Search for tag: "newborn"

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.

Interviewer: Craniosynostosis. It's a condition that causes a newborn's head to be misshapen. And it should be treated. To learn more about the condition, how to identify it, and why it needs to be treated, we've got Dr. John Kestle, he's a pediatric neurosurgeon, and Dr. Faizi Siddiqi, he's a pediatric plastic surgeon. And they are experts. They do the surgery that actually treats craniosynostosis.

So let's start with the first question, which is very basic. Dr. Kestle, what is craniosynostosis?

Dr. Kestle: So it's a condition where the bones that are normally separate are fused. And it restricts growth and creates abnormal head shapes. The pattern is usually present at birth or very soon after birth. That's different from the benign conditions where the head shape gets distorted because the baby is laying on one side. Those babies have a normal shape in the beginning and their head shape gets distorted over the first couple of months of life because they're lying on one side.

Interviewer: How does a parent generally find out that their child has craniosynostosis or synostosis?

Dr. Siddiqi: When they're born, they're usually told that after delivery, as Dr. Kestle mentioned, the head is going to be a little misshapen from the birthing process. And that usually corrects within two to three weeks. If that doesn't correct, then they're kind of suspicious and they visit their pediatrician. And then hopefully that's when they're referred for further evaluation by us.

Interviewer: And then what does that head shape look like? We do have a link to a pamphlet that you have that can help a parent. But just describe it briefly.

Dr. Kestle: So the typical head shapes, number one, most common is sagittal synostosis. It makes the head long and narrow, and the forehead and the back of the head kind of stick out. And the back of the head is narrower than the middle of the head. You can see those features when you look down from above.

Probably the second most common type is metopic synostosis. And that's when the suture down the forehead closes early and the forehead looks like the bow of a boat, or a triangle.

The other two types are less common. One is coronal synostosis, and that misshapes one side of the forehead so the forehead is pulled back, and the nose is sometimes crooked, and the eye socket on that side is usually a little bit elevated. And then the very rare one is the lambdoid synostosis, where the back of the head is flat on one side and the ear tends to be pulled back toward the flat side.

Interviewer: So how is it diagnosed then? So a parent recognizes that their child might have a misshapen head, they're concerned, they would go to a pediatrician first?

Dr. Siddiqi: Certainly they visit with their pediatrician and then they're referred to our synostosis clinic for further evaluation.

Interviewer: Okay. The pediatrician doesn't do any sort of imaging or anything like that generally?

Dr. Siddiqi: Sometimes they do. Oftentimes they don't because they don't want to subject the child to a CT scan unless they've seen a specialist and they're confident of the diagnosis. So we would see those kids in the clinic. Most of the time, it's a clinical diagnosis.

Interviewer: Meaning it's just visual, you're visually confirming it?

Dr. Siddiqi: Yeah. But once we decide it is and we talk about surgery, then we would want to get a CT scan, generally speaking, to be definitive about the diagnosis. And the scan also gives us information about the brain, which is helpful as well.

Interviewer: Why do you choose a CT scan over, say, an X-ray or some other sort of imaging?

Dr. Siddiqi: A CT scan gives much more detail of not only the bones, but, as I said, also the brain as well.

Dr. Kestle: The X-ray is very unreliable in making the diagnosis. And the CT scan has been changed over the years so the dose of radiation that's received is lower and lower. So now it's a very reasonable thing to do. It gives excellent anatomy, helps us with planning a surgery, makes the surgery safer.

Interviewer: And, Dr. Siddiqi, when do you generally like to treat a synostosis then?

Dr. Siddiqi: So if we see a baby with, let's say, sagittal synostosis that comes in at 2 to 3 weeks of age, then we've seen that the optimal time for surgery would be somewhere around 3 months of age. Between 2 and 4 months of age. That's why we stress the importance of early referral.

And the reason for that is if we can get the kids in by that time, we can get the surgery done, and then we can get them in the helmet and the duration of a helmeting would be as short as six months. So if we see these kids later on, the helmeting duration is much longer.

Interviewer: And, Dr. Kestle, if a child doesn't receive treatment for a synostosis, what could be the potential outcome then?

Dr. Kestle: So the natural history is that the shape will stay the same or get progressively worse because everything is growing except the fused suture. So number one, it's an issue of shape and appearance.

Number two, there are potential effects on the brain if it's left untreated. There's an incidence around 15%, maybe 20%, in the kids with sagittal synostosis that the brain growth will be restricted. And that can lead to brain problems, chronic headache, possibly visual problems.

With the other types of synostoses, that number is a little higher. And so it's nearly impossible to predict which baby with synostosis is going to get into those brain problems later. But that incidence of raised pressure is enough that we worry about leaving it alone.

Occasionally, we'll see an older child who had a CT scan for another reason, like maybe a concussion, and we identify a fused suture. But their shape is normal, and they're healthy, and their brain is developing normally. That's the situation where we might just follow them. But the baby that has the abnormal shape soon after birth is the ones where we recommend treatment.

Dr. Siddiqi: I would just add that . . . echo what Dr. Kestle said. The two indications are the shape and the risk of pressure on the brain. But the shape is important. A lot of families ask, or even other providers say, "Is this cosmetic?" It's not cosmetic. Cosmetic means, by definition, it's normal and you're making it better. It's not normal to have craniosynostosis. I just wanted to make that clear.

Dr. Kestle: I just want to really emphasize that it's visual. It's the shape that makes the diagnosis. So much so that what we do for almost every patient is have the family send photos. And we can pretty much make the diagnosis from the photographs and then decide if they need additional testing, how quickly we need to see them, and so on. But it's really a visual inspection of the head shape that tells you the diagnosis 90-plus percent of the time.

Interviewer: So really at 3 weeks, if a parent suspects that their child might have a synostosis, they should get in contact with a couple of specialists or a specialty center such as yourselves. You would encourage them to do that as quickly as possible. Is time really of the essence?

Dr. Kestle: For sure. And we can make plans based on photos, and we can see them in the clinic and talk about it, and then targeting between 2 and 3 months for corrective surgery.

Dr. Gellner: A new baby brings a whole new set of concerns for parents, one being their baby's breathing. What's normal and what is not is what I'll talk about on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Parents often come in with concerns that their baby has breathing problems. Sometimes it's just normal baby breathing. Sometimes it's something that even makes us as pediatricians worried. Babies do breathe faster than older kids and adults. In fact, newborns breathe about 40 to 60 times a minute and may only slow down to 30 to 40 breaths per minute when they're sleeping. One of the most common questions we get about breathing in newborns is that they will breathe really fast for a second and then seem to stop breathing for about 10 seconds before breathing normally again, so where they're sort of like [makes breathing sounds]. This is called periodic breathing, and it's normal till about six months old.

We don't get worried about these pauses with breathing. This is much different than apnea, which is where a baby doesn't breathe for 20 or more seconds and starts to turn blue. That's a real emergency.

Another question we get a lot is, when a baby is coughing or choking while eating and they can't seem to catch their breath. If your baby is an aggressive eater, meaning they want food and they want it now and they want it as fast as possible, then you've got an aggressive eater on your hands. Now if your baby is coughing or choking on feeds and this starts right away, like before you even leave the hospital with your newborn, that's something different. And that could cause concern for either the respiratory system or the digestive system with how they formed prior to birth, or with what your baby is eating, or true reflux.

If your baby has a cold virus, then we are extra concerned about their breathing. Their tiny airways can be compromised quickly. Your baby may have flaring nostrils, retracting, which is where you see that each time they take a breath they'll suck in at the ribs, below the breastbone or above the collarbone. If they have those, this means your baby is struggling to take each breath.

If your baby is grunting with each breath, then they're trying to keep air in their lungs to build up oxygen. Any of those things or any time a baby turns blue, that's a 911 call. That baby needs help immediately. Babies have a lot to figure out in their first few months: how to breathe with lungs they haven't used before they were born, remembering to breathe, how to eat and breathe at the same time. So if your baby has any signs of problems breathing, call your pediatrician, go to the emergency room, or call 911 right away.

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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. Van Hala: Hi, I'm Dr. Sonja Van Hala, and I worked at Sugar House Family Health Center through the University of Utah. I'm a family doctor.

I talk to many parents who are wondering when they'll get a full night's sleep. You know, every baby is different and has their own rhythm. Really early on the baby is in charge, and especially if you're breastfeeding, you're going to want to respond to their rhythm. So when they awake and they start crying, you know, you'll check to make sure their diaper is clean and then you'll most likely be feeding them.

And then oftentimes, they're sleeping in between their feedings. But when the baby is small, their stomach isn't very big and so they need to feed about every two to three hours if they're breastfeeding. With formula, it might be spaced out a little bit more, every three to four hours, and then oftentimes they're sleeping in between.

You can start to expect around two months of age or so some longer stretches of sleeping, five to six hours perhaps at night. But really, we don't start fussing with trying to train them to sleep until closer to four months of age when their stomach is a bit bigger, we know that their growth is going well, and they're able to tolerate longer stretches of sleep.

One thing that I encourage, and I would start doing this early on with your newborn infant, is a bedtime routine, and this can include bathing, singing, reading, just really slowing things down prior to bed and getting the baby in the mood to go to sleep. Once the baby is closer to four months of age, if they start waking in the middle of the night, it's a good idea to just see if they really are fully awake and if they need your attention or if they're just making some noise and you can just let them be and then they'll settle themselves back down.

Certainly, in the middle of the night, it's important to not train them that they're going to have a fun time in the middle of the night. So ways to handle that is if you do need to give them attention in the middle of the night to either feed them or change their diaper, keep the lights down low, don't play, try to not do too much talking and stimulation, try to keep it boring. Do what you need to do and then put the baby back to bed, and then hopefully they'll eventually learn that awaking in the middle of night, you know, really isn't that much fun and so they'll start stringing more hours together.

So I would say if you get some good night's sleep in the first few months of life, that is wonderful and enjoy it. But usually, you're not going to have a full night sleep, meaning five or six hours, until probably around three to four months of life, and around four months is when you can start doing some sleep training with your child and try to extend those hours.

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Interviewer: Newborn acne, is it something to worry about? What should you do about it? We'll find out next on The Scope.

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

Interviewer: Dr. Amy Williams is a pediatrician with University of Utah at the South Jordan Clinic. And a parent has a child and the child gets a rash. And I understand that's a call you get a lot.

Dr. Williams: Yes.

Interviewer: They tend . . . a little freaking out happens. So let's talk about when you should be concerned about that rash, and when it's probably not a big deal, and what to about it.

Dr. Williams: Yeah, great question. I think it's a really difficult thing sometimes to know what a rash is. And quite honestly, a lot of times, doctors have to get second opinions. Rashes can be sometimes very easy and sometimes they are just confusing. So the newborn, usually, they come out with a lot of rashes and I think that's something we can focus on because a lot of them are things that parents can do at home and they don't need to bring them in.

The rash that I most commonly get questions about is the newborn acne, and it usually start to show up a couple of weeks after they're born and they get something that looks very much like a teenager's acne: the white pimples and the red on the cheeks, on the forehead. Sometimes it's all over the neck. And parents get really concerned because it shows up and we . . . they don't know what to do.

A lot of times, this is all just related to the changes that are happening in the baby during that first couple of weeks: they came out of mom, they were exposed to mom's hormones and everything and they're having this changes in their body. And the acne shows up, but quite honestly, it's a very healthy, happy, non-urgent rash. And it's something that parents can do nothing about and just allow the baby to recover from it. It usually takes a couple of weeks, sometimes a couple of months.

Interviewer: And no harm done?

Dr. Williams: No harm.

Interviewer: No skin damage?

Dr. Williams: You don't have to start buying over the counter acne medicine.

Interviewer: It's a little early to start, right?

Dr. Williams: In fact, we encourage you not to do that for a baby. Their skin is so sensitive that they really can't handle any of the medication we do for teenagers or adults. It's very healthy rash and you don't have to do anything about it all, and it will go away on its own.

Interviewer: Are there ever any instances where it doesn't?

Dr. Williams: Sometimes they are so severe that we will have a dermatologist look at it and have an evaluation to see if there's any treatment. Obviously, if there are any signs that it's getting infected or the rash is changing, those are things I would definitely bring the in for. And you can always bring them in for a concerning rash and we can always talk to you about it. If it doesn't feel all right to you, bring your baby in.

Interviewer: Yeah. And you said this lasts for about two weeks, generally?

Dr. Williams: It lasts a couple of weeks to sometimes a couple of months. Sometimes, it lasts until they're four months old and then it resolves on its own. But it's not related to food, it's not related to anything else other than their body just changing.

Interviewer: So if the acne is kind of coming and going and a new one appears, and then disappears and the new appears that goes on for a couple of months, that's totally normal?

Dr. Williams: Totally normal. Don't pop them.

Interviewer: Okay. That more good advice. For the rest of your life, that's good advice, right?

Dr. Williams: Don't ever pop them. It is something that is natural and although maybe they won't look great in baby pictures, it is absolutely normal and fine. Please don't put makeup on the baby. Just let them be who they are, let them transition.

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

Dr. Stoesser: Hi, my name is Kirsten Stoesser, and I am a family medicine physician at University of Utah Health Care. One of the common questions I get is, "How do you know if your newborn is getting enough to eat?" So there are a few ways to be able to assess if your baby is getting enough to eat. One is just does your baby seem relaxed and happy right after a feed? Does your baby seem content and going back to sleep or relaxing? Although babies can be irritable a lot, and cry a lot, and crying doesn't always mean that they're hungry.

So there are a few other things that you can look at as well. One is, how many wet diapers are they making? In the first day after they're born, they should make one wet diaper in 24 hours, and then you add one diaper a day for the next few days. So, by two days, they should have two wet diapers, by three days three wet diapers. And from the fourth day on, they should really be making about four to six wet diapers per day.

In addition to the number of wet diapers, you can also look and see what does the urine look like? If the color of the urine is pretty pale, that means that they're getting enough liquid. But if it's a dark yellow, or if it's even a pink-orangish color, that can mean that they are dehydrated and that they need to get more fluid in.

In addition to the number of wet diapers, looking at the stools, it can be really helpful. These also change in their character and number within the first few days, first few weeks. Initially right after a baby is born, the stool will be black and tarry, that's the meconium, and then it turns to a greenish and then a brownish color. And then, with breastfed babies, the stool then transitions to being a yellow, what we call a mustard-yellow color and, kind of, a seedy consistency or like a cottage seed consistency. In the first week to first month, they usually make about two to three stools a day with breastfed babies. And after one to two months, there can be a large variation. They can make one stool a day, or they might go a few days without having a stool, and that again can be normal.

And then the other thing to look at, to make sure that your baby is being fed well, is weight gain. And although that's a hard thing to do at home, when you bring your baby in for clinic visits at three to four days after they're born, and at their two-week, and their two-month visit, we will check their weight and then look at that on a graph to see how they are comparing to other babies of the same age, and are they within the normal weight. And a lot of times, parents worry that their baby is not feeding well, but when we can show that they're gaining weight normally and appropriately, that shows that they are getting enough nutrition.

Sometimes we will have parents come in more frequently if we do have a concern about the weight, so that we can check it a few days or a week later, just to make sure that a baby is gaining appropriately. And normally they should gain about an ounce a day, or about four to seven ounces per week within those first few weeks, first few months. Although most babies, they will lose some weight in their first few days. That's normal. By two weeks, certainly of age, they should be back to their birth weight.

Again, the things to look at are how many wet diapers are they making? What are their stools like? And are they gaining weight? And if you have any concerns, certainly calling into the clinic, or make in an appointment to come in. And we can always check your baby, and be more than happy to figure out what's going on, and how we can help.

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Dr. Gellner: "Top Five Old Wives' Tales About your Newborns," or, "How to Troubleshoot your Newborn," on today's "Scope." I'm Dr. Cindy Gellner.

Announcer: Remember that one thing that one person told you that one time about what you should or shouldn't do when raising your kids? Find out if it's true or not. This is "Debunking Old Wives' Tales" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Newborns don't come with instruction manuals, so parents often worry when things really are normal. For example, "Excessive crying means something is seriously wrong." Not necessarily. Newborns cry up to two hours a day, sometimes it's because they're hungry, babies have a "nah" cry for this. Sometimes it's because they're wet or their diaper is too tight, or they're stimulated, and babies have a "wah" cry for this. I know, it's pretty cool. I learned that from my lactation consultant.

Or it could be colic, and your pediatrician can help you determine if this is why your baby cries. As the mom of a former colicky baby, I say, "Good luck and good news," it does go away by itself in three to four months. It's making it through the colic period that's tough.

Another concern for parents of girls is that some baby girls have vaginal bleeding. No, your daughter's not going through puberty already. It's actually due to mom's hormones coming out of her system. Little girls get white discharge during the latter part of the first week of life and sometimes it turns blood-tinged. Normally, this goes away in a few days and unless your daughter starts having pubic hair before age eight, you're fine.

Then there's periodic breathing, which freaks a lot of parents out. Babies have this funny way of breathing where they'll sometimes hold their breath and then they'll breathe really fast, and then normal again, and it might seem like an eternity that they're holding their breath, but it's really only seconds. This happens because the part of the brain that controls breathing hasn't fully developed yet. Now, if your baby stops breathing for more than 20 seconds and turns blue, that's not periodic breathing, that's a trip to the ER.

Then there's their bellybutton That scares parents most of all, it seems. Everyone thinks that the yellow goop is an infection, but it's not. It's the remnants of something called Wharton's jelly, which is what makes up the umbilical cord. True infections are very rare. Bleeding is common too. Remember, that's where all the blood vessels were that connected baby to mom. The blood finishes coming out until the cord completely seals itself. If you have any questions about your baby's navel, pediatricians are really good at evaluating cute baby bellies.

Finally, "Yellow drainage from one or both eyes is a serious infection or pink eye." Probably not. It's most likely an infected tear duct. Your baby probably has one eye that waters a lot too. The tear ducts can take awhile to open, so it's easy to get them infected. Antibiotic drops will help with the goopiness, but it will come back until the tear duct itself opens, usually by a year old. Bottom line is, if you have any concerns about your newborn, don't hesitate to ask your pediatrician. Babies are what we do best.

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Interviewer: If you're feeling a little bit overwhelmed with your newborn, it's totally natural because it's hard having a newborn. We're going to find out exactly what that means, and hopefully reassure you coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Sonia Van Hala is with University of Utah Health Care and one of things she likes to reassure her patients about is when you have a newborn, it's hard. It's difficult. And you find that your patients come in and they think that they are inadequate in some way because it is hard. Tell me a little bit about that.

Dr. Van Hala: Babies are remarkable in so many ways, and especially remarkable in how they really turn your world upside down and you're trying to figure out, how do I right things? The biggest thing that parents are challenged with is when things aren't going according to their expectations. We talk a lot about this as we're approaching the delivery date. I deliver babies as well. Just in being flexible and thinking about what's reality going to look like.

The arenas that I see the big challenges happening are in breastfeeding. When breastfeeding is hard either because of too little milk, too much milk, difficulty with the latch. Just having to work really hard at it, so breastfeeding is a common concern.

Also sleep deprivation. Trying to figure out how to manage with not a full nights worth of sleep. I think one of the big things with that is, just trying to not do too much because if you expect to carry on with your regular life while you're figuring out how to have a newborn, well that's a bit too much at that time. You can postpone those other things until a later time. Focus on your newborn first.

Interviewer: Take it easy on yourself.

Dr. Van Hala: Take it easy on yourself. Then, the third issue would be the fussy baby. There are a lot of really unfussy babies out there. When you see them you think "Oh, that's just lovely" and that's really hard when your baby is not one of them. I know because I had two fussy babies myself. So I really have a lot of heartfelt empathy for those parents who come in concerned about the baby that just cries a lot.

For those parents I say bring your child in as many times as you need, if you are worried about something medical going on. So that your doctor can check your child to make sure your child is well and there is nothing that's being missed.

Also know that babies do cry. The range of temperaments between babies is quite broad and it's very normal. The other really important piece is, it's temporary. So your baby will eventually stop crying and you will eventually have a good relationship with your child.

Interviewer: You said early on that parents come in with expectations about what's it's going to be like having a newborn. What are some of the expectations that they have that aren't quite in tune with reality and I think these answers should be something like, when a parent hears it they're like, "Oh, that's me. I'm expecting too much, maybe I should be more over here."

Dr. Van Hala: I think it falls into some of the arenas I just mentioned regarding feeding, temperament, sleep. Also, your emotional response to that. It's pretty common for parents to, especially moms, who are tired, who are trying to breastfeed, and do all this new stuff, to feel overwhelmed, to maybe not feel so delighted to be with their child all the time and then have guilt surrounding that.

Interviewer: Because what good mother would not want to be around their child all the time? Right? Isn't that the expectation?

Dr. Van Hala: Right, right and then they judge themselves and get down on themselves. You know what? That is totally normal, but I really encourage my moms to just be easy on themselves. Recognize this is a hard job and they will make it through it and they will have a good relationship with their child when they get through it. Sometimes people are worried about the quality of time that they're spending with their child when they are not feeling as positive as they had hoped they would be.

Interviewer: But that time is just the same to the child.

Dr. Van Hala: It is.

Interviewer: All that other stuff is our internal thing.

Dr. Van Hala: Yes, that's exactly right.

Interviewer: What about parents that see other parents on Facebook and think "Their life's is so perfect."

Dr. Van Hala: Yeah, Facebook.

Interviewer: Just judging yourself against other parents and how other parents experience are going and not knowing the whole story. Does that happen a lot?

Dr. Van Hala: Absolutely. Well I think it's common and popular to post the good and fun things in our life. We don't want to be posting all the stuff that's sort of a downer. That can be a disservice to parents with a newborn. If all they're seeing is these positive images, and then they're looking at themselves and saying "That's not me, what's wrong?" When really, there's nothing is wrong. Their experience is normal. It's also temporary

Interviewer: What's that last piece of advice you'd have for a parent that is struggling with these things. Just be sweet to yourselves?

Dr. Van Hala: Yes, absolutely. Be kind to yourself. Gentle, loving, kindness. Right? Also seek a support network, people who can help you out and reach out to them and do ask for help. A lot of people just don't feel comfortable asking for help, do. People want to help and they're not going to know your needs unless you speak up.

Also, important to mention, if you're feeling really down and low, you're just feeling like can't pull out it and you're not having the happiness, do check in with your doctor. Make sure you're not dealing with having postpartum depression. That's a real entity and it does affect your health, and the health of your child, and the health of your relationships. Seek support from your friends your family and also your physician.

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Dr. Miller: You've been told that your baby that's about to be born could have a medical or surgical complication. We're going to talk about what happens next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here today with Dr. Mariana Baserga, and she is a neonatologist and also a pediatrician. She is a specialist in the care of little tiny babies. And Mariana is going to tell us a little bit about what happens during delivery and right after delivery. So let's suppose that you are a mother or you're a family that has been told that the delivery may result in a child that has some significant medical complications. Can you describe for the mother-to-be what might happen during that delivery so that we can best help the child?

Dr. Baserga: As a group of specialist in pediatrics that take care of newborn babies that may came with problems at birth, we have a team in the neonatal intensive care unit that can provide the family with the support needed at the time of delivery. The way this is planned is that ahead of the delivery, we do meet once or twice, as many times as needed, with these families to discuss the plan for the delivery.

Dr. Miller: So now, I would think that most mother's families would find out about the baby's condition through some of the modern tests that we have, such as . . .

Dr. Baserga: Ultrasound.

Dr. Miller: . . . ultrasound or echoes of the child in utero, in the womb as well as maybe some genetic testing that's done from time to time. Is that usually how these problems are picked up by the obstetrician?

Dr. Baserga: Correct. The technology now allows us to do very sophisticated ultrasounds that can pick even small defects when the baby is being developed in utero. And if we know that the baby is going to be born with a problem that would need medical assistance after birth in the NICU, the team is present at the time of delivery and the baby is passed from the OB or obstetrics delivery room through a window into the neonatal intensive care unit.

Dr. Miller: And that could happen quite quickly.

Dr. Baserga: Yes, right after the delivery.

Dr. Miller: And so the mother might not be able to hold the baby necessarily.

Dr. Baserga: Correct.

Dr. Miller: This could happen rapidly and the mother would probably know about what was going to happen that she may not be able to hold that baby or see the baby.

Dr. Baserga: Correct.

Dr. Miller: The surgical team or medical team would quickly take the baby and then perform whatever procedures are needed.

Dr. Baserga: Right, depending on the diagnosis that the baby may have, we need to pass their babies through the window to the intensive care unit rapidly.

Dr. Miller: Talk to me a little bit about this window.

Dr. Baserga: Yeah, that's a real window with glass and everything that slides open. And there are three of them in the intensive care unit to communicate with the operating rooms. So if there's a C-section or caesarean section, we have opportunities to pass the baby to the neonatal intensive care unit. And one is communicated to our regular delivery room. So a vaginal delivery can also be achieved in that manner.

And then, in the intensive care unit, we have a special bed called a warmer, where we put the baby so the baby can stay warm. We will have specialists that are able to put a tube in their airway if needed, to assist the baby in ventilation. We have very specialized nurses that will be putting IV lines if we need to, to provide fluids and sugar to the baby.

And once the baby is medically stable, if the baby needs to be transferred to a surgical center, we can call the neonatal or prenatal transport team that has specialized equipment to transport the baby to level 4 NICU for any special procedures that have to happen including surgery by specialized pediatricians.

Dr. Miller: So it sounds like most pregnant women are advised about the process that could take place. So they're usually aware of what's probably going to happen, and that I would think that lessens their anxiety some.

Dr. Baserga: Yeah, the families want to know where the baby is going to be, who is going to be taking care of the baby, what's the plan. When is the first time they would be able to touch the baby and hold the baby?

Dr. Miller: How very important. So as I understand it, the baby goes through the window, and perhaps, there's surgery. It could be neurosurgery, it might be cardiac surgery, it could be general surgery, it could be some other type of intensive care. Then does the baby come back after the procedure to an intensive care area? What happens then?

Dr. Baserga: So the procedures that are needed to resolve the baby's problem may differ. We are even able to perform surgery in the NICU in Primary Children's if a patient is too sick to go to the operating room. But, having said that, if the baby goes to an operating room, following surgery, the baby would recover in the neonatal intensive care unit and most likely would stay there until discharged home. We don't typically transfer babies to other areas of the hospital since we have the specialists that can help them achieve that discharge time.

Dr. Miller: So they stay right in that unit until the time when they're ready to be discharged home with their mom?

Dr. Baserga: Correct.

Dr. Miller: So as I understand it here in the University of Utah, when delivery occurs, if there are certain medical procedures that are necessary then that little Neonatal little transfer to cross to Primary Children's Hospital, where those specialist work and perform their procedures.

Dr. Baserga: Correct.

Dr. Miller: So once the baby transfers through the window, the little baby goes through the window, they don't go right to surgery or to some other procedure. You will probably stabilize the little baby. Is that right? You perform whatever you need to do to make sure that baby is stable.

Dr. Baserga: Yeah. The main thing is to make sure that the baby is safe for transport. So to establish that, we have to make sure there is stable airway. So if the baby needs intubation or a ventilator, we have to provide that. We have to make sure we have access to give medications through an IV. And once we see that the baby is stable enough, then the baby can be transferred to a children's hospital for neonatal surgery.

Dr. Miller: And how is the information communicated back to the mom who is obviously separate now from the baby after the delivery?

Dr. Baserga: Yeah, that's very important. After the baby is transferred back to the hospital where the surgery will happen, us, the neonatologists, are the ones that keep the parents informed. Typically if the father is present, he goes with the transport team, and he stays with the baby during the whole process to the children's hospital. Mom, unfortunately after having a caesarean section or a vaginal delivery cannot go right away, but after few hours if she is feeling well, we can provide transport for mom to be taken in a wheel chair to Primary Children's to see the baby also.

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