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. 

What’s That Noise? Is My Baby Going To Stop Breathing?

Being a new mom is hard.  Most moms will tell you that the first months of baby’s new life were a blur of fatigue and misery.  You are tired from child birth and then from waking up every three hours to feed baby.  You are depressed from what pregnancy has done to your body, and new baby does not give back much love.  All baby seems to do is cry, eat, sleep, and make dirty diapers.  And then, if this is your first baby, babies do odd things that scare you.  They get rashes on their faces, they hiccup, and your instinct is to think “What’s wrong?  Is this the beginning of a horrible illness?”

We see a lot of new born babies in the Emergency Department for a lot of new mom worries.  The vast majority of these things are normal and safe.  Most moms call or see their doctors to get reassurance, or read a book on raising babies.  Some moms don’t think to call their doctor though, or don’t have a doctor yet after they leave the hospital.  Then when the sun goes down, the baby does something that really scares them, and they come in.

Parental worries about newborns come in two groups- breathing and feeding.  The breathing worry is basically: Is my baby going to stop breathing?  Moms lay awake at night and hear their babies make a snoring-like sound.  Babies do this because they have to breathe through their nose, and any dried up mucus up there makes for noisy breathing.  But moms worry- is that going to block baby’s airway?  Worse for mom is when babies have a runny nose and gag and choke on mucus.  Then they are really afraid!  Finally, many babies have irregular breathing, what we call “periodic breathing.”  They will sometimes pause for a few seconds between breaths.  Though all of these things are normal and safe, moms worry that this is the beginning of crib death, or SIDS (Sudden Infant Death Syndrome). 

The other big category of mom worries is spitting up and pooping.  When babies spit up, moms are concerned that baby will choke to death on the vomit.  This is a particular worry these days when we tell moms to lay babies down on their backs.  Moms also worry that babies who spit all the time won’t gain weight, and will waste away.  Finally, some newborns will go three or four days without pooping, and moms worry that that is bad.  Again, all these things are normal.  Babies spit up, but are designed to cough and gag and swallow, and thus clear their airway when they are on their backs.  Newborns may spit up a lot, but they hold down enough calories to grow and thrive.  And babies can normally go three or four days without pooping, and this is normal as long as when they do poop, it comes out soft.  Babies don’t explode or get blocked by skipping days pooping. 

The only things that really worry us about newborns is fever, and sleeping in bed with mom.  In this blog I talk a lot about not worrying about fevers in children.  The only exception to this is fevers in newborns.  Any temperature above 100.4 in a newborn needs to be checked out by a doctor right away.  Sometimes this could mean a more serious infection.  Even more worrisome is moms who worry about their babies so much that they bring baby into their beds.  They think that they can watch baby more closely, but this is the exact WRONG thing to do.

It turns out that crib death, or Sudden Infant Death Syndrome (SIDS) is caused by baby smothering.  In adult beds, they smother in thick bed clothes, soft mattresses and pillows, or under heavily sleeping adults.  Also, no one should ever sleep on a couch with baby either, for the same reasons.  Baby is actually safer sleeping in their own crib, face up, with no thick blankets or pillows or stuffed animals. 

So before you leave the hospital with your new baby, be sure to have a doctor to call and visit about your worries.  Read a book about new babies- the hospitals often have these to give out.  This way you can save the Emergency Department for emergencies, and not spitty babies.