Newborn Care: Your Baby's First Four Weeks

In the hospital: routine newborn care

Most US hospitals offer these in the first day or two:

• Skin-to-skin contact and a first feed within the first hour.
• Vitamin K injection: prevents a rare but serious bleeding disorder (vitamin K deficiency bleeding).
• Eye ointment: erythromycin to prevent certain eye infections caught during birth.
• Hepatitis B vaccine: the first dose of the vaccination schedule, given within 24 hours.
• Newborn screening blood test: a heel prick, usually at 24 to 48 hours, checks for dozens of rare but treatable conditions such as phenylketonuria, hypothyroidism and sickle cell disease.
• Hearing screen and a pulse oximetry test for critical congenital heart disease.
• Jaundice check before discharge.

Feeding your newborn

How often and how much

Newborns have tiny stomachs and need to eat often: 8 to 12 times in 24 hours, roughly every 2 to 3 hours, including at night. Feed when you see early hunger cues such as rooting, sucking on hands and lip smacking. Crying is a late sign.

• Breastfeeding: most feeds last 10 to 40 minutes. Wake a sleepy baby if more than 3 to 4 hours have passed in the first 2 weeks. Help with latch, pain or supply is available from lactation consultants; see breastfeeding problems.
• Formula feeding: about 1 to 2 oz (30 to 60 ml) per feed in the first few days, rising to about 2 to 3 oz (60 to 90 ml) by the end of the first week. Never prop a bottle. Follow the mixing instructions exactly; never dilute formula.
• Vitamin D: breastfed babies need a daily vitamin D supplement (400 IU) starting in the first days.
• No water, juice or honey. Newborns get all the fluid they need from milk. Honey can cause infant botulism before 12 months.

Is my baby getting enough?

Diapers and weight are the best guide:

Most newborns lose some weight in the first 3 to 5 days, and regain their birth weight by 10 to 14 days.

Umbilical cord care

The cord stump dries, darkens and falls off in about 1 to 3 weeks.

• Keep it clean and dry. Fold the diaper below it.
• Use plain water if it gets dirty, then pat dry. Alcohol is no longer routinely recommended.
• Give sponge baths until it falls off.
• A few drops of blood when it separates are normal.
• See a doctor for redness spreading onto the skin, swelling, pus, a bad smell, or fever.

Bathing and skin care

• A sponge bath 2 to 3 times a week is enough until the cord falls off. Then use a tub with 5 cm (2 inches) of warm water, about 37 °C to 38 °C (98.6 °F to 100.4 °F). Test with your elbow.
• Never leave a baby alone in or near water, even for a moment.
• Use mild, fragrance-free cleanser sparingly. Dry skin and peeling in the first weeks is normal and needs no treatment.
• Clean the diaper area with water or unscented wipes. Use a barrier ointment for redness.
• Trim nails with baby clippers or file them to prevent scratching.

Safe sleep

The American Academy of Pediatrics recommends:

• Back to sleep for every sleep, naps and nights.
• A firm, flat mattress in a crib, bassinet or play yard that meets safety standards, with a fitted sheet only. No pillows, bumpers, blankets or toys.
• Room-share, not bed-share, ideally for at least the first 6 months.
• Never sleep with a baby on a sofa or armchair.
• Avoid overheating; dress the baby in no more than one extra layer than an adult would need.
• Offer a pacifier at sleep time once breastfeeding is established.
• No smoking, alcohol or drug use around the baby.

These steps lower the risk of sudden infant death syndrome and suffocation.

What's normal for a newborn

Many things that worry new parents are normal:

• Breathing: irregular, with fast and slow periods and short pauses under 10 seconds (periodic breathing).
• Sneezing and hiccups: clear the nose and are not signs of a cold or allergy.
• Skin: milia (tiny white bumps), newborn rash (erythema toxicum), peeling, and blue hands and feet in the first days.
• Swollen breasts or a little vaginal discharge or bleeding: caused by the mother's hormones; it fades within weeks.
• Startle reflex and jittery chin or limbs when crying, which stop when touched.
• Crossed eyes from time to time.
• Spitting up small amounts.
• Mild jaundice in the first week. Get it checked if it spreads below the chest or the baby is sleepy. See newborn jaundice.

Fever and infection in newborns

Newborns have immature immune systems and may not show obvious signs of serious infection. A fever of 38 °C (100.4 °F) or higher taken rectally in a baby under 3 months always needs immediate medical assessment, even if the baby looks well, because it can be a sign of neonatal sepsis or meningitis. A low temperature can also be a sign of infection. Do not give fever medicine to a newborn before speaking to a doctor.

Reduce infection risk: wash hands before handling the baby, keep sick visitors away, and make sure caregivers are up to date with whooping cough (Tdap) and flu vaccines.

Car seats and safety

• Use a rear-facing car seat for every ride, starting with the trip home.
• Never leave a baby alone on a bed, sofa or changing table.
• Never shake a baby. If crying becomes overwhelming, put the baby down safely in the crib and step away for a few minutes.

Looking after yourself

Rest when the baby sleeps, accept help, and eat and drink well. The baby blues are common in the first 2 weeks. Low mood, anxiety or intrusive thoughts lasting longer than 2 weeks may be postpartum depression and deserve help. For care beyond the first month, see infant health.

Frequently asked questions

How often should a newborn eat?

Newborns should feed 8 to 12 times in 24 hours, about every 2 to 3 hours, including overnight. Feed on demand when you see early hunger cues. In the first 2 weeks, wake your baby if more than 3 to 4 hours have passed since the last feed.

How many wet diapers should a newborn have?

Expect about one wet diaper per day of life for the first few days, then at least 6 wet diapers a day from about day 5 or 6. Fewer wet diapers, dark urine or no stools can mean the baby is not getting enough milk.

When does the umbilical cord fall off?

Usually between 1 and 3 weeks after birth. Keep it clean and dry and give sponge baths until it falls off. See a doctor if the skin around it becomes red and swollen, it oozes pus or smells bad, or your baby has a fever.

When should I worry about my newborn?

Seek emergency care for a temperature of 38 °C (100.4 °F) or higher, breathing difficulty, blue color, floppiness, poor feeding, green vomit or a seizure. Call your pediatrician the same day for spreading jaundice, fewer wet diapers or a red, smelly cord.

Is it normal for newborns to sneeze and breathe irregularly?

Yes. Newborns sneeze often to clear their small nasal passages, and their breathing varies between fast and slow with short pauses. Pauses longer than 15 to 20 seconds, blue color or labored breathing need urgent medical attention.