Going home from the hospital with your newborn is one of life’s greatest joys. After spending nine long months pregnant, and making it through labor and delivery, you finally get to start life as a family. The only problem? You’re exhausted and your body feels like you ran a marathon or worse.
Your birth experience may have surprised you, breastfeeding is likely harder or more time consuming than you thought, and you understandably may be feeling overwhelmed — whether this is baby #1 or baby #3. But we promise, you can do this. Here’s what you need to know about the first 24 hours home with your baby.
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Feed your baby on demand. It’s not realistic for new babies to follow an exact schedule, but you will notice they generally want to feed every 2-4 hours, which works out to about 8-12 feeds a day. The clock starts from the time of the beginning of the feed, not the end. So if baby nurses at 8 AM, you may be nursing again at 10 AM. Watch for subtle cues like rooting (turning her head and opening her mouth in search of your breast), suckling motions or bringing her hand to her mouth. Crying is another sign, but it’s best to try to feed your baby before she gets so hungry that she has difficulty latching or guzzles down a bottle too quickly, which can lead to more gas and spit up.
Speaking of gas and spit up, these are some of the normal newborn joys you will grow accustomed to. Spit up and gas, even after every feed, does not necessarily mean anything is wrong, so try not to worry. To minimize spit up when nursing: burp baby between breasts or more often if needed. If bottle feeding: pace the feed, keep bottle horizontal versus vertical and burp baby half way through the bottle. No matter how baby is fed, plan to keep her upright for at least 15 minutes after feeding.
Call your pediatrician if your baby is not waking to feed, she’s skipped more than 2 feeds in a row, or her spit up is greenish or seems excessive.
In the first 24 hours of life, we expect at least one wet diaper and one stool. The pediatrician taking care of your baby in the hospital will be watching for this, but what should you expect once you are home?
The sticky, tar-like meconium stools will gradually transition to brownish-green and then to a yellow, seedy, more liquid consistency if your baby is breastfed. Formula fed babies will tend to have slightly more formed, light brown-tan colored stools. Some babies will poop after every feed while others will go over 24 hours without pooping. So long as your baby is feeding well and not spitting up in excess there is no reason to be concerned with either scenario. It’s important to note that babies often turn bright red, cry and push very hard when they are trying to poop. This is normal and as long as the poop remains soft they are not constipated, they are simply learning how to poop.
Wet diapers are a sign your baby is staying hydrated and getting adequate feedings. The number of wet diapers should increase as your baby gets older in days. An easy rule of thumb is that you can expect one wet diaper on the first day of life, two on the second and three by the third and so on. After this you typically lose count, but if you notice a decrease in wet diapers or no wet diapers in over 12 hours, give your pediatrician a call.
Consider yourself lucky if you get any amount of quality sleep your first 24 hours home. Not only is your baby likely to demand most of your energy, you will naturally find it hard to relax as you’ll be anticipating when baby may wake up or worried about baby waking up. While babies normally sleep up to 17 hours per day, their sleep is not particularly sound. They startle easily, make strange little noises and mostly breathe through their noses so often sound congested. Their days and nights seem backwards in the beginning, so you will likely find yourself awake most of the night. This will get better with time. And you will get better at relaxing as you get to know baby’s adorable sounds and startles.
Sleeping on your chest will likely be your baby’s favorite place to rest. This is fine while you are awake, but as your exhaustion sets in, be mindful that falling asleep with baby on your chest is dangerous. The best place for him is on his back in his crib or bassinet.
Crying and other miscellaneous concerns
Your baby will cry a lot. Often he’s communicating discomfort from gas, a dirty diaper, or hunger, and other times he just wants to be held. If the diaper is clean, he seems warm enough and has just recently been fed, basic soothing techniques like swaddling and rocking your baby should help.
Sneezing, hiccups, and nasal congestion are all very common and typically require no intervention. If you notice some mucous in your babies nose, you can use your bulb syringe from the hospital along with a drop or two of nasal saline to remove the mucous.
The umbilical cord will fall off between 1-3 weeks. In the meantime, try to keep the area around it clean and do not submerge it in water until after it has fallen off and dried up. Sponge bathing is all that is needed for your baby until then. If the cord is surrounded by red, swollen skin, is oozing pus or just doesn’t seem right, call your pediatrician.
The nights are long and while those first 24 hours (or weeks) may feel never ending, we promise, one day you will look back with overwhelming nostalgia. So enjoy those newborn snuggles, accept help and take a moment to just enjoy your new baby.
Tiffany Fischman, M.D., FAAP, is a general pediatrician at Calabasas Pediatrics and Children’s Hospital Los Angeles. She previously worked at The Brigham and Women’s Hospital in Boston where she practiced general pediatrics and newborn medicine and held the position of Clinical Instructor of Pediatrics at Harvard Medical School.
In her free time she enjoys running, traveling, blogging on the latest topics in children’s health, and spending time with her husband and three young children, all under the age of five.
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