Chapter 6

The First Month

You’ve brought your baby home and you’re giving parenthood everything you’ve got. Yet you can’t help wondering: Is everything you’ve got enough? After all, your schedule (and life as you vaguely recall knowing it) is upended, you’re still fumbling over feedings, and you can’t remember the last time you’ve showered … or slept more than 2 hours in a row.

As your baby grows from a precious but largely unresponsive newborn to a full-fledged cuddly infant, your sleepless nights and hectic days will likely be filled not only with pure joy but also with exhaustion—not to mention new questions and concerns: Is my baby getting enough to eat? Why does he spit up so much? Are these crying spells considered colic? Will she (and we) ever sleep through the night? And how many times a day can I actually call the pediatrician? Not to worry. Believe it or not, by month’s end you’ll have settled into a comfortable routine with baby, one that’s still exhausting but much more manageable. You’ll also start to feel like a seasoned pro in the baby-care game (at least compared to what you feel like today)—feeding, burping, bathing, and handling baby with relative ease.

Baby Basics at a Glance: First Month

Sleeping. A newborn baby doesn’t have much of a pattern to his or her sleep schedule. Baby will be sleeping anywhere from 14 to 18 out of every 24 hours.

Eating. Baby’s getting only breast milk or formula at this age:

• Breast milk. Baby will nurse 8 to 12 times during every 24-hour period, taking in a total of anywhere from 12 to 32 ounces of breast milk (if you were counting). That’s a feeding roughly every 2 to 3 hours, timed from start of one to start of next. Feed on demand, rather than by the clock.

• Formula. Start with 1 ounce at a time, 8 to 12 times per 24 hours, in the first week or so (for a total of 12 ounces). By the end of the first month, baby will probably take 2 to 3 ounces of formula per 24 hours, or 16 to 32 ounces total. Since formula takes longer to digest than breast milk, you may be able to spread out meals to one every 3 to 4 hours. Even formula-fed newborns are best fed on demand and to appetite, rather than on a schedule.

Playing. A newborn baby doesn’t really need any toys (your cuddles and caresses are the best toys for your little one), but since baby can see objects 8 to 12 inches away (the distance to your face as you hold that bundle), a mobile or play gym is a good option for stimulating baby when your arms aren’t free. Babies love looking at bold patterns and faces, so if you’re able to find a mobile that combines both, even better.

Feeding Your Baby This Month: Pumping Breast Milk

This early in the breastfeeding game, your breasts and your baby probably haven’t spent much time apart, and that’s as it should be for starters. But there will almost certainly come a day (or a night) when you’ll need to (or want to) be away from your baby during a feeding—whether you’re working, taking a class, traveling, or just out for the night—and you’ll be taking your breasts with you. How will you catch a breastfeeding break while still making sure your baby gets the best? Easy: Express yourself.

Why Pump?

It’s not so much a law of physics as it is a law of busy motherhood: You can’t always count on your baby and your breasts being at the same place at the same time. There is a way, however, to feed your baby breast milk (and keep your milk supply up) even if you and baby are miles apart: by pumping (or expressing) milk.

Wondering when you’d need or want to pump? Here are some common reasons:

• Relieve engorgement when your milk comes in

• Collect milk for feedings while you’re working

• Provide relief bottles for when you’re away from home

• Increase or maintain your milk supply

• Jump-start your milk supply if it’s slow coming in

• Store milk in the freezer for emergencies

• Prevent engorgement and maintain milk supply when nursing is temporarily stopped because of illness (yours or baby’s) or because you’re taking a medication that’s breastfeeding-unfriendly

• Provide breast milk for your sick or premature baby in the hospital

• Stimulate relactation if you change your mind about formula feeding

• Induce lactation if you’re adopting a newborn

Choosing a Pump

Sure, you can express milk by hand—if you have a lot of time, don’t need a lot of milk, and don’t mind a lot of pain. But why bother, when pumping makes it so much easier, more comfortable, and more productive to express yourself? With so many breast pumps on the market—from simple manual models that cost a few dollars to pricier electric ones that can be bought or rented—there’s one (or more) to fill your needs and fill your baby’s supplementary bottles with the best food around.

Before deciding which type of pump suits your expressing style, you’ll need to do a little homework:

• Consider your needs. Will you be pumping regularly because you’re going back to work or school full time? Will you pump only once in a while to provide a relief bottle (or to relieve engorged breasts)? Or will you be pumping around-the-clock to provide nourishment for your sick or premature baby, who may be in the hospital for weeks or months?

• Weigh your options. If you’ll be pumping several times a day for an extended period of time (such as when working full-time or to feed a preterm infant), a double electric pump will probably be your best bet. If you need to pump only occasionally, a single electric, battery, or manual pump will fill your needs (and those few bottles). If you’re planning to express only when you’re engorged or for a once-in-a-great-while bottle-feeding, an inexpensive manual pump may make sense.

• Investigate. Not all pumps are created equal—not even among those in the same general category. Some electric pumps can be uncomfortable to use, and some hand pumps painfully slow (and sometimes just plain painful) for expressing large quantities of milk. Scout the field by checking websites and stores that carry a wide variety of pumps, considering features and affordability. Ask friends or check out online reviews and posts to see which pumps other moms are pumped up about … and which don’t make the grade. Or discuss the options with an LC or your baby’s doctor.

All pumps use a breast cup or shield (known as a flange), centered over your nipple and areola. Whether you’re using an electric or manual pump, suction is created when the pumping action is begun, mimicking baby’s suckling (some more efficiently than others). Depending on the pump you use (and how fast your let-down is), it can take anywhere from 10 to 45 minutes to pump both breasts—not surprisingly, higher priced pumps yield speedier results. Here are the general types of pumps on the market:

Electric pump. Powerful, fast, and usually easy to use, a fully automatic electric pump closely imitates the rhythmic suckling action of a nursing baby. Many electric pumps allow for double pumping—a great feature if you’re pumping often. Not only does pumping both breasts simultaneously cut pumping time in half, it stimulates an increase in prolactin, which means you’ll actually produce more milk faster. Electric pumps can cost a few hundred dollars, but if you’re pumping often, it may be well worth the investment. (Also, when you weigh it against the cost of formula, you’ll almost certainly come out ahead.)

Most electric pumps come in portable models that are inconspicuous (the black carrying cases are designed to look like backpacks or shoulder bags). Some pumps also come with a car adapter and/or battery pack (some come with rechargeable batteries) so you don’t have to plug them in. There are even some models that have a memory feature that learns your personal pumping rhythm and remembers it for the next time you express. Another feature: Hands-free pumps attach to your bra and allow you to work, play with your baby, blog online, or otherwise be a mommy multitasker while pumping (there are also specially designed bras that allow for handsfree pumping).

Need a pump that’s really heavy duty (for instance, because you’re pumping full-time for your preemie or trying to relactate)? There are hospital-grade electric pumps you can buy (very expensive) or rent (more cost effective)—often from the hospital you’ve delivered in or from a lactation center. An LC, the La Leche League, or an online search can help you get connected to a reputable rental company.

A double electric pump cuts pumping time in half.

Manual pump. These hand-operated pumps are fairly simple to use, moderate in price, easy to clean, and portable. The most popular style is a trigger-operated pump that creates suction with each squeeze of the handle.

The trigger on a manual pump creates suction with each squeeze of the handle.

Is Your Pump Covered?

Pumped up about preventive care services available to women under the Affordable Care Act? You should be, especially because many (though not all) insurance plans are required to provide breast pumps to new moms at no extra cost, and without co-pays or deductibles. The legislation is designed to ensure that every mom has the opportunity to provide her baby with the ultimate in prevention: breast milk. The catch? Since the law’s recommendations aren’t specific, coverage varies from health plan to health plan—and there’s considerable variation in what sort of pumps are covered. Some plans cover the purchase of manual pumps only, while others exclude hospital-grade pumps, and still others allow moms to rent a pump but not purchase one. Most plans require moms to get the pump from designated vendors (who might not have the model you want), and many plans require that you get a prescription for a pump from your doctor (another hoop to jump through).

Confused? The best thing to do is to contact your health plan (call the number on your insurance card) to find out what you’ll be covered for—and if you’re not happy with what’s offered, let your insurance company know that you and your baby deserve better (you do).

Preparing to Pump

Whenever you pump (and no matter what type of pump you’re using), there are basic prep steps you’ll need to take to ensure an easy and safe pumping session:

• Time it right. Choose a time of day when your breasts are ordinarily full. If you’re pumping because you’re away from your baby and missing feedings, try to pump at the same times you would normally feed, about once every 3 hours. If you’re home and want to stock the freezer with breast milk for emergencies or relief bottles, pump 1 hour after baby’s first morning feeding, since you’re likely to have more milk earlier in the day. (Late afternoon or early evening, when your milk supply is likely to be at its lowest thanks to exhaustion and end-of-the-day stress, is often an unproductive time to pump.) Or pump from one breast while nursing your baby from the other one—the natural let-down action your body produces for your suckling baby will help stimulate milk flow in the pumped breast as well. (But wait until you’re skilled at both nursing and expressing, since this can be a tricky maneuver for a newbie.) Still got extra milk after a feed? Pump whatever baby didn’t finish and save it for later.

• Wash up. Wash your hands and make sure that all your pumping equipment is clean. Washing the pump parts immediately after each use in hot, soapy water will make the job of keeping it clean easier. Dishwashers can work well, too. If you use your pump away from home, carry along a bottle brush, bottle wash, and paper towels for washup.

• Set the scene. Choose a quiet, comfortable environment for pumping, where you won’t be interrupted by phones or doorbells and where you’ll have some privacy. Cozy up in a chair that allows you to relax in relative comfort. At work, a private office, an unoccupied meeting room, or a designated nursing room can serve as your pumping headquarters. An office restroom is definitely not ideal, and in fact, federal law requires employers in companies with more than 50 employees to provide a private place other than the bathroom for pumping. If you’re at home, wait until baby’s naptime or when your little one is otherwise occupied—in a swing or infant seat—so you can concentrate on pumping (unless you’re pumping while nursing).

• Chill out. The more relaxed you are, the more productive a pumper you’ll be. So try to chill out for a few minutes first—visualize, use meditation or another relaxation technique, listen to music or a white noise app, or do whatever you find helps you unwind.

• Hydrate. Have some water before you get started pumping.

• Encourage let-down. Think about your baby, look at baby’s photo, and/or picture yourself nursing, to help stimulate let-down. If you’re home, giving baby a quick cuddle just before you start pumping could do the trick—or you can pump while your baby sits beside you in an infant seat or swing. If you’re using a hands-free pump, you can even try holding your baby while you pump—though many babies won’t be too happy about being so near and yet so far from their source of food. Applying hot soaks to your nipples and breasts for 5 or 10 minutes (clearly not so practical at work), taking a hot shower (ditto), doing breast massage, or leaning over and shaking your breasts are other ways of enhancing let-down. A convenient alternative at home or at work: hot/cold packs—packs that you can chill in the freezer before using when you want them soothingly cold or that you can microwave for a few seconds when you want them warm (as in when you want to encourage let-down).

Pumping Shouldn’t Hurt

Simply put, pumping shouldn’t hurt. If it does, make sure you’re pumping correctly, not going over recommended pumping time limits, and that you’re treating any soreness or cracking (or other sources of pain, such as infection) you might be having.

Check, check, check to all three—and you’re still finding pumping physically painful? The problem may lie with the pump itself (in which case, it might be time for a switch, if that’s financially feasible), but it’s more likely to be a matter of a too-small (or less often, too large) flange size, a very common problem that’s easily fixed. If the flange is the right size, your nipple will move freely in the flange tunnel during pumping, and not much of the areola will be drawn into the tube with the nipple. Check your flange in action next time you pump—and when in doubt, try sizing up or down to see if pumping becomes less of a pain (at least, physically).

Pumping Practice Makes Perfect

No matter what method of expressing you choose, you may find it difficult to extract much milk the first few times. Consider those initial pumping sessions to be practice—your goal should be to figure out how to use the pump, not necessarily to score large quantities of milk. Milk probably won’t be flowing in copious amounts during early sessions anyway, for two reasons: First, you’re not producing that much milk yet if your baby is still less than a month or two old. Second, a pump (especially as wielded by a novice pumper) is much less effective in extracting milk than a baby is. But with perseverance (and practice, practice, practice), you’ll become a pro pumper in no time.

How to Express Breast Milk

Though the basic principle of expressing milk is the same no matter how you go about it (stimulation and compression of the areola draws milk from the ducts out through the nipples), there are subtle differences in techniques.

Expressing milk by hand. To begin, place your hand on one breast, with your thumb and forefingers opposite each other around the edge of the areola. Press your hand in toward your chest, gently pressing thumb and forefinger together while pulling forward slightly. (Don’t let your fingers slip onto the nipple.) Repeat rhythmically to start milk flowing, rotating your hand position to get to all milk ducts. Repeat with the other breast, massaging in between expressions as needed. Repeat with the first breast, then do the second again.

If you want to collect the milk expressed, use a clean wide-topped cup under the breast you’re working on. You can collect whatever drips from the other breast by placing a breast shell over it inside your bra. Collected milk should be poured into bottles or storage bags and refrigerated as soon as possible (click here).

Expressing milk with a manual pump. Follow the directions for the pump you’re using. You might find moistening the outer edge of the flange with water or breast milk will ensure good suction, but it’s not a necessary step. The flange should surround the nipple and areola, with all of the nipple and part of the areola in it. Use quick, short pulses at the start of the pumping session to closely imitate baby’s sucking action. Once let-down occurs, you can switch to long, steady strokes. If you want to use a hand pump on one breast while nursing your baby on the other, prop the baby at your breast on a pillow (being sure he or she can’t tumble off your lap). You can also use a manual pump to get breasts primed for electric pumping, though that means double the equipment and more work for you, so no need unless you find you have a very hard time getting started with the electric pump.

Expressing milk with an electric pump. Follow the directions for the pump you are using—double pumping is ideal because it saves time and increases milk volume. If you find it helps, you can moisten the outer edge of the flange with water or breast milk to ensure good suction. Start out on the minimum suction and increase it as the milk begins to flow, if necessary. If your nipples are sore, keep the pump at the lower setting. You might find you get more milk from one breast than the other. That’s normal, because each breast functions independently of the other.

(Tell) Tales from the Other Side

If you’re not double pumping, the breast not being pumped will start getting into the action ahead of time … and likely leak accordingly. To avoid a mess, make sure the breast that’s being ignored is well packed with breast pads (especially if you’ll be going back to your desk after pumping), or take advantage of every drop of milk and collect whatever leaks in a bottle, a clean cup, or a breast shell.

Where Does the Milk Go?

Many pumps come with containers that can be used as storage and feeding bottles, and others allow you to use a standard feeding bottle to collect the milk. Hoping to build up a freezer stash? Special breast milk storage bags are convenient for freezing milk and are less likely to break than disposable bottle liners, which are made of thinner plastic. Some pumps allow you to collect the expressed milk directly into the storage bags, so you can skip the extra step of transferring the milk from bottle to bag before storing—and the risk of spilling any drops of that precious fluid. If you will be transferring, be sure to wash any containers or bottles used for milk collection in hot soapy water or a dishwasher after you’re finished transferring the milk from the collection containers to the storage containers.

Storing Breast Milk

Keep expressed milk fresh and safe with these storage guidelines:

• Refrigerate expressed milk as soon as you can. If that’s not possible, breast milk will stay fresh at room temperature (but away from radiators, sun, or other sources of heat) for as long as 6 hours and in an insulated cooler bag (with ice packs) for up to 24 hours.

• Store breast milk for up to 4 days (96 hours) in the back of the refrigerator where temperatures are coolest (though ideally, it’s best to use the milk within 2 to 3 days). If you’re planning to freeze it, first chill for 30 minutes in the refrigerator, then freeze.

• Breast milk will stay fresh in the freezer for anywhere from a week or 2 in a single-door refrigerator to about 3 months in a two-door frost-free model that keeps foods frozen solid, to 6 months in a freezer that maintains a 0°F temperature.

• Freeze milk in small quantities, 3 to 4 ounces at a time, to minimize waste and allow for easier thawing.

• To thaw breast milk, shake the bottle or bag under lukewarm tap water; then use within 30 minutes. Or thaw in the refrigerator and use within 24 hours. Do not thaw in a microwave oven, on the top of the stove, or at room temperature—and do not refreeze.

• When your baby has finished a feed, throw out any breast milk that’s left in the bottle. Also toss any milk that has been stored for longer than recommended times.

Quick Tip

Fill breast milk storage containers or bags for the freezer only three-fourths full to allow for expansion, and label with the date (always use the oldest milk first).

Exclusive Pumping

Determined to feed your baby mama’s milk but circumstances (say, problems with latching) have made breastfeeding a struggle, or even impossible? There’s still a way to give baby the best from the breast: exclusive pumping. It’s definitely tougher on moms than nursing is (babies are usually more efficient at extracting mama’s milk from the source than a pump is), but pumping all your little one’s meals is doable, if you’re dogged about it. Here are some tips to keep in mind if you decide to exclusively pump:

• Get a good double pump. Since you’ll be spending a lot of one-on-one time with your pump, you’ll want one that’s efficient—and that works two by two. Doubling up when pumping with a double electric pump will cut back on the time you spend pumping and will actually pump up your milk output.

• Pump often. Pump as often as baby would be eating (every 2 to 3 hours in the early months) to make sure your supply of breast milk becomes established. That includes pumping at least once or twice during the night.

• Pump long enough. To make sure you’re stimulating your breasts enough to continue producing milk (and increasing the amount of milk they produce), be sure to pump for around 15 to 20 minutes (that’s per breast if you’re not double pumping) or until the milk stops dripping at each pumping session (which could be longer than 20 minutes for some moms). Don’t exceed the recommended time limit in hopes of scoring more milk—chances are you’ll only score sore nipples.

• Don’t drop pumps until your supply’s pumped up. It could take anywhere from 6 to 12 weeks until your milk supply is well established. Once it is, you can start dropping some pumping sessions, but if you find your milk supply diminishing, increase pumping frequency until you’re back where you want it to be.

• Record … or not. Some experts suggest moms record how much milk they’re pumping per session. Others recognize that keeping a record (or spreadsheet) is time consuming and can add to the worry. If you’re struggling with a low supply, for instance, recording your output will only stress you out, and possibly decrease your supply. Do what works for you.

• Supplement if needed. Sure, your goal is to feed your baby breast milk only, but if your supply is too low, if you’re too pooped to pump enough, or if you decide for any other reason that you just can’t commit to exclusive pumping anymore, don’t feel guilty. Feed your little one with as much breast milk as you can and supplement with formula to fill in as needed (you can even mix breast milk and formula in the same bottle). Remember, every drop of breast milk counts!

Breast Milk at a Glance

It’s normal for breast milk to be bluish or yellowish in color. Sometimes it’ll even look clear—and that’s probably because you’ve expressed only the foremilk (the hindmilk will usually look thicker and creamier). So if your pumped milk looks thin and watery, it could be because you’re not pumping long enough—or the bags or bottles you’re pumping into aren’t big enough—to get the hindmilk. Expressed milk will also sometimes separate into milk and cream. This, too, is normal. Just swirl gently to mix before feeding (try not to shake, because that could cause a breakdown of some of the milk’s valuable components).

What You May Be Wondering About

“Breaking” Baby

“I know it’s a cliché, but I really am afraid of breaking the baby—he seems so tiny and fragile.”

Newborns are actually a whole lot sturdier than they appear to their nervous newbie parents. The truth is—and it’s one that should keep you from shaking in your slippers every time you get ready to pick up your tiny little bundle—you can’t break a baby. That delicate-looking, vulnerable-seeming infant is actually an incredibly resilient, elastic little being—one who’s really built to take even the clumsiest care and handling a new parent can dish out.

And here’s another happy truth: By the time your newborn turns 3 months old, he’ll have gained the weight and control over his head and limbs that will make him seem less floppy and fragile … and you’ll have gained the experience that will make you feel completely confident as you carry him and care for him.

The Fontanels

“My baby’s soft spot on her head seems so … soft. Sometimes it seems to pulsate, which really makes me nervous.”

That “soft spot”—actually there are two and they are called fontanels—is tougher than it looks. The sturdy membrane covering the fontanels is capable of protecting a newborn from the probing of even the most curious sibling fingers (though that’s definitely not something you’d want to encourage), and certainly from everyday care.

These openings in the skull, where the bones haven’t yet grown together, aren’t there to make new parents nervous about handling their baby (though that’s often the upshot) but rather, for two very important reasons. During childbirth, they allow the fetal head to mold to fit through the birth canal, something a solidly fused skull couldn’t do. Later, they allow for the tremendous brain growth during the first year.

The larger of the two openings, the diamond-shaped anterior fontanel, is located on the top of a newborn’s head, and it may be as wide as 2 inches. It starts to close when an infant is 6 months old and is usually totally closed by 18 months.

This fontanel normally appears flat, though it may bulge a bit when baby cries, and if baby’s hair is sparse and fair, the cerebral pulse may be visible through it (which is completely normal and absolutely nothing to worry about). An anterior fontanel that appears significantly sunken is usually a sign of dehydration, a warning that the baby needs to be given fluids promptly. (Call the baby’s doctor immediately to report this sign.) A fontanel that bulges persistently (as opposed to a little bulging with crying) may indicate increased pressure inside the head and also requires immediate medical attention.

The posterior fontanel, a smaller triangular opening toward the back of the head less than half an inch in diameter, is much less noticeable and may be difficult for you to locate (and no need to try). It’s generally completely closed by the third month but may be closed at birth or shortly after. Fontanels that close prematurely (they rarely do) can result in a misshapen head and require medical attention.

What Month Is It, Anyway?

Trying to figure out what month baby’s in—and which one you should be reading right now? Here’s how it works: The “First Month” chapter covers your baby’s progress from birth to the first-month birthday, the “Second Month” chapter gives you the lowdown on your 1-month-old until he or she turns 2 months old, and so on. The first year blow-by-blow ends as baby blows out those first birthday candles.

Having Enough Breast Milk

“When my milk came in, my breasts were overflowing. Now that the engorgement is gone, I’m not leaking anymore. Does that mean I’m not making enough milk?”

Since the sides of your breasts don’t come marked with ounce calibrations (and aren’t you pretty glad they don’t?), it’s virtually impossible to tell at a glance how your milk supply is holding up. Instead, you’ll have to look to your baby. If he seems to be happy, healthy, and gaining weight well, you’re producing enough milk—which the vast majority of moms do. Leaking like a faucet or spraying like a fountain are more common early on, when supply often exceeds demand (though some moms continue to leak and spray, and that’s normal, too). Now that your baby has caught up to your flow, the only milk that counts is the milk that goes into him.

True problems with supply happen, but they’re pretty uncommon. If at any time your baby doesn’t seem to be getting enough milk, more frequent nursing plus the other tips here should help you boost your supply. If they don’t, check with the doctor.

“My baby was nursing about every 2 or 3 hours and seemed to be doing really well. Now, suddenly, she seems to want to nurse every hour. Could something have happened to my milk supply?”

Unlike a well, a milk supply rarely dries up if it’s used regularly. In fact, the exact reverse is true: The more your baby nurses, the more milk your breasts will produce. And right now, that’s what your hungry little girl—who’s probably going through a growth spurt that’s spurring her appetite into overdrive—is counting on. Growth spurts most commonly happen at 3 weeks, 6 weeks, and 3 months, but can occur at any time during an infant’s development. Sometimes, even a baby who’s been sleeping through the night begins to wake for a middle-of-the-night feeding during a growth spurt. Simply put, your baby’s active appetite is likely her way of ensuring that your breasts will step up milk production to meet her growth needs. (Click here for more on these so-called cluster feedings.)

Just relax and keep your breasts handy until the growth spurt passes. Don’t be tempted to give your baby formula (and definitely don’t consider adding solids) to appease her appetite, because a decrease in frequency of nursing would cut down your supply of milk, which is just the opposite of what the baby ordered. Such a pattern—started by baby wanting to nurse more, leading to mom doubting her milk supply, prompting her to offer a supplement, followed by a decrease in milk production—is one of the major causes of breastfeeding being ditched early on.

Sometimes a baby begins to demand more daytime feedings temporarily when she begins to sleep through the night, but this, too, shall pass with time. If, however, your baby continues to want to nurse hourly (or nearly so) for more than a week, check her weight gain (and see below). It could mean she’s not getting enough to eat.

Baby Getting Enough Breast Milk

“How can I be sure my breastfed son is getting enough to eat?”

When it comes to bottle-feeding, the proof that baby’s getting enough to eat is in the bottle—the empty bottle. When it comes to breastfeeding, figuring out whether baby’s well fed takes a little more digging … and diaper diving. Luckily, there are several signs you can look for to reassure yourself that your breastfed baby is getting his fair share of feed:

He’s having at least 5 large, seedy, mustardy bowel movements a day. Fewer than 5 poops a day in the early weeks could mean he’s not getting enough to eat (though later on, around age 6 weeks to 3 months, the rate could slow down to one a day or even one every 2 to 3 days).

His diaper is wet when he’s changed before each feeding. A baby who pees more than 8 to 10 times a day is getting adequate fluid.

His urine is colorless. A baby who is not getting enough fluids passes urine that is yellow, possibly fishy smelling, and/or contains urate crystals (these look like powdered brick, give the wet diaper a pinkish red tinge, and are normal before breast milk comes in but not later).

You hear a lot of gulping and swallowing as your baby nurses. If you don’t, he may not be getting much to swallow. Don’t worry, however, about relatively silent eating if baby is gaining well.

He seems happy and content after most feedings. A lot of crying and fussing or frantic finger sucking after a full nursing could mean a baby is still hungry. Not all fussing, of course, is related to hunger. After eating, it could also be related to gas, an attempt to poop or to settle down for a nap, or a craving for attention. Or your baby could be fussy because of colic (click here). Keep in mind, however, that no crying at all in a newborn (or very little crying) can be a red flag—a possible sign that baby is not thriving (babies should cry). Click here for more.

You experienced engorgement and your breasts feel full in the morning. Engorgement is a good sign you can produce milk. And breasts that are fuller when you get up in the morning and after 3 or 4 hours without nursing than they are after a feed indicate they are filling with milk regularly—and also that your baby is draining them. If baby is gaining well, however, lack of noticeable engorgement shouldn’t concern you.

You notice the sensation of let-down and/or experience milk leakage. Different women experience let-down differently (click here), but feeling it when you start feeding indicates that milk is coming down from the storage ducts to the nipples, ready to be enjoyed by your baby. Not every woman notices let-down when it occurs, but its absence when baby’s not thriving is a red flag.

You don’t get your period during the first 3 months postpartum. If you’re breastfeeding exclusively, you’re not likely to get your period, particularly in the first 3 months. If you do, it’s possible you may not be producing enough milk.

Filling Out

Most babies start to fill out by 3 weeks, looking less like scrawny chickens and more like softly rounded babies. In most cases, you can expect a breastfed baby to regain his or her birthweight by 2 weeks and then gain roughly 6 to 8 ounces a week for the next couple of months. Formula-fed babies usually gain weight faster in the beginning.

Worried your baby’s not filling out fast enough? Remember that your eyes are not necessarily a reliable gauge of your baby’s weight gain—after all, you get to see your little one every day, so you’re less likely to notice growth than those who see baby less often. Still have doubts? Call the doctor’s office and ask if you can bring your baby in for a drive-by weigh-in. Don’t try to weigh your baby on a home scale—even if you do the weigh-yourself-with the baby and then weigh-yourself-without maneuver. Home scales are not sensitive enough to pick up those ounces and half ounces that matter so much to a newborn’s weight.

Supplemental Nursing System

Here’s how the SNS works: A bottle filled either with pumped breast milk or formula hangs around your neck. Narrow flexible tubes leading from the bottle are gently taped onto your breasts, extending slightly past the nipples. As your little one nurses at the breast, he or she gets the supplement through the tube along with any milk that comes from your breasts. It’s win-win, since baby gets the nutrition he or she needs and your breasts get the stimulation they need.

That is, when it works according to plan. Some moms find their babies fuss over or even reject feeding from a breast that has a tiny tube hanging off it (it could make it uncomfortable or difficult for some babies to latch on properly). If you find your baby is struggling to nurse when you’re using the SNS, have a lactation consultant watch your technique and offer advice and tips on how to make using the SNS easier and better, if possible.

“I thought that breastfeeding was going pretty well, but the doctor says my baby girl isn’t gaining weight quickly enough. What could be the problem?”

Breastfed babies typically don’t pack on the ounces as fast as their formula-fed friends, and that’s not usually a concern. It’s also the reason why charts that use formula-fed babies to gauge average growth have fallen out of favor. It’s a good idea to make sure the one your pediatrician is using to gauge your baby’s gain is based on breastfed averages (the World Health Organization, or WHO, chart is). Occasionally, however, a baby truly doesn’t thrive on breast milk alone, at least not from the start, and there are several possible reasons why. Identify what’s holding up your baby’s weight gain, and chances are you’ll be able to find a fix for the problem, so she can continue nursing and start gaining weight faster:

Possible problem: You’re not feeding baby often enough.

Solution: Increase feedings to at least 8 to 10 times in 24 hours, and try never to go more than 3 hours during the day or 4 at night between feedings. That means waking up a sleeping baby so that she won’t miss dinner or feeding a hungry one even if your slowpoke just finished a meal an hour earlier. If your baby is “happy to starve” (some newborns initially are) and never demands feeding, it means taking the initiative yourself and setting a busy feeding schedule for her. Frequent nursings will not only help to fill baby’s tummy (and fill out her frame), they will also stimulate your milk production.

Possible problem: Baby’s not draining at least one breast at each feeding, or you’re switching breasts too early on in a feed. The result: Your baby doesn’t get the rich, higher-calorie hindmilk that’s intended to fill (and fatten) her up, and she doesn’t gain enough weight.

Solution: Make sure your baby finishes one breast (10 to 15 minutes minimum should do the trick sufficiently) before you offer the second. That way she’ll be able to quench her thirst with foremilk but still cash in on the calories in the hindmilk. Let her nurse for as long (or as little) as she likes on the second breast, and remember to alternate the starting breast at each feeding.

Possible problem: Your baby is considered a sluggish or ineffective suckler (called a “lazy” suckler by the experts). This may be because she was preterm, is ill, or has abnormal mouth development (such as a cleft palate or tongue or lip tie). The less effective the suckling, the less milk is produced, setting baby up for failure to thrive.

Solution: Until she’s a strong suckler, she will need help stimulating your breasts to provide adequate milk. This can be done with a breast pump, which you can use to empty the breasts after each feeding (save any milk you collect for future use in bottles). Until milk production is up to snuff, your doctor will very likely recommend supplemental bottle-feedings of formula (given after breastfeeding sessions) or the use of a supplemental system, or SNS (see box). The SNS has the advantage of simultaneously stimulating your production while supplementing your baby’s supply.

If your baby tires easily while feeding, you may be advised to nurse for only a short time at each breast (be sure to pump the rest later to empty the breast of the hindmilk and to keep up your milk supply), then follow with a supplement of expressed milk (which will contain the all-important and calorie-rich hindmilk) or formula given by bottle or the supplemental nutrition system, both of which require less effort by the baby.

Possible problem: Your baby hasn’t yet learned how to coordinate her jaw muscles for suckling.

Solution: A baby who hasn’t quite yet mastered the art of the suckle will also need help from a breast pump to stimulate her mama’s breasts to begin producing larger quantities of milk. In addition, she will need lessons in improving her suckling technique—the doctor may recommend you get hands-on help from an LC and possibly even a pediatric occupational or speech therapist. While your baby is boning up on her technique, she may need supplemental feedings (click here). For further suggestions on improving suckling technique, contact your local La Leche League.

Possible problem: Your nipples are sore or you have a breast infection. Not only can the pain interfere with your desire to nurse, reducing nursing frequency and milk production, but it can actually inhibit milk let-down—especially if you’re tensing up.

Solution: Take steps to heal sore nipples or cure mastitis.

Possible problem: Your nipples are flat or inverted. It’s sometimes difficult for a baby to get a firm hold on such nipples. This situation sets up the negative cycle of not enough suckling, leading to not enough milk, to even less suckling, and less milk.

Solution: Help baby get a better grip during nursing by taking the outer part of the areola between your thumb and forefinger and compressing the entire area for him to suckle on. Use breast shells between feedings to make your nipples easier to draw out.

Possible problem: Some other factor is interfering with milk let-down. Letdown is a physical function that can be inhibited as well as stimulated by your state of mind. If you’re stressed out about breastfeeding (or in general), not only can let-down be stifled, but the volume and calorie count of your milk can be diminished.

Solution: Try to de-stress before and during feeds by playing soft music, dimming the lights, using relaxation techniques, or meditating. Massaging your breasts or applying warm soaks also encourages let-down, as does opening your shirt and cuddling baby skin-to-skin during feeds.

Possible problem: Baby’s become frustrated at the breast—due to problems on her side or yours. The frustration leads to fussing, which leads to tension for you, which leads to more frustration and fussing for baby, and a cycle begins, sometimes sabotaging breastfeeding.

Solution: Seek the hands-on help of a lactation consultant, if possible, to get any latching, positioning, or other problems resolved so both you and baby can stay calm and on task. Try to relax yourself and your baby as much as possible before feeds (see previous tip)—and always begin feeds before your baby starts showing hunger cues (and is more likely to become frantic at the breast).

Possible problem: Your baby is getting her sucking satisfaction from a pacifier. Babies are born to suck, but too much sucking on a nonnutritive pacifier can sabotage your baby’s interest in breastfeeding.

Solution: Save the pacifier for only when baby sleeps (or put it aside for now)—instead, breastfeed baby when she seems to want to suck.

Possible problem: Your baby’s appetite is dampened by supplementary water.

Solution: Giving your breastfed baby a supplementary bottle of water is a no-no before 6 months, since it not only supplies nonnutritive sucking but can also decrease her appetite and, in excess, dangerously dilute blood sodium levels. Click here for more on supplementary water.

Possible problem: You’re not burping baby between breasts. A baby who’s swallowed air can stop eating before she’s had enough because she feels uncomfortably full.

Solution: Bringing up the air will give her room for more milk. Be sure to burp baby between breasts (or even mid-breast if she’s a slow feeder) whether she seems to need it or not—more often if she fusses a lot while nursing.

Possible problem: Your baby is sleeping through the night. An uninterrupted night’s sleep is great for you, but not necessarily for your milk supply. If baby is going 7 or 8 hours a night without nursing, your milk may be diminishing, and supplementation may eventually be needed.

Solution: To make sure this doesn’t happen, you will have to wake your little sleepyhead (and yourself) at least once in the middle of the night. She shouldn’t be going longer than 4 hours at night without a feeding during the first month.

Possible problem: You’re stomach sleeping. Yes, you earned it after so many months of side sleeping. But when you sleep on your tummy, you also sleep on your breasts—and all that pressure on your breasts can cut down on milk production.

Solution: Turn over, at least partway, to take the pressure off those mammary glands.

Possible problem: You’ve returned to work. Returning to work—and going 8 to 10 hours without breastfeeding or pumping during the day—will definitely decrease milk supply.

Solution: One way to prevent this is to express milk at work at least once every 4 hours you’re away from baby (even if you’re not using the milk for feeding).

Possible problem: You’re doing too much too soon. Producing breast milk requires a lot of energy. If you’re expending yours in too many other ways and not getting enough rest, your breast milk supply may diminish.

Solution: Try a day of almost complete bed rest, followed by 3 or 4 days of taking it easy, and see if your baby isn’t more satisfied (hey, you’ll feel better, too).

Possible problem: There are bits of placenta left in your uterus. Your body won’t accept the fact that you’ve actually delivered until all the products of pregnancy have left the building—and that includes the entire placenta. If fragments remain, your body may not produce adequate levels of prolactin, the hormone that stimulates milk production.

Solution: If you have any abnormal bleeding or other signs of retained placental fragments, contact your practitioner at once. A dilatation and curettage (D&C) could put you and your baby on the right track to successful breastfeeding while avoiding the danger a retained placenta can pose to your own health.

Possible problem: Your hormones are out of whack. In some women, prolactin levels are too low to produce adequate amounts of milk. Other women have thyroid hormone levels that are off, causing a low milk output. And in still others, insulin deregulation can be the cause of a low milk supply.

Solution: Speak to your doctor or endocrinologist. Tests can determine the problem, and medications and other treatments can get you back up and regulated, hopefully getting your milk production back up and running, though the process will likely take time, and supplementation with formula may be necessary at least in the short term.

Timing Is Everything

A reminder: Like labor contractions, intervals between feedings are timed from the beginning of one to the beginning of the next. So a baby who nurses for 40 minutes starting at 10 a.m., then sleeps for 1 hour and 20 minutes before eating again, is on a 2-hour schedule, not a 1-hour-and-20-minute one.

Once in a while, even with the best efforts, under the best conditions, and with the best support and professional advice, it turns out a mom can’t provide all the milk her baby needs. A small percentage of women are simply unable to breastfeed exclusively, and a small few can’t breastfeed at all. The reason may be physical, such as a prolactin deficiency, insufficient mammary glandular tissue, markedly asymmetrical breasts, or damage to the nerves going to the nipple caused by breast surgery (more likely to be the case if you’ve had a reduction than an augmentation). Or it could be due to excessive stress, which can inhibit let-down. Or, occasionally, it may not be pinpointed at all.

If your baby isn’t thriving, and unless the problem appears to be one that can be cleared up in just a few days, her doctor is almost certain to prescribe supplemental formula feedings (click here)—possibly with a formula designed for supplementation. Not to stress. What’s most important is adequately nourishing your baby, not whether you give breast or bottle. In most cases when supplementing, you can have the benefits of the direct parent-baby contact that nursing affords by letting baby suckle at your breast for pleasure (hers and yours) after she’s finished her bottle, or by using a supplemental nursing system. Often, a baby can return to exclusive breastfeeding (or the combo; click here) after a period of supplementation—a goal that’s definitely worth trying for.

Once a baby who is not doing well on the breast is put on formula temporarily, she almost invariably thrives. In the rare instance that she doesn’t, a return trip to the doctor is necessary to see what is interfering with adequate weight gain.

Tongue-Tied

Ever hear the term “tongue-tied”? It’s often used to refer to someone who’s too shy, excited, or embarrassed to get words out. But tongue-tie is actually a very real hereditary medical condition that affects up to 2 to 4 percent of infants, and in some cases can impact their ability to breastfeed successfully.

Known in doctor speak as ankyloglossia, this hard-to-pronounce congenital condition means that the frenulum—the band of tissue that connects the bottom of the tongue to the floor of the mouth—is too short and tight. The result? The tongue’s movements are restricted, and your baby may have difficulty nursing.

How can you tell if your little one is tongue-tied? If baby is unable to stick out his or her tongue fully, or if that little tongue looks heart shaped, it could mean that it is “tied.” Another clue: When your baby sucks on your finger, his or her tongue doesn’t extend over the gum line as it should.

Most tongue-tied babies—usually those whose frenulums are attached farther back in the mouth—have no problem breastfeeding. But if your baby can’t use his or her tongue efficiently enough to suck strongly on your nipple and areola, he or she may not be getting enough milk—and slow weight gain and extra fussiness may result. What’s more, if the frenulum is so short that the tongue can’t extend over the lower gum, your baby may end up compressing your nipple with his or her gums instead of the tongue, and that can cause nipple soreness, pain, clogged ducts, and a host of other problems for you. You’ll know that your little one’s tongue-tie is causing breastfeeding problems if you hear a clicking sound when he or she nurses or if your baby loses the nipple again and again during a nursing session, which happens because he or she can’t extend the tongue enough to get a good grip.

If you think tongue-tie might be the cause of your baby’s breastfeeding problems—or even if you aren’t sure and only suspect that might be the problem—have your baby checked out by the pediatrician or an LC. If your baby’s tongue-tie is truly causing feeding problems, the doctor can clip the frenulum to loosen it and allow the tongue to move freely. Called a frenotomy, the clipping is an extremely quick in-office procedure causing little pain—though not all pediatricians perform it and you might need to be referred to a specialist.

Baby’s tongue-tie isn’t causing feeding problems? No need to be concerned. In most cases the frenulum recedes on its own during the first year, and causes no long-term issues with feeding or speaking.

Similar to tongue-tie is the less common lip-tie, which involves the upper lip and gum. The upper lip also has a connective tissue attachment called the maxillary labial frenum (you can feel yours if you run your tongue between your upper lip and top of the gum) and if that tissue is short and tight, or if it attaches farther down the gum or even between where the front teeth will eventually come in, it may cause breastfeeding problems as well. That’s because in some cases a lip-tie may restrict the movement of the upper lip, making it harder for baby to latch on properly. You can tell if your baby has a lip tie just by lifting his or her upper lip and seeing where it attaches. If it’s high up, it’s normal. If it’s attached low on the gum and you’re having trouble nursing (you won’t necessarily), check in with an LC who can show you specific positional techniques to help make breastfeeding a success or advise you on a procedure to revise the lip-tie.

Nursing Blisters

“Why does my baby have a blister on his upper lip? Is he sucking too hard?”

For a baby with a hearty appetite, there’s no such thing as sucking too hard—though you of tender nipples may disagree. Nursing blisters, which develop on the center of the upper lips of many newborns, both breast-and bottle-fed, do come from vigorous sucking—but they’re nothing to worry about. They have no medical significance, cause no discomfort to your baby, and will disappear without treatment within a few weeks to months. Sometimes, they even seem to disappear between feedings.

Feeding Schedule

“I seem to be breastfeeding my new daughter all the time. Should I think about getting her on a schedule?”

One day, your little one will be ready to eat by the clock. But for now, the only schedule that matters is the one her tummy sets for her—and it goes like this: “I’m empty, you fill me. I’m empty again, you fill me again.” It’s a schedule that’s built on demand—not on timed intervals—and it’s the very best way for a breastfed baby to feed. While bottle-fed newborns can do well on a 3- or 4-hour schedule (in other words, because formula is so filling, they will usually demand another feeding only when 3 to 4 hours have passed), breastfed infants need to eat more often. That’s because breast milk is digested more quickly than formula, making a baby feel hungry again sooner. On-demand breastfeeding also ensures that mom’s milk supply keeps pace with baby’s growing appetite, which fuels baby’s growing body—and nurtures a successful breastfeeding relationship.

So breastfeed as often as your little eating machine demands during these early weeks. Just keep three things in mind as you do. One, new babies tend to nod off before they’re finished filling their tanks. Making a concerted effort to keep your baby awake at the breast until she’s had a full meal will keep her from waking up hungry an hour later. Two, babies cry for reasons other than feelings of hunger. Getting to know her cries (click here) will help you figure out whether she’s really in the market for a meal, or for a cuddle, some rocking, or a nap—and that will cut down on feeds she doesn’t need. And three, once in a while, a baby’s frequent feeding—especially if she never seems satisfied, isn’t gaining weight, or shows other signs that she’s not thriving—can mean she’s not getting enough to eat (click here). If you’re concerned that’s the case with your baby, check in with the doctor.

Once your milk supply is well established, usually at about 3 weeks, you can start stretching the time between feedings. When your little one wakes crying an hour after feeding, don’t rush to feed her. If she still seems sleepy, try to get her back to sleep without nursing her. If she seems alert, try some socializing. Or a little massage. Or a change of position or point of view. If she’s fussy, try wearing her, rocking her, walking with her, or offering her the pacifier. If it’s clear she’s really hungry, go ahead and feed her—again, just make sure she takes a full meal instead of a nip-and-nap snack bar approach.

In time, those round-the-clock feeds will become a thing of the sleep-deprived past—and feedings will start coming at more reasonable intervals—2 to 3 hours, and eventually, 4 or so. Still on-demand for her, but far less demanding for you.

Double the Trouble, Double the Fun

Got your hands—and both arms—full with twins? While you probably had many months to prepare for your new life with a double blessing, the reality of life with two babies can hit like a ton of bricks—and a ton of dirty diapers. That is, unless you know how to contain the chaos—and how to handle (and enjoy) this doubly challenging time:

Double up. Do as much as possible for your babies in tandem. That means waking them at the same time so they can be fed together, wearing them in a sling together, walking them in the stroller together. Double burp them together across your lap, or with one on your lap and the other on your shoulder. When you can’t double up, alternate. At an early age, daily baths aren’t necessary, so bathe babies on alternate nights. Or bathe them every second or third night and sponge in between. Putting them foot to foot or swaddled side by side in the same crib during the early weeks may help them sleep better. But check with the pediatrician, since some experts warn that prolonged tandem sleeping can increase the SIDS risk once the twins are able to roll over.

Split up. The work, that is. When both parents are around, divide the household chores (cooking, cleaning, laundry, shopping) and the babies (you take over one baby, your spouse the other). Be sure that you alternate babies so that both get to bond with both parents. And of course, accept all the help you can get, from any willing source.

Try the double-breasted approach. Nursing twins can be physically challenging but eliminates fussing with dozens of bottles and endless ounces of formula—plus, it’ll leave more room in your doubly stretched budget (formula feeding two babies can cost a couple of small fortunes). Since trying to breastfeed only one baby at a time can turn into a 24/7 nursing marathon, try feeding them simultaneously (it’s a good thing breasts come in pairs!). You can prop your twosome on a twins feeding pillow in the football position with their feet behind you (click here), or with their bodies crossed in front of you. Alternate the breast each baby gets at every feeding to avoid creating favorites and mismatched breasts should one baby turn out to be a greedier suckler than the other, or to avoid one baby getting less to eat if one breast turns out to be a less productive provider. If you find it too difficult to breastfeed your twins exclusively, you can nurse one while you bottle-feed the other—again alternating from feeding to feeding.

Plan to have some extra hands on hand, if you’re bottle-feeding. Bottle-feeding twins requires either an extra set of hands or great ingenuity. If you find yourself with two babies and just two hands at feeding time, you can sit on a sofa between the babies (prop them up on pillows or a twins feeding pillow) with their feet toward the back and hold a bottle for each. Or hold them both in your arms with the bottles in bottle-proppers raised to a comfortable height by pillows. You can also occasionally prop the bottle for one in a baby seat (but never lying down) while you feed the other the traditional way or put both of them in their infant seats side by side and feed them at the same time. Feeding them one after the other is another possibility, but you’ll be spending twice as much time feeding them—and will have half as much time to get anything else done. Back-to-back feeds will also put the babies on somewhat different napping schedules if they sleep after eating, which can be good if you’d like some time alone with each, or bad if you depend on that tandem sleeping time to rest or get other chores done.

Don’t split z’s. Sleep will necessarily be scarce for the first few months, but it will be scarcer if your babies are always waking at different times during the night. Instead, when the first cries, wake the second (if he or she isn’t already awake) and feed them both. Any time that both members of your darling duo are napping during the day, catch a few winks yourself—or at least try to put your feet up.

Double up on equipment. When you don’t have another pair of hands around to help, utilize such conveniences as baby carriers (you can use a large sling for two babies, use two slings, or tote one baby in a carrier and one in your arms), baby swings, and infant seats. A play yard is a safe playground for your twins as they get older, and because they’ll have each other for company, they will be willing to be relegated to it more often and for longer periods than a singleton would. Select a twin stroller to meet your needs, and don’t forget that you will need two car seats. Put both in the backseat of the car.

Keep twice as many records. Who took what at which feeding, who was bathed yesterday, who’s scheduled for today? Unless you keep a log or use an app, such as the What to Expect app, to keep track, you’re sure to forget. Also make note in a permanent record book of immunizations, illnesses, and so on. Though most of the time, the babies will both get everything that’s going around, occasionally only one will—and you may not remember which one.

Go one-on-one. Though it won’t be easy (at least in the beginning), there are ways to find that special one-on-one time with each baby during the day. When you’re better rested yourself, stagger naptime—put one baby down 15 minutes before the other—so you can devote some individualized attention to the one who’s awake. Or take only one on an errand and leave the other one with a sitter. Even everyday baby care—diaper changes or getting the babies dressed—can be a chance to bond with each of your twins.

Be doubly alert once your twins are mobile. You’ll find, as your babies begin crawling and cruising, that what one of them doesn’t think of in the way of exploits, the other will. So they will need to be watched twice as carefully.

Double up on support. Other parents of twins will be your best source of insights and tips, so be sure to tap in to them. Don’t know anyone in the same double boat? Start hanging out on twin message boards online (check out WhatToExpect.com).

Expect things to get doubly better. The first 4 months with twins are the most challenging. Once you begin to work out the many logistics, you’ll find yourself falling into an easier rhythm. Keep in mind, too, that twins are often each other’s best company. Many have a way of keeping each other busy that parents of demanding singletons envy—and that will free you up more and more in the months and years to come.

Changing Your Mind About Breastfeeding

“I’ve been breastfeeding my son for 3 weeks, and I’m just not enjoying it. I’d like to switch to a bottle, but I feel so guilty.”

Not having fun breastfeeding yet? That’s pretty common, given the bumpy start that so many brand new breastfeeding teams get off to (sore nipples … latching on problems … both of those and more?). Usually, even the rockiest road leads to a smooth ride by the middle of the second month—at which point, breastfeeding becomes a walk in the park, and typically, an enjoyable one at that. So it might make sense to hold off on your decision until your baby is 6 weeks old—or even 2 months. If by then you’re still finding breastfeeding a drag, you can quit or consider doing the combo (supplementing with formula instead of breastfeeding exclusively). Your baby will have received many of the benefits of breastfeeding, and you’ll have given breastfeeding your best shot. Which means you can win-win when you ultimately wean-wean. Another option that some moms prefer: pumping their baby’s meals and feeding from a bottle.

Decided that you don’t have it in you to wait on quitting? Grab a bottle of formula and get busy. For tips on bottle-feeding with love, click here.

Too Much Formula

“My baby loves his bottle. If it were up to him, he’d feed all day. How do I know when to give him more formula or when to stop?”

Because their intake is regulated both by their appetite and by an ingenious supply-and-demand system, breastfed babies rarely get too much—or too little—of a good thing. Bottlefed babies, whose intake is regulated instead by their parents, sometimes do—if they drink too much formula, that is. As long as your baby is healthy, happy, wetting his diapers regularly, and gaining adequate weight, you know he’s getting enough formula. In other words, if your little one is eating to his appetite (even if that appetite is huge), there’s nothing to be concerned about. But if his bottle becomes the liquid equivalent of an all-you-can-eat buffet—refilled even when he’s full—he can easily get too much.

Too much formula can lead to a too chubby baby (which, research shows, can lead to a too chubby child and a too chubby adult). But it can also lead to other problems. If your baby seems to be gaining weight too quickly, or if he seems to be spitting up a lot (more than normal, click here) he might be taking more ounces than his tiny tummy can handle at this point. Your baby’s pediatrician will be able to tell you what his rate of gain should be, and how much formula (approximately) he should be getting at each feeding (Click here for guidelines of how much formula to feed). If he does seem to be taking too much, try offering smaller-volume feedings, and stop when baby seems full instead of pushing him to finish. If he’s fussy after a feed, consider that he may just need a burp—not a second serving. Or serve up some comfort or entertainment instead (babies cry for reasons other than hunger; click here to help decode your baby’s cries). Keep in mind, too, that it may just be the sucking (not the formula that comes with it) that he’s craving. If your baby’s a natural-born sucker, consider offering a pacifier after he’s had his fill of formula, or help him find his fingers or a pacifying fist to suck on.

Supplementary Water

“I’m wondering if I should be giving my son a bottle of water.”

When it comes to feeding, newborn babies have just two options—and so do the parents who feed them: breast milk or formula. For the first 6 months or so, one or the other (or a combo of the two) will provide your baby with all the food and fluids he needs, no water necessary. In fact, adding supplementary water to a baby’s already all-liquid diet isn’t only unnecessary, in excess it can be dangerous—possibly diluting his blood and causing serious chemical imbalances (just as adding too much water when preparing formula can). If your baby’s breastfeeding, water can also satisfy his appetite and his need to suck—possibly sabotaging breastfeeding and weight gain.

Once your sweetie has started solids, offering sips of water from a cup (babies can’t get too much water from a cup, only a bottle) will be fine—and good practice for the days when all his drinks will come from a cup instead of your breasts or a bottle. If the weather’s really hot, some pediatricians will okay sips of water for a formula-fed baby before solids are started, but do check first.

Vitamin Supplements

“We’ve heard a lot of different opinions about vitamin supplements. Should we give our baby one, and what kind should we give him?”

When it comes to deciding whether or not to give your baby a vitamin supplement (and which kind to give), it’s the pediatrician’s opinion that matters most. That’s because your baby’s doctor will take into account not only the ever-evolving research and recommendations on vitamin supplements, but your little one’s unique needs.

If your little one is exclusively or partially breastfed, he’ll be getting most of the vitamins and minerals he needs from breast milk (assuming you’re eating a good diet and taking a daily prenatal vitamin or one designed for breastfeeding moms). But he’ll definitely fall short on vitamin D, which is why pediatricians recommend that breastfed babies get 400 IU a day of vitamin D in the form of a supplement (probably A-C-D, which combines vitamins A, C, and D), starting in the first few days of life. And while he’ll score enough iron from your breast milk in the first 4 months, levels can diminish after that point—which is why the pediatrician is likely to add an iron supplement to the mix (1 mg/kg per day, probably in an A-C-D supplement with iron added) at least until iron-rich solids (like fortified cereals, meat, and green vegetables) are introduced. As an added precaution, the pediatrician may suggest that your little one stay on an iron supplement throughout the first year. The added benefit of combining iron with vitamin C (either in a supplement or with food): The vitamin C helps with iron absorption.

If your little one is exclusively bottle-fed, chances are he’s getting most of the nutrients he needs through formula—though he may fall short on vitamin D until he’s consistently drinking enough to meet his daily quota (he’d have to down a minimum of 32 ounces, something he’s not likely managing yet). To fill the gap, the pediatrician may recommend giving your baby a vitamin D supplement (probably in the form of A-C-D drops) at least in the short term. Later, once your baby gets serious about solids and starts drinking less formula, the doctor may suggest adding iron as well, again probably in an A-C-D with iron formula.

Ask the pediatrician for recommendations on what supplements your baby needs (if any), and when. Happily, most infant vitamin drops are tasty, and many (though far from all) babies have no problem taking them. It might be easier to give the drops right before a feed, when your baby’s apt to lap them up (from hunger)—or you may find him more receptive after a feed. A tasteless powdered supplement can be substituted for the drops if your baby takes a bottle (you mix them right into formula or breast milk—just make sure your baby drinks the whole bottle to get the full dose). The powder can also be mixed with solids once they’re started (but again, only if you can count on baby finishing that bowlful).

If your baby has health problems, was premature, or if you’re breastfeeding and think your diet might be lacking some important vitamins and minerals (say, if you’re a vegan and you’re not getting enough B12, zinc, or calcium), the doctor might recommend additional supplements for your baby. Preterm infants who are breastfed will likely be prescribed an iron supplement of 2 mg/kg daily, starting at 1 month of age and continuing until their intake of iron-rich foods fills the requirement for this essential mineral.

What about fluoride? Babies under 6 months don’t need fluoride supplementation, and older babies need it only if there isn’t adequate fluoride in the water supply or if they don’t drink tap water (bottled water doesn’t contain it). Ask your baby’s doctor for specific recommendations. Keep in mind that with fluoride, as with most good things, too much can be bad. Excessive intake while the teeth are developing in the gums, such as might occur when a baby drinks fluoridated water (either plain or mixed with formula) and takes a supplement, can cause fluorosis, or mottling (“chalk marks” appearing on the teeth). Excessive intake can also occur if excessive amounts of fluoridated toothpaste are used. Click here for more information.

For Parents: Getting Everything Done

Take the responsibility of caring for a newborn baby for the first time. Add in the days and nights that seem to blur together as one endless feeding. Plus a few too many visitors, a generous helping of postpartum hormonal upheaval for mom (and some for dads, too), and, possibly, a fair amount of home clutter accumulated during your stay in the hospital or in the last days of pregnancy—when you could barely move, never mind clean. Throw in the inevitable mountain of gifts, boxes, wrapping paper, and cards to keep track of. It’s only natural to feel that as your new life with baby begins, your old life—with its order and cleanliness—is crumbling around you.

As hard as it may be to believe now, your inability to keep up with both new baby and house during the first weeks or months in no way predicts your future success at the juggling act called parenthood. Things are bound to get better as you get more sleep, become more adept at all those baby-care tasks, and learn to be a little more flexible. It will also help to:

Get help. If you haven’t already arranged for household help—paid or unpaid—and taken steps to streamline housekeeping and cooking chores, now’s the time to do so. Also be sure that there is a fair division of labor (both baby care and household care) between parents, if there are two.

Get your priorities straight (before you straighten up). Is it more important to get the vacuuming done while baby’s napping or to put your feet up and relax? Is it really essential to clean out the fridge, or would going for a stroll with the baby be a better use of your time? Keep in mind that doing too much too soon can rob you of the energy to accomplish anything well, and that while your house will someday be clean again, your baby will never be 2 days, or 2 weeks, or 2 months old again. In other words: Stop (cleaning) and smell the babies.

Get organized. Have a million to-do’s floating through your sleep-deprived head? Write them down. First thing every morning (or before you crash every night), make a list of what needs to be done. Divide your priorities into three categories: chores that must be taken care of as soon as possible, those that can wait until later in the day, and those that can be put off until tomorrow, or next week, or indefinitely. Assign approximate times to each activity, taking into account your personal biological clock (are you useless first thing in the morning, or do you do your best work at the crack of dawn?) as well as your baby’s (as best you can determine it at this point).

Though organizing your day with lists doesn’t always mean that everything will get done on schedule (in fact, for new parents it rarely does), it will give you a sense of control over what may now seem like a completely uncontrollable situation. You may even find, once you’ve made your list, that you actually have less to do than you thought. Don’t forget to cross off or delete completed tasks for a satisfying feeling of accomplishment. And don’t worry about what’s not crossed off—just move those items to the next day’s list.

Another good organizational trick of the new parent trade: Keep a running list of baby gifts and their givers as they’re received. You think you’ll remember that your cousin Jessica sent that darling blue-and-yellow onesie set, but after the seventeenth onesie set has arrived, that memory may be dim. And check off each gift on the list as the thank-you note is sent, so you don’t end up sending two notes to Aunt Karen and Uncle Marvin and none to your boss.

Get simplified. Take every shortcut you can find. Make friends with frozen vegetables and healthy frozen entrées, your local salad bar, the pizza delivery guy, online grocery and diaper shopping.

Get a jump on tomorrow tonight. Once you’ve bedded baby down each night and before you collapse, summon up the strength to take care of a few chores so that you’ll have a head start on the next morning. Restock the diaper bag. Measure out the coffee for the coffeepot. Sort the laundry. Lay out clothes for yourself and the baby. In 10 minutes or so you’ll accomplish what would take you at least three times as long with the baby awake. And you’ll be able to sleep better (when your little one lets you) knowing that you’ll have less to do in the morning.

Get out. Plan an outing every day with your little one—even if it’s just a walk around the mall. The change of pace and space will allow you to return to Casa Chaos somewhat refreshed.

Get to expect the unexpected. The best-laid plans of parents often (actually, very often) go awry. Baby’s all bundled up for an outing, the diaper bag is ready, your coat is on, and suddenly the distinct gurglings of an explosive poop can be heard from under all baby’s gear. Off comes coat, bunting, diaper—10 minutes lost from an already tight schedule. To allow for the unexpected, try to build extra time into everything you do.

Get the joke. If you can laugh, you’re less likely to cry. So keep your sense of humor, even in the face of total disorder and utter clutter—it’ll help you keep your sanity, too.

Get used to it. Living with a baby means living with a certain amount of mayhem most of the time. And as baby grows, so will the challenge of keeping the mayhem in check. No sooner will you scoop the blocks back into their canister than he or she will dump them back out again. As fast as you can wipe mashed peas off the wall behind the high chair, your baby can redecorate with strained peaches. You’ll put safety latches on the kitchen cabinets, and your one-baby demolition derby will figure out how to open them, covering the floor with your pots and pans.

And remember, when you finally pack your last child off to college, your house will be orderly once again—and so empty and quiet that you’ll be ready to welcome the pandemonium (and even the dirty laundry) they bring home on school vacations.

Whites, Colors, and Baby’s?

Tired of separating your baby’s laundry (especially because the loads, like the clothes, are so tiny)? Here’s a happy laundry alert: Most babies probably don’t need their clothes washed separately from the rest of the family’s, with special baby laundry soaps. Even the high-potency detergents that really get clothes clean, eliminating most stains and odors (the kind babies are very good at generating), aren’t irritating to most infants when well rinsed. (Rinsing is most thorough, and stain-fighting powers are most effective, with liquid detergents.)

To test your baby’s sensitivity to your favorite laundry detergent, add one item that will be worn close to baby’s skin (such as a t-shirt) to your next family load, being careful not to overdo the detergent or underdo the rinse. If that tender skin shows no rash or irritation, go ahead and wash baby’s clothes with yours. If a rash does appear, try another detergent, preferably one without colors and fragrances, before deciding you have to stick with a baby laundry formula.

Love the smell of baby laundry detergent? Go ahead, make your day—and your whole family’s laundry—smell baby fresh.

Spitting Up

“My baby spits up so much that I’m worried she’s not getting enough to eat.”

Although it seems as if your little one is literally losing her lunch (and breakfast, and dinner, and snacks), she’s almost certainly not. What looks like a lot of spit-up probably amounts to no more than a tablespoon or two of milk, mixed with saliva and mucus—certainly not enough to interfere with your baby’s nourishment. If your baby’s growing well, peeing and pooping plenty, and thriving, there’s no need to cry over spit-up milk—or to worry about it.

Doctors are fond of saying that spit-up is a laundry problem, not a health problem. It’s smelly and messy, but it’s normal—and so common. Most babies spit up at least occasionally, and many spit up with every feeding. The reason for this malodorous mayhem? Newborns have an immature sphincter between the esophagus and stomach, which allows food to back up—even more easily, since they spend most of their time lying flat on their backs or semireclining. They also have excess mucus and saliva that needs to be cleared—and up and out is the most effective way for an infant to ship that goop out. Often, they spit up because they eat too much (especially if they’re bottle-fed and mommy or daddy is pushing more ounces than a tiny tummy can handle), or because they’re getting too many air bubbles with their milk (particularly if they were crying before the feed or didn’t get burped enough during it). Later, teething babies often gag and spit up thanks to all the drool they’re producing.

Most babies stop spitting when they start sitting, usually at about 6 months. The introduction of solids (also at about 6 months) can help limit spit-up, too—after all, it’s easier to spit up an entirely liquid diet. Until then, there’s no sure way to stop the spitting up (though a bib for your baby and a burp cloth for you should prevent some of the mess), but you can cut down on the frequency:

• Keep bubbles at bay by minimizing air gulping during mealtimes (don’t feed her when she’s crying, and try to calm her down before feeds).

• Put gravity in your corner by feeding her with her upper body elevated (as upright as is comfortably possible).

• Tilt bottles so that the liquid (not air) fills the nipple, or use bottles that don’t allow air to enter the nipple.

• Avoid bouncing her around while she’s eating or just afterward. You’ll be less likely to bring up the works if you keep her relatively still.

• Break for burps often enough—at least once, halfway through her feedings (if you wait until the end, one big bubble can open the floodgates). If she’s a slow eater or seems fussier than usual, break more frequently.

• Keep her upright as much as possible after meals.

Most babies are “happy spitters”—in other words, the spitting doesn’t bother them in the slightest (though the same probably can’t be said for their parents), and it doesn’t affect weight gain or growth. Some babies may have discomfort with spitting—or may be gassy or have other signs of reflux without spitting—and the doctor might diagnose it as gastroesophageal reflux disease or GERD (click here).

If your baby’s spitting is accompanied by prolonged gagging and coughing or associated with poor weight gain, if it seems severe, or if the vomit is brown or green in color or shoots out 2 or 3 feet (projectile vomiting), call the doctor. These could indicate a medical problem, such as an intestinal obstruction or pyloric stenosis (click here).

Quick Tip

Keep a small plastic bottle of water mixed with a little baking soda handy for spit-up spot cleaning. Rubbing a cloth moistened with the mixture on spots will keep them from setting and will eliminate most of the odor. Or carry a to-go spot remover. Or use a diaper wipe. And definitely get in the habit of pretreating spots when it’s time for laundry.

Blood in Spit-up

“When my 2-week-old spit up today after I breastfed her, there were some reddish streaks that looked like blood in with the curdled milk. Now I’m really worried.”

Any blood that seems to be coming from your newborn, particularly when you’ve found it in her spit-up, is bound to worry you. But before you panic, try to determine whose blood it actually is. If your nipples are cracked, even very slightly, it’s probably your blood, which baby could be sucking in (and then spitting up) along with the milk each time she nurses.

If your nipples aren’t obviously the cause (they may be, even if you can’t see the tiny cracks), or if you’re not breastfeeding, call your pediatrician to help you figure out the source of the blood in your baby’s spit-up.

Milk Allergy

“My baby is crying a lot, and I’m wondering if he might be allergic to the milk in his formula. How can I tell?”

As eager as you might be to uncover a cause (and an easy cure) for your baby’s crying, it’s not likely the milk that’s to blame. Milk allergy may be the most common food allergy in infants, but it’s a lot less common than most people believe (only about 2 to 3 in 100 babies will develop a true allergy to milk). And when a baby is allergic to milk, other symptoms will accompany the crying.

A baby who is having a severe allergic response to milk will usually vomit frequently and have loose, watery stools, possibly tinged with blood. Less severe reactions may include occasional vomiting and loose, mucousy stools. Some babies who are allergic to milk may also have eczema, hives, wheezing, and/or a nasal discharge or stuffiness when exposed to milk protein.

Unfortunately, there’s no way to test for milk allergy, except through trial and error—but don’t try anything (including a change of formula) without the doctor’s advice. If there is no history of allergy in your family, and if your baby doesn’t have any symptoms other than crying, the doctor will probably suggest that you treat the crying spells as ordinary colic (click here).

If there is a family history of allergies or your baby has symptoms of milk allergy other than crying, the doctor may recommend a trial change of formula, from regular cow’s milk formula to hydrolysate (in which the protein is partly broken down or predigested). If the symptoms disappear, it’s likely your baby is allergic to milk (though sometimes it can just be a coincidence), and you’ll probably be told to keep him on the hydrolysate formula for now. Happily, milk allergies are eventually outgrown, so at some point the pediatrician may recommend a reintroduction of cow’s milk formula, or after a year, whole milk. If symptoms don’t return when you switch back, your baby either wasn’t really allergic in the first place or has outgrown the allergy (at which point you can bring on the dairy products without worry).

A switch to soy formula usually isn’t recommended when a true milk allergy is suspected, since a baby who’s allergic to milk is often allergic to soy as well.

Very rarely the problem is an enzyme deficiency—an infant is born unable to produce lactase, the enzyme needed to digest the milk sugar lactose. Symptoms of congenital lactose intolerance include gas, diarrhea, bloated stomach, and failure to gain weight. A formula containing little or no lactose will usually resolve the problem.

If the problem is not traced to milk allergy or intolerance, it’s probably best to stay with—or switch back to—a cow’s milk formula, since it is the better breast milk substitute (though the doctor may suggest one for sensitive stomachs).

Sensitivities in Breastfed Babies

“I’m breastfeeding exclusively, and when I changed my baby’s diaper today, I noticed some streaks of blood in his bowel movement. Does that mean he’s allergic to my breast milk?”

Babies are virtually never allergic to their mother’s milk, but in rare cases, a baby can be allergic to something in his mom’s diet that ends up in her milk—often cow’s milk proteins. And it sounds as if this might be the case with your very sensitive infant.

Symptoms of such an allergy, known as allergic colitis, may include blood in baby’s stool, extreme fussiness, lack of (or minimal) weight gain, and vomiting and/or diarrhea. Your baby could have one or all of these symptoms. Researchers suspect that some babies may become sensitized to certain foods mother eats while baby is still in utero, causing allergies after birth.

Although cow’s milk and other dairy products are common culprits in these reactions, they’re not the only ones. Others include soy, nuts, wheat, and peanuts. A quick check with your baby’s doctor will probably lead you to this course of action: To determine what in your diet is causing your baby’s allergy, try eliminating a potential problem food for 2 to 3 weeks. Baby’s symptoms may ease during the first week after you’ve eliminated a food from your diet, but for a sure call, wait the full 2 to 3 weeks to confirm that you’ve found the culprit.

Occasionally, no correlation between foods and allergic symptoms is found. In that case, your baby might just have had a gastrointestinal virus that caused the streaks of blood in his stool. Or there might be small cracks or fissures in his anus that caused the bleeding. Another possibility: Baby may have swallowed your blood if your nipples are cracked—and that blood can exit in spit-up or poop (sometimes the blood can give poop a black tinge instead). Monitoring by your baby’s doctor should solve the mystery.

Bowel Movements

“I expected 1, maybe 2, bowel movements a day from my breastfed baby. But she seems to have one in every diaper—sometimes as many as 10 a day. And they’re very loose. Could she have diarrhea?”

Most breastfed infants seem bent on beating the world record for dirtying diapers. But not only is a prolific poop pattern not a bad sign in a breastfed newborn—it’s a very good sign. Since the amount that’s coming out is related to the amount going in, lots of movements a day in the first 6 weeks means your baby’s getting plenty of nutrition from your breast milk.

In the early days, breastfed babies usually have—on average (and average being the operative word here)—one poopy diaper per day of life. In other words, on day 1 of her life, she’ll poop once, and on day 2 she’ll poop twice. Fortunately, this pattern doesn’t usually continue past the fifth or so day of life. After day 5, the average breastfed newborn will poop about 5 times per day. What counts as a BM worth counting? Any poop bigger than the size of a quarter can be added to your tally (if you’re keeping track, that is). Some babies—like yours—will poop more (sometimes even once per feeding), some less (though consistently infrequent poops in the first few weeks can mean a baby’s not getting enough to eat). By 6 weeks the poop pattern of breastfed babies may start to change, and you may notice your baby skipping a day (or two … or even three) between BMs. Or not. Some babies will continue to poop up a storm, filling their diapers several times a day or more throughout the first year. It’s not necessary to continue keeping count after 6 weeks as long as baby is happy and gaining weight. The number may vary from day to day, and that’s perfectly normal, too.

Normal, also, for breastfed infants is a very soft, sometimes even watery, stool. But diarrhea—frequent stools that are liquidy, smelly, and may contain mucus, often accompanied by fever and/or weight loss—is less common among babies who dine on breast milk alone. If they do get it, they have fewer, smaller movements than bottlefed babies with diarrhea and recover more quickly, probably because of the infection-fighting properties of breast milk.

Explosive Bowel Movements

“My son’s poops come with such force and such explosive sound, I’m beginning to think there’s something’s wrong with my breast milk.”

A breastfed newborn is rarely discreet when it comes to pooping. But the noisy barrage that fills the room as your little one fills his diaper is completely normal. While giggle inducing (for parents), and sometimes a bit embarrassing (in public), these explosive movements and the surprising variety of sounds that punctuates their passing are just a result of gas being forcefully expelled from an immature digestive system. Things should quiet down in a month or two.

Passing Gas

“My baby passes gas all day long—very loudly. Could she be having tummy troubles?”

The digestive exclamations that frequently explode from a newborn’s tiny bottom (otherwise known as farts) are, like those explosive poops, perfectly normal. Think of it like new plumbing, which it essentially is. Once your newborn’s digestive system works out the kinks, the gas will pass more quietly and less frequently, if not less pungently.

Constipation

“I’m wondering if my formula-fed baby is constipated. He’s been averaging only one BM every 2 or 3 days.”

When it comes to constipation, frequency isn’t what counts—consistency is. Formula-fed babies aren’t considered constipated unless their poops are firmly formed or come out in hard pellets, or if they cause pain or bleeding (from a fissure or crack in the anus as a result of pushing a hard poop). If your baby’s movements are soft and passed without a struggle (even if they arrive only once every 3 to 4 days), he’s not constipated. No need to jump to constipation conclusions, either, if he grunts, groans, and strains when he poops. That’s standard pooping practice for babies, even when passing soft poop, probably because their anuses aren’t strong or coordinated enough for easy elimination. Not to mention that young babies, who usually poop lying down, get no help from gravity.

If your baby really does seem to be constipated, check with the doctor for confirmation and a treatment plan, if necessary. Don’t use any at-home remedies without medical advice.

For breastfed babies, constipation is rare, but infrequent poops in the early weeks can be a sign that an infant isn’t getting enough to eat (click here.

Sleeping Position

“I know my baby’s supposed to sleep on her back, but she seems so uncomfortable that way. Wouldn’t she sleep better on her tummy, or at least on her side?”

There are no two ways about it: Back sleeping is a must for your baby’s safety. Research has shown that compared with tummy sleepers, back sleepers have fewer fevers, fewer problems with nasal congestion, and fewer ear infections, and are no more likely than tummy sleepers to spit up during the night (or choke on their spit-up). But by far the most important reason why back sleeping is crucial: Placing babies to sleep on their backs sharply reduces the risk of crib death (Sudden Infant Death Syndrome, or SIDS).

Start your baby sleeping on her back (without any sleep positioners or wedges, both of which are considered unsafe) right away, so that she’ll get used to and feel comfortable in that position from the beginning. Some babies fuss more on their backs at first—that may be because they feel less cozy and secure, since they can’t cuddle up against the mattress. They may startle during sleep more on their backs, too, and that can lead to more frequent wake-ups (click here for more on startling). Swaddling your little one for sleep (or putting her in a sleep sack) will help ease startling and help make her more comfy—and content—on her back.

The incidence of SIDS is highest in the first 6 months, although the recommendation of “back to sleep” applies for the whole first year (and applies no matter who’s putting baby to sleep, so make sure anyone who cares for your baby follows this recommendation). Once baby starts rolling over, however, she may decide that she prefers a tummy position for sleep—still, continue to put your baby down on her back and let her decide about flipping.

And don’t forget the flip side of back to sleep: tummy to play. Click here for more.

Flat Out, the Best Way to Sleep

With all the significant health and safety benefits of back-to-sleep come a couple of relatively minor drawbacks. One—that newborns sleep less cozily on their backs—can be minimized by swaddling, which will keep your baby bug snug and secure in a back-sleeping position. Another—that babies who sleep on their backs are more likely to develop flat or bald spots from always facing the same direction—can be prevented with a flip. Alternate your infant’s position for sleep (head at one end of the crib one night, the other the next). Because babies tend to focus on the same spot in a room (say, a window) when they’re on their backs, flipping their position will ensure that one side of the head won’t get all the pressure—and that will make flattening or balding on that side less likely. If, in spite of your efforts, your baby’s head flattens or a bald spot develops, don’t worry—chances are these problems will go away on their own. Rarely a special headband or helmet will be prescribed to correct a severe case.

Putting baby on her tummy to play when she’s awake (and watched) will minimize flattening while allowing her to develop muscles and practice gross-motor skills.

Safe Sleeping

The safest way to place your baby down to sleep is on his or her back. Babies placed on their stomachs to sleep are at greater risk of SIDS. But safe sleeping is about more than just sleeping position. It’s also about where your baby sleeps and what’s in the crib or bassinet with him or her. Bottom line: Never place baby on soft bedding (firm mattresses only, with no “pillow-top”), or in a crib (or parents’ bed) with pillows, comforters or fluffy blankets, bumpers, or stuffed animals because of the risk of suffocation. Also especially unsafe for sleep: beanbag chairs, waterbeds, gliders, recliners, armchairs, and sofas—anything upholstered. And the best place for baby to sleep in the early months? In your room, next to your bed—in his or her own crib or bassinet. Click here for more on SIDS and safe sleeping.

Is Silence Golden When Baby Is Sleeping?

Should silence rule when baby is sleeping? Should you tiptoe around the house when he’s snoozing? Put your phone to vibrate when she’s napping? Ask visitors to knock on the door instead of use the doorbell? Go full-on librarian, shushing the dog and anyone who tries to speak above a whisper?

Maybe not. These typical techniques for keeping a sleeping baby sleeping might work in the short term, but may backfire in the long term—when you discover that your little one can’t sleep in the real world, a world where phones and doorbells ring and dogs bark. Plus, it may not be necessary—or even productive.

Just how much noise, and what kinds of noise, a newborn can sleep through depends partly on the sounds he or she became accustomed to before birth (say, that barking dog) and partly on individual temperament. Some babies are much more sensitive to stimulus than others, but others can’t sleep without some background noise (after all, the uterus your little one is used to was a pretty noisy place). So take cues from your baby in figuring out how far you must go to protect him or her from noise during naps and at night. If a baby turns out to be especially sound-sensitive during sleep, it’s probably wise to silence the phone, to change the doorbell to a less shrill ring, and to turn down the volume around the house. Avoid these tactics, however, if baby sleeps through everything.

No Sleeping Pattern

“My baby wakes up several times a night to feed, and I’m exhausted. Shouldn’t she be getting into a regular sleeping pattern by now?”

As much as you and your aching body (and dark-circled under-eyes) would love a full night’s sleep, you’ll have to wait a little longer before you can clock one in. Babies aren’t expected to sleep through the night in the first month, for a couple of reasons. One, with so much growing to do—and such a small tank to fuel up with—most still need at least one (and usually more) feeds to get them through the night. This holds especially true for breastfed newborns, who need frequent feeds even at night—making sleeping through the night an impossible dream for the first 3 months or so. Weight plays a role, too—a small baby will need to feed more often than a large one, and will continue to need during-the-night feeds until she catches up in the pounds department. Trying to start a sleep schedule too soon could not only interfere with the establishment of a mom’s milk supply, but also affect baby’s growth. Another reason for answering your baby’s midnight (and 3 a.m.) calls, whether she’s breastfed or bottlefed, small or large: She is just beginning to learn about the world, which is still a new and somewhat scary place. The most important lesson she needs to learn now isn’t how to sleep on a schedule, but that when she cries, you’ll be there to comfort her—even in the middle of the night, when you’re understandably beyond beat, and even when she’s up for the fourth time in 6 hours.

Though you may find it hard to believe right now, your little one will one day sleep through the night—and so will you.

Better Sleep for Baby

Any sleep sound good to you right now (preferably at night)? You can optimize your baby’s sleep potential (and thus, yours) with these soothing sleep strategies, many of which re-create some of the comforts of home in the womb:

Keep it cozy. The wide open spaces of a crib can be an unsettling setting, making your tiny newborn feel isolated, vulnerable, and far removed from the cozy confines of mommy’s womb. So consider putting your baby to sleep in a snugger space that better approximates the uterine home just left behind—a cradle, a bassinet, or a play yard that has a bassinet top. For added coziness, swaddle your infant or use a sleep sack.

Control for temperature. After 9 months of perfect climate control, being too warm or too cold can disturb a baby’s sleep (and overheating can be a risk factor for SIDS). So keep baby and the room temperature just right (touch the nape of baby’s neck to check on comfort).

Rock-a-bye, baby. In the uterus, your baby was most active when you were resting—when you were up and on the go, your baby slowed down, lulled by the motion. Out of the womb, movement still has a soothing effect. Rocking, swaying, and patting will help get your baby to sleep. A vibrating pad that can be slipped under the crib mattress can continue the rocking motion once you’ve put your baby down.

Sound it out. The uterus is a noisier place than you’d think. For months, your baby slept to the sound of your heartbeat, the gurgling of your tummy, and the ambient sound of your voice—which can make sleeping without some background noise tricky now. So try the hum of a fan or a white noise machine, the soft strains of baby-friendly tunes from a musical mobile or app, or one of those baby soothers that imitate uterine or heartbeat sounds.

Wait out those whimpers. Research suggests that a parent’s proximity during baby’s sleep may reduce the risk of SIDS—which is why experts recommend room sharing for the first 6 to 12 months. The only downside with this arrangement: You’ll be more likely to pick up your baby at the slightest stirring. For better sleep all around, wait out those whimpers and pick your little one up only once it’s clear he or she is awake and ready for a feed or attention.

Make bedtime routine. Since your newborn will fall asleep most of the time while nursing or bottle-feeding, a bedtime routine might seem unnecessary. But it’s never too early to get in the bedtime routine habit—and while you’re at it, a naptime routine, too. Later it can become more involved (and include a nightly bath—which isn’t necessary yet), but for now it can simply come as a series of predictable steps designed to unwind your little one: Dim the lights, speak in hushed tones, add a little soft music, cuddle quietly, give a gentle massage, maybe even read a story. The breast or bottle can be last on the agenda for babies who still fall asleep that way, but can come earlier for those who have already learned to doze off on their own.

Don’t nix naps. Some parents try to solve nighttime sleeping problems by keeping their babies awake during the day, even if the baby wants to sleep. The problem with this strategy: Overtired babies sleep more fitfully than well-rested ones. It’s fine to limit the length of daytime naps if your little one is still mixing up days and nights—but don’t nix those much-needed naps altogether.

See the light of day. Infants exposed to afternoon sunlight tend to have a better night’s sleep, so try an after-lunch stroll.

Know when to quit the crutches. For now, as your newborn adjusts to sleep on the outside (instead of snuggled in your cozy womb), a little extra comfort—in the form of soothing motion, white noise, or music—can go a long way in encouraging better sleep. Just be ready to wean baby off these comforting sleep crutches later in the first year (usually by about 6 months or so).

Restless Sleep

“Our baby seems so restless and noisy when he sleeps. Is there a way to get him to sleep more soundly?”

Sleeping “like a baby” sounds pretty peaceful—but the truth is, baby sleep rarely is. While newborns do sleep a lot (16 hours a day on average), they also wake up a lot in the process. That’s because much of their sleep is REM (rapid eye movement), a light, active sleep phase with dreaming, a lot of restless movement, and sometimes startling—and for babies, a lot of noise. When you hear your baby fuss or whimper at night, it’s probably because he’s finishing a REM period.

As he gets older, your baby’s sleeping patterns will mature. He will have less REM sleep and longer periods of the much sounder, deeper “quiet sleep,” from which it’s harder to wake him. He will continue to stir and whimper periodically, but less frequently.

In the meantime, if you’re sharing a room with your noisy little sleeper (as recommended by AAP for SIDS prevention), keep in mind that picking him up at every midnight murmuring will disrupt his sleep (and yours). Instead, wait until you’re sure he’s awake and ready for a feed or comfort—a steady cry will clue you in.

Mixing Up of Day and Night

“My 3-week-old sleeps most of the day and wants to stay up all night. How can I get her to reverse her schedule so we all can get some rest?”

Got a little baby vampire on your hands—partying all night, sleeping all day? That’s not surprising, given that just 3 weeks ago, your baby lived in the dark round the clock. It was also in your womb that she became accustomed to snoozing the day away (since that’s when you were most active, knocking her out with rocking)—and kicking her heels up at night, when you were lying down, trying to rest. Happily, her nocturnal ways are only temporary, and as she adjusts to life on the outside, she’ll stop mixing up her days and nights—likely on her own, probably within the next few weeks if not sooner.

If you’d like to help speed her realization that nighttime is the preferred sleep time (not the preferred party time), a little gentle persuasion may do the trick. Start by limiting her daytime naps to no more than 3 or 4 hours each. Although waking a sleeping infant can be tricky, it’s usually possible. Try changing her diaper, holding her upright, burping her, rubbing under her chin, or massaging her feet. Once she’s somewhat alert, try a little interaction to stimulate her: Talk to her, sing lively songs, or dangle a toy within her range of vision, which is about 8 to 12 inches. (For other tips on keeping baby awake, click here) Don’t, however, try to keep her from napping at all during the day, with the hope that she’ll sleep at night. An overtired, and perhaps overstimulated, baby is not likely to sleep well at night.

Making a clear distinction between day and night may help, too. Wherever she naps, avoid darkening the room or trying to keep the noise level down. When she wakens, ply her with stimulating activities. At night, do the opposite. When you put baby to bed, strive for darkness (use room-darkening shades), relative quiet, and inactivity. No matter how tempting it may be, don’t play with or do a lot of socializing when she wakes up during the night, don’t turn on the lights or the TV while you’re feeding her, avoid unnecessary diaper changes, and keep communications to a whisper or softly sung lullabies.

Baby’s Breathing

“Every time I watch my newborn sleep, her breathing seems irregular, her chest moves in a funny way, and frankly it frightens me. Is something wrong with her breathing?”

Not only is that kind of breathing during baby sleep normal, but so are you for worrying about it (that’s what new parents do).

A newborn’s normal breathing rate is about 40 breaths each minute during waking hours, but when your sweetie sleeps, it may slow down to as few as 20 breaths per minute. Her breathing pattern during sleep is also irregular, and that’s normal (if stress-inducing to you). Your baby might breathe fast, with repeated rapid and shallow breaths, lasting 15 to 20 seconds, and then pause (that is, stop breathing—and this is where it gets really scary), usually for less than 10 seconds (though it might seem forever to you), and then, after that brief respiratory respite, breathe again (which is generally when you can start breathing again, too). This type of breathing pattern, called periodic breathing, is standard during sleep for babies, and is due to your baby’s immature (but, for her age, developmentally appropriate) breathing control center in the brain.

You may also notice your baby’s chest moving in and out while she is sleeping. Babies normally use their diaphragms (the large muscle below the lungs) for breathing. As long as your baby doesn’t seem to be working hard to breathe, shows no blueness around the lips, and resumes normal shallow breathing without any intervention, you have nothing to worry about.

Half of a newborn’s sleep is spent in REM (rapid eye movement) sleep, a time when she breathes irregularly, grunts and snorts, and twitches a lot—you can even see her eyes moving under the lids. The rest of her slumber is spent in quiet sleep, when she breathes very deeply and quietly and seems very still, except for occasional sucking motions or startling. As she gets older, she will experience less REM sleep, and the quiet sleep will become more like the non-REM sleep of adults.

In other words, what you’re describing is normal baby breathing. If, however, your baby takes more than 60 breaths per minute, flares her nose, makes grunting noises, looks blue, or sucks in the muscles between the ribs with each breath so that her ribs stick out, call the doctor immediately.

“Everybody always jokes about parents standing over their baby’s crib to hear if he’s breathing. Well, now I find myself doing just that—even in the middle of the night.”

Anew parent standing over a baby’s crib checking for breathing does seem like good stand-up material—until you become a new parent yourself. And then it’s no laughing matter. You wake in a cold sweat to complete silence after putting baby to bed 5 hours earlier. Could something be wrong? Why didn’t he wake up? Or you pass his crib and he seems so silent and still that you have to poke him gingerly to be sure he’s okay. Or he’s breathing so hard, you’re sure he’s having trouble breathing. You … and all the other new parents.

Not only are your concerns normal, but your baby’s varied breathing patterns when he snoozes are, too. It’ll probably take a while, but eventually you will become less panicky about whether he’s going to wake up in the morning—and more comfortable with both you and him sleeping 8 hours at a stretch.

Still, you may never totally be able to abandon the habit of checking on your child’s breathing (at least once in a while) until he’s off to college and sleeping in a dorm—out of sight, though not out of mind.

Wondering if those breathing monitors—the ones that clip on to your baby’s diaper or slip under the mattress and then sound an alarm when there’s been no movement for 20 seconds—will bring the peace of mind you’re looking for? They might—and many parents are able to sleep more soundly thanks to the security of knowing their sweet sleeper’s breathing is being monitored. But before you shell out the big bucks for these devices, keep in mind that the number of false alarms they give may actually cause more anxiety than they are supposed to prevent, and many parents, fed up with the repeated false alarms, end up switching the devices off altogether. What’s more, there’s no evidence that these monitors prevent SIDS.

Moving a Sleeping Baby to a Crib

“Every time I try to put my sleeping baby down in her crib, she wakes up.”

She’s finally asleep after what seems like hours of nursing on sore breasts, rocking in aching arms, lullabying in an increasingly hoarse voice. You edge cautiously to the crib, holding your breath and moving only the muscles that are absolutely necessary. Then, with a silent but fervent prayer, you lift her over the edge of the crib and begin the perilous descent to the mattress below. Finally, you release her, but a split second too soon. She’s down—then she’s up. Turning her head from side to side, sniffing and whimpering softly, then sobbing loudly. Ready to cry yourself, you pick her up and start all over.

If you’re having trouble keeping a good baby down, wait 10 minutes until she’s in a deep sleep in your arms, then try:

A high mattress. You’ll find it much easier to place your baby in her crib if you set the mattress at the highest possible level (at least 4 inches from the top of the rail). Just be sure to lower it by the time your baby is old enough to sit up. Or start out using a bassinet or cradle or a play yard with a bassinet insert, which may be easier to lift a baby into and out of.

Close quarters. The longer the distance between the place where baby falls asleep and the place where you are going to put her down, the more opportunity for her to awaken on the way. So feed or rock her as close to the cradle or crib as possible.

A seat you can get out of. Always feed or rock your baby in a chair or sofa that you can rise from smoothly, without disturbing her.

The right side. Or the left. Feed or rock baby in whichever arm will allow you to put her in the crib most easily. If she falls asleep prematurely on the wrong arm, gently switch sides and rock or feed some more before attempting to put her down.

Constant contact. When baby is comfortable and secure in your arms, suddenly being dropped into the open space of a mattress can be startling—and result in a rude awakening. So cradle baby all the way down, back first, easing your bottom hand out from under just before you reach the mattress. Maintain a hands-on pose for a few moments longer, gently patting if she starts to stir.

A lulling tune. Hypnotize your baby to sleep with a traditional lullaby (she won’t object if you’re off-key or don’t actually know all the words) or an improvised one with a monotonous beat (“aah, aah, ba-by, aah, aah, ba-by”) or with a few rounds of “shh.” Continue as you carry her to her crib, while you’re putting her down, and for a few moments afterward. If she begins to toss, sing some more, until she’s fully quieted.

A rock till she drops off to dreamland. One of the benefits of a rockable cradle or bassinet—you can continue that soothing rocking once she’s down for the count. Another option: a vibrating mattress pad designed to be slipped under the crib mattress that runs for a half hour or so—long enough, hopefully, for your sweet little one to fall deeply to sleep.

Babies Are Supposed to Cry

Some cry more than others, but all newborns cry—and they’re supposed to. After all, that’s how babies make sure they get their needs met (think of it as survival of the loudest). So a baby who’s not doing much crying at all—who seems content most of the time, whether or not those needs are being met—may be telling you something else entirely: that he or she is not strong or healthy enough to cry. If your baby is doing very little crying after the first couple of days of life—especially if he or she isn’t demanding the most basic of needs, regular feeds—check in with the doctor without delay. You may just have a very laid-back little one on your hands (and in that case you’ll have to stay on top of those needs even if he or she doesn’t demand them), or your baby may not be thriving, in which case getting the right medical attention is vital.

Putting Crying on Hold

It’s a credo for newborn crying: When your baby cries, you come running. But what if baby cries when you’re in the middle of rinsing shampoo out of your hair … or draining boiling water from a pot of pasta … or unclogging the toilet that’s about to overflow … or finishing a text to your boss … or finishing, um, a little business in the bedroom? Do you need to drop everything to pick up your crying baby? Of course not—letting a baby cry for a minute or 2 or even 5 every now and then isn’t harmful, as long as he or she can’t get into trouble while waiting for you, and especially if your usual response time is prompt.

Even taking a 10- to 15-minute break during a particularly trying crying marathon won’t hurt—and it might help both of you get through this challenging phase of babyhood. In fact, some experts suggest building those breaks in if you’re dealing with a particularly tough case of colic: setting up a routine in which you let baby cry for those short intervals in a safe place like the crib, picking him or her up and trying to comfort for another 15 minutes, then putting him or her down and repeating. Clearly, don’t try this if it seems to make the colic worse or if it’s something you just don’t feel comfortable doing.

Crying

“I know babies are supposed to cry—but ever since we came home from the hospital with our baby, she’s been crying. A lot.”

Most parents do a fair amount of high-fiving at the hospital—pretty certain that they scored the one baby on the block who hardly cries. But that’s because few babies do a whole lot of crying in their first hours of life, when they’re still catching up on their rest and recovering after delivery. Fast-forward a couple of days—usually right about the time that parents bring their bundle of joy home—and baby usually changes her tune. And that’s not surprising. Crying is, after all, the only way infants have of communicating their needs and feelings—their very first baby talk. Your baby can’t tell you that she’s lonely, hungry, wet, tired, uncomfortable, too warm, too cold, or frustrated any other way. And though it may seem impossible now, you will soon be able (at least part of the time) to decode your baby’s different cries and know what she’s crying for (click here).

Some newborn crying, however, seems entirely unrelated to basic needs. In fact, 80 to 90 percent of all babies have daily crying sessions of 15 minutes to an hour that are not easily explained—or decoded. These periodic crying spells, like those associated with colic, a more severe and persistent form of unexplained crying, most often occur in the evening. It may be that this is the most hectic and stressful time of day in the home—everybody’s tired, everybody’s hungry (and mom’s milk supply may be at its lowest level of the day), everybody’s done, done, done and that goes for baby, too. Or it may be that after a busy day of taking in and processing all the sights, sounds, smells, and other stimuli in her environment, a baby just needs to unwind with a good cry. Crying for a few minutes may even help her nod off to sleep.

Hang in there. As your baby becomes a more effective communicator—and as you become more proficient at understanding her—she will cry less often, for shorter periods, and will be more easily comforted when she does cry. Meanwhile, even if your baby’s crying doesn’t seem to reach colicky proportions (and fingers crossed, it won’t), the same strategies that help with colic may help restore calm—see the next question.

You Can’t Spoil a Newborn

Worried about spoiling your newborn by always responding so quickly to those cries? Don’t be—it isn’t possible to spoil a baby in the first 6 months. Responding promptly to crying won’t make your baby more demanding—in fact, quite the opposite is true. The faster your newborn’s needs are met, the more likely he or she is to grow into a more secure, less demanding child.

Colic

“I’m almost afraid to consider that our baby has colic—but with all this crying, I can’t imagine what else it might be. How do I know for sure he’s colicky?”

Call it colic, call it extreme crying … call it miserable. And, call it common, too, because if misery loves company, parents of colicky babies have quite a pity party going on. It’s estimated that 1 in 5 babies have crying spells, usually beginning in late afternoon and sometimes lasting until bedtime, that are severe enough to be labeled colic. Colic differs from ordinary crying (see previous question) in that baby seems inconsolable, crying turns to screaming, and the ordeal lasts for 3 hours, sometimes much longer, occasionally nearly round-the-clock. Most often colicky periods recur daily, though some babies take an occasional night off.

Doctors usually diagnose colic based on the “rules of three”: at least 3 hours of crying, at least 3 days a week, lasting for at least 3 weeks—but of course, some babies are colic over-achievers, crying far more hours and days and weeks. The baby with a textbook case of colic pulls his knees up, clenches his fists, and generally moves his legs and arms more. He closes his eyes tightly or opens them wide, furrows his brow, even holds his breath briefly. Bowel activity increases, and he passes gas. Eating and sleeping are disrupted by the crying—baby frantically seeks a nipple only to reject it once sucking has begun, or dozes for a few moments only to wake up screaming. But few infants follow the textbook description exactly—different babies do colic differently, and sometimes the same babies do colic differently on different days.

Colic generally begins during the second or third week of life (later in preterm infants), and usually gets as bad as it’s going to get by 6 weeks. Though colic may feel as though it will never end, it will typically start to taper off at 10 to 12 weeks (light at the end of the tunnel!). By 3 months (later in preterm babies), most colicky infants seem to be miraculously cured—with just a few continuing their problem crying through the fourth or fifth month or (shudder) beyond. The colic may stop suddenly—or end gradually, with some good and some bad days, until they are all good.

Though these daily screaming sessions, whether they’re marathons or shorter sprints, are usually called “colic,” the word is really just a catchall term for problem crying—the problem being, there’s no solution to it besides the passing of time. There isn’t a clear definition of exactly what colic is or how (and if) it differs from other types of extreme crying. But when it comes down to it—do definitions and differences really matter when your baby’s crying for hours on end, and you’re powerless to calm him down? Realistically, probably … not so much.

What might help—at least a little—is to know that colic isn’t your fault, or anyone else’s fault. While the exact causes of colic remain a mystery, what experts do know is that it isn’t the result of genetics, anything that happened during pregnancy or childbirth, or parenting skills (or lack of them, in case you’re wondering). Here are some theories of what’s behind all that crying:

Overload. Newborns have a built-in mechanism for tuning out the sights and sounds around them, which allows them to eat and sleep without being disturbed by their environment. Near the end of the first month that mechanism disappears, leaving babies (and their brand new senses) more vulnerable to the stimuli in their surroundings. With so many sensations coming at them, some infants become overwhelmed, often (not surprisingly) at the end of the day. To release that stress, they cry—and cry and cry. Colic ends when the baby learns how to selectively filter out some environmental stimuli and in doing so, avoid a sensory overload. If you think this might be the cause of your baby’s colic, the try-everything approach (rocking, bouncing, driving, swinging, singing) may actually make things worse. Instead, watch how your baby responds to certain stimuli and steer clear of the offending ones (if baby cries harder when you rub or massage him, limit that kind of touching during colic—instead, try wearing your baby or using a swing once he’s old enough).

Immature digestion. Digesting food is a pretty demanding job for a baby’s brand new gastrointestinal system. As a result, food may pass through too quickly and not break down completely, resulting in pain when gas is passed. When gas seems to be pulling the colic trigger, there are medications that may help (see box). When it’s the type of formula that might be the culprit, a change (in consultation with the pediatrician) to one that is more easily tolerated or digested may be in order. Much less likely, it could be something in a breastfeeding mom’s diet that’s triggering the colic. To find out if that’s the case, you can try eliminating common offenders in your diet (caffeine, dairy, cabbage, broccoli) to see if that makes a difference over a couple of weeks.

The colic hold puts comforting pressure on a newborn’s gassy tummy.

Reflux. Research has found reflux may sometimes trigger the excessive crying of colic. Reflux irritates the esophagus (much like heartburn in an adult), causing discomfort and crying. If reflux seems to be the cause of the colic in your baby, some of the treatment tips here may help.

Exposure to smoking. Several studies show that moms who smoke during or after pregnancy are more likely to have babies with colic. Secondhand smoke may also be a culprit. Though the link exists, it is unclear how cigarette smoke might cause colic. (The bottom line for loads of more significant health reasons: Don’t smoke or let anyone else smoke around the baby.)

What’s reassuring about colic (besides that it doesn’t last forever) is that babies who have these crying spells don’t seem to be any the worse for wear … though the same can’t always be said for their parents. Colicky babies thrive, usually gaining as well as or better than babies who cry very little, and are no more likely to have behavioral problems than other children later on. They’re often more alert as babies (which is probably part of their problem, since they take in more of the kind of stimuli that ends up overwhelming them), and better problem solvers as toddlers. Looking for a solution for this problem? There really isn’t one—besides the passing of time—but in the meantime, check out the strategies for dealing with colic on the pages that follow.

For Parents: Surviving Colic

There’s no question that parents get the worst of colic. Though it can safely be said that even hours and hours of daily crying doesn’t seem to hurt a baby, it certainly does leave its mark on mom and dad. Listening to a baby’s screams is irritating and anxiety-provoking (yes, even when you love that baby with all your heart). Objective studies show that it’s linked to a rise in blood pressure, a speeding up of the heartbeat, and changes in blood flow to the skin—in other words, it can take a physical and emotional toll. To cope with colicky crying that just won’t quit, try the following:

Break it up. If you’re the one who’s been left holding the crying baby 7 nights a week at colic time, the strain is bound to wear on you, your health, and your relationships with your baby and with others. If there are two parents at home during baby witching hours, make sure colic duty is divided up equally between the two of you (an hour on, an hour off, a night on, a night off, or whatever arrangement you find works best). A fresh set of arms (and a different rocking rhythm, and a different singing voice) sometimes induces calm in a crying baby, which may make switching off frequently your best bet.

Then, try to make sure you take an occasional break together. If you can find a babysitter or a family member who’s patient and experienced with crying babies, go out for dinner (even if you’re breastfeeding, you should be able to squeeze in a meal), hit the gym, or just take a long, quiet walk.

If you’re the only parent in the house either all or some of the time (or as often happens, all of the colic time), you’ll need to call on help even more often—coping with a crying infant for hours a day every day is a lot for any one person to handle. No help in sight? Keep reading.

Take a break. Sure, it’s important to respond to crying, which is an infant’s only way of communicating. But every once in a while, it doesn’t hurt to give yourself a break from your baby—and your baby a break from you. Try the strategy described in this box, and use those 10 or 15 minutes to do something relatively relaxing: Do a few yoga poses, watch a little TV, listen to some music. Hopefully, you’ll be a little less ragged and a little more refreshed when you pick up baby again for round two (or three, or four)—and that will do you both some good.

Tune out. To lessen the effect of your baby’s wails, use earplugs or noise-canceling headphones—they won’t block out the sound entirely, just dull it so it won’t be so wearing. Or tune in to some iTunes—the music will not only soothe you (and if you’re lucky, baby), it’ll also give you a rhythm to move to.

Get physical. Exercise is a great way to work off tension, something a crying baby will give you plenty of. Work out at home with baby early in the day, head to the gym that has child-care services, or take the baby for a brisk walk outdoors when fussy hour hits—it may help calm you both. And always keep a stress ball nearby, for times when you need to knead.

Talk about it. Do a little crying yourself—on any willing shoulder: your spouse’s, the pediatrician’s, a family member’s, a friend’s. Or vent on social media. Talking about the colic won’t cure it, but you may feel a little better after sharing—especially if you share with others in the same rocky boat (or who’ve been in the same boat—and weathered the storm). Just knowing you’re not alone in the world of inconsolable babies can make a world of difference.

If you really feel violent, get help. Almost everyone finds a constantly crying baby hard to take, sometimes even hard to love—and that’s completely normal (you’re only human, just like your baby). But for some, endless crying becomes more than they can cope with. The result is sometimes child abuse. You may be even more likely to cross that line if you’re suffering from untreated (and possibly undiagnosed) postpartum depression. If your thoughts of hurting your baby are more than fleeting, if you feel like you’re about to give in to the urge to hit or shake your baby or harm him or her in any way, get help immediately. Put your baby in a safe place and get on the phone right away with your spouse, a friend or relative, the doctor, or someone else who can help you. Or bring your baby over to a neighbor’s house and ask for help. Even if your powerful feelings don’t lead to child abuse, they can start eroding your relationship with your baby and your confidence in yourself as a parent unless you get counseling (and if you’re suffering from postpartum depression or psychosis, appropriate treatment) quickly. Don’t wait it out—get the help you need now.

Prescription for Colic

Looking for a colic cure you can count on while you’re counting the days until your cute little crier has crossed the 3-month threshold—hopefully leaving colic behind? Unfortunately, there are no prescriptions or potions—traditional or homeopathic or complementary and alternative—that are guaranteed to stop the crying. There are, however, a few that doctors sometimes suggest—if only to offer parents desperate for “anything.” In most cases the evidence that they work doesn’t add up, and if parents see an improvement, it’s most likely because babies with colic improve after a few months anyway. Here are some treatments that have plenty of anecdotal evidence, but not much in the way of science, to back them up:

Antigas drops. Colicky babies are often extra gassy (whether they’re gassy because they’re crying or they’re crying because they’re gassy—or both—isn’t clear), and studies show that reducing the gas may reduce the discomfort (and the crying). So, simethicone drops, the same antigas ingredient found in many adult preparations (formulated for babies under such brand names as Mylicon and Phazyme), are often recommended for relief. Two trials comparing crying duration, however, found no difference between babies treated with simethicone drops and those not treated. Ask the doctor whether these drops might help relieve your baby’s symptoms.

Probiotics. Something else to ask the doctor about: probiotic drops, which may reduce crying in some colicky babies, probably because they can ease tummy troubles. Again, research has yet to consistently back this up.

Gripe water. In the category of “little evidence, lots of anecdotes,” gripe water, a combination of herbs and sodium bicarbonate in drops, is touted for its baby-soothing benefits. Anecdotally, many parents swear by gripe water, but no reliable studies have shown its effectiveness in reducing colic symptoms. Check with your baby’s doctor for a recommendation.

Chiropractic. The theory behind this treatment is that when a baby’s spine is misaligned, it can lead to digestive issues and discomfort. Gentle manipulation of the spine is supposed to remedy this, though the clinical evidence hasn’t backed that up. Plus, some doctors say chiropractic on infants isn’t safe—so definitely get the pediatrician’s advice (and a referral to a qualified practitioner) before booking this kind of treatment.

Herbs. Herbal remedies, such as fennel extract, or herbal tea (chamomile, licorice, fennel, balm mint, and so on), given by dropper, may be somewhat effective in relieving symptoms of colicky babies, but not significantly, according to studies. Check with the pediatrician before using any herbal remedy.

Just remember, as desperate as you might be for a problem crying panacea, don’t give your baby any medication, herbal or otherwise, without talking to your baby’s doctor first. And really, the best prescription for colic isn’t treating the baby, but rather treating the parents—finding ways to relieve your stress from all that crying (see box) and reminding yourself that colic isn’t harmful to your baby—and that it will pass (promise!).

For Parents: Helping Siblings Live with Colic

So, let’s recap the last few weeks as it appears to your older (but still very young) child. First, mommy disappears for a couple of days and then returns (super tired and achy) with her arms full of a strange little bundle that’s too small to play with but apparently not too small to take up everyone’s lap and attention … or to be gifted with a steady stream of toys. The baby cries a lot, and just when it seems like there’s no way anything could possibly cry any more or any louder, this red-faced creature starts to cry even more and even louder. Screaming, shrieking, howling for hours on end—not to mention, during the hours of the day that were always big sib’s favorite: dinner with mommy and daddy, bath and story time, cuddles. All of which seem to have gone out the window suddenly (and big sib probably, by now, not-so-secretly wishes that baby would follow out the window). Instead of being a time for eating, sharing, and quiet play, early evening turns into a time of disrupted meals, frantic pacing and rocking, and distracted, irritable parents.

You can’t make colic easy on your older child any more than you can make it easy on yourself (in fact, it’s bound to be a little harder, since your firstborn can’t grasp that colic is a “phase”). But you can help ease the toll little sib colic can take if you:

Show and tell. Explain, on your older child’s level, what colic is—that it’s baby’s way of getting used to being in a new and strange world, which can be a little scary at first. Reassure him or her that most of the crying will stop once the baby learns more about the world and figures out other ways of saying, “I’m hungry,” “I’m tired,” “My tummy hurts,” “I need a cuddle,” “I’m scared.” Show the brand new big sib a photo of himself or herself crying as a newborn, and then as a smiling older baby and toddler—this might help illustrate that there’s hope for this newborn.

Play the no-blame game. Little children tend to blame themselves for everything that goes wrong in a home, from mommy and daddy’s arguing to a new baby’s crying. Explain that all this crying is nobody’s fault—that all babies cry when they’re new.

Load up on love. Dealing with a colicky baby can be so distracting—especially in the context of an already busy day—that you may forget to do those special little things that show a toddler or older child you care. Even during the worst of the storm, make sure you break from the pacing and rocking occasionally to give your older son or daughter a reassuring hug. If baby is soothed by walks outdoors, put the little crier in a carrier and take a stroll with your older child–or head to the playground (you can push the swing wearing a sling). The new baby will be lulled, and your older child will feel loved.

Divide the baby, conquer the sibling rivalry. When both parents are home, try taking turns walking the floor with the baby during colic marathons, so that your older child is usually getting the attention of at least one parent. Another option: One parent can take baby out for a ride in the stroller or the car (the motion often helps subdue the colic) while the other parent spends some quality quiet time at home with your older son or daughter. Or one of you can take your big kid out to dinner (for pizza with a side of peace and quiet) or, if it’s still light out, for an early evening excursion to the playground while the other toughs it out at home with The Screamer.

Put baby on mute. Okay … you can’t mute your little crier, but you can help muffle baby’s wails so big bro or sis can catch a break from the constant background crying. Gift your older child with soundproofing earmuffs and set him or her up with a book to look at, crayons to scribble with, play clay to pound on. Or let your big kid listen to an audiobook with low volume headphones that dampen the sound of baby’s cries. Or let your older child listen to music with headphones in another room (again, keep the volume low so as not to damage your big kid’s ears) to help drown out baby’s howling.

Preserve the rituals. Routines are comforting to young children, and when they’re disrupted, it can be enormously unsettling—especially during times when life is more unsettled than usual (as when there’s a new, crying baby in the house). Do your best to make sure your older son or daughter’s treasured rituals don’t fall victim to your baby’s colic. If bedtime has always meant a leisurely bath (complete with bubbles and splashing), a cuddlefest, and two stories, strive for a leisurely bath, cuddlefest, and two stories every night, even when colic’s in full swing. Dividing the colic duty will, hopefully, make those routines possible more often than not.

Go one-on-one. Even if it’s only half an hour a day—maybe during your newborn’s best nap of the day, probably before daily colic kicks in—try to schedule some special one-on-one time to spend with your older child, without screeching baby sibling tagging along. Play teddy bear picnic, bake muffins, paint a mural (on an extra-large piece of paper), put together a puzzle, start an egg carton garden. Have other stuff to do while you have a chance? Chances are, there’s nothing more important.

Coping with Crying

“My baby just won’t stop crying … and I need help helping her (and me).”

There’s nothing more frustrating than trying to console an inconsolable baby—especially when you’ve been trying, trying, trying … and baby’s still crying, crying, crying. But the truth is, not all soothing strategies work on every baby, and few work on every baby every time—but chances are you’ll find at least a couple in the following list of tricks that will work on your baby some of the time. Just give each a fair shot before you switch to another (and don’t pull out too many tricks at one time, or you’ll overload baby’s circuits—and step up the crying you’re trying to stop):

Respond. Of course you know that responding to your baby’s cries is important—but put yourself in her little booties for a moment, and you’ll see just how important. Crying is a baby’s only way of communicating her needs—but it’s also her only way of wielding any control at all over a vast and bewildering new environment: She cries, you come running to her side—powerful stuff when you’re otherwise completely powerless. Though it may sometimes seem the definition of pointless in the short term (you come, she still cries), responding promptly to your baby’s cries will, studies show, reduce her crying in the long run. In fact, babies whose parents responded to them regularly and promptly in infancy cry less as toddlers. What’s more, crying that’s been left to intensify for more than a few minutes becomes harder to interpret—the baby becomes so upset, even she doesn’t remember what started all the fuss in the first place. And often, the longer baby cries, the longer it takes to stop the crying.

Assess the situation. Even a colicky baby who does a lot of unexplained crying can cry for a reason, too. So always check to see if there’s a simple and fixable cause for crying. The usual suspects: Your baby’s hungry, tired, bored, wet or poopy, too warm, or too cold, or needs food, a nap, some rocking, some attention, a change of position, a new diaper, to be swaddled.

Do a diet check. Be sure your baby isn’t always crying because she’s always hungry. Lack of adequate weight gain or signs of failure to thrive can clue you in. Increasing baby’s intake (pumping up your milk supply if you’re breastfeeding) may eliminate excessive crying. If baby is bottle-fed, ask the doctor whether the crying might be due to an allergy to her formula (though this isn’t very likely unless crying is accompanied by other signs of allergy). If you’re breastfeeding, consider doing a check of your own diet, since there’s the very slight possibility that the crying might be triggered by baby’s sensitivity to something you’re eating. Test more common culprits, like dairy, caffeine, or gas-producing vegetables like cabbage, by removing them one at a time from your diet and seeing if there’s an improvement in baby’s symptoms. You can add them back in one at a time to narrow down the culprit or culprits, if any.

Get close. In societies where babies are always worn or toted in carriers, there isn’t as much crying or fussiness. This traditional wisdom seems to translate well in our world, too. Research has shown that babies who are worn or carried for at least 3 hours every day cry less than babies who aren’t toted as often. Not only does wearing or carrying your baby give her the pleasure of physical closeness to you (and after 9 months of constant closeness, that may be just what baby’s crying for), but it may help you tune in better to baby’s needs.

Swaddle. Being tightly wrapped is very comforting to many newborns, especially during those fussy periods, since it offers the same warm, snug security they grew accustomed to in the womb. A few, however, intensely dislike swaddling. The only way you’ll know which holds true for your baby is to give swaddling a try the next time colic begins (click here).

Take a clue from kangaroos. Like swaddling, kangaroo care—cuddling your baby close to you, cocooned under your shirt or zipped into a sweatshirt skin-to-skin, heart-to-heart—gives many babies a sense of comforting security. Just keep in mind that, as with swaddling, some babies prefer more freedom of movement and will resist being held tightly.

Rhythmic rocking. Most babies find comfort (and calm) from being rocked, whether in your arms, a carriage, a vibrating or swaying infant seat, a baby swing (when baby’s old enough), or being worn while you walk or sway. Some babies respond better to fast rocking than to slow—but don’t rock or shake your baby forcefully, since this can cause serious whiplash injury. For some babies, rocking side to side tends to stimulate, rocking back and forth to calm. Test your baby’s response to different kinds of rocking.

A warm-water bath. A bath can soothe some babies—though bath-haters may just scream louder when they hit the water.

Soothing sounds. Even if your singing voice has a fingernails-on-the-black-board effect on others, your baby will probably love it … and be lulled by it. Learn whether your baby is soothed by soft lullabies, sprightly rhymes, or rock ballads or pop tunes, and whether a hushed, high-pitched, or deep voice is the ticket to calm. But don’t stop at singing. Many babies are calmed by other sounds as well—the hum of a fan, vacuum cleaner (you can wear your baby while you vacuum—combining motion with sound, and getting your floors clean at the same time), or clothes dryer (try leaning your back against the dryer while you’re wearing your baby to get a nice vibration with the machine’s purr). Also soothing: a repeated “shh” or “ahhhhh, ahhhhh,” a white noise machine, or an app that plays nature sounds—like the wind blowing through trees or waves breaking on the beach.

Massage. For babies who like to be stroked—and many do—massage can be very calming, especially if you give it while you’re lying on your back, baby on your chest. (Click here for tips on baby massage.) Experiment with light and firmer strokes to make sure you’re rubbing your baby the right way. Your baby’s not buying the massage? Don’t push the rub—some little ones are touch averse when they’re fussy.

Add a little pressure. On baby’s tummy, that is. The “colic carry” (see illustration) or any position that applies gentle pressure to baby’s abdomen (such as across your lap, with belly on one knee and head on the other), can relieve discomfort that might be contributing to the crying. Some babies prefer being upright on the shoulder, but again with pressure on their bellies while their backs are being patted or rubbed. Or try this gas reliever: Gently push baby’s knees up to his or her tummy and hold for 10 seconds, then release and gently straighten them. Repeat several times. Alternatively, you can bicycle baby’s legs gently to relieve any gas pain.

Satisfy with sucking. Sucking doesn’t always have to come with a meal—and in fact, newborns sometimes need to suck just for sucking’s sake. Using the breast or bottle to satisfy your baby’s need for extra sucking can lead to a cycle of too much feeding, too much gas, and too much crying. When your baby’s fussy but not hungry, try a pacifier (that’s why they call them soothies) or your pinkie. Or help your little one find her fist to suck on.

Comfort with consistency. Even babies who are too young for a schedule can be calmed by consistency—singing the same song, swaddling the same way, rocking at the same speed in the same direction, playing the same white noise sounds. Consistency is likely to pay off with soothing techniques, too. Once you find what works, stick with it most of the time, and try not to switch around too much from one strategy to the other during the same crying jag.

Get out of the house. Sometimes, just a change to an outdoor location will magically change a baby’s mood. Add motion, and you’ve got a really powerful soothing potion. So take your baby for a walk in the stroller or in a sling or carrier, or strap her into the car seat for a drive (but turn around and head home if the crying continues in the car—otherwise it could distract you from the road).

Control air. A lot of newborn discomfort is caused by swallowing air during feeds. Discomfort leads to crying—and crying leads to more swallowed air, a cycle that you definitely want to break when you can. Babies will swallow less air during feeds if they’re properly latched on during breastfeeding or slightly upright during bottle-feeding. The right-size nipple hole on a bottle will also reduce air intake. Be sure it isn’t too large (which promotes gulping of air with formula) or too small (struggling for formula also promotes air swallowing). Hold the bottle so that no air enters the nipple (or choose one that controls for air), and be sure to burp baby frequently during feedings to expel swallowed air. Sometimes a change of nipple or bottle can significantly reduce crying.

Start fresh. As new as your newborn is to the world, she’s wise beyond her days when it comes to picking up your feelings. If you’re struggling for hours to soothe your baby, you’re bound to be stressed out—and she’s bound to sense it and be stressed out by it. The result? More crying, of course. If you can, periodically hand baby off to another pair of loving arms so you can both get a stress break and a fresh start. Have no one to relieve you? Try putting your baby down in a safe place for a few minutes (see box).

Excise excitement. Having a new baby to show off can be fun—everyone wants to see the baby, and you want to take her everywhere to be seen. You also want to expose baby to new experiences in stimulating environments. That’s fine for some babies, too stimulating for others (particularly young ones). If your baby is colicky, limit excitement, visitors, and stimulation, especially in the late afternoon and early evening.

Check with the doctor. While the odds are that your baby’s daily screaming sessions are due to normal crying or colic, it’s a good idea to talk the situation over with the doctor—if only to get some reassurance and maybe a few extra soothing strategies. Describing the crying (its duration, intensity, pattern, any variation from the norm, and any accompanying symptoms) will also help the doctor rule out any underlying medical condition (like reflux or a with your older child—or head to the playground (you can push the swing wearing a sling). The new baby will be lulled, and your older child will feel loved.

Wait it out. Sometimes nothing relieves colic but the passing of time. And while that time may seem to stretch on forever—especially if your baby’s colic is a daily struggle—it may help to remind yourself (over and over and over again): This, too, shall pass—usually by the time baby’s 3 months old.

Pacifier

“My baby has crying jags in the afternoon. Should I give him a pacifier to comfort him?”

It’s easy, it’s quick, and for many babies it turns on the comfort and turns off the tears more reliably than a dozen hoarse choruses of “Rock-a-Bye Baby.” There’s no denying a pacifier can work remarkably well at comforting your baby and calming his crying (especially if he has a strong need to suck but hasn’t yet figured out how to get his fingers in his mouth). But should you pop that binky into your baby’s mouth at the first whimper? Here’s a look at some pacifier pros and cons:

Pros

• A pacifier could save your baby’s life. Talk about a powerful positive: Research has linked pacifier use to a decreased risk of SIDS. Experts believe that babies who suck on pacifiers may not sleep as deeply and wake more easily than babies who don’t, making them less susceptible to SIDS. Another theory is that sucking on a pacifier might help open up air space around a baby’s mouth and nose, which ensures he gets enough oxygen. Because of the reduced SIDS risk, the AAP suggests that pacifiers be used for babies under age 1 at naptime and bedtime (assuming your baby will take one—not all babies will).

• The pacifier is in the parent’s control. That can be a good thing when nothing but plunking that pacifier in your baby’s mouth will generate calm. Plus, unlike the thumb, which is in baby’s control, when you decide it’s time for your baby to give up the binky, you’re the one who’ll be able to pull the plug (whether your little one will put up a fight is another issue).

Cons

• If a baby gets attached to a binky, the habit can be a hard one to break—especially once your baby turns into a more inflexible toddler (when the continuing use of pacifiers is linked to recurrent ear infections and, later, to misaligned teeth).

• A paci can become a crutch for the parents. Plunking that pacifier in your baby’s mouth can become just a little too easy and a lot more convenient than trying to figure out the reason for the fussing or if there might be other ways of placating him. The result may be a baby who can be happy only with something in his mouth, and who is unable to comfort himself any other way.

• Being paci dependent can mean less sleep for everyone, because babies who learn to go to sleep with a pacifier might not learn how to fall asleep on their own—and they might put up a sniffly fuss when the binky gets lost in the middle of the night (requiring weary mom or dad to get up and pop it back in each time baby wakes up). Of course, though inconvenient, this is a pretty minor con compared with the significant pro of safer sleep for pacifier-using newborns.

What about nipple confusion or pacifiers interfering with breastfeeding? Contrary to popular belief, there is little evidence that pacifiers cause nipple confusion. And as far as throwing a monkey wrench into long-term nursing for your little monkey, the data doesn’t bear that out either. In fact, some research shows that limiting the pacifier for newborns actually decreases the rate of exclusive breastfeeding. Still, there’s no doubt that your milk supply is dependent on your baby’s suckling—which means that spending too much time with a mouth full of binky can mean too little time spent with a mouth full of breast, which can mean too little stimulation for your milk supply.

The bottom line on binkies? Make moderation your motto. Consider bringing on a paci at sleep times (as recommended) and at fussy times (when your baby really seems to need relief … and so do you). Give one a try, also, if your little one has such a strong need for sucking that your nipples have become human pacifiers or if baby is taking too much formula because he’s not happy without a nipple in his mouth. Just don’t overuse it—especially if binky time is cutting down on feeding time or socializing time. Remember, it’s hard to coo or smile when you’re sucking. And try not to use it as a substitute for attention or other kinds of parent-provided comfort.

Most important, be sure to use the pacifier safely. Never attach one to the crib, carriage, playpen, or stroller, or hang it around your baby’s neck or wrist with a ribbon, string, or cord of any kind—babies can be strangled this way. And have in mind a plan to ditch the pacifier down the road once your baby is approaching his first birthday, at which point the pros will start to be outweighed by the cons—and your little one will be better off trying to figure out how to self-soothe in other ways.

Healing of the Umbilical Cord

“The cord still hasn’t fallen off my baby’s belly button, and it looks really awful. Could it be infected?”

Healing belly buttons almost always look worse than they actually are—even when they’re healing normally. Not surprising when you consider what an umbilical stump is—the remnants of the gelatinous, blood-vessel-filled cord that spent months nurturing and nourishing your baby but is now yucky, gross, and without a doubt, overstaying its welcome—not to mention, preventing the much-anticipated appearance of your baby’s adorable belly button. (It pretty much goes without saying that there’s nothing adorable about an umbilical stump.)

The cord stump, which is shiny and moist at birth, usually turns from yellowish green to black, starts to shrivel and dry up, and finally falls off within a week or two—but the big event can occur earlier, or even much later (some babies don’t seem to want to give theirs up). Until it does drop off, keep the site dry (no tub baths) and exposed to air (turn diapers down so they don’t rub). When it does fall off, you might notice a small raw spot or a small amount of blood-tinged fluid oozing out. This is normal, and unless it doesn’t dry up completely in a few days, there is no need for concern.

Unsightly though that cord stump might be, it’s unlikely that it’s infected—especially if you’ve been taking care to keep it dry. But be sure to keep a close eye on your baby’s healing stump if he was born premature or at a low birthweight, or if the stump falls off early, since research suggests these may increase the risk of a belly button infection.

If you do notice pus or a fluid-filled lump on or near your baby’s umbilical-cord stump and a reddish hue around the stump, check with your baby’s doctor to rule out infection, which is rare. Symptoms of an infection may also include abdominal swelling, a foul-smelling discharge from the infected region, fever, bleeding around the umbilical-cord stump, irritability, lethargy, and decreased activity. If there is an infection, antibiotics can be prescribed to clear it up.

Umbilical Hernia

“Every time she cries, my baby’s navel seems to stick out. What does that mean?”

It probably means that your baby has an umbilical hernia—which (before you start worrying) is absolutely nothing to worry about.

Prenatally, all babies have an opening in the abdominal wall through which blood vessels extend into the umbilical cord. In some cases (for black babies more often than white), the opening doesn’t close completely at birth. When these babies cry, cough, or strain, a small coil of intestine bulges through the opening, raising the navel and often the area around it in a lump that ranges from fingertip to lemon size. While the lump might look a little scary (and sound even scarier when you hear it’s a hernia), it’s likely to resolve on its own eventually, without any intervention. Small openings usually close or become inconspicuous within a few months, large ones by age 2. In the meantime, the best treatment for an umbilical hernia is usually no treatment at all. So definitely don’t listen to old-schoolers and others who tell you to tape or bind the hernia down.

Circumcision Care

“My son was circumcised yesterday, and there seems to be oozing around the area today. Is this normal?”

Not only is a little oozing normal, it’s a sign that the body’s healing fluids are heading to the site to begin their important work. Soreness and, sometimes, a small amount of bleeding are also common after a circumcision and nothing to be concerned about.

Using double diapers for the first day after the procedure will help to cushion your baby’s penis and also to keep his thighs from pressing against it—but this isn’t usually necessary later. Usually, the penis will be wrapped in gauze by the doctor or mohel (a ritual circumciser of the Jewish faith). Check with your baby’s doctor about continuing care—some doctors recommend putting a fresh gauze pad, dabbed with Vaseline, Aquaphor, or another ointment, on the penis with each diaper change, while others don’t think it’s necessary as long as you keep the area clean. You’ll also need to avoid getting the penis wet in a bath (you probably won’t be dunking your baby yet anyway, because the umbilical cord is not likely to have fallen off at this point) until healing is complete. Clearly it will get wet when he pees, and that’s not a problem as long as you change diapers as needed.

Swollen Scrotum

“Our son’s scrotum seems disproportionally huge. Should we be concerned?”

Probably not. Testicles—as you probably know—come encased in a protective pouch called the scrotum, which is filled with a bit of fluid to cushion them. And thanks to exposure to mom’s hormones in utero and a little bit of normal genital swelling at birth, a newborn’s testicles can look rather large—especially next to his baby-size penis. In some babies the swelling doesn’t go down a few days after birth, likely the result of an excessive amount of fluid in the scrotal sac. Called hydrocele, this condition is nothing to worry about since it gradually resolves during the first year, almost always without any treatment.

Ask about your little man’s parts at the next doctor’s visit, just to be sure it isn’t an inguinal hernia (click here), which can either resemble a hydrocele or occur along with it. An exam can quickly determine whether the swelling is due to excess fluid or if there is a hernia involved—or both—or whether it’s just baby scrotum business as usual. If you notice swelling that seems painful, tenderness, redness, or discoloration, contact the doctor right away.

Hypospadias

“We were just told that the outlet in our son’s penis is in the middle instead of the end. What will that mean?”

Every so often, something goes slightly awry during prenatal development of the urethra and the penis. In your son’s case, the urethra, the tube that carries urine (and after puberty, semen), doesn’t run all the way to the tip of the penis but opens elsewhere. This condition is called hypospadias and is found in an estimated 1 to 3 in 1,000 boys born in the United States. First-degree hypospadias, in which the urethral opening is at the end of the penis but not in exactly the right place, is considered a minor defect and requires no treatment. Second-degree hypospadias, in which the opening is along the underside of the shaft of the penis, and third-degree hypospadias, in which the opening is near the scrotum, can be corrected with reconstructive surgery.

Because the foreskin may be used for the reconstruction, circumcision (even ritual circumcision) is not performed on a baby with hypospadias who will require surgery.

Occasionally, a girl is born with the urethra opening at the wrong place, sometimes into the vagina. This, too, is usually correctable with surgery.

Swaddling

“I’ve been trying to keep my baby swaddled, like they showed me in the hospital. But she keeps kicking at the blanket, and it gets undone. Should I stop trying?”

Just because swaddling is standard procedure in the hospital doesn’t mean it has to be standard procedure at home—especially if your baby’s not a fan. Most newborns do love that cocooned feeling of being all wrapped up in a tight little bundle, and will sleep better on their backs when swaddled—especially because they’ll startle less. Swaddling also helps ease colic in many babies. But even with all those potential perks, some babies just don’t see it that way. For them, being wrapped up is too restrictive, and they’ll fight it every time. A good rule: If swaddling seems to feel good to your newborn, do it. If it doesn’t, don’t. But before you give up on swaddling your little one altogether, see if using a velcro swaddler might keep her from kicking it off, or opt for a zip-up cocoonlike swaddler or a sleep sack (there are also hybrids—swaddlers that have velcro tabs on top and a sack on the bottom). Or try leaving her arms unwrapped to see if that gives her the freedom of movement she seems to crave (and giving her access to her fingers for the comfort she craves) while still providing her with extra stability on her back during sleep.

Once babies become more active, they usually start kicking off or squirming out of their swaddles, no matter what kind. That’s a sign to call it quits on swaddling—especially during sleep, since a kicked-off blanket poses a suffocation risk. Continued swaddling can also keep a baby from practicing motor skills—so once a baby stops needing that snug cocoon (usually around 3 to 4 months, though some babies crave the swaddle for longer), it’s time to unwrap your baby burrito for good.

Outings with Baby

Never again will you be able to leave the house empty-handed—at least not when baby’s along. And while you won’t always need all these items when you head out with your little one, it’s a good idea to pack these essentials in your diaper bag when you’re out and about:

A changing pad. If your diaper bag doesn’t have one, pack a waterproof pad. You can use a towel or a cloth diaper in a pinch, but they won’t adequately protect carpeting, beds, or furniture when you’re changing baby away from a changing table.

Diapers. How many depends on how long your outing will be. Always take at least one more than you think you’ll need—you’ll probably need it if you don’t.

Diaper wipes. A small convenience pack is easier to carry than a full-size container, and especially convenient if you can refill it. Or you can use a small ziplock plastic sandwich bag to tote a mini-supply. Wipes aren’t just for bottoms, by the way—use them to wash your own hands before feeding baby and before and after changes, as well as for wiping spit-up and baby-food stains from clothing, furniture, or your baby (or you).

Plastic bags. You’ll need these for disposing of dirty disposable diapers, particularly when no trash can is available, as well as for carrying wet and soiled baby clothes home.

Formula, if you’re bottle-feeding. If you’re definitely (or possibly) going to be out past the next feeding with a bottle-fed baby, you’ll have to bring a meal along. No refrigeration will be necessary if you take along an unopened singleserving bottle of ready-to-use formula, a bottle of water to which you’ll add powdered formula, or a bottle that stores both powder and water separately until you’re ready to shake and serve. If, however, you bring along formula you’ve prepared at home, you’ll have to store it in an insulated container along with a small ice pack or ice cubes.

Burp cloths. As any veteran parent knows, a burp cloth can spare you (and others who hold your baby) smelly shoulders.

A change of baby clothes. Baby’s outfit is picture-perfect and you’re off somewhere special. You arrive, lift your bundle of cuteness from the car seat, and find a pool of loose, mustardy stools has added the outfit’s “finishing touch.” Just one reason why it’s wise to carry along an extra—or two extra—sets of clothing. And while you’re thinking about clothing, carry along a sun hat when the sun is shining and a cold weather hat when the weather calls for it.

An extra blanket or sweater. Between seasons? When temperatures fluctuate unpredictably, an additional layer will come in handy.

A pacifier, if baby uses one. Carry it in a clean plastic bag or use one that comes with a cover. Consider packing a spare, too, as well as paci wipes to clean pacis that get dropped (they will).

Toys. For a very young baby, bring along something to look at in the car seat or stroller (mirrors can be magic). For older babies, lightweight toys they can swat at, poke at, and mouth will fill the bill.

Sunscreen. If there’s no shade available, use a small amount of baby-safe sunscreen on baby’s face, hands, and body (recommended even on babies under 6 months) year-round. Even in winter, snow’s glare and sun’s rays can combine to cause serious burns.

A snack (or two, or three) for baby. Once solids are introduced, bring along baby food (no refrigeration is needed before it’s open, no heating up is needed before serving) if you’ll be out during mealtime. Include a spoon stashed in a plastic bag (save the bag to bring the dirty spoon home in), a bib, and plenty of paper towels. Later, you can tote a selection of finger foods such as puffs or rice cakes to pull out as needed. And while you’re at it, pack a snack for you, too, especially if you’re a breastfeeding mama.

Other must-haves. Depending on your baby’s needs, you may want to carry diaper rash ointment or cream, bandaids (especially once baby has started crawling or walking), and any medication your baby is due to be dosed with while you’re out (if refrigeration is required, pack with an ice pack in an insulated container).

Keeping Baby the Right Temperature

“I’m not sure how many layers I need to put on my baby when I go out with him.”

Once a baby’s natural thermostat is properly set (within the first few days of life), he doesn’t need to be dressed any more warmly than you dress yourself. So, in general (unless you’re the type of person who’s always warmer or colder than everyone else), choose clothing for him that’s smaller and cuter, but not heavier, than what you’re wearing. If you’re comfy in a t-shirt, your baby will be, too. If you’re chilly enough for a sweater, your baby will need one as well. Jacket for you? Jacket for your baby.

Still unsure if you’ve bundled your little bundle just right? Don’t check his hands for confirmation. A baby’s hands and feet are usually cooler than the rest of his body, because of his immature circulatory system. You’ll get a more accurate reading of his comfort by checking the nape of his neck or his arms or trunk (whichever is easiest to reach under his clothing) with the back of your hand. Too cool? Add a layer. Too warm? Peel one off. If he seems extremely cold to the touch, or dangerously overheated, click here.

Don’t take the fact that your baby sneezes a few times to mean he’s cold either—he may sneeze in reaction to sunlight or because he needs to clear his nose. But do listen to your baby. Babies will usually tell you that they’re too cold (the same way they tell you most everything else) by fussing or crying. When you get this message (or if you’re just not sure whether you’ve dressed him appropriately), run that temperature check with your hand and adjust as needed.

The one part of a baby that needs extra protection in all kinds of weather is his head—partly because a lot of heat is lost from an uncovered head (especially a baby’s head, which is disproportionately large for his body), and partly because many babies don’t have much protection in the way of hair. On even marginally cool days, a hat is a good idea for a baby under a year old. In hot, sunny weather, a hat with a brim will protect baby’s head, face, and eyes—but even with this protection (plus sunscreen), exposure to full sun should be brief.

A young baby also needs extra protection from heat loss when he’s sleeping. In deep sleep, his heat-producing mechanism slows down, so in cooler weather, bring along an extra blanket or covering for his daytime nap in the stroller. If he sleeps in a cool room at night, a toasty blanket sleeper or sleep sack will help him stay warm (quilts and comforters are unsafe coverings for a sleeping baby). Don’t, however, put a hat on baby when you put him to sleep indoors, since it could lead to overheating. Ditto for overbundling, particularly when baby is sleeping (do the nape of the neck check again).

When it comes to dressing baby in cold weather, the layered look is not only fashionable, it’s sensible. Several light layers of clothing retain body heat more efficiently than one heavy layer, and the outer layers can be peeled off as needed when you walk into an overheated store or board a stuffy bus, or if the weather takes a sudden turn for the warmer.

Taking Baby Out

Running a cabin fever, but sticking close to home because you’re worried your newborn’s not ready for the great outdoors (or the great superstore)? Assuming you’re up to a field trip yourself (those first couple of postpartum weeks can be pretty grueling), feel free to plan your first escape from home. A healthy, full-term baby is hardy enough to handle any number of excursions—whether it’s a stroll in the park or a trip to the market.

When you take baby out, dress him or her appropriately, protect him or her from weather extremes, and always take along an extra covering if there’s a possibility of a change for the cooler in the weather. If it’s windy or rainy, use a weather shield on the stroller. If it’s very chilly or extremely hot and humid, limit the amount of time your baby spends outdoors. Avoid more than brief exposure to direct sunlight, even in mild weather. And, most important, if your outing is in a car, be sure your baby is properly harnessed in a rear-facing infant car seat.

In the first 6 to 8 weeks, do consider a little crowd control—particularly during flu season. Limit exposure to large indoor gatherings—even big family parties where Pass the Baby might be played, exposing your little one to germs.

Touchy Strangers

“Everybody wants to touch our son—the cashier at the pharmacy, perfect strangers in the elevator, random people in line at the ATM. I’m always worried about germs.”

There’s nothing that cries out to be squeezed more than a new baby. Baby cheeks, fingers, chins, toes—they’re all irresistible. And yet resist is just what you’d like others (especially others who are strangers) to do when it comes to your newborn.

Understandably you’re touchy about all that uninvited touching—and legitimately concerned about your baby being on the receiving end of so many germs. After all, a very young infant is more susceptible to infection because his immune system is still relatively immature and he hasn’t had a chance to build up immunities. So, for now at least, politely ask strangers to look but not to touch—particularly when it comes to baby’s hands, which usually end up in his mouth. You can always blame it on the doctor: “The pediatrician said not to let anyone outside the family touch him yet.” As for friends and family, ask them to wash their hands before picking up baby, at least for the first month (keep hand sanitizer handy so they can use it before you hand over your baby). Anyone with sniffles or coughs should stay away. And skin-to-skin contact should obviously be avoided with anyone who has a rash or open sores.

No matter what you do or say, expect that every once in a while your baby will have some physical contact with strangers. So if a friendly neighbor tests your child’s grasp on his finger before you can stop the transaction, just pull out a diaper wipe and discreetly wash off baby’s hands. And be sure to wash your own hands after spending time outdoors and before handling your baby. Germs from outsiders (and from door handles or shopping carts) can easily be spread from your hands to your baby.

As your baby gets older, it will not only be safe to lift the hygiene bubble—it’ll be smart. Your little one will need to be exposed to a variety of garden-variety germs in order to start building up immunities to those common in your community. So after the first 6 to 8 weeks, plan to loosen up a little and let the germs fall where they may.

Baby Breakouts

“My baby seems to have little whiteheads all over his face. Will scrubbing help clear them?”

Though you may be surprised—and a little bummed—to find a sprinkling of tiny whiteheads on your sweetie’s face where you expected to see baby-soft skin, these blemishes, called milia, are very common (affecting about half of all newborns), temporary, and definitely not a sign of pimple problems to come. Milia, which occur when small flakes of dead skin become trapped in tiny pockets on the surface of your little one’s skin, tend to accumulate around the nose and chin, but occasionally show up on the trunk, arms, and legs, and even on the penis. The best treatment? Absolutely no treatment at all. As tempting as it may be to squeeze, scrub, or treat milia, don’t. They’ll disappear spontaneously, often within a few weeks but sometimes not for a few months or more, leaving your son’s skin clear and smooth—that is, unless he comes up against another common baby complexion challenge: infant acne (see the next question).

A Summer Rash

It’s what many babies are wearing every summer season: heat rash. Also known as prickly heat, its telltale tiny red spots on the face, neck, armpits, and upper torso are caused when perspiration builds up because of clogged sweat-gland ducts. Though the rash usually fades on its own within a week, you can treat baby with a cool bath, but avoid powders or lotions that can further block the sweat from flowing. Call the doctor if pustules, increased swelling, or redness develop.

“I thought babies were supposed to have beautiful skin. But my 2-week-old girl seems to be breaking out in a terrible case of acne.”

Does your baby have more pimples than an eighth grader? Just when she seems ready for her close-up—head rounding out nicely, eyes less puffy and squinty—here comes infant acne. This pimply preview of puberty, which affects about 40 percent of all newborns, usually begins at 2 to 3 weeks (right about the time you were going to schedule that first formal portrait) and can often last until baby is 4 to 6 months old. And believe it or not, as with adolescent acne, hormones are believed to be mainly to blame.

In the case of newborns, however, it’s not their own hormones that are probably prompting the pimple problems, but mom’s—which are still circulating in their systems. These maternal hormones stimulate baby’s sluggish oil glands, causing pimples to pop up. Another reason for infant acne is that the pores of newborns aren’t completely developed, making them easy targets for infiltration by dirt and the blossoming of blemishes.

Infant acne isn’t the same as newborn milia—the acne is made up of red pimples, while milia are tiny whiteheads. They both, however, call for the same treatment: absolutely none—that is, beyond patience (though some suggest that dabbing the affected area with breast milk can help speed the healing process—and there’s no reason not to try that at home if you’re breastfeeding). Don’t squeeze, pick, scrub with soap, slather with lotions, or otherwise treat your newborn’s acne. Just wash it with water two or three times daily, pat it dry gently, and it will eventually clear, leaving no lasting marks—and that beautiful baby skin you’ve been waiting for in its place. And just in case you’re already worrying about your little one’s middle school yearbook photos, know that infant acne doesn’t predict future pimple problems.

Baby’s Skin Color

Wondering when your mixed-race baby or baby of color will actually turn the color he or she is meant to be? Babies who are destined to be dark-skinned are usually born with light skin—often a shade or two lighter than their color will end up. It could take weeks or months—or in some cases, a few years—before your little cutie shows his or her true colors. Looking for a sign of how pigmented he or she will be eventually? Some parents swear that the ears will clue you in—check out the top of your baby’s tiny ears and you’ll notice they’re darker than the rest of your newborn’s skin tone. There’s a good chance he or she will end up being close to that color.

Skin Color Changes

“My baby suddenly turned two colors—reddish blue from the waist down and pale from the waist up. What’s wrong with her?”

Watching your baby turn color before your eyes can be unsettling, to say the least. But there’s nothing to worry about when a newborn suddenly takes on a two-tone appearance, either side to side or top to bottom. As a result of her immature circulatory system, blood has simply pooled on half of your baby’s body. Turn her gently upside down (or over, if the color difference is side by side) momentarily, and normal color will be restored.

You may also notice that your baby’s hands and feet appear bluish, even though the rest of her body is pinkish. This, too, is due to immature circulation and usually disappears by the end of the first week.

“Sometimes when I’m changing my new baby, I notice his skin seems to be mottled all over. Why?”

Purplish (sometimes more red, sometimes more blue—it depends on the color of your baby’s skin) mottling of a tiny baby’s skin when he’s chilled, crying, or even (in some babies) all the time isn’t unusual. These transient changes are yet another sign of an immature circulatory system, visible through baby’s still very thin skin. He should outgrow this colorful phenomenon in a few months. In the meantime, when it occurs, check the nape of his neck or his midsection to see if he is too cool. If so, add a layer of clothing or raise the thermostat. If not, just relax and wait for the mottling to disappear, as it probably will in a few minutes.

Hearing

“My baby doesn’t seem to react much to noises. She sleeps right through the dog’s barking and my older son’s tantrums. Could her hearing be impaired?”

It’s probably not that your baby doesn’t hear the dog barking or her brother screaming, but that she’s used to these sounds. Although she saw the world for the first time when she exited the womb, it wasn’t the first time she heard it. Many sounds—from the music you played, to the honking horns and screeching sirens on the street, even to the whir of the blender if you were an expectant fan of smoothies—penetrated the walls of her peaceful uterine home, and she became accustomed to them.

Most babies will react to loud noise—in early infancy by startling, at about 3 months by blinking, at about 4 months by turning toward it. But those sounds that have already become a part of the background of a baby’s existence may elicit no response—or one so subtle, you might miss it, like a change in her position or activity.

Still concerned about your baby’s hearing? Try this little test: Clap your hands behind her head and see if she startles. If she does, you know she can hear. If she doesn’t, try again later—children (even newborns) have a wonderful way of ignoring or blocking out their environment at will, and she may have been doing just that. A repeat test may trigger the response you’re looking for. If it doesn’t, try to observe other ways in which your baby may react to sound: Is she calmed or does she otherwise respond to the soothing sounds of your voice, even when she isn’t looking directly at you? Does she respond to singing or music in any way? Does she startle when exposed to an unfamiliar loud noise? If your baby seems never to respond to sound, check in with the doctor. Most newborns are screened routinely for hearing problems before leaving the hospital (click here), so it’s likely that yours was screened and found to be fine—but it’s always best to ask if you’re not sure whether your baby was screened or what the results were. The earlier hearing deficit is diagnosed and treated, the better the long-range outcome.

How Loud Is Too Loud?

Most babies love music—but that doesn’t mean you should pump up the volume, especially when you’re in an enclosed area, like the car. A baby may cry when music (or another noise) is too loud, but don’t rely on your little one’s complaints to tell you when to turn down the sound. A baby’s ears, in fact, don’t have to be “bothered” to be harmed.

According to the National Institute for Occupational Safety and Health, more than 15 minutes of exposure to 100 decibels is unsafe for an adult. And noise that is hazardous to an adult is even more dangerous to a baby because of the thinner skull and smaller ear canal, which makes the sound pressure entering the ear greater. In fact, an infant might perceive a sound as 20 decibels louder than an adult or older child does, making a toy that emits 90 decibels of sound seem more like 110 decibels to your little one’s tender ears—equal to the noise of a power mower, chain saw, or subway train. The bottom line on sound: It’s too loud if you can’t talk easily over it. Turn it down, or take your baby to a quieter place quickly.

Even white noise machines that are meant to soothe baby with background sounds can be harmful to tiny ears if they’re played too loud or positioned too close. To play it safe, place any white noise far from baby’s crib, and set volume to low.

Keeping Baby Safe

Babies look pretty fragile, but they’re actually pretty sturdy. They don’t “break” when you pick them up, their heads don’t snap when you forget to support them, and they weather most minor falls without major injury.

Still, babies can be vulnerable, and in ways that parents wouldn’t necessarily think. Even a newborn seemingly too tiny to get into trouble sometimes does—rolling off a changing table or a bed long before he or she is mobile. To protect your baby from injuries that don’t have to happen, be sure to follow all of these safety tips all of the time:

• In the car, always buckle your baby into a rear-facing infant car seat no matter how far you’re going or how fast or slow you’ll be driving—and no matter how much baby is crying. Wear a seat belt yourself, and make sure whoever’s doing the driving does, too—no one’s safe unless the driver is. And never drink and drive (or drive when you’re very tired or taking medication that makes you sleepy), text while driving, or talk on a phone that’s not hands-free while driving, or let baby ride with anyone who does. (Click here for more on car seat safety.)

• Always keep one hand on baby at bath time while you suds and rinse with the other. If you bathe baby in a large tub, put a small towel or cloth at the bottom to prevent slipping.

• Never leave your baby unattended on a changing table, bed, chair, or couch—not for a second. Even a newborn who can’t roll over can suddenly extend his or her body and fall off. If you don’t have safety straps on your changing table, you should always keep one hand on your baby.

• Never put baby in an infant (or car) seat or carrier on a table, counter, dryer, or any other elevated surface, or leave baby unattended in a seat on any surface, even the middle of a soft bed or sofa (where suffocation is a risk should baby tip over).

• Never leave a baby alone with a pet, even a very well-behaved one.

• Never leave baby alone in a room with a sibling who is under 5 years old. A game of peekaboo affectionately played by a preschooler could result in tragic suffocation for an infant. A loving but overly enthusiastic bear hug could crack a rib.

• Don’t leave baby alone with a sitter who is younger than 14, or one you don’t know well or whose references you haven’t checked. All sitters should be trained in infant safety and CPR (and so should all family members who might be caring for your baby, you included).

• Never jiggle or shake your baby vigorously (even in play) or throw him or her up into the air.

• Never leave baby alone at home, even while you go for the mail, move the car, or check the laundry in the apartment building basement. It takes only seconds for an accident to happen.

• Never leave a baby or child alone in a vehicle, not even for a moment. In hot (or even mild) weather, even keeping the windows down might not prevent the baby from succumbing to heatstroke. During winter months, snow can block a car’s exhaust pipe, and warming up a car can cause carbon monoxide to back up into the car. A baby left alone in a car during cold weather is also at risk of hypothermia. In any weather, a baby left unattended can be quickly snatched.

• Never take your eyes off your baby when you’re shopping, going for a walk, or sitting at the playground. A baby in a stroller or shopping cart makes an easy target for abduction.

• Remove any strings, cords, or ribbons longer than 6 inches from gowns, hoodies, and other baby clothing.

• Avoid using any kind of chain or string on baby or on any of baby’s toys or belongings—that means no necklaces, no strings for pacifiers or rattles, no religious medals on chains, and no ribbons longer than 6 inches on cribs or cradles, or anywhere else for that matter. Be sure, too, that baby’s crib, play yard, and changing table are not within reach of electrical cords (which present double danger), cords from phones or chargers, or venetian blind or drapery cords. All of these items can cause accidental strangulation.

• Don’t place filmy plastics, such as dry-cleaner bags or other plastic bags, on mattresses, the floor, or anywhere baby can get at them.

• Never leave an unattended infant within reach of pillows, stuffed toys, or plush items, or let baby sleep on a sheepskin, plush-top mattress, beanbag, waterbed, or a bed wedged against the wall. Always remove bibs and any hair ties or barrettes before putting baby down to sleep.

• Consider keeping a fan on in baby’s room during sleep. Research suggests that the circulating air may reduce the risk of SIDS.

• Remove crib gyms and mobiles once baby can get up on hands and knees (around 4 to 6 months).

• Do not place baby on any surface next to an unguarded window, even for a second, and even when baby’s asleep.

• Use smoke detectors and carbon monoxide detectors in your home, and install them according to fire department recommendations.

Vision

“I put a mobile over my baby’s crib, hoping the colors would be stimulating. But he doesn’t seem to notice it. Could something be wrong with his eyesight?”

It’s more likely there’s something wrong with the mobile—at least, where it’s located. A newborn baby focuses best on objects that are between 8 and 12 inches away from his eyes, a range that seems to have been selected by nature not randomly, but by design—it being the distance at which a nursing infant sees his mother’s face. Objects closer to or farther away from a baby lying in his crib will be nothing but a blur to him—though he’ll fixate on something bright or in motion even in the distance if there’s nothing worth looking at within his range of vision. Your baby will also spend most of his time looking to his right or left, rarely focusing straight ahead or overhead in the early months. So a mobile directly above his crib isn’t likely to catch his attention, while one hung to one side or the other may. But even a mobile hung in the right place may not move your baby, at least not right away. Most babies don’t pay attention to mobiles at all until they’re closer to 3 to 4 weeks or even older, and others will always find something better to look at.

Even though your newborn’s vision is a work in progress (it will take several months for his focus to mature, and he won’t be able to perceive depth well until 9 months), he still loves to look. And gazing at the world is one of the best ways he has of learning about it. So what should you give him to look at besides his favorite sight—you? Most young babies like to study faces—even crudely drawn ones, and especially their own in crib mirrors (though they won’t recognize them as their own until well after their first birthday). Anything with high contrast, such as patterns of black and white or red and yellow, will capture more attention than subtle ones, and simple objects will score more than complex ones. Light is a baby mesmerizer—whether it’s from a ceiling track, a lamp, or a window (especially one through which light is filtered via the slats of blinds).

Vision screening will be part of your baby’s regular checkups. But if you think your baby doesn’t seem to be focusing on well-located objects or faces or doesn’t turn toward light, mention this to his doctor at the next visit.

Crossed Eyes

“The swelling is down around my baby’s eyes. Now she seems cross-eyed.”

What looks like crossed eyes is probably just extra folds of skin at the inner corners of those precious peepers. If that’s the case, which it usually is with newborns, the skin will retract as your baby grows, and her eyes will probably begin to seem more evenly matched. During the early months, you may also notice that your baby’s eyes don’t work in perfect unison all the time. These random eye movements mean she’s still learning to use her eyes and strengthening her eye muscles. By 3 months, coordination should be much improved.

Check with the pediatrician if you don’t notice any improvement in her eye coordination, or if her eyes always seem to be out of sync. If there is a possibility of true crossed eyes (strabismus, in which the baby uses just one eye to focus on what she’s looking at, and the other seems aimed anywhere), consultation with a pediatric ophthalmologist is in order. Early treatment is important, because so much that a child learns she learns through her eyes, and because ignoring crossed eyes could lead to “lazy” eye, or amblyopia (in which the eye that isn’t being used becomes lazy, and consequently weaker, from disuse).

Teary Eyes

“At first, there were no tears when my baby cried. Now her eyes seem filled with tears even when she’s not crying. And sometimes they overflow.”

Tiny tears don’t start flowing out of the tiny eyes of newborns until close to the end of the first month. That’s when the fluid that bathes the eye (aka tears) is produced in sufficient quantity by the glands over the eyeballs. The fluid normally drains through the small ducts located at the inner corner of each eye, and into the nose (which is why a lot of crying can make your nose run). The ducts are particularly tiny in infants, and in about 1 percent of babies—yours included—one or both are blocked at birth.

Since a blocked tear duct doesn’t drain properly, tears fill the eyes and often spill over, producing the perpetually “teary-eyed” look even in happy babies. But the clogged ducts are nothing to worry about. Most will clear up by themselves by the end of the first year without treatment, though your baby’s doctor may show you how to gently massage the ducts to speed up the process or suggest you drop a little breast milk into the eye to help clear the clog. (Always wash your hands thoroughly first before using massage. If baby’s eyes become puffy or red, stop massaging and tell the doctor.)

Sometimes, there is a small accumulation of yellowish white mucus in the inner corner of the eye with a tear duct blockage, and the lids may be stuck together when baby wakes up in the morning. Mucus and crust can be washed away with water and cotton balls. A heavy, darker yellow discharge and/or reddening of the whites of the eye, however, may indicate infection or another condition that requires medical attention. The doctor may prescribe antibiotic ointments or drops, and if the duct becomes chronically infected, may refer your baby to a pediatric ophthalmologist. Call the doctor if a tearing eye seems sensitive to light or if one tearing eye looks different in shape or size from the other.

Sneezing

“My baby sneezes all the time. He doesn’t seem sick, but I’m afraid he’s caught a cold.”

New babies have plenty to sneeze at besides colds. For one thing, sneezing is a protective reflex that allows your baby to clear out amniotic fluid and excess mucus that might be trapped in his respiratory passages. Frequent sneezing (and coughing, another protective reflex) also help him get rid of foreign particles that make their way into his button nose from his environment—much as sniffing pepper makes many adults sneeze. Your baby may also sneeze when exposed to light, especially sunlight.

First Smiles

“Everybody says that my baby’s smiles are ‘just gas,’ but she looks so happy when she does it. Couldn’t they be real?”

No new parent wants to believe that baby’s first smiles are the work of a passing bubble of gas—not a wave of love meant especially for mommy or daddy. But scientific evidence so far seems to back up this age-old buzz kill: Most babies don’t smile in the true social sense before 4 to 6 weeks of age. That doesn’t mean that a smile is always “just gas.” It may also be a sign of comfort and contentment—many babies smile as they are falling asleep, as they pee, or as their cheeks are stroked.

When baby does reveal her first real smile, you’ll know it (your baby will engage her whole face in the smile, not just her mouth), and you’ll melt accordingly. In the meantime, enjoy those glimpses of smiles to come—undeniably adorable no matter what their cause.

Hiccups

“My baby gets the hiccups all the time. Do they bother him as much as they do me?”

Some babies aren’t just born hiccupers, they’re hiccupers before they’re born. And chances are, if your baby hiccuped a lot on the inside, he’ll hiccup plenty in the first few months on the outside, too. What causes those hiccups? One theory is that they’re yet another in baby’s repertoire of reflexes. Another theory is that infants get hiccups when they gulp down formula or breast milk, filling their tummies with air. Later on, giggles may bring on the hiccups. Whatever the trigger, hiccups don’t bother your baby. If they bother you, try letting your baby breastfeed or suck on a bottle or pacifier, which may quell the attack.

ALL ABOUT:
Baby Development

First smiles, first coos, first time rolling over, first unassisted sit, first attempt at crawling, first steps. Your little one’s first year is a baby book of momentous milestones just waiting to be filled out. But when will your little one reach those milestones, you wonder? Will that first smile come at an impressively early 4 weeks … or a wait-for-it 7? Will your baby roll ahead when it comes to rolling over—or lag behind? Sit out crawling? Or run circles around the babies in the neighborhood before they’ve even pulled up to a stand? And is there anything you should do—or can do—to speed up your baby’s progress on the developmental road ahead?

The truth is that while every baby is born tiny and cute, each develops differently—at a pace that seems less influenced by nurture than hardwired by nature. Every little one comes programmed with a timetable of development that specifies the arrival of many important skills and achievements. And while parents can definitely nurture along the schedule that nature has already set (or hold baby back from meeting those milestones by withholding nurture), many of the spaces in that developmental baby book were filled out before your baby was even born.

The Pattern of Development

How will your baby grow and develop physically? Only your baby’s DNA knows for sure—and it isn’t telling. But here’s something you can count on and look for while you’re waiting to fill in those blanks. While every baby develops physically at a different rate, each child’s development—assuming it isn’t being held back by environmental or physical factors—follows the same basic patterns. First, a baby develops from the top down, from head to toes. Babies lift their heads up before they can hold their backs up to sit, and hold their backs up to sit before they can stand on their legs. Second, they develop from the trunk outward to the limbs. Children use their arms before they use their hands, and their hands before they use their fingers. Physical development also progresses, not surprisingly, from the simple to the complex.

Infant development is usually divided into four areas:

Social. Babies arrive a little lump-like—but happily, they don’t stay that way for long. By 6 weeks, most babies express their first truly social skill: smiling. But even before that, they’re priming for a life of engagement and interaction with other humans (starting with mommy and daddy)—making eye contact, studying faces, and tuning in to voices. Some babies are more socially outgoing from the start, while others are naturally more serious and reserved—personality traits that come courtesy of their genes. Even so, the more social stimulation a baby receives, the faster those social skills will develop. A major delay in social development that goes beyond individual differences in personality could indicate a problem with vision or hearing, or another developmental issue that may need some watching. It could also be a product of baby’s environment—maybe because he or she isn’t getting enough eye contact or smiles or conversation or close cuddling that’s needed to develop socially.

Language. A little one who’s working a large vocabulary at an early age or who speaks in phrases and sentences way before his or her baby peers is probably going to have a way with words. But the tot who relies on pointing to make a point or grunts to make a request well into the second year may catch up and do just as well or even better later on. Since receptive language development (how well baby understands what is said) is a better gauge of progress than expressive language development (how well baby actually speaks), the little one who says little but understands much isn’t likely to be experiencing a developmental delay. Again, very slow development in this area occasionally indicates a vision or hearing problem and should be evaluated.

Large motor development. Some babies seem physically active (make that, perpetually in motion) from the first kicks in the womb. Once born, they keep packing a physical punch—holding their heads up at birth, crawling by 6 months, walking by 9 months. But many slow starters make quick strides later on, steadily catching up and even gaining on those early movers and shakers. Very slow starters, however, should be evaluated to be certain there are no physical or health obstacles to normal development (which early intervention can often overcome fast).

Small motor development. Reaching for, grasping, and manipulating objects—everything your baby does with those adorable fingers and hands—is considered small motor development, but it’s no small task. Coordinating those early movements between eyes and hand isn’t easy for babies—which means your little one will eye that rattle long before he or she can grasp it with those tiny hands (and finally, figure out how to shake it). Early eye-hand coordination may predict your baby will be good with his or her hands—but a baby who takes longer to fine-tune fine motor development isn’t necessarily going to be “all thumbs” later on.

What about your baby’s smarts? Don’t overthink it—or even give it a first thought—at this tender age. Most indicators of intellectual development (creativity, sense of humor, and problem-solving skills, for example) don’t even come into play—or into your child’s play—until at least the end of the first year. Think of them as intellectual gifts just waiting to be unwrapped. While DNA means your baby arrives hardwired with certain strengths, nurturing all sides of your little one means you’ll be helping him or her reach (or exceed) that baked-in intellectual potential. And among the best ways to nurture your newborn’s brain power are the simplest and most intuitive ways: making eye contact with your baby, talking and singing to your baby, and reading to your baby early (starting from birth) often (making it a treasured daily ritual right from the beginning).

Another thing to keep in mind while your baby’s busy making milestones: The rate of development in different areas is usually pretty uneven. Just as some adults are social butterflies and others are physical busy bees, different babies have different strengths, too, and may zoom ahead in one area (smiling at 6 weeks or talking up a storm at a year) but lag behind in others (not reaching for a toy until 6 months or not walking until a year and a half).

Something else to remember: Babies tend to concentrate on learning one skill at a time, and while they’re learning it, they’re laser-focused on it—which often means that already mastered skills or skills they’ve been dabbling in will be temporarily shelved. A baby may be blasé about babbling when he’s practicing pulling up. Or she may be sidetracked from sitting when she becomes all-consumed with crawling. Once a skill is mastered, another moves to center stage—and your baby may even seem to forget the last skill while forging ahead on the next. Eventually, your little one will be able to integrate all those various skills—new, old, and yet to be conquered—and use each spontaneously and appropriately. Even then, some skills will be left behind—because, well, your baby has moved on.

No matter what your little one’s rate of development ends up being—no matter how quickly those spaces in that baby book (or app) get filled out, and in what order—what is accomplished in the first year is nothing short of amazing. Never again will so much be learned so quickly.

With the emphasis on quickly—since the first year will be over a lot faster than you’d probably imagine right now. Keep an eye on your baby’s development, but don’t let watching that timetable (or the timetable of the baby down the block) keep you from enjoying the incredible days, weeks, months, and years of growing and developing that lie ahead. And don’t forget, your baby is one of a kind. For a developmental timeline, click here.

Making Time for Tummy Time

Keeping your baby safe means never forgetting “back to sleep.” But keeping your baby on target with developmental milestones means also remembering the flip side of back-to-sleep: tummy-to-play. The AAP recommends tummy time play with your baby two to three times a day for about 3 to 5 minutes (though you may need to start out with fewer minutes and may find you can work up toward more). Special mats are available, but a blanket and (if you want) a soft, rolled towel under baby’s chest will work just as well. The best—and coziest—place for your baby to do tummy time right from the start? Lying on your tummy or chest. Remember: back-to-sleep, tummy-to-play.

Baby hates tummy time? Click here for tips on making it more enjoyable for your little one.

Today’s Slower Babies

Something you should definitely keep in mind when that compulsion to compare gets the best of you (and it will): Babies today are developing later in some major gross motor skill categories than they used to. Not because they’re less naturally precocious, but because they’re spending less time on their tummies. Putting babies to sleep on their backs dramatically reduces the risk of SIDS, but it also temporarily slows motor development in some babies. With little opportunity to practice those skills babies used to practice on their tummies (such as crawling), more babies are accomplishing these skills later. Many are even skipping the crawling stage entirely (which is no problem, since it’s not considered a developmental must-do).