Thursday, December 27, 2012

Normal Newborn Concerns

I love talking to first time parents. Many of my colleagues don't, but there is just something about being able to educate them that their little bundle of joy is normal, and what they are experiencing will pass. It is gratifying to hear the relief in their voices when you reassure them that they will survive their sleepless night, and this screaming mess will grow to be a cooing miracle.
Here is a short list of some of the more common things that I find that new parents call about frequently that you may find helpful:

Diarrhea- Breast fed infants bowel movements constantly change, and it is very normal for a breast fed infant to have as many as 10 watery, yellow seedy stools per day. Parents should only be concerned if the infant acts sick, develops a fever, poor sucking reflex, not latching on as well, stools become mucusy or bloody, not urinating, or stools dramatically increase in frequency or any other concerning symptoms. Frequent, liquid stools in a breast fed infant is not necessarily diarrhea.
Cyanosis or mottling of extremities- New parents frequently call about noticing this in the feet especially. The circulatory system of newborns and young babies are not fully developed yet, and the feet appearing blue is very normal. If they feel warm to touch and the infant is exhibiting otherwise normal behavior, you might suggest they elevate the extremities for a brief period and see if the color returns to normal. If not, call back or if any other symptoms seen.
Cyanosis around the mouth-This is know as circum-oral cyanosis or peri-oral cyanosis, and if the lips and tongue are pink, respirations are normal, and infant is feeding well, this is can be normal. The parents will often report it as the infant appears "blue around the mouth". This is due to the engorgement of the venous plexis and is normal.
Irregular Breathing- Newborns often do not have quiet breathing. Especially on falling asleep, newborns can appear to be panting with very rapid breaths. This can last from seconds to minutes. They can also have very long pauses lasting 10 to 15 seconds. This is called periodic breathing and can be alarming, but parents need to be educated this can be perfectly normal as long as it does not persists and the infant has no color change.This is due to the central nervous system not being fully developed yet.
Congestion- Sneezing and congestion can be normal. Newborns have never encountered foreign substances and airflow through their nose, and sneezing is normal process to try to clear the nasal passages. 
Jerking or Twitching- The nervous system is very immature, and newborns are very jittery. Arms, legs, lips and chin can quiver, jerk and shake. They also have an exaggerated startle reflex that can cause them to jerk their arms and/or rhythmically shake their arms. Jitters can be distinguished from seizure activity by holding the arms or legs that are jittery or shaking. Seizures will not stop, but jitters will once the effected body part is held.

I hope these tips may help some of you dealing with nervous new parents. As I said, it is a job well done when you can talk them off the fence, and they can realize they are have a normal healthy infant that they need to nurture and enjoy and not have to worry that something is terribly wrong.