Your Baby’s First Few Weeks

Posted September 26, 2018,

Your baby’s first few weeks of life are a whirlwind. I previously wrote about what to expect in the first few days after birth in hopes that new parents will feel more confident about bringing home their newborn. However, babies change and develop rapidly. Things they are doing in the first few days will evolve and parents often find themselves wondering if these new behaviors are normal. Don’t worry, most of what you will experience is very normal.

FEEDING
Breastfed babies should be fed on demand in the beginning. This might mean an every 1-2 hour feeding schedule from the start of the feeding. After the first few weeks you might start to see some predictable patterns once your milk supply is well established . Your baby is likely to feed 8-12 times per day, including waking overnight to eat. Some babies will go through several growth spurts during the first few months of life. A growth spurt is when baby nurses more frequently for a 24 hour period to help increase the milk supply. Don’t introduce a bottle at this time because it may interfere with the process of producing more milk. Don’t forget that breastfeeding is a supply and demand process. It can be exhausting, but growth spurts can be very normal and it’s good to know they are coming. Also, be prepared for the “witching hour” at the end of the day when some babies will cluster feed. This means they will feed every hour for a few hours, but then hopefully fall asleep for a good stretch.

Formula fed babies will also feed on demand. However, they may feed a little less frequently since formula will not empty as quickly from the stomach, making baby feel full a little longer. Over the first few weeks of life, you will start to notice that your baby wants more volume. Most newborns will start out taking 1-2 ounces per feeding but by 1 month may be ready for 3, or even 4, ounces per feeding. Let your baby be the guide. It’s important not to overfeed your baby so if your baby is pushing the bottle out or does not want anymore milk, don’t force it.

SPIT UP
Gastroesophageal reflux, the movement of stomach contents into the esophagus, is very normal and common in newborns. Reflux happens for several reasons.

The sphincter at the end of the esophagus is not fully developed and loosens periodically, allowing stomach contents to move into the esophagus.
Swallowed air from crying or gulping comes up the esophagus in the form of a burp, bringing milk with it.
Overfeeding causes extra milk to overflow the stomach into the esophagus.
Frequent positional change contributes to movement of milk from the stomach to the esophagus.

Reflux will start within the first few weeks of life, can peak around 4 months and usually resolves by 9-12 months. Reflux tends to resolve once baby’s muscles are stronger, they spend more time upright and are eating solid foods. Don’t worry if you notice spit up in an otherwise healthy baby who is gaining weight. You may even see spit up come out the nose! It’s time to worry if your baby is in pain (crying excessively with or without arching of the back), isn’t gaining weight or has blood in the spit up. You will also want to seek care immediately if your baby is forcefully vomiting every feed as this can be a sign of pyloric stenosis.

Management of gastroesophageal reflux generally involves conservative management. This includes holding baby upright for 20 minutes following feeds, providing smaller volumes of feeds more frequently, a change in formula, and potentially making changes to mom’s diet. Anti-reflux medication has not been shown to be very effective and can have side effects, including decreased absorption of nutrients. These medications should be reserved for babies who are having complications of reflux, otherwise known as gastroesophageal reflux disease, or GERD. GERD will present with pain and/or poor weight, as stated above.

POOP
Talking about your baby’s poop, sometimes obsessing over it, is something you probably never considered before having children. Yet, here we are. The variety of poop patterns babies experience can be stress inducing for parents. In my previous post on newborns I mentioned the normal transition from meconium to typical yellow seedy stools. Over time, however, your baby’s poop will change again.

Breastfed babies will have poops with almost every feeding for the first 6-8 weeks of life. This is due to the colostrum in the milk. Once the colostrum disappears, so will the poops. Some breastfed babies don’t poop for a week. Don’t freak out! If they aren’t uncomfortable there isn’t anything to worry about. Breastfed poops might also be watery and they may also be green. Green foamy poops can happen if baby is getting too much lactose rich early milk and not enough of the fattier hind milk. Try feeding longer on one side before switching to the other. Also green poop can happen if mom is eating a lot of green veggies. The only colors I worry about are blood, black and tarry, or no color at all.

Formula fed babies will start with yellow seedy poops but may eventually have green poop. This is perfectly ok. Sometimes formula fed babies have a hard time passing poops so talk to your pediatrician about treatment options for constipation. NEVER water down formula or give a bottle of water to your baby. As above, seek care if you see blood, black and tarry poop, or poop without any color at all.

SLEEP
While every baby is different, one thing all babies are good at is being inconsistent. Once you have a pattern and think you have it figured out, your baby will change. My advice in the first few weeks is to read your baby’s cues and when they look sleepy, put them down to sleep. Don’t expect them to fall asleep on their own yet, that will come later. At 6-8 weeks I recommend a routine of feeding when baby wakes up, some play time next (this can include tummy time), and then when baby yawns or looks sleepy to initiate a routine like reading or singing to get them ready for sleep. Put them down already asleep until it’s time to sleep train. Repeat that cycle throughout the day and you will start to learn your baby’s cries and behaviors which is tremendously helpful in the long run. It will also help you be prepared for sleep training if you have already separated feeding from sleep. Don’t forget to always keep baby safe during sleep!

OTHER HELPFUL HINTS

All babies are born having been exposed to mom’s hormones. That means they may have swollen nipples or breast buds. Boys may have a swollen scrotum and girls may have clear vaginal discharge. Baby girls may even have a little withdraw bleeding, like a mini period. Don’t worry, this is very normal.
Babies have a wide opening in the center muscles of the abdomen as the muscles are not fully developed yet. You may notice a ridge down the middle of the belly until baby grows and develops those muscles. Furthermore, they have a hole where the umbilical cord entered the body. This can cause a small reducible umbilical hernia which will most likely resolve on it’s own. If your baby has a large umbilical hernia that will not go in and baby is fussy or vomiting, seek medical care. DO NOT force the hernia back in.
Babies are noisy. They get stuffy noses, grunt, and generally make a lot of noises that may seem like something is wrong. This can be entirely normal, especially while they are sleeping! Of course this will keep parents up but in most cases if baby is asleep, comfortable and does not appear to be in distress, these noises are fine. For a stuffy nose, apply some saline drops to help your baby clear the nasal passages.
Everybody produces gas, including your baby. Plus baby is swallowing air with gulping, crying, or taking a bottle. Unfortunately, babies have to work harder to pas gas due to a lack of coordination in the GI tract and lack of muscle strength. This does not mean they are in pain or you need to make a change to their feeding. It is entirely normal for a baby to pass gas. If they are struggling a little try a light belly massage or bicycle their legs to help get the gas out.
Babies can have periodic breathing, which is a pattern that presents with a pause in breathing followed by some rapid, shallow breaths. This should only last around 10 seconds. Sometimes babies will take big sigh breaths as well. Prolonged rapid and shallow breathing and prolonged pauses in breathing are concerning so have your baby seen if you experience either.

If your baby is doing anything that seems unusual or you have any questions about your baby’s habits and behaviors, talk to your pediatrician.

feeding, gerd, nursing, pediatrician, poop, reflux, sleep, spit up

Jaime Friedman, M.D., F.A.A.P.

Dr. Friedman has been practicing pediatrics in San Diego for over ten years, initially working at Rady Children’s Hospital in its Urgent Care and then moving to Children’s Primary Care Medical Group in 2004. She is now the lead physician of the new CPCMG 4S Ranch office. Dr. Friedman is Board Certified and a Fellow of the American Academy of Pediatrics. She has been one of San Diego Magazine’s Top Docs for the past 8 years and was elected Best Doctor in East County by The Californian in 2011. Dr. Friedman went to medical school in Baltimore, Maryland, where she grew up, and did her pediatric residency in Portland, Oregon, at Doernbecher Children’s Hospital. She is still a very loyal Baltimore Ravens fan and loves football. On a professional level, Dr. Friedman’s interests include literacy, breastfeeding, and fitness. While at the CPCMG El Cajon office, she started a new Reach Out and Read location,, and is working on providing books for patients at all CPCMG locations. She also plans to organize regular kid-friendly hikes for the 4S Ranch community. Personally, she has walked in three Breast Cancer 3-Day walks, volunteers at her children’s school, and has been active on the PTA. She also volunteers as the camp doctor every summer at Camp Mountain Chai. When she isn’t working, Dr. Friedman enjoys every minute she can with her husband and two children. Together, they love to ride bikes, spend time with friends, and play with their 2 Australian Shepherds, Luna and Lucy.

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