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Newborns do a lot of strange movements and behaviors that quite often scare parents. What are normal newborn reflexes, and when should parents worry?

The first one most parents know and call the startle reflex. It's technically called the Moro reflex. Parents often tell me it's when their baby gets scared, but that's not really the reason. Babies don't get scared as newborns. It's due to their nervous system response to a sudden change in sensory stimulation.

And it's a good thing, actually. In fact, it's able to be seen on ultrasounds when a mom is only 16 weeks pregnant, and a baby's own cry can even stimulate it. It lasts until babies are about 2 to 3 months old.

So when should you worry? Well, if you had a difficult labor and there was concern that your baby might have had some oxygen deprivation, then an exaggerated Moro reflex could be concerned for something called hypoxic-ischemic encephalopathy. Basically, the brain is hurt by having the oxygen supply cut down.

Neurologists can help evaluate and treat this, and the good news is it's picked up really closely after birth. And if there's any concern, your baby will be in the intensive care unit really quickly for a full evaluation. If your baby is otherwise in the normal newborn nursery and goes home, there's a good chance this is not what your baby has.

Another normal reflex is the suck or rooting reflex. And that's just what it sounds like. It's basically what helps the baby learn to find a food source and eat. This reflex doesn't start until about 32 weeks of pregnancy, which is why preemies have such a hard time learning how to eat. This reflex is fully developed at about 36 weeks.

Now, when parents see this, they automatically think their baby is hungry and often that's true. It could be that it's just the reflex and they suck on their fingers and hands as a self-soothing behavior. I see a lot of parents trying to force their babies to eat and then the babies get over-full and throw up.

Then there's the tonic neck reflex. We call it the fencing reflex because they have one arm outstretched and one bent and they're about to say, "En garde!" Some parents worry that there is a problem because both arms aren't in the same position or both arms aren't being used the same way at the same time. But this is normal, and it can last until they're about 7 months old.

Finally, this isn't a reflex, but it's something parents ask me about all the time at the newborn checkups. It's called periodic breathing. Babies do this weird thing where they look like they're breathing really fast, then they can hold their breath for up to 10 seconds, and then they take a big breath in and then they're back to normal breathing. And it can happen when they're sleeping or when they're awake. And it usually lasts until they're about 6 months old.

Babies' lungs are still developing and their brains are still trying to figure out how to send messages to the lungs to remind them to breathe. Basically, they are still trying to figure out this whole breathing thing and breathing patterns. And it looks scary, but it's normal.

So when should you worry about your baby's breathing? If they're consistently breathing more than 60 times a minute, if they're having retractions where it looks like their stomach muscles are sucking in under their ribs, if they are making grunting noises with each breath, or if they hold their breath for more than 20 seconds and turn blue, those are not periodic breathing, and that needs to be evaluated right away to see if your newborn's oxygen is low. Depending on how severe the symptoms are, the best place for your newborn to be evaluated for breathing issues may be the emergency room.

One last thing. What about those eyes? Well, babies have very little control over their eye movements right away. That's why they always look at you cross-eyed. They're trying to figure out how to control their eye movements and learn to focus on things.

Also, it's not uncommon for a baby to roll their eyes when they're sleeping or when they're almost asleep, like when they're going to sleep or trying to wake up. But this should not be the norm. If they are not rolling their eyes but doing more of a rhythmic back and forth, something called nystagmus, that is absolutely not normal.

If your baby rolls their eyes often, that is not normal. If your baby's eyes roll and your little one also has stiffness in their arms or legs or has shaking that doesn't look like the startle reflex, that could be a seizure and that's an immediate trip to your local children's emergency room.

Many things can cause seizures in a new baby, including low blood sugar, low calcium levels, metabolic diseases, or brain abnormalities, in addition to epilepsy and high fevers. Your child will probably be admitted to the hospital and see a neurologist for tests to determine why they are having these weird movements and possible seizures.

So while a lot of these normal behaviors look concerning, they are often just part of your baby adjusting to being in the outside world. If your baby has any of the not-so-normal behaviors I talked about, please have them see their pediatrician right away or go to your closest pediatric emergency room.

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Interviewer: It's time for another listener question and we're here with Dr. Kirtly Parker Jones. Dr. Jones, the question sent in was, "Could my baby be allergic to my breast milk? I've noticed that he's not really absorbing it, he's not really taking it, but he's fine with formula milk."

Dr. Jones: To start at the beginning, babies cannot be allergic to your breast milk.

Interviewer: The answer is just no?

Dr. Jones: The answer is no. However, there are proteins in what you eat that are absorbed into your bloodstream that then come out in the breast milk, and certainly there are flavors in what you eat that come out in the breast milk. In fact, there are flavors of what you eat when you're pregnant that flavor the amniotic fluid, and the baby is already kind of drinking your garlic or your hot sauce, or whatever it might be. The babies will not be allergic to your breast milk. Newborns don't actually form an allergic response. So it takes a while for babies to be able to even form an allergic response.

So, if newborns are throwing up, you start to really worry that maybe they have a problem with their stomach. So sometimes babies actually have a weakness in their stomach that allows the fluid to come back up. So some babies actually have to be fed kind of thickened milk or have to be slept tilted like people who have reflux. So babies can have reflux and newborns can have reflux until they're a little older. So babies can have reflux and that can make them throw up, and it's not they're allergic, it's just that they can't keep the fluid down.

Secondly, there are some babies with congenital malformations that cause a blockage in the esophagus. This is very rare and it's devastating. So there's a blockage in the esophagus and the fluids go down into their lungs. This is called a TE, a tracheoesophageal fistula. Once again, it's the baby that's not actually absorbing because it's going down the wrong way.

Now, let's take babies a little bit older. They actually can be allergic and develop an allergy to things that are in your food, and the most common is milk. So milk proteins in milk, of course, when . . . oh, cow's milk, there is something called casein and this is a protein that a mom might actually have in her blood and that the baby might actually develop an allergy to. That being the case, babies might get a little distended, they might be a little uncomfortable, and sometimes, they may even have a rash around their rear where it's kind of irritating.

Now, what about the baby that seems to be fine with formula and not so well with breast milk? Well then, the questions is, is the baby getting better suckling with the nipple . . . the formula? Is there something in the mother's food that's flavoring her breast milk? Meaning is she eating a lot more garlic, or is she eating spicy things that are getting through and the baby doesn't like the taste? And then the question is, is the mother putting anything on the nipple that the baby doesn't like the taste of? So we put all these lotions on our bodies and women put lotions and Bag Balm, which doesn't really taste very good. Bag Balm is something they put on nipples of cows when the nipples break down with nursing cattle, and so that may not taste very good.

So what are you putting on the skin and the answer is nothing, is the baby actually latching on well? So sometimes the baby has to struggle getting the whole nipple in their mouth, but it's easy to put the nipple from the bottle. There are many cultural norms about what you should and should not eat because of what goes in your breast milk, like don't eat cabbage because it will make your baby bloated. Well, unfortunately, cabbage won't make your baby bloated. It might make you bloated, but not your baby.

Of the things that they worry about, cow's milk is the first and about 2% to 3% of babies might actually be allergic to the cow's milk that their mother has in their food. And if a baby seems like it's not absorbing or is irritated by the breast milk, the question is what is it? And you have to kind of take things away. The top ones are peanut, soy, and cow's milk, but there may be other things. So moms need to eat carefully. The baby may not like garlic in their breast milk. By the way, wine goes right through the breast milk, too, so be careful.

So the long and the short of it is the baby is not allergic to your breast milk, but it can be allergic to what you're eating. There are lots of cultural superstitions about what mom should and shouldn't eat, and what should go in the breast milk. There's not much science, but if you take away one thing at a time and see if the baby does better, you might figure out what it is. And of course, your pediatrician can really help you work this out.

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Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Stoesser: Hi, my name is Kirsten Stoesser, and I am a family medicine physician. A question that a lot of new parents have is whether or not they need to supplement breastfeeding with formula. In most cases, this is not necessary but in some cases it can be helpful.

One of the times where we recommend that somebody supplement with formula is if the baby is not gaining weight appropriately, especially in those first few days to the first week. If we see that a baby has lost more than 10% of its birth weight and is not able to gain that back adequately enough and quickly enough with breastfeeding, then we will recommend to do supplementation with formula.

This doesn't mean, though, that you have to do a bottle feeding. There are actually some ingenious ways to be able to administer formula. One of my favorite ways is what's called the "Supplemental Nursing System," or the SNS system, and this involves sort of a drip line. There's a line that's taped over the mother's shoulder and then this line comes down and is taped across the breast and the nipple.

So a baby can still breastfeed and even if they're not getting much while breastfeeding, they are getting the formula that drips in and baby is still getting practice with breastfeeding so they're not losing that skill and mothers are still getting the stimulation at the breast, which helps to promote further breast milk production. Usually, when babies do the SNS system, they just need to do this for a few days and then they're able to catch up the growth and the weight that they need and are able to go back to breastfeeding.

There are different ways to supplement. Sometimes it can be because the baby's not getting enough nutrition, and sometimes it's because the mother's not producing enough milk. And so if the mother's not producing enough milk, having ongoing stimulation at the breast is important. So in addition to having the baby feed, one thing that I'll recommend to moms to do is to get a breast pump and after baby feeds to actually pump for five to ten minutes on both sides so that the breasts are getting adequate stimulation.

Another thing that's really important is for the mom to get plenty of sleep, which I know is hard, to make sure that she's eating regular meals, to drink plenty of fluids and to try to relax as much as possible. Another thing I'll recommend is that sometimes if just even one feed in the middle of the night, if somebody else can do that feeding, they can do a bottle feeding with either formula or with pumped breast milk, then that can allow mom to get a few hours more of uninterrupted sleep and sometimes that can help with breast milk production during the day because mom's not as exhausted.

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