Module 2: First Two Weeks
The first two weeks are the most overwhelming, as you leave the safety net of the hospital and tackle newborn care on your own. It’s a learning process, so be gentle with yourself as you, your partner, and your newborn navigate this new stage together.
When Is My First Pediatrician Visit?
In the first 2-3 days after discharge from the hospital. At this visit, we’ll check on weight and jaundice, and answer questions about feeding and newborn care.
We’ll often see you again at two weeks to make sure your baby has regained their birth weight, and that their abdomen looks healthy after the umbilical cord stump falls off. Sometimes, we’ll see you sooner than that if the weight or jaundice level at the first visit warrants closer follow up.
What Is The Overall Newborn Schedule?
While there’s a lot of variance in exact timing, the general daytime schedule you’ll follow in the first two weeks looks something like this:
Newborn wakes up and is ready to feed. Change diaper and breast/chest- or formula-feed.
Newborn will have a wake window where you can interact with them via tummy time, talking to them, reading, singing, making silly faces, or walking around with them.
Newborn will get sleepy, and you’ll set them down for their nap.
This sequence will repeat every 3 or so hours. Overnight, you’ll eliminate the wake windows, and focus solely on feeds and sleep. Often, this schedule gets thrown off from something interfering with sleep or feeding and having downstream effects on the rest of the day, and it’s totally alright if that happens! Give yourself grace. This is just a guide to help get a general idea of what newborns are like, and tomorrow’s a new day if today felt chaotic and overwhelming.
How Often Should I Feed My Newborn?
In these early days, it’s typically “on demand,” which means when your newborn says they’re hungry! This is when they show hunger cues (turning their head, more alertness, fists moving to mouth, and sucking on hands). It’s around every 1.5-3 hours in a newborn, and can vary depending on the child and milk supply (if breast/chest-feeding).
Sometimes, your infant may cluster feed, which is when they opt for smaller-volume, more frequent feeds (hourly) rather than larger-volume, less infrequent feeds (every 3 hours). It tends to happen more frequently during growth spurts (3 weeks, 3 months, and 6 months) and last for a few days at a time. While it can feel like an exhausting schedule, it usually only lasts for a few days at a time and resolves in the first 6 months, so know that there’s an end in sight.
I recommend not going any longer than 3 hours without a feed overnight until your newborn at minimum regains their birth weight (usually around 2 weeks), since less frequent feeds can lead to slow weight gain or dehydration. After that, you can go for longer stretches (4-5 hours), though they still likely won’t sleep through the entire night until at least 3-6 months. All infants are different, so don’t fret if yours takes a little longer for that full night’s rest. Most important in dictating nighttime feeding frequency is weight gain. If the trend is solid, most doctors are comfortable with letting your infant run the show with respect to feeding schedule.
Note: Module 3 and Module 4 review Breast/Chest-Feeding and Formula-Feeding, respectively.
When Should My Baby Regain Their Birth Weight?
In the 1st week, it’s normal for newborns to lose weight (up to around 10%) due to fluid losses after delivery and difficulties with feeding. Most babies will reach their birth weight again by 2 weeks.
If your newborn loses >10% or takes longer to regain their birth weight, your PCP will help with lactation education, formula supplementation or fortification instructions, and frequent weight checks. We’re most concerned about dehydration, so it can help to keep a feeding diary and count wet diapers to ensure your infant’s getting enough fluid.
What Will Stools Look Like? What’s Normal?
In the first 1-2 days, stools are tar-like, black, and sticky. This is called meconium. After this stage, stools turn transitional for the next 2-3 days, which means that the color will lighten to green or brown, and evolve into a looser consistency. The final stage is milk stools, which are more yellow and consistently soft and mushy. This should occur at 5-7 days.
There’s usually a lot of concern about when to worry about stool color. Once the milk stool stage is reached, there’s variance. You can see green, brown, yellow, or a combination of these colors in different shades. They may change from one day to the next, and that’s OK. The 3 colors that we worry about and require evaluation are red, black, and white / clay-colored. If there are red or black stools, that suggests an issue with intestinal bleeding, while white stools raise concern about the gallbladder and liver’s function. A lot of mucus or very watery stools can imply issues with absorbing breastmilk/formula, and is another reason to see your PCP.
How Frequently Will Stools Come? How Do I Know If My Baby Is Constipated?
At the start of life, stools occur one to a few times daily, after which they may start to space out depending on if they’re breast/chest-fed or formula-fed (breast/chest-fed infants will often go longer without stools, sometimes a few days at a time). There’s a wide range of normal, so it’s completely fine if your newborn is either having a dirty diaper with each feed, or going 3-4 days without a stool (so long as the consistency is soft).
In newborns, there’s often concern about constipation due to frequent straining. This is called infant dyschezia and is really common. It’s a fancy way of saying that stooling is a learned skill, and it takes a while to get it down! If you think about it, stooling isn’t totally automatic. Your newborn needs to know their intestines are full, figure out how to coordinate their muscles to bear down and get the stool out, and determine if they emptied everything. In figuring this out, they may seem fussy or get red in the face. If the stool comes out mushy and soft, then this is normal. If it comes out hard (like small rocks or pebbles), if there’s more than 5 days without stool, or if there’s streaks of blood, then we’re concerned about constipation and you should talk to your Pediatrician. If your newborn didn’t stool in the first 24 hours of life, this is another concern that warrants evaluation.
What About Peeing?
You’ll notice wet diapers more often than dirty ones (though sometimes, there’s a combination of the two). In the first 4-5 days, a good rule of thumb is to expect at least the number of diapers as your newborn is days of life (e.g., 1 diaper on their first day, 2 diapers on their second) as feeding is established. After Day 5, they should have a goal of at least 6 diapers daily (typically one with every feed), with any less warranting Pediatrician evaluation for feeding issues and dehydration.
What’s That Pink Dust / Faint Bleeding In My Child’s Diaper?
A common issue in the urine during the first few days of life (especially in breast/chest-fed babies) are urate crystals. These appear as red, pink, or orange dusty staining in the diaper. Often, it looks similar to faint bleeding, so parents understandably get nervous! Not to worry, though. It just means that the urine is still concentrated (which is normal during the first week as newborns are getting the hang of feeding), and they’ll disappear as milk supply gets established and feeding is more consistent. If they last longer than one week, see your PCP.
How Do I Care For Circumcision And The Uncircumcised Penis?
You’ll want to clean the area with warm water and a gentle soap during dirty diaper changes to avoid infection. In the first 3-5 days, it’s also recommended to add Petroleum Jelly (Vaseline) to the tip of the penis to create a protective barrier. This prevents it from sticking to the diaper as it heals. The circumcision site should take about 1 week to heal. While there may be a few drops of blood or some dried crusting as healing occurs, there shouldn’t be large amounts of blood (larger than a quarter), swelling, redness, or foul-smelling discharge. If you notice these, see your Pediatrician.
In uncircumcised penises, care is even simpler. Other than cleaning the area with diaper changes, don’t mess with it! In male babies, the foreskin is very tight due to natural adhesions attaching the foreskin to the penis. Over time, these will loosen (usually by around 5 years of age, though sometimes not until the teen years), so that the foreskin is fully retractable. Until that occurs, though, avoid retracting it yourself. In rare cases, it can get stuck behind the head of the penis and cut off circulation, causing lasting damage.
