First Few Days After Birth

A newborn usually has a plastic cord clamp on the umbilical cord. The clamp may be removed when the cord is completely dry.

No attempt should be made to pull on or remove the umbilical cord stump because it will fall off on its own in a week or two. The umbilical cord stump should be kept clean and dry. There is no need to apply alcohol or other antiseptic solutions to the stump.

Rarely, the umbilical cord can become infected, so any signs of redness, swelling or discharge should be checked by a doctor.

Circumcision in male newborns, if desired, is usually done within the first few days of life if the infant is medically stable. The decision about having a newborn circumcised usually depends on the parents' religious beliefs or personal preferences.

There are few medical issues that require circumcision. Sometimes there is an unusually tight foreskin (phimosis) that is obstructing the flow of urine, and circumcision must be done to remove the obstruction.

Circumcisions are generally uncomplicated procedures. A small percentage of boys have a complication during the circumcision procedure, usually minor bleeding or local infection. However, serious complications occasionally occur.

Circumcision should not be done if the boy has not urinated yet or has a bleeding disorder or if the penis is abnormal in any way, because the foreskin may be used for any plastic surgical repair that may be needed later. Circumcision must be delayed if, during the pregnancy, the mother took medications that increase the risk of bleeding, such as anticoagulants (blood thinners) or high-dose aspirin (more than 100 mg per day). The circumcision should be delayed until all such medications have been eliminated from the newborn's system.Circumcision should not be done if the boy has not urinated yet or has a bleeding disorder or if the penis is abnormal in any way, because the foreskin may be used for any plastic surgical repair that may be needed later. Circumcision must be delayed if, during the pregnancy, the mother took medications that increase the risk of bleeding, such as anticoagulants (blood thinners) or high-dose aspirin (more than 100 mg per day). The circumcision should be delayed until all such medications have been eliminated from the newborn's system.

Most newborns have a mild rash sometime during the first week after birth. The rash usually appears in areas of the body rubbed by clothing—the arms, legs, and back—and rarely on the face. It tends to disappear without treatment. Applying lotions or powders, using perfumed soaps, and putting a cover over diapers that does not allow moisture to dry are likely to make the rash worse, especially in hot weather. Dryness and some skin peeling often occur after a few days, especially in the creases at the wrists and ankles.

Newborns may develop a yellow color to their skin (jaundice) after the first day of life. Mild jaundice is very common and usually normal. However, jaundice that appears before 24 hours of age is of particular concern and may indicate more serious problems. If the newborn develops jaundice, the doctors usually do a blood test to measure the level of bilirubin, which is the pigment in bile that causes jaundice. If the level of bilirubin is above a certain number, treatment with phototherapy is begun. In phototherapy, the newborn is placed without clothes under special lights ("bili" lights) to break down the bilirubin so it can be eliminated. The lights may be needed for 2 days to a week.

Typical newborn jaundice should go away by 2 weeks of age. An infant who has jaundice that occurs after or continues after 2 weeks of age should be evaluated by a doctor.

Phototherapy or "Bili Lights"

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Bili lights are a type of light therapy (phototherapy) that is used to treat jaundice in newborns. Jaundice is a yellow coloring of the skin and whites of the eyes that is caused by too much of a yellow substance called bilirubin. Blue or white light shined on the skin helps break down bilirubin, and most doctors use special commercial phototherapy units.

The infant in this photo wears a protective eye mask. The bonnet keeps the eye mask in place.

ASTIER/BSIP/SCIENCE PHOTO LIBRARY

In the first 2 days of life, urine produced by a newborn is concentrated and often contains chemicals called urates, which can turn the diaper orange or pink. If a newborn does not urinate within the first 24 hours of life, a medical evaluation may be needed.

The first bowel movement is a sticky greenish black substance called meconium. Every baby should pass meconium within the first 24 hours after birth. If a baby does not do so, the doctor may do tests to determine whether there is a problem. Occasionally, for instance, a birth defect may cause a blockage of the intestines.

Most newborns lose 3 to 9% of their birth weight during the first several days of life, mostly because fluid is lost in urine and also because meconium is passed, vernix caseosa (the waxy white coating covering the skin of newborns) is lost, and the umbilical cord dries and falls off. Newborns return to their birth weight in about 1 to 2 weeks. Breastfed infants may lose more weight initially than formula-fed infants. After that, they should gain about 20 to 30 grams (1 ounce) each day for the first few months. Infants generally weigh twice their birth weight by about 5 months of age. Infants delivered by cesarean section tend to lose more weight and take longer to regain birth weight (up to 3 weeks) than those born by vaginal delivery.

In the United States, infants are commonly born in the hospital and discharged within 24 to 48 hours. Infants who are discharged before they are 48 hours old should have a checkup with a health care professional 2 to 3 days later (see Preventive Health Care Visits in Children).

Infants born at home or discharged earlier than 12 hours may need earlier follow-up to complete recommended screenings.

Infants who are discharged after 48 hours have a checkup within 3 to 5 days, or sooner if they have any specific problems (such as poor feeding, constipation, diarrhea, or jaundice).

Before the infant is discharged, parents are given specific information regarding when to call the pediatrician's office. For example, parents should immediately call the pediatrician if their infant has fever (temperature should be taken rectally), respiratory distress, loss of appetite, bilious vomiting (vomiting greenish yellow material), or a blue discoloration of the skin (cyanosis).

Once home, having a new baby in a household requires a great deal of adjustment for all involved. For a household that has had no children, changes in lifestyle may be dramatic. When other children are present, jealousy can be a normal reaction. Preparing other children for the new baby and being careful to pay attention to them and include them in caring for the baby can ease the transition. Pets may also need some extra attention to help them adjust to the baby. In some cases, keeping pets away from the baby may be necessary.