So the day’s finally here.

You’ve gone through your pregnancy and despite whether it was a difficult pregnancy or not, you made it out the other side with your precious baby in hand.

Walking through the threshold of your home, you realize that things have changed and that you’re about to embark on a new life and one that, while exciting, is also uncertain. If this is your first baby, this is even more the case, though many of us who have had more than one child can vouch for the fact that it’s always life-changing when your newest family member enters our lives. We know that change is upon us but in what permutation, we’re not sure. It’s anyone’s guess, really.

As this is a common feeling for many moms as they start their new lives with their babies,  it can indeed feel daunting, if not stressful, to say the least. Being responsible for another life completely is not something that most parents take lightly. Is it any wonder then, that we stress about how we’re going to manage at home to the best of our abilities? Add to this the realities of day-to-day life, including  spending time with our spouses, housework and our other kids who also need our support, and there’s the potential for mom to feel overloaded.

Thankfully, this doesn’t have to be the case, as there are a few simple things that can be done to make the transition to new mom as easy as it can be.

Here are 5 Simple Tips For Managing The First Few Weeks After Baby:

1)   Accept help – Once you’ve had the baby, don’t be surprised by the deluge of offers of help from caring family and friends. Your first instinct may be to decline, after all, this is your time alone with your baby and you wouldn’t want your focus to be taken away from your new addition. The reality is that even in those first few days and weeks when your feeling is to spend every waking hour with your child, the reality is that sleep is required in order for you to be at your best. Ditto for being able to do anything else around the house. When a loved one offers to come over and watch the baby while you sleep, shower, take some time alone or otherwise, accept it graciously and be thankful that you’ve got such wonderful people in your life to help.

2)   Don’t worry about the house – Adding to point #1, you may worry about the state of the house, since people are coming over to help you out. Don’t worry about the house. Your friends and family will understand if you haven’t gotten around to vacuuming or washing the floor lately. What’s important is your child, your bonding time with your child and your sleep, so focus on those and worry about the cleaning when the baby’s a bit bigger. And if your friends want to help clean the house, let them!

3)    Take care of yourself – It’s really important to address any health or body concerns that may have come up after your child’s birth. Following the advice of accepting help, make sure that you’re doing something for yourself during this very demanding time. Make sure to follow up with your doctor regarding any body changes or updates since giving birth. If you’re breastfeeding and having some difficulty, it’s okay seek out assistance and ask for help

4)   Carve out some “me” time – As impossible as it may seem with a new baby, this doesn’t have to mean an extended break alone. “Me” time could be 15 minutes alone, away from the baby, while you steal away to a quiet room to read, close your eyes or meditate. It could mean a quick walk around the block

5)   Don’t stand on ceremony – What this means is that while a daily schedule may be good in theory, it doesn’t always translate in reality. Sometimes the baby will fuss longer than planned, other times he’ll sleep beyond the prescribed nap times. In either instance, don’t worry or stress. Unless he’s feverish or clearly ill, variations on daily behavior is normal and on the positive side, a good opportunity for you to get that very well-deserved break.

Baby massage may seem superfluous or silly to some people, but it’s popularity is growing in the U.S. and it has actually been practiced for centuries in many cultures around the world. But, does it have any significant health benefits? You might be surprised at how much it does. In fact, touch plays a much more important role in human development than scientists first imagined.

Consider these facts:

• Skin is by far the largest of all of our sense organs.
• It develops early in utero – at less than 8 weeks, when the fetus is less than an inch long, the sense of touch is already highly developed – before there are eyes or ears.
• Between the pulsing of the amniotic fluid and the contracting and expansion of the walls of the womb, the uterine environment is a space of constant massage.
• When a baby is born, his vision is still fuzzy, but touch is a primary way he can interact with the world for the first few months.

Just from these basic biological facts, it becomes clearer that touch must be important for infant development. But, to what extent? Here’s a snapshot of the myriad medical benefits researchers have discovered over the years.

• In 1986. Dr. Tiffany Fieldand her colleagues gave preterm infants a 15-minute massage, three times per day, for ten days resulting in 21-47% greater weight gain than standard care alone. Those infants were also discharged six days earlier on average than control infants, saving approximately $10,000 in hospital costs per infant. Since then, they’ve also found:
  • Infants who experienced massage therapy cried less and had lower cortisol levels, suggesting lower stress.
  • Touch stimulation can positively affect physiological, behavioral, and social development among infants.
  • Young children with eczema who received daily massage from their parents saw symptoms decrease.

• Dr. Kathryn Barnard at the University of Washington found that infants who were held more showed superior cognitive development as long as eight years later.

• Research by Theodore Wacks, a psychologist at Purdue, showed that infants who experienced more skin-to-skin contact had an advantage in mental development in the first six months of life.

 
It turns out infant touch benefits pretty much all systems of the body – nervous, circulatory, digestive, respiratory, endocrine – the impacts are profound.

And, the benefits aren’t just for babies. You can probably guess that parents sleep better when babies sleep better (which they do with infant touch). And, it reduces parental stress levels, too! Field found that mothers who do infant massage report lower levels of depression, they seem to be more sensitive to their baby’s cues and the babies are more responsive to the mother through the whole first three months.

Still question whether touch is as important as eating and sleeping? Consider one more landmark study.

In the 1960s, Dr. Harry Harlow separated infant monkeys from their mothers at six to twelve hours after birth and substituted “surrogate” mothers made either of heavy wire mesh or of wood covered with cloth. Both mothers were the same size, but the wire mother had no soft surfaces and was equipped with a bottle from which the baby could “nurse”while the other mother was cuddly, covered with foam rubber and soft terry cloth, but had no food. Despite the fact that only one surrogate mother could feed them, the infants still spent more time cuddling with the cloth mother. (They also found that the monkeys“raised” by wire mesh moms were very aggressive as adults.) These results led researchers to believe closeness and affection are as imperative to healthy development as food.

In today’s busy world, it’s all-too-common for parents to give a child a pacifier or put them in front of a video screen to keep them calm and quiet. But, those convenient moments of calm may be having subtle impacts on your child’s development. Take time to slow down. Take time to touch. Take time to cuddle. They aren’t babies for long and your investment of time and touch is a priceless investment in their health and well-being.

Dr. Greene’s Answer:

Kids will sometimes go through phases where their sleep (and your sleep!) is interrupted, but when the transition is sudden and recent, my first thought is, “What might have changed?”

Often there is a short-term discomfort that makes it unpleasant to fall asleep and that breaks the habit of good sleep. At 4 months old, common reasons would include teething and ear infections. (Interrupted sleep is the most reliable symptom of ear infections. Far more so than ear tugging or fever.) If you suspect she is uncomfortable, you will want to treat that discomfort. If you are not sure, you may want to have her checked just so you will know what you are dealing with.

If teething seems to be causing pain, then something like Hyland’s homeopathic teething tablets or Tylenol may relieve the pain and make her less scared of lying down (pain is usually worse at night and when falling asleep).

If discomfort is not a problem, she might be feeling some new separation anxiety (though this usually does not start until 5 months or later) where she is afraid to be alone. Or her developing large muscle skills may leave her not wanting to be down on her back. Kids often go through rough periods of sleep for the week or two before motor milestones.

The approach I used with my own kids (when I was sure it was not pain or discomfort) was to try to put them down at about the same time every day so they would get in a rhythm of feeling drowsy at that time, then to stand by their sides, gently patting them and singing to them, telling them I love them until they fell asleep. I would do anything except lie down with them or feed them. Within a week or two, they had all learned to sleep well–though this needed to be repeated sometimes, such as after an ear infection.

Another approach is to let her sleep with you. Most families throughout history have slept that way–as well as most families around the world today–and it is a fine choice for some families and not for others.

Dr. Greene’s Answer:

When we recognized that kids sleeping on their backs were much less likely to have a problem with SIDS, we started seeing more and more babies with the back of the skull flattened from spending so much time on it. This is a condition called plagiocephaly and will usually stop getting worse and start improving when kids start to spend most of the day up out of that position. Often it corrects all the way on its own and if not, it is just a cosmetic issue.

But there is a different condition called craniosynostosis where the bones in the skull fuse together too early. This gets worse over time and sometimes it is just cosmetic, but sometimes it can decrease the space for the brain to grow (usually this means a lot of fusing). If your child does have this fusing, it would be important to evaluate how much worse it is likely to get over time.

Consulting with a pediatric neurosurgeon, or craniofacial surgeon, is a good way to do that, depending on when your child starts spending most of the day off of the back of his head.

It might be worth talking with your doctor about waiting a month or two before the CT to see if the condition is improving, or at least not getting worse. Another approach would be to seek specialty surgical referral before getting the CT. On the other hand, sometimes the diagnosis is clear from the exam. Your doctor may have good reason to suspect that it is craniosynostosis. If it is, the earlier you correct it the easier it is.

Evaluation by a neurosurgeon and CT scanning are necessary to determine the severity of the problem. These steps do not mean that you are on an inevitable path to surgery. Most kids in this situation do not need surgery in the end.

Related concepts:

Bad Dreams

Introduction to nightmares:

Mommy, I had a bad dream…

What are nightmares?

Nightmares are unpleasant dreams that awaken a dreamer from sleep.
We’ve learned much about nightmares from traumatic events, which are known to cause a predictable pattern of nightmares: first dreams that relive the event, then dreams that relive the primary emotion of the event using different scenarios (different pictures), then dreams that incorporate aspects of the event into other parts of life.
Nightmares are an important means of addressing the normal difficult events and emotions of childhood, to weave them into the fabric of our minds in a constructive way.
Night terrors are very different from nightmares.

Who gets nightmares?

Birth is a wonderful and terrible experience. There is much to be happy about and much to learn about in the weeks that follow. Babies’ dreams must incorporate and address those things that bring them pleasure and those that make them cry. In all likelihood, the peak age of crying, the first 6 weeks, is also the peak age of nightmares.
These nightmares are not unsuccessful dreams. Far from it! They help babies learn and grow; nightmares may even be an important reason that crying diminishes after 6 weeks.
Stressful events, such as injections, circumcision (which should never be done without anesthesia), being left alone or dropped, or even feeling hungry, need to be learned about and integrated. Anything worth crying about is worth dreaming about.
Nightmares are most evident between the ages of 3 to 5 years — the peak age when children talk about their fears.

What are the symptoms of nightmares?

Children wake up and remember a scary or sad dream, usually in the second half of the night. They may be sad or afraid when they wake up, and are often crying. Children who are old enough will often wake their parents and tell them they had a bad dream.
Unlike with a night terror, they will recognize their parents and be comforted by their presence. In addition, unlike a night terror, they will often have trouble falling back asleep because of fear.

Are nightmares contagious?

Nightmares are a normal part of development. They are not contagious, although children will often respond to the fear and sadness of those around them.

How long do nightmares last?

Individual nightmares are brief.
Nightmares can occur throughout life, but tend to decrease with each passing year.

How are nightmares diagnosed?

Nightmares are diagnosed based on the history.
They are to be distinguished from night terrors. In pre-verbal children, they should be distinguished from ear infections, reflux, hernias, or other causes of pain.

How are nightmares treated?

An individual nightmare is treated with your reassuring presence. Holding your child and talking soothingly about the dream can diminish the fear and sadness.
If your child is old enough to tell or draw the story of the dream, it can be helpful to find a way for the story to reach a happy ending. Addressing the underlying emotions can help your child make sense of them.

How can nightmares be prevented?

Much excellent children’s literature directly addresses difficult dreams. Other books address children’s common fears and concerns. This literature, and other art, can help children do some of the integrating work of nightmares without the nightmares themselves.

Related A-to-Z Information:

Colic, Ear Infection, Gastroesophageal Reflux, Hernia (Inguinal hernia), Night Terrors, Separation Anxiety, Tantrums

Introduction to colic:

It usually strikes toward the end of a long day, when your baby is just about at the age when your sleep deprivation has really begun to set in. Your baby stops being the quiet, peaceful, miracle baby and begins screaming every evening. It is no wonder that parents become frustrated, discouraged, and depressed.

What is colic?

Almost all babies go through a fussy period. When crying lasts for longer than three hours a day, and is not caused by a medical problem (such as a hernia or an infection), it is called colic. This phenomenon is present in almost all babies, the only thing that differs is the degree.
The child with colic tends to be unusually sensitive to stimulation. Some babies experience greater discomfort from intestinal gas (and they tend to swallow even more air when they cry!). Some cry from hunger, others from overfeeding. Some breastfed babies are intolerant of foods in their mother’s diets. A few bottle-fed babies are intolerant of the proteins in formula. Fear, frustration, or even excitement can lead to abdominal discomfort and colic.
Whatever the mechanism, I believe that the fussy period exists in order to change deeply ingrained relationship habits. Even after the miracle of a new birth, many parents and families would revert to their previous schedules and activities within a few weeks – if the new baby would only remain quiet and peaceful. It would be easy to continue reading what you want to read, going where you like to go, doing what you like to do as before, if only the baby would happily comply. Instead, the baby’s exasperating fussy period forces families to leave their previous ruts and develop new dynamics that include this new individual. Colic demands attention. As parents grope for solutions to their child’s crying, they notice a new individual with new needs. They instinctively pay more attention, talk more to the child, and hold the child more – all because of the colic. Colic is a powerful rite of passage, a postnatal labor pain where new patterns of family life are born.

Who gets colic?

Almost all babies will develop a fussy period. About 20 percent of babies will cry enough to meet the definition of colic. The timing varies, but colic usually affects babies beginning at about three weeks of age and peaking somewhere between four and six weeks of age.

What are the symptoms of colic?

For most infants the most intense fussiness is in the evening. The attack often begins suddenly. The legs may be drawn up and the belly distended. The hands may be clenched. The attack often winds down when the baby is exhausted, or when gas or stool is passed.

Is colic contagious?

Colic is not contagious, but babies do respond to the emotions of those around them. When others are worried, anxious, or depressed, babies may cry more, which can make those around them more worried, anxious, or depressed.

How long does colic last?

Colic will not last forever! After about six weeks of age, it begins improving, slowly but surely, and is generally gone by twelve weeks of age. When colic is still going strong at 12 weeks, it’s important to consider another diagnosis (such as reflux).

How is colic diagnosed?

Colic is usually diagnosed by the history. A careful physical exam is wise to be sure the baby does not have a hernia, intussusception, a hair tourniquet, a hair in the eye, or another medical problem that needs attention.

How is colic treated?

Helping a child with colic is primarily a matter of experimentation and observation. Different children are comforted by different measures. Some prefer to be swaddled in a warm blanket; others prefer to be free. The process of treating colic involves trying many different things, and paying attention to what seems to help, even just a little bit.
Holding your child is one of the most effective measures. The more hours they are held, even early in the day when they are not fussy, the less time they will be fussy in the evening. This will not spoil your child. Body carriers can be a great way to do this.
Some babies are only happy when they are sucking on something. A pacifier can be like a miracle for some.
Singing lullabies to your baby can be powerfully soothing. It is no accident that lullabies have developed in almost every culture. The noise of a vacuum or of a clothes dryer is also soothing to many babies.
As babies cry, they swallow more air, creating more gas and more abdominal pain, which causes more crying. This vicious cycle can be difficult to break. Gentle rocking can be very calming (this is directly comforting and seems to help them pass gas). When you get tired, an infant swing is a good alternative for babies at least 3 weeks old with good head control.
Holding your child in an upright position may help (this aids the movement of gas and decreases heartburn). A warm towel or a hot water bottle on the abdomen can help. Some babies prefer to lie on their tummies, while someone gives them a backrub. The gentle pressure on the abdomen may help.
Some children seem to do best when they are going for a ride in the car. If your child is one of these, you might try a device developed by a pediatrician to imitate car motion and sound.
Some parents report an improvement by giving simethicone drops, a defoaming agent which reduces intestinal gas. It is not absorbed into the body and is therefore quite safe. Sometimes doctors will prescribe stronger medicines for severe colic (but this should only be done after a physical exam). If nothing else seems to work, you might try pretending your baby is sick, and taking a rectal temperature (do not use a mercury thermometer). This will often cause babies to pass gas and obtain relief.
There are many stories about foods that breastfeeding moms should avoid. Most often, I hear about abstaining from broccoli, cabbage, beans, and other gas-producing foods. The scientific evidence is strongest for avoiding stimulants such as caffeine and caffeine-related compounds (those found in chocolate). The other foods in mom’s diet that are most likely to cause a problem are dairy products and nuts. I would try eliminating these for a few weeks. Other foods may also irritate the baby. Experimentation and observation will guide you.
Switching formulas is not helpful for most babies, but is very important for some.
Taking a break is a good idea. Each of you can take charge and spell the other. Time for oneself is an important part of the new family dynamic. You will be able to pay more loving attention to your baby when you’ve had a chance to get refreshed.

How can colic be prevented?

A fussy period is likely no matter what prevention techniques are undertaken. Good feeding techniques (as advised by a lactation consultant, if appropriate), good burping, and early identification of possible allergies in the baby’s or mother’s diet may help prevent colic. Experimenting with the comfort techniques outlined above before colic develops can help you identify your baby’s needs and desires, and can help stop the fussy period from becoming so intense.

Related A-to-Z Information:

Diaper Rash, Food Allergies, Gastroesophageal Reflux, Hernia (Inguinal hernia), Intussusception, Nightmares

Colic is often defined by the rule of threes – crying more than 3 hours a day, more than 3 days a week, for more than 3 weeks. Parents usually report increased gas and gas-related symptoms in these babies. Difficulty digesting specific carbohydrates can lead to increased gas.

A study published in the May 2002 issue of Pediatrics divided babies (averaging 5 months old) into two groups, those who had, and those who had not, been diagnosed with colic at some point during the first 6 months. Each baby received a 4-ounce serving of apple juice and a 4-ounce serving of white grape juice, and was monitored in a metabolic chamber for 3 hours after each serving.

The observers did not know which babies were which. Those in the colic group proved to have significantly poorer absorption of the sorbitol and of the elevated fructose in the apple juice (as shown by measuring increased hydrogen gas in their breath). They also were more agitated, spent more calories, cried more, and slept less after the apple juice. Their non-colic peers had no detectable problem digesting the apple juice. Both groups tolerated the non-sorbitol, lower-fructose white grape juice without a problem.

Some kids have a harder time digesting certain carbohydrates than others. Avoiding those carbohydrates can lead to less gas and more peace.

We’ve known now for several years that discontinuing the use of a pacifier can reduce ear infections in children. A study published in the September 2000 issue of Pediatrics looked at the effect of simply having nurses give a leaflet to parents about the side effects of pacifier use and also instructing them to limit pacifier use to moments when the child was falling asleep (and stopping it entirely at about 10 months of age). The results?

Continuous pacifier use decreased by more than 20% and ear infections dropped by almost 30% at the clinics where this education took place. I hope you will consider Daily Dose a leaflet:^) How much better to prevent ear infections than to treat them with round after round of antibiotics!

Dr. Greene’s Answer:

I’ll never forget the night my firstborn son came home from the hospital. Earlier that day, while in my arms in the labor and delivery suite, he had stopped breathing for what seemed like an eternity, but was probably about 20 seconds. His face had turned blue. I reported this to those taking care of him, who thought that I was just a nervous first-time parent who happened to also be a medical student with an over-active imagination. They examined him, found nothing wrong, and persuaded me to take him home without a machine to monitor his heart and lungs. They would check him again soon.

That night his mother, my mother, and I took turns hovering over the sleeping form of my precious son. Our nighttime vigil felt interminable. Each breath seemed so precarious — or had I really just imagined that he had turned blue?

Everything went well that night, with no further episodes. In the light of the next day, we brought my son to visit a friend — who was also a professor of pediatrics. While awake in his arms, it happened again. My son turned blue and stopped breathing. Suddenly, everyone was concerned. This led to a flurry of tests. My son was diagnosed with Apnea of Infancy, and went home with a heart and lung monitor, which he wore for nine months.

For a child to take a breath, he needs an open, unobstructed airway from the nose or mouth all the way down into the lungs. He needs properly functioning respiratory muscles. He also needs a signal to breathe, originating in the respiratory center of the brain, and accurately transmitted via nerves to the appropriate muscles. This signal to breathe may be a conscious choice, or may be an unconscious response to the sensors which measure the oxygen content, carbon dioxide content and pH of the blood.

Any part of this pathway may fail to work properly. Sometimes the system may work when a child is awake, but not when he is asleep.

Apnea of infancy is the cessation of breathing for longer than 15-20 seconds, or for any duration if it is accompanied by color changes or an abnormally slow heart rate. This respiratory pause can result from a host of different causes.

In central apnea, the brain’s control of breathing isn’t working. This can be the result of immaturity of the respiratory center of the brain, or of bleeding, drugs, seizures, brain injury, neuromuscular disorders or other problems. In obstructive apnea, the urge to breathe is present, but breathing is mechanically blocked. This can result from upper airway collapse, gastroesophageal reflux, vocal cord spasm, pneumonia, external pressure on the airway, and a long list of other causes.

Testing revealed my son’s apnea to be a combination of central and obstructive apnea. Rising levels of carbon dioxide in his blood failed to trigger him to take a breath, particularly when he was asleep. Sometimes, when he was awake, his vocal cords would close, blocking his airway. His large tonsils also partially blocked the airway. Eventually he outgrew these problems, and has been quite healthy ever since.

The treatment of apnea consists of correcting the underlying cause (if possible) or waiting for the child to grow out of it. In the meantime the child wears a sensor connected to an apnea monitor to alert the parents if there is another apnea spell. An alarm goes off if the breathing pauses, if the heart rate drops, if the heart rate is too high, if the sensor leads become disconnected, if there is a power failure, or if the back-up battery is running low. The parents are trained in cardiopulmonary resuscitation (CPR), to help the child resume breathing when a spell occurs.

Once my son was on a monitor, I was able to sleep.

For most children with apnea, the operating room is a safer place to be than almost anywhere else. The child’s breathing, heart rate, and oxygen saturation are continuously monitored. During the operation, adequate oxygen is delivered, and the signal for each breath comes from the ventilating machine. An open airway is ensured by an endotracheal tube. If something were to go wrong, the child is surrounded by the optimal people and equipment to reverse the problem.

The risk posed to your son by general anesthesia will depend on the underlying cause of his apnea. I urge you to discuss your son’s situation both with the anesthesiologist and with your regular doctor. With full information, they can help you weigh the risks and benefits of the operation, and provide the best care — whatever you decide.

Dr. Greene’s Answer:

During the later part of pregnancy, each baby develops her own sleep/wakefulness rhythm. You can get a good idea of what this rhythm is by the baby’s activity patterns. Some babies will tend to be fairly quiet during the day — lulled to sleep by the gentle rocking motion as Mom moves about her daily activities. These same babies often begin doing gymnastics in Mom’s belly about the time things get quiet at night. Other babies tend to be active while Mom is active during the day and to be quieter at night. Whatever your baby’s pattern before birth, it is likely that she will continue the same rhythm in the period shortly after birth.

It sounds like your daughter is currently a night owl. Even if you did nothing, this pattern would begin to switch. The strong, inborn clock would begin to set itself according to daylight hours over several weeks. Thankfully, there are effective ways to speed up this process.

Several types of environmental stimuli can alter her internal rhythm. The most powerful wake-up activity is direct eye contact. When your baby locks eyes with you, it’s almost like she’s drinking a double latte — her heart rate speeds up, her blood pressure rises a bit, and she becomes more awake. Babies also tend to become more alert when exposed to bright lights, the sound of conversational speech (they want to know what everybody’s talking about), and having their feet tickled and played with.

When actively trying to switch a new baby’s time clock, have bright lights on in the house during daylight hours. Keep up a steady stream of talking in normal conversational tones around your daughter during the day. Play with her feet often, and make eye contact with her whenever you can.

As soon as the sun begins to go down, purposely avoid all of these things. When you feed her, try not to make eye contact with her. Speak only in whispers or sing-song tones. Sing lullabies. Have the lights dim in the house. And don’t stimulate her feet.

Of course, some daytime naps are appropriate, and your daughter should be awake at night for feedings. The goal is to try to move your daughter’s primary awake time to the daylight hours. By following the above suggestions, her rhythm should change fairly rapidly. Doing this for as little as two or three days and nights will make a dramatic difference. You can help her body learn the rhythm that daytime is for excitement, play, and interaction while nighttime is for cuddling and sleeping.

In just a few weeks you will be looking back at this time with amazement. Was she ever really as small as those tiny clothes that she no longer fits into? She was always able to hold her head up, wasn’t she? Didn’t she always smile back at me? And even then, though you still won’t be sleeping through the night, the all-night play sessions will seem like a distant memory of a magical time before you knew just how wonderful being a parent really was.