Starbucks, where I’m able to totally focus on my work. But, when I pay attention, I realize how much I’m filtering out – movement of people in and out the door, conversations around me, the smells of coffee and food, the sounds of the espresso machines, the music, the cars passing in the parking lot and more. A newborn sitting next to me would be overloaded by all that, and not able to filter any of it out. And when they get overstimulated, the only way to let go of that tension is to cry and cry.

Crying

Break Time

So, how do we know if a baby is overstimulated? First, we watch for the mild disengagement cues that I mentioned above. An engaged baby has a relaxed body, calm rhythmic breathing, and bright eyes. If the baby starts squirming, speeds up their breathing a bit, starts to turn away from you or if their eyes get glassy and they look “spaced out”, those are signs that they need a break. Go to a quieter place, or interact less (it’s fine to hold them, but don’t coo at them and ask for their attention). Don’t move as much, or if they’re moving, make it the same rhythmic, repetitive movement over and over again. Be a boring parent – predictable, reliable, nothing new to process.

Signs of Overstimulation

If we don’t give them a break, then some babies will just shut off when they hit their sensory limit – they’ll fall asleep. But some babies when they overload, send out an SOS with signs of overstimulation. Their face may turn red. They may frown, turn their head away, arch their back to move away, hold out stiff “stop-sign” hands, squirm uncomfortably, or cry. (Video) An overstimulated cry tends to be a grinding cry or high pitched inconsolable cries.

If you’re seeing an SOS, give them a break as above. Turn off the TV or the music, or whatever other stimulation may be overloading them. Choose a calming method and stick with it! This is not the time to try ten different calming methods in a row – that will only further overload them! Try the Happiest Baby on the Block method: swaddle them, shhh them (create a white noise), rock them, give them something to suck on, and hold them so they’re resting on their side or stomach – the back is a startle position. Just settle into that one calming method for several minutes straight while they try to settle down.

Other Causes of Crying

Overstimulation is one cause for crying (and, I think, the one new parents are least likely to know about). However, babies also cry if they are hungry or tired or gassy. So, when they’re crying, also be sure to look for the other cues to have a sense of what their underlying needs are. Work to meet those needs. As soon as their needs are met, it is easier to soothe their crying and settle them down to contentment or to sleep.

Sleep

When babies are tired, they show tired cues: they yawn, their eyes start to drift closed, they may rub at their eyes or their ears, or turn their head side to side like they’re trying to get comfortable on a pillow. In my parenting experience, this is what I think of as a magic window of opportunity. If I can create an environment where it’s easy for my tired baby to fall asleep, they will. But, if I miss that window, because we’re out and about, or I’m in the middle of making dinner, or whatever, then baby wakes back up. And they go into this weird hyper alert state – it’s like in college when you hit that 2 am – should have gone to sleep hours ago state where everything seems funnier than it should… it’s hard to settle them back down out of this state, and then they end up overstimulated and crying it out.

So, when you see those tired cues, seize the moment! Swaddle them, nurse them, rock them and sing a lullaby… do whatever your quiet, settling-down to bedtime routine is. Again, be boring – do the same thing over and over again. If you introduce new things now, they’ll wake back up to discover them.

When babies first fall asleep, they are in the light sleep state. Over time, they’ll cycle between light sleep and deep sleep. In light sleep, they may twitch, their eyelids may flutter, they may grimace or smile, or suck in their sleep. This is the REM – rapid eye movement – stage of sleep and it’s great for brain development. But it’s light sleep – if you disturb them at this point, they may wake back up. So, if you want to lay them down in a crib to sleep, it’s best to do it when they’re drowsy but not yet asleep. Hold them on their side as you lower them down, till they are on their side on the mattress. Then gently roll them onto their back, and pat them for a few minutes till they fall asleep. (If when you lower them down, they are on their back, this can activate the Moro reflex, or the startle reflex, and wake them back up.) If you missed your chance, then it’s best to just relax with them in your arms until they settle from light sleep to deep sleep. It may take 15 – 20 minutes, but it’s worth it if they’ll stay asleep after that! And it gives you that chance to “rest while the baby rests.”

You’ll know a baby is in the deep sleep state if all their muscles are relaxed, their face is relaxed, their breathing is slow, deep, and rhythmic. If you lift up their arm, and let go, it drops back to their side. When they’re in deep sleep, you can do whatever you want! You could vacuum, or hammer nails into the wall to hang a picture, and they’d probably sleep through it.

Throughout a nap or through night-time sleep, your baby will cycle through sleep states. When they rouse up to light sleep, they may wiggle or whimper. Sometimes you can settle them back down from this. Try going to them, laying a hand gently on their belly, or shhh-ing them quietly. If you’re lucky, they’ll go back to sleep. If they’re ready to wake up, they will wake up despite this effort.

Although a newborn may sleep as much as 18 hours a day, they rarely sleep for more than 3 hours at a stretch. It’s considered “sleeping through the night” if they sleep for a five hour stretch, but most don’t even do that in their first several weeks. It is normal and natural for your newborn to wake up several times throughout the night. (Learn lots more about infant sleep patterns here.)

There are things you can do to help create an environment where they can get as much sleep as possible. First, help them begin to differentiate between day and night. In the daytime, have lights on, be active, get out and about. Even when they’re napping, it’s OK to have the lights on. At night time, keep things dim, quiet, and boring. When you have a wide awake baby at 2 am, it’s tempting to sit and watch videos, but the noise and light may help to keep them awake. When they smile and coo and want to play at 2 am, it’s hard to resist. But you can just quietly meet their needs without a lot of stimulating interaction.

Swaddling a baby will help it to sleep longer stretches – when they move up into a light sleep cycle, if they’re not swaddled, they can wiggle around a lot, and wake themselves, but if they’re swaddled, they may just settle back to sleep. Note: only swaddle your baby in a lightweight blanket they could breathe through if it came loose and covered their face. When they figure out how to break out of it and it’s loose, then learn the double swaddle, which is harder to get out of – I’ve seen it last up till five months. If your child figures out how to turn over from back to belly while swaddled, then they should no longer be swaddled.

If the baby sleeps in the same room as you, they are likely to wake a little more often, but they tend to be smaller wake-ups without a lot of crying where they’re more easily soothed back to sleep. If they sleep in a separate room, they may sleep longer stretches, but when they wake up, they wake up all the way and may cry more and may be harder to soothe back to sleep. Research shows that parents gets more total sleep when the baby is in the room with them, and sleeping in the same room also reduces the risk of SIDS, or Sudden Unexplained Infant Death.

It’s important to be aware of safer sleep practices and other ways to reduce the SIDS risk, including: putting baby to sleep on their back, on a firm mattress, with no pillows or blankets. Breastfeeding also reduces the risk. Exposure to tobacco and smoking increases the risk, and it’s best to avoid exposure.

Learn more about infant sleep here.

Over time, your baby will sleep longer stretches, and have a more predictable sleep and feeding schedule, but in those early weeks of parenting, sleep deprivation is definitely a challenge for parents! In episode 10 of the podcast, Life with Baby, I’ll offer lots of tips for coping with infant sleep and all the other challenges of adapting to life with a newborn.

In this episode, we’ve talked a lot about infant cues – those instinctive behaviors babies show that can help to communicate their needs and help you to meet those needs more promptly and more effectively. Crying is a late cue – they are less likely to escalate to crying if their needs are met early. However, even if you do everything perfectly, your baby will cry. So please, never gauge your success as a parent on whether your baby sleeps on a schedule and never cries! All you can do as a parent of a newborn is do the best you can to create an environment where their needs are met. There will be good days where you feel successful at everything you do, and other days where you feel like the world’s worst parent. Seek out support from other parents and from parenting professionals for those rough days, and trust that in the long run, you’ll have more good days than bad.

Learn More

There is so much more to learn about caring for a baby than I was able to cover here! To learn more: