The neonatal period refers to the first 28 days of the life of a newborn. It is a time when the babies experience rapid changes. They establish their feeding pattern, bond with the parents, and in case of any congenital malformations, they may be recognized. It is also worth to note that the child is at very high risk of infections during this period, both from the healing cord and the underdeveloped immune system.
Table of Contents
- The Five Senses: Trying to Make a Sense Out of The World
- Mastering the Basics of handling a Newborn
- Danger Signs: When to Call The Doctor Immediately
The Five Senses: Trying to Make a Sense Out of The World
During the neonatal period, you may not notice much change, but the child is usually busy absorbing and learning a lot in terms of the five senses. The baby connects to you and the world around them through these senses. At birth, the senses of smell and taste are the strongest, while others develop in the next several months.
1. The smelling sense
The sense of smell is usually one of the very first senses to emerge. In fact, odors do pass through the placenta, and so, the sense of smell is usually up and running before birth. If placed on the abdomen of the mom immediately after birth, the newborn can crawl up to the breast, through the fine-tuned sense of smell.
A number of scientific studies have shown that babies are capable of smelling throughout the third trimester and even earlier. After a few days, the baby can recognize the mom simply by the smell of the skin. That is why a cuddle from mummy has such a soothing effect. It is also believed that through the scents sense, a baby can differentiate breastmilk from another mum.
Since the smell that the child finds most comfortable is the mom’s, you can play around with the power of scent to calm an irritable child. For instance, when you want to leave your baby alone for the first time, leave a t-shirt or sleeping gown that you have worn on the pillow. When the baby smells your scent, they will feel relaxed and comforted. Use of nicely smelling essential oils is another way to calm the baby. However, be sure not to use the oils directly on the baby’s skin to avoid skin sensitivities.
The nose of the neonate is usually short and flat to prevent it from suffocation when attached to the breast.
At birth, the eyes are usually nearly adult size, but eyesight develops as the baby grows in the next several months. The eyelids may appear like they are swollen or puffy, but this is so to protect the sensitive developing eyes. The eyes also look crossed as the baby has not yet developed enough muscle strength.
Throughout the first month, there are rapid changes in which they begin to track moving objects, but it is until after the second month that they can easily focus on an object near them.
Within the first month, a baby can only focus between eight and fifteen inches away (distant objects appear blurred). This is just the distance between them and your face when they are breastfeeding. That is why it is essential to maintain eye contact when nursing.
Though eyesight takes a while to develop, they explore the wonders of the world with the eyes, even before they learn to grasp an object, crawl or even sit up.
3. Sense of touch
Babies are born with sensitive skin, and the sense of touch and emotional engagement plays a crucial role in childhood development. Plenty of research studies have linked skin-to-skin contact with brain development.
The sense of touch begins to develop as early as six weeks of pregnancy. These movements mark the very first explorations of the baby. They touch their face, push around with the hands and feet, and even discover the uterine wall. This sense continues to develop after delivery and beyond the first year.
A gentle touch is one sure way of calming a neonate. Make use of caressing, massaging, stroking, rocking and swaddling the baby. You can also try kangaroo nursing, where you maintain skin to skin contact when the baby is only in diapers. Place the baby on your (mum or dad) bare chest then cover with a light cloth. It will help to regulate the baby’s heart and breathing rate, increase oxygen levels, improve sleep and to you, it increases the levels of oxytocin, a love hormone.
The sense of hearing is usually well developed, and, by birth, the child will have known the mother’s voice. However, the part of the brain that responds to complex sounds and attaching meaning to sounds continues to develop throughout infanthood. Most hospitals conduct a hearing screen test within the first month of life. Babies with hearing loss can be diagnosed within this duration.
The baby is usually able to pay attention to high-pitched voices, and they can startle at unexpected sounds. Human voices especially the mum’s or dad’s are the favorite baby rhythm. So, enjoy talking to the baby, and by the time they are turning two to three months, you will see them responding using vowels. Also, if you are at a distance and the baby cries, approach them as you talk. You will be surprised at how your voice quickly quiets them.
The sense of taste is also usually well-developed, but the quantity of taste buds and reactions to different types of substances increases as the baby grows. At birth, the taste buds are generally quite sensitive, and they can distinguish between sweet and sour, but of course, the sweet tooth takes the day. Reactions to salty foods and other things come later after five months.
Other than the senses, expect changes in other systems including
- The neonate will be covered with light fuzzy hair known as lanugo hair. The hair disappears few days or weeks after birth. Before delivery, its role is to hold vernix caseosa (the thick white cream on the baby’s skin that protects and moisturizes the baby in the womb ) in place, and after birth, it helps to prevent heat loss. If the hair is too much and does not completely fall off after one month, it may be a sign of certain conditions like Congenital Adrenal Hyperplasia (CAH), and therefore, it will be prudent to see a pediatrician.
- In the first few days, the neonate’s bone skulls are not usually fully fused, and the baby usually has open spaces at the joints, known as fontanelles. The rationale is to allow the skull to move through the birth canal and also, to permit growth of the brain after birth. Babies have two fontanelles- the anterior and posterior. The anterior fontanelle closes up after the third month while the posterior one closes by the 18th If you notice a bulging or sunken fontanelle, it indicates that the baby is sick.
- The musculoskeletal system is usually not as strong. The baby can neither support their weight nor sit down. However, if you put the baby in the standing position on a flat surface, they will begin to step one foot in front of the other. That is a reflex known as the stepping reflex, and it disappears after two months. They can also kick the arms and legs though in an uncoordinated manner, raise the hand to the mouth and turn the head when you touch the cheek. At the end of the neonatal period, the baby should be able to lift the head when placed in the stomach position.
- On physical development, expect the baby to lose some weight within the first few days, which is usually regained after 7 to 10 days. At the end of the neonatal period, the neonate should have gained 110 to 220 grams and grow about 2.5 to 3.5 inches.
In a nutshell, you will only see very little of the development as the baby has feeble control of their muscles, and all they appear to do is eat, poo, pee, cry and sleep. They rely on very basic reflexes to survive and discover themselves, you and the world around them. However, there are timelines for certain things- at the end of one month, the baby should be able to:
- Show behavioral response to noise either by startling, blinking or making slight movements.
- Look at objects, especially human faces
- Keep the hand in a tight fist
- Raise the head when in the prone position.
If not, there could be slowed development that warrants professional advice.
Mastering the Basics of handling a Newborn
The fragility of a newborn can be quite confusing and intimidating, especially if it is the first time. With gentle care and tender love, you will form the baseline for the coming months and years of growth and development.
First, their immune system of a newborn is not as good as that of a toddler, and if not taken care of properly, you could be spending sleepless nights in the hospital. Remember to keep your hands clean by either handwashing or sanitizing, before and after handling the baby.
2. Head and neck control
Always support the head and neck of the baby. Remember that the baby does not have proper head control. The appropriate technique when picking them up is to slide your hand under the head and the other, under the bottom. Once you have a good hold of the baby, lift them up close to your chest. If you would like the baby to cradle on your shoulder, support the head and neck with one of your hands and the other side should be spread over the bottoms. When breastfeeding, the head should rest on a pillow or your elbow.
3. Feeding and burping
Breastmilk is considered the best, but formula feeding is also an option. Whatever you choose, ensure you feed the baby on demand, not later than 2 to 3 hours apart. If breastfeeding, you will notice that the more you breastfeed, the more the milk supply. Do not wait for the baby to communicate that they need to feed by crying. The baby expresses their need to feed by moving lips, sucking sounds, sucking fingers or sticking the tongue out.
When feeding, the baby swallows air, and it gets trapped in the gastrointestinal tract. Burping to release this air, is a skill that every parent has to master. To burp, sit down and cradle the baby on your chest and shoulder then gently pat the baby’s back with one arm. If you do not frequently burp the baby, they will have abdominal discomfort, and that means irritability and crying spells.
4. Shaken Baby Syndrome
Avoid shaking the baby whether out of frustration or when playing. The effects of shaking a baby can be very serious and can cause lifelong brain injury or even death. When shaken, the brain bounces in the skull, causing severe bleeding and swelling. There is also shearing and tearing of the retina of the eye, which causes more bleeding or blindness. When such injuries occur, the baby is said to have Shaken Baby Syndrome (SBS).
5. Touch, kiss and hug me
Foster physical and emotional bonding- it will significantly contribute to the neonate’s development. Begin bonding few minutes or hours after birth. Gently cradle, breastfeed, maintain eye contact, gentle stroking, and practice skin to skin contact.
In the first few weeks, swaddling will really help in soothing, calming and keeping the baby comfortable. Proper swaddling involves cozily wrapping the baby in a soft blanket with the arms close to the body. It is an essential skill that will almost always help you when the baby is overstimulated or irritable.
It also prevents the baby from being disturbed by their own startle, keeps them warm, and reminds them of their snug position in the uterine environment. However, swaddling should only be done within the first two months of life. During the third month, they can roll over to a position that increases the risk of Sudden Infant Death Syndrome (SIDS).
7. The poop and pee
The first time that you change a diaper, the poop will be meconium, which is a copious greenish or dark tar-like substance that accumulates in the baby’s intestines in the uterus. After 24 hours, all the meconium will have passed out, and you will start seeing transitional stools that appear mucoid and at times seedy. After that, the poop may not always remain the same. For a breastfed baby, it may be at times mustard-like in color, watery, mushy or seedy. On the other hand, formula-fed babies have pale yellow or brownish green stool.
In the first five days, you will see soiled diapers at least once daily. Later on, the baby may take two to three days to pass stool. This is normal so long as the stool is soft and easy to pass. If the baby takes more than five days to poop, you have to call a doctor. You should also be concerned if you see fresh blood, thick black stools or diarrhea.
When changing soiled or wet diapers, never leave the baby unattended on the changing table- so always have the needed supplies with you. Clean the genital area with damp cotton or a piece of cloth. For a girl, always clean from front to back, to avoid introducing infections to the vagina and urinary tract.
For urine, the baby will have at least two wet diapers per day, in the initial days when you are only producing colostrum. As the days pass, the breastmilk supply increases and so does urine output. You will, therefore, notice more wet diapers.
It is necessary to change a diaper every two to three hours, but you do not have to wake the baby if they are asleep. If the diaper stays longer, the acid content of the urine and bowel can irritate the child. The bacteria in the poo may also invade the skin, causing diaper rash.
To prevent diaper rash
- Change wet or soiled diapers often
- Clean the genital area and pat it dry after every change
- Avoid tight diapers
- Allow some diaper-less time
- Use petroleum jelly, zinc oxide or any other ointment if the baby gets the rash often
- Avoid harsh detergents and fabric softeners
- Wash your hands after every diaper change to prevent the rash from spreading to other body parts or siblings
If the cord stump has not fallen off, remember to fold down the front part, so that it does not cover the cord area.
8. The umbilical stump
The umbilical cord typically falls off within 10 to 14 days. Before then, utmost care is needed or else the area may be infected. You should never attempt to pull the cord out as it increases the risk of infections and bleeding. Focus on keeping the area clean and dry. If you notice any signs of infection (pus, bad odor, red skin, tenderness, elevated body temperature or bleeding), you should call the pediatrician.
For the first week or until the cord falls off, you are encouraged to sponge bath the baby, using a warm damp cloth. If you prefer using the basin, baby tub or sink, always make sure that the cord area is above the water level. After the cord dries and falls off, you can then move to tub baths. The water should be warm (not hot), the baths ought to be brief, and the room must always be warm (preferably use a heater to pre-warm the room). It is not necessary to wash the baby every day in the neonatal period- three times a week is enough.
10. The sleeping patterns
Neonates sleep a lot- for up to 17 hours (8 to 9 hours daytime and 8 hours at night). However, they rarely stay asleep for 2 to 4 consecutive hours. You will therefore have a very demanding and tiring schedule that first month and probably up to three months. In between the sleep and awake cycles, change the diaper, feed, and bond with the baby.
Danger Signs: When to Call The Doctor Immediately
According to the World Health Organization (WHO), 46% of mortalities in under-fives are babies in their first 28 days of life. It is therefore undoubted that the neonatal period is the most critical, for the survival of a child. Many of the deaths are attributed to late recognition of neonatal illnesses and delay in seeking professional help. It is thus necessary for you to know when to recognize illness in a newborn or any other child.
The red signs include
- Fast breathing rate
- Difficulty in breathing
- Hot (above 37.50C) or cold (below 35.50C) body temperature
- Refusal to feed
- Lethargy or weakness
- Yellowness of the skin or eyes
- Signs of infection at the umbilicus
Any other abnormal change warrants a checkup. Follow your parental instincts and never delay seeking help for any reason.
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