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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.

Interviewer: So, today, we're here with Dr. John C. Carey. He's an MD and professor of pediatrics at the University of Utah Health and Primary Children's Hospital. So when we're talking about hearing loss in children, you know, when we're talking with newborns, you were telling me that there was a bit of this screening process that we do, what's it called?

Dr. Carey: So it's called universal newborn hearing screening. It was initiated in Utah in 1999, which was one of the first states to actually pass the legislation to screen all of our newborns. But by the mid part of the next decade, the mid-2000s, all 50 states had mandated that their health departments had to provide newborn screening so that we could detect early on, literally first few days of life, that that particular newborn had a hearing loss.

Interviewer: So, I guess, how frequently are we testing? Are we doing like, you know, the first week, the first month? I've heard 1-3-6.

Dr. Carey: In testing for all the babies that are born in the hospital, which in Utah is about 99%, the hearing screen is done before they're discharged. So it's done by one, two, three, four days of age. If they fail either ear, they get a second screen. That's usually done a week or so later. That's the one of the 1-3-6. We want to make sure that second screen is done before one month of age. And then from that, it turns out that the majority of those children who fail the first screen, don't have a hearing loss. There's something plugging their ear, like, you know, the ear wax of the newborn and so on.

So when they get their second screen, that really narrows things down to now we have a few percent of babies. And then when they're seen by three months by the audiology specialist, by the actual hearing specialist, we can determine whether or not they have what is called a permanent hearing loss or not. If there's fluid in the middle ear, it's not considered permanent because our ENT colleagues can drain that fluid with tubes. And eventually that, with time, can resolve itself. So that's not considered permanent. What's permanent is when it's not due to fluid and they still fail one or both ears, and then that's confirmed by the audiologist before three months.

Interviewer: And then you bring them in one more time at the six-month mark?

Dr. Carey: And then, well, by six months, we're hoping that all of those children who are determined to have permanent hearing loss of some degree could be mild, it could be more, but by six months all will have their hearing aids and also be, if they need them, and also be lined up for early education of children with hearing loss. So, by six months, we want that to be in motion.

Interviewer: And how many kids do you find are affected by these types of conditions?

Dr. Carey: After you go through the screening first time, second time, get the test by the audiologist, you're left at about 1 in 500 newborns. Now, there are a few weeks or months old. One in 500, which would be about 100 children a year in Utah, have a permanent hearing loss. After heart defects, hearing loss is the most common birth defect in human babies.

Interviewer: Wow.

Dr. Carey: So everything else you can think about from oral facial clefts or some of the orthopedic abnormalities or other syndromes, like Down syndrome, they all have a frequency of less than 1 in 500.

Interviewer: And what does the screening for a baby look like? Do you put little headphones on them? What does that look like?

Dr. Carey: You actually do put something in their ears. In the first screening, you put something in their ears, and this almost sounds magical, but what they're doing is they're putting a sound wave in through the ear canal. It goes through the eardrum and the three famous middle ear bones, the smallest bones in the body, through the oval window to the hearing structure called the cochlea. And so, when it gets to the cochlea, the hair cells inside, people are familiar with all that with maybe a hair cell problem, get to the hair cell, the hair cells bounce the sound wave back, and the computer detects that change.

So what you're doing, in Utah, what we're doing . . . other states do something different. Most states do what we do, which is to test cochlear, the inner hair cell function by bouncing these sound waves through, the hair cells react, bounce it back, and the computer at different frequencies, at different loudness records whether or not the cochlea is working properly.

Interviewer: Wow.

Dr. Carey: So if the hearing loss is due purely to the nerve and not necessarily the hearing nerve connected to the cochlea, but purely to the nerve, a child will pass the hearing screen much of the time. So the limitation of our hearing screening, which most states do, this is called an otoacoustic emission. You can see the words, oto, ear, acoustic, the sound. Emission is the hair cells bouncing it back, you know. Most states do otoacoustic emission.

Interviewer: So for one of these parents whose children are identified with one of these hearing issues, what kind of services can the Utah Hearing Center provide?

Dr. Carey: The beneficial aspect of early detection is that you actually get the kids in for treatment and proper education. And the majority of those children will go to a regular class in a regular school. Those that have the most profound degrees of hearing loss, that don't necessarily respond to hearing aids, can go to our outstanding special schools we have throughout the state. They're the schools for children with hearing loss and visual disabilities. They still do say deaf and blind. So those schools have their branches of them throughout the state. They provide for the children that have some of the more moderate to severe, but especially those that have the profound degree that if untreated with something like a cochlear implant, those children would go on to be called deaf.

So deafness is the degree of hearing loss preventing regular communication as you and I would have it in this type of setting so that one would have to learn sign language and then be a part of a very rich community of people with deafness. But on the other hand, would have more challenges with communicating with the rest of society. That particular place we're talking about, that particular situation, just, you know, in the last two decades, in half of my career here at Primary Children's can now be altered dramatically with a cochlear implant so that children with a cochlear implant will usually, with the right rehabilitation and such, will actually go to regular kindergarten.

Interviewer: A study shows just how important getting a flu shot during pregnancy really is. Up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Julie Shakib. Assistant professor of pediatrics at the University of Utah School of Medicine and medical director of the well-baby and intermediate nursery. Dr Shakib, if you Google flu shot and pregnancy, you'll find that there are actually some very vocal people out there who say that you should not get a flu shot if you're pregnant. Did you in part do this study to address those concerns?

Dr. Shakib: I agree it's a concern that not enough pregnant women are getting the flu vaccine during pregnancy but the key driver for why we decided to do this study is we knew we had the opportunity to look at a large dataset over a number of influenza seasons.

We also knew that we had the opportunity to look at the gold standard for flu which is laboratory confirmed influenza and infants and no one had really done that before. We saw an opportunity to contribute to what's known about how maternal immunization can affect the baby.

Interviewer: What did those things tell you?

Dr. Shakib: What we found in our research is that when mom reported influenza immunization during pregnancy, their infants were 70% less likely to have laboratory confirmed flu than moms who didn't report immunization during pregnancy. Additionally we found that in the same cohort of women who did and did not report immunization, that moms who did report immunization their infants were 81% less likely to have influenza hospitalizations in their for six months of life.

Interviewer: Those are both indicators that these infants are not getting the flu if their mothers get the flu shot during pregnancy. That there's a benefit to the infant from the mom's flu shot. Why is that particularly important for the in the infant and for the mother?

Dr. Shakib: That's a great question. The reason it's important is because immunization against flu isn't indicated in newborns until they're six months of age. That's because the vaccine just isn't effective in that first six months. So maternal immunization is one of the only ways we have to provide the baby with some protection until they're old enough to receive and get benefit from the vaccines themselves.

Interviewer: What happens when infants get the flu? Is it worse for them than for say you or me?

Dr. Shakib: It is. It's much worse in the first year of life than it is for adults. They're much more likely to be hospitalized for flu. Much more likely to have complications such as pneumonia. They have higher rates of morbidity and mortality from flu than older age groups do.

Interviewer: Do we know how long the mother's immunization protects the baby after it's born?

Dr. Shakib: That's another interesting question. We do know that it's dependent on when the mom received the vaccine during pregnancy. But the mom needs to get the vaccine as soon as it's available during her pregnancy. That's not something that can be timed to be exactly right for the infant.

Interviewer: Well and of course I mean, we all know that not every flu shot works. The flu changes every year and so getting a flu shot doesn't necessarily guarantee that you're going to protect the baby?

Dr. Shakib: The one thing I would say about our study that's really interesting is that even though we looked over nine seasons of influenza data, we still saw a benefit. We know every year the vaccine isn't a perfect match. What I would suggest is there is protection. How perfect it is, no vaccine is perfect, no protection is 100%. But some protection from a serious illness that we couldn't get otherwise, is the purpose of immunizing during pregnancy.

Interviewer: How did you do the research?

Dr. Shakib: Essentially we did a data analysis of nine seasons of influenza, we basically retrieved all the records and looked at documentation for whether moms reported receiving flu vaccine versus those who didn't and then compared the specific outcomes including influenza like illness, laboratory confirmed flu and flu hospitalizations in infants based on their mom's immunization status.

Before the H1N1 pandemic a lot of women were not receiving the flu vaccine. So we had a number of years where we had low immunization rates and moms that changed thankfully a fair amount with H1N1 but didn't change enough because still only about 50% of women report getting the flu vaccine during pregnancy.

Interviewer: Pregnant women, are they particularly susceptible to flu?

Dr. Shakib: They're not more likely to get the flu, but they are more likely to have some severe outcomes from the flu because of changes to their immune system, their circulation during pregnancy. So we saw with H1N1 pandemic that pregnant women were disproportionately sicker and more severely affected. Flu vaccine is a little bit of a two for one benefit. Moms need to be protected while they're pregnant, but they're also providing protection to their baby with the same shot.

Interviewer: What's kind of the main message you want to get across?

Dr. Shakib: I think that the key message is that we need to take every opportunity to both support and provide flu vaccine to pregnant women during their pregnancy. Obstetricians, midwives, nurse practitioners, anyone who cares for pregnant women needs to actively endorse and offer flu vaccine to their patients. Patients need to feel empowered to ask for it if they haven't been offered it during their pregnancy.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Interviewer: Poison prevention strategies for parents whose kids just started crawling, walking or climbing.

Sherrie Pace is a health educator for the Utah Poison Control Center.

Interviewer: You broke out these three segments. Why?

Sherrie: I did because development kind of changes through those three areas. With the crawlers, they're super excited to get moving. They've been looking around and seeing all these things that they want to explore for a long time and all of a sudden, they can move.

Interviewer: Yes. So before they can move, do you really have to worry that much as far as poison?

Sherrie: Well, it's always good to make sure older sibling aren't getting anything in their way. And making sure you're correctly dosing if there's medication to be given. Those are typically the infant top poisonings.

Interviewer: What should you do to protect crawlers?

Sherrie: They can reach things on low shelves, low cupboards, low drawers, anything that's left on the floor. Kind of think of it from a child's point of view as you look around your home. And then, you'll want to make sure that you put things up and out of reach of those little crawlers and then use child resistant closures because when they get a hold of medicine bottles, believe it or not, even little, tiny people can sometimes get those open.

Interviewer: And they're persistent. And I think if nothing else, that's in their favor. They will sit there and work on it for hours.

Sherrie: Putting locks on the cupboards and below cupboards. Keeping things out of their little reach.

Interviewer: Are locks are pretty effective? I've gone to other people's houses and those locks sometimes, I feel like I didn't realize it was there. I pull the door and I get it open pretty easily.

Sherrie: It's a deterrent, but nothing is childproof. It's child-resistant so it gives you a little more time to catch them in the act.

Interviewer: I even thought, like if you're cleaning around the house and you leave your cleaners out on the floor, you might not think of that. But, quickly, somebody could get into that, a little crawler.

Sherrie: It just takes a couple of seconds. and that's one of the biggest problems with the kids getting into the things, is it happens a lot at times and when things are out and in use. Even if we're good about putting things up high, when we're actually cleaning the floor and we've got that cleaner out and we're distracted for a split second, it can happen.

Interviewer: So think like a crawler. Get down on your hand and knees and crawl around and see what you see. Let's talk about walkers.

Sherrie: Walkers. The peak age for poisoning is 18 months. And that's usually new little walkers. They can reach higher. They actually on their tippy toes can reach pretty deep onto a counter top. And that's something where we see some difficulty. They can certainly get to higher cupboards, higher drawers than crawlers. So you have to think of it from their perspective as well. But they have a little more breach than those crawlers did.

Interviewer: The stuff on the bathroom counter, for example, nail polishes. Is toothpaste bad?

Sherrie: Toothpaste, we get a lot of calls on toothpaste. Certainly, call us if that happens because you never know what's in that. If there's fluoride in it, there could be more problems. It's just something to call us about.

Interviewer: For walkers, you've got to not only think like a crawler but like a walker and a reacher.

Sherrie: A reacher, absolutely.

Interviewer: Are there any other tips you have for the walkers?

Sherrie: Yes. Definitely with older siblings, that can be a problem too. I've definitely heard stories where an older sibling leaves something on the counter, doesn't think their little toddler sibling can get it and they do.

Interviewer: The next one: climbers and, obviously, extending the reach a little bit.

Sherrie: Right. So nothing's off limits at this age.

Interviewer: How old is a climber, generally?

Sherrie: Honestly, that depends. Some kids never really are big climbers and others, they are just so motivated to get whatever they can see. So they are scrambling up drawers, stepping drawer to drawer like stairs, getting up on counter tops in high cupboards. And if you have the climber, it's very challenging.

Interviewer: What do you do what are some tips for that?

Sherrie: I would recommend keeping especially medications locked up. Under kind of lock and key.

Interviewer: That sounds really extreme. Do people really do that?

Sherrie: It's an extreme, but it's not a bad idea, especially with your medications.

Interviewer: Especially, if you have some of those powerful painkillers. Those can be deadly.

Sherrie: They can be particularly problematic. But definitely using the child-resistant closures that can slow them down and the child protective locks that can slow them down. All those things help a little bit to catch them in the act. And obviously, adult supervision, you can't ever say enough about that.

Interviewer: It sounds like a lot of these strategies are more about slowing somebody down than really maybe getting something completely out of reach. Or is it a little bit of both?

Sherrie: Well, it's a little bit of both. When things are out of sight too, that's something where the kids aren't as enticed to get something. So a really high shelf and a cupboard with the door closed, they're less likely to be going for something that they can't see.

Interviewer: All right. When does it get better? At what point do you not have to worry quite so much that your child might get into something particularly bad?

Sherrie: Our statistics show that the majority of our calls are for kids under age six. We really recommend a lot of these strategies for under age six just because cognitively, their functioning, they can't read yet. It's difficult for them to maybe distinguish between things that are safe and things that aren't. And everything goes in the mouth when you're a little kid. It's how they explore. It's always a good idea to keep things up and out of reach.

Interviewer: After six, not quite as bad, but still probably, you need to keep an eye on things.

Sherrie: You still need to be cautious.

Sherrie: Give us a call if you need us. That's what we're there for. We know that things happen. We don't judge you. We understand things can go wrong and that's why we're there. The number is 800-222-1212.

updated: December 9, 2021
originally published: March 20, 2016

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health," with Dr. Kirtly Jones on The Scope.

Dr. Jones: Every woman comes on to Labor and Delivery . . . well, most women come into Labor and Delivery hoping for a healthy, wonderful, peaceful, home experience in the hospital where it's safer. We really count on people to give us the information that helps us prepare for when things don't go well.

Today in The Scope studio, we're talking to Janet Fisher, the nurse educator on Labor and Delivery at University of Utah Hospital. What would you recommend in terms of dialog with your clinician and information that would help your clinician be prepared for something that might not go well?

Janet: It's really important that a woman shares with us all information about her medical history, any surgeries that she's had, any social things that she may do. This is not by way of making judgments of people, it's really just important that we know everything because things may have an impact on the woman or her baby. In order for us to take safe care of somebody, if we have complete information about you, then we are going to make very safe decisions on how to care for you if you are having an emergency.

Dr. Jones: Right. So women who've had, let's say, we'll take high blood pressure and pregnancy in the past, they're at risk for that again. We would be very careful watching them during their pregnancy and labor and delivery. Women who might be taking some recreational drugs and maybe they don't want to talk about it, but it may profoundly affect not only their blood pressure, but it may have a counter-effect on what we treat their blood pressure with. So honesty is the best way for a healthy baby and a healthy mom, yeah?

Janet: It absolutely is. Once again, there are absolutely no judgments being made here. Our sole objective is to take safe care of you and safe care of your baby. And the best way to do this is for you to be very open and honest about everything.

Dr. Jones: The other situation that I remember seeing on Labor and Delivery are . . . I would say there's a tension between women who want a natural process to happen and a birth is a natural process, but they feel like there's too much intervention and there are too many medications. About 50% of women who become high-risk deliveries walked into the hospital as low-risk women.

Janet: That's true, yes.

Dr. Jones: So when women come with a set of expectations, and some of these are written down, a delivery plan, asking for a little flexibility, we'll do the teaching and the explaining, but a little flexibility when we see things happening that make us worry, and having a discussion.

Janet: Well, I think, once again, we want everybody to have the birth experience that they have planned. It's very important to us to support every woman's plan because it is a major life event. It's something that you will always remember. But part of the reason you came to the hospital, and one of the major responsibilities as a health care provider, is that we have to constantly be monitoring you to make sure that you are staying on the path that we know is normal.

If we see you starting to deviate from that normal, it's our responsibility to tell you that and to talk to you about what our concerns might be and what our recommendations are. When this works best is if, as a woman, you are open to listening to us and to realize that what we bring to you is a lot of years of experience and knowledge and that we are not trying to circumvent your plan. Our goal is for you and your baby to be happy and healthy.

Dr. Jones: Both of these things we've just talked about, one is being open and disclosing all the parts of your health, and the other is being, both clinicians and women, being open to conversations when things aren't going so well, is all about having a conversation.

Janet: Very much so.

Dr. Jones: Doctors and nurses need to have the conversation so our patients feel safe. And patients need to have the conversation with us when they're nervous about something so that we can explain. I think at University Health Care, we work very hard to make those conversations go both ways.

Janet: Absolutely. I know it seems rather odd because here you are coming into the hospital to have a birth, a very personal and intimate experience, and these strangers are walking into the room, but you will be amazed at how quickly we bond. You come to rely on us and, hopefully, trust us. That is one of our biggest goals, when we're taking care of you, is to develop a trustful relationship. A big part of that is ongoing conversations with you and we want to listen, we want to hear what you have to say. By contrast, we want you to listen to us as well.

Dr. Jones: What our goals are for the ideal experience of a very difficult time because no one who has had a birth would say it's an easy process, but we want what's best for the mom and the baby. We want happy memories as well.

Janet: Absolutely. A positive birth experience is a number one goal for you and your family.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: You've just had a baby and then you've got to go to your first doctor's appointment for the first checkup. How about if the doctor came to you instead of you needing to go to the doctor? We'll talk about a brand new service at University of Utah Healthcare called "newborn home visits," next on The Scope.

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

Interviewer: Dr. Amy Williams is a pediatrician at the South Jordan Clinic for University of Utah Healthcare and the person who came up with this great idea and you're going to love her for it, newborn home visits. Why did you decide that newborn home visits were a good idea?

Amy: I think there's a really difficult time in the beginning of after having a baby that mothers are trying to establish a relationship with this new baby. They're trying to get home from the hospital and recover and so I felt like it was a really good time for us to come in and help patients with just a critical period in their life that they need some help.

Interviewer: Yeah, so otherwise they'd have to come in and visit a doctor. At what point in the newborn's life is that first visit?

Amy: They are usually coming in within the first week so they get home from the hospital, a couple days later, they're supposed to pack up, get back into a clinic again to have that baby reestablished with their primary care provider and we're trying to alleviate that first three to five days or that first week when they're supposed to come and see us.

Interviewer: And what do you feel the benefits are for that other than

Amy: There are lots. Lots.

Interviewer:
of course, you know, it's convenient. But let's talk about all of them.

Amy: Well, one of them is that we're taking that transition period that the mom's trying to have and just taking that stress from her life so that's obviously a great benefit. We come into the home so it's helpful for parents. They get to show us what they're working with at home so sometimes that's even a benefit where we can look at their environment, help them, show breastfeeding right at their place as opposed to coming to some foreign little clinic office and just reducing the risk of that baby coming in and exposing them to all the other stuff again.

Interviewer: Yeah, sure, sure. Sure.

Amy: It's also a benefit to mom if she's had some sort of surgery. Recovering from having a baby is physically hard and it takes a lot of healing and so if mom's able to move less, we're also doing mom a favor, not only the baby.

Interviewer: Give me an example, tell me a story of a time you went in and you were able to take the mother's environment and actually help making caring for her newborn easier because you saw something going on that they didn't realize.

Amy: I had twins that came home from the newborn intensive care unit. They were premature and they were sent home on car beds, so not car seats. And the mom was trying to figure out how to get her kids in these car beds to the clinic. So I said, "Don't worry about it. We're going to come to your house and we will check them and make sure that we can transition them to a car seat at your house."

So we got to the house, we were able to setup oxygen, just monitoring and see if they could do these car seats. And during that time, we were able to see how the mom was moving around the house and how she was functioning with twins, how she was holding them and help her with breastfeeding and all of that. It was great because after that, she's able to take her kids anywhere now in car seats and she doesn't have to try and figure out how to do these car beds, which are quite cumbersome.

Interviewer: Tell me how do you get that home visit? Is there a special code word?

Amy: Well, the University, right now, we're just offering it at South Jordan Health Clinic, but we want to start getting it out to all the other clinics. So anyone who has their baby seen at the University of Utah Healthcare in any of the community clinics, hopefully at some point we'll have it all there. Right now, parents can just call the 801-213-4500 number that they normally would call to get an appointment for their babies at South Jordan Health Clinic. And at that time, the call center offers them either a home visit or the parents can ask for one and we would set them up and then we would come on out.

Interviewer: What are some of the patients saying about this program that have used it?

Amy: I haven't heard one negative thing yet.

Interviewer: Yeah, okay.

Amy: It's been all awesome. I think parents are overwhelmed, they're excited. They feel like this is something that they wished they could have used with their other kids and now they're excited that it's here for their newborns now. I've heard some parents start with a little hesitancy of having somebody come into their house. They're worried about it not being clean and after you have a baby, the last thing anybody is thinking about is having their house clean. We do not have any care as to what the house itself, what its organization is all about and parents feel really reassured once we get in there that we're not there to judge them on what's around the house, but more to just take care of them and their baby.

Interviewer: And it's really just one of the ways the University of Utah Healthcare is trying to make healthcare a lot more accessible to people instead of the old model where they always have to come to us. We go to them and try to make it more convenient. It's kind of the new way.

Amy: I think University has an interest in getting out to the community and being a part of the community. And this is just one way that we can access our neighbors, our friends, our patients. And it establishes a much better rapport and trust with both sides.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Dr. Gellner: You've heard that saying, having a baby changes everything. Well, it really does. And one of the first things that you need to be aware of as a parent is: Does your child have jaundice or not? What is jaundice and how you can help your baby is what we'll talk about today. I'm Dr. Cindy Gellner for The Scope

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Dr. Gellner: So you bring your beautiful pink baby home and within three to five days their skin goes from pink to yellow and their eyes turn yellow. What is it? It's jaundice, and jaundice is caused by a chemical called bilirubin.
Now you're baby's liver does not turn on until they are about a week old, and so all the red blood cells in their body only last a couple of days. When they start breaking down, since the liver is not turned on, the breakdown product of the red blood cells, called bilirubin, builds up in the baby's body. Until the liver is turned on and is able to break down that bilirubin, your child will continue to get more yellow. Sometimes this is a problem. Sometimes your baby's body is able to take care of it without any further complications

There are a few causes of jaundice. The physiologic jaundice is the one we just talked about, where it's due to an immature liver. Jaundice first appears by two to three days of age, and it disappears by one to two weeks of age and the levels of bilirubin are not high enough to need any further treatment.

There is breastfeeding jaundice. So breast feeding jaundice occurs when your baby does not get enough breast milk, and it occurs in about 5% to 10% of newborns. The symptoms are similar to those of the physiologic jaundice due to the immature liver. Sometimes babies who have breastfeeding jaundice need to be supplemented until the mother's milk is able to be fully produced and the baby can have all the nutrition he or she needs from the breast milk.

Breast milk jaundice occurs in about 10% of breast fed babies, and it's caused by a special substance that some mothers produce in their milk. The substance causes your baby's intestine to absorb more bilirubin back into his or her body than normal, and this type of jaundice starts at about 4 to 7 days old, and may last up to 3 to 10 weeks. This type of jaundice is not harmful either.

The kind of jaundice that we really do worry about is the kind where the blood types don't match. So this is where the mom is O blood type, and the baby is blood type other than the O blood type, or if the mother has the Rh negative factor. The blood types have a letter and either a plus or a minus, positive or negative. So if the baby's mom is negative and the baby is positive, what this means is that the blood types are going to sort of react with each other. If the mother has the Rh negative blood, her OB will know that, and the mom will usually get a shot called RhoGAM during her pregnancy and also within the first three days after delivery, and this prevents her from forming antibodies that might endanger other babies she has in the future.

But what about the baby that she currently has? This is where we find out the baby's blood type, find out if it's the same or different from the mom's, and if it's different we take that into close consideration with when we need to check the levels of bilirubin in the babies. They're always checked before the baby goes home from the newborn nursery, and then one of the things we check about at the visit when we see them a few days after nursery discharge is: Do they have jaundice? If they have jaundice, we can do the test for it, and if the bilirubin is high enough, then we can start the phototherapy.

The phototherapy is usually what people refer to as the bili-blankets or the tanning beds, because they look like that. It's basically blue light that helps break down bilirubin in the skin. Quite often we're able to get phototherapy to the home so the babies do not need to be hospitalized again.

How high a bilirubin level the baby can tolerate depends on how many hours old they are. So the older the baby is, the higher they can tolerate a bilirubin by themselves before we need to start the phototherapy.

If your child was a premature baby or they had a lot of bruising on the scalp, they may also have a lot of bilirubin build up, and that's another risk factor for when we would consider starting phototherapy at home.

So how can you help your baby not have jaundice issues? You want to feed your baby frequently. Make sure your baby is making several wet diapers a day, and you want to make sure that they are starting to have bowel movements, transitioning from that sticky, tarry meconium to the loose yellow seedy types of stools that they will have once all of that is out of their system.

The more the baby eats, the more the baby poops, the less yellow they'll be.

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