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Newborn and Infant Care

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08/14/2006

Question:

my baby is 3 weeks old and she cries when i put her down, when someone else is holding her, then running poop (yellow) everytime she has a bottle. so right when she falls asleep she poops so i change her and her buttom is red and tender is it me or is it the milk? or what is it?

Answer:

You certainly have a lot going on with your new baby!

All babies are different. Some need more holding than others and they signal this need by crying. In cultures other than the western cultures of the US, Canada, and Europe, new babies are held constantly. In fact, the part of the baby's brain that is growing most rapidly now, the limbic system, is responsible for the baby craving contact with others. Your baby also has learned your specific scent and prefers you since she is most comfortable with your care. Of course this does not make it easy on parents. If she is very fussy, she may also sense the discomfort of others and cry because she senses their tension and insecurity in caring for her. Babies normally cry an average of 2 hours total per day and have their peak amount of crying at 6 to 8 weeks of age. This is all normal, although stressful for those caring for the baby. It's often a good idea to keep track for a week of when she cries, what is happening at that time, and how long the crying lasts. Take this with you to your doctor visit and work with him or her to identify patterns to her crying to see if there are consistent triggers.

Many fussy babies respond to swaddling and being held in a side lying or tummy-lying position in your arms (always but your baby on her back in her crib or bassinet to sleep). Combined with rocking and shushing sounds, this often turns the crying off. Dr. Harvey Karp has a wonderful book and DVD on how to calm the fussy baby. It is called the Happiest Baby on the block and both can be ordered on-line from www.thehappiestbaby.com. It's the best set of information I have encountered on coping with crying. Other things that have helped fussy babies are: being carried in a Snuggli or sling, sitting in a vibrating infant seat, going for a car or stroller ride, white noise such as a fan or vacuum cleaner, and riding in an infant swing (be sure to swaddle first).

Many babies have yellow stools and these may be quite soft. There are a number of things to consider. Is the formula made correctly? Are the bottles and nipples free of harmful bacteria? Is the water safe and free of harmful substances? Does the baby have a formula intolerance?

First, check to make sure you are making the formula correctly according to the directions on the can. Make sure that the bottles and nipples have been thoroughly cleaned in hot, soapy water each day. Only heat and use a bottle once, discarding leftover formula.

If you have well water and are using it without its having been tested, switch to bottled water for making the formula until your water company can test a water sample. It costs about $15 to have it tested if you bring in the sample. It costs more if the water company comes out to collect it. If it has been tested and approved, be sure to boil it for 15 minutes and cool it before you make the formula. If you are using ready to feed formula and have city water, take a diaper with stool in it in a plastic bag to your baby's doctor and have the doctor decide if there is a problem or not. This is the fastest way to determine if there is a problem or not.

If you have a family history of lactose intolerance or food allergies, it is more likely that the baby may have an intolerance to the formula resulting painful symptoms that are making her cry. If there is an intolerance to your current formula, the doctor will recommend a different formula. Even with a change in formula, it may take a week for your baby's digestive system to adjust.

Gastroesophageal reflux may be giving your baby painful heartburn. Usually babies with reflux cry more after eating and like to be held upright to avoid painful reflux. All babies are more prone to this early in life. While many babies with this problem spit up a lot, others don't. If your baby  does spit up, take a soiled burp cloth with you to your baby's doctor visit so that the doctor can better judge whether the amount is excessive or not. Pay attention to how the baby feels after eating. If the baby is not spitting up and sleeps well after eating, reflux is unlikely to be the problem.

Promptly call your baby's doctor if you see blood or mucous in the stool or large water rings around the solid stool. These are not normal stools.

Skin in the diaper area is very fragile and easily irritated by stool and urine. Diaper rash and irritation are preventable with three strategies. 1) Change your baby's diaper often, about 8-10 times per day. Re move stool containing diapers as soon as possible. 2) Cleanse the baby's skin well with each diaper change using wipes without alcohol. 3) Always apply a cream or ointment barrier product with every diaper change even when there is no rash or irritation.

I hope I have offered some helpful strategies and wish  you much luck and pleasure with your new baby.

For more information:

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University