BABY'S FIRST MONTH: MEDICAL CONCERNS

The following medical problems are of particular concern to parents during the first month.

Breathing Difficulties

Normally, your baby should take from 20 to 40 breaths per minute. This pattern is most regular when he is asleep and healthy. When awake, he may occasionally breathe rapidly for a short period, then take a brief pause (less than ten seconds) before returning to normal breathing. If he has a fever, his breathing may increase by about two breaths per minute for each degree of temperature elevation. A runny nose may interfere with breathing because his nasal passages are narrow and fill easily. This condition is eased by using a cool-mist humidifier and gently suctioning the nose with a rubber aspirating bulb (ordinarily given to you by the hospital). Occasionally, mild salt-solution nose drops are used to help thin the mucus and clear the nasal passages.

Excessive Sleepiness

Because each infant requires a different amount of sleep, it's difficult to tell when a baby is excessively drowsy. If your infant starts sleeping much more than usual, it might indicate the presence of an infection, so notify your pediatrician. Also, if you are nursing and your baby sleeps more than five hours without a feeding in the first month, you must consider the possibility that he is not getting enough milk or perhaps is being affected through the breastmilk by a medication that you are taking.

Floppiness

Newborn infants all seem somewhat floppy because their muscles are still developing, but if your baby feels exceptionally loose or loses muscle tone, it could be a sign of a more serious problem, such as an infection. Consult your pediatrician immediately.

Hearing Problems

Pay attention to the way your baby responds to sounds. Does she startle at loud or sudden noises? Does she become quiet or turn toward you when you talk to her? If she does not respond normally to sounds around her, ask your pediatrician about formal hearing testing. This testing might be particularly appropriate if your infant was extremely premature, was deprived of oxygen, had a severe infection at birth, or if your family has a history of hearing loss in early childhood. If there is any suspicion of hearing loss, your infant should be tested as early as possible, as a delay in diagnosis and treatment is likely to interfere with normal language development.

Jitters

Many newborns have quivery chins and shaky hands, but if your baby's whole body seems to be shaking, it could be a sign of low blood sugar or calcium levels, or some type of seizure disorder. Notify your pediatrician so he can determine the cause.

Rashes and Infections

Common newborn rashes include the following:

· Cradle cap (seborrheic dermatitis) appears as scaly patches on the scalp. Washing the hair and brushing out the scales daily helps control this condition. It usually disappears on its own within the first few months but may have to be treated with a special shampoo.

· Fingernail or toenail infections will appear as a redness around the edge of the toenail or fingernail, which may seem to hurt when touched. These infections may respond to warm compresses but usually need to be examined by a doctor.

· Umbilical infections often appear as redness around the umbilical stump. They should be examined by your pediatrician.

· Diaper rash

Thrush

White patches in the mouth may indicate that your baby has thrush, a common yeast infection. This condition is treated with an oral antifungal medication prescribed by your pediatrician.

Vomiting

If your baby starts forcefully vomiting (shooting out several inches rather than dribbling from the mouth), contact your pediatrician at once to make sure the baby does not have an obstruction of the valve between the stomach and the small intestine (hypertrophic pyloric stenosis). Any vomiting that persists for more than 12 hours or is accompanied by diarrhea or fever also should be evaluated by your pediatrician.

Weight Gain Problems

Your baby should be gaining weight rapidly (1/2 to 1 ounce per day) by the middle of this month. If he isn't, your pediatrician will want to make sure that he's getting adequate calories in his feedings and that he is absorbing them properly. Be prepared to answer the following questions:

· How often does the baby eat?

· How much does he eat at a feeding, if bottle-feeding? How long does he nurse, if breastfeeding?

· How many bowel movements does the baby have each day?

· What is the amount and thinness or thickness of the stools?

· How often does the baby urinate?

If your baby is eating well and the contents of his diapers are normal in amount and consistency, there is probably no cause for alarm. Your baby may just be getting off to a slow start, or his weight could even have been measured wrong. Your pediatrician may want to schedule another office visit in two or three days to reevaluate the situation.