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CHAPTER FIVE: Your Baby at Two Weeks
Congratulations! You have survived, possibly even thrived, with your new baby at home. Now it is time to pack him up and take him to his first visits at the doctor's office. Remember to allow extra time for these trips; it is amazing how much time it takes to get a newborn ready to travel in the car, especially if he spits up or needs a diaper change right after you get him dressed. Also, remember to dress him appropriately for the weather, strap him in snugly in the car seat, and don't forget the diaper bag!
Major Topics of the First Two Weeks
The major topics of the first two weeks involve the baby's weight and jaundice. As discussed in Chapter 3, all babies will lose weight and may become jaundiced in the first several days of life. The circumstances vary based on the child, but on average, both the maximum amount of weight loss and the highest level of bilirubin (the chemical which causes jaundice) occur on the fourth day of life. That is why the first doctor's visit is scheduled for when your baby is three to five days old.
At all well visits, the first order of business is to obtain the baby's weight. Be ready to undress your child completely. For the first several months, most offices like to weigh the baby naked since the extra weight of a diaper or a onesie is significant on a newborn. You can put the diaper back on after the weighing, but it makes the exam easier for the doctor to leave the rest of the clothes off for now. As you might be waiting in the exam room for a while, wrap baby up in a blanket to keep him warm.
You might want to bring a cloth of some sort to put over baby once you've taken his diaper off and are transferring him to the scale-just in case he pees on the way. Either that, or pack an extra shirt for you in the diaper bag!
While most babies only lose 6 to 8 percent of their birth weight, some babies lose more than 10 percent and become significantly dehydrated. This is an issue of particular concern for breastfeeding moms. It may be that mom's milk is not completely in yet and thus baby is not getting a full amount of breast milk. It may be that your baby is small or slightly premature and tires easily. For whatever reason, some babies are not able to eat for long enough periods of time to gain weight. If a baby has lost too much weight by this visit, he will need to be more closely monitored and if you are breastfeeding, you would probably benefit from contacting a lactation consultant for help. (See Chapter 11 on breastfeeding for more details.) The doctor will schedule him for regular weight checks until it is clear he is gaining an appropriate amount of weight. On average, a baby will gain one ounce per day, but the range for healthy babies is one-half to two ounces per day.
Keeping a Diaper Diary
It is helpful to keep a record of your baby's wet diapers and bowel movements for the first few days after you leave the hospital. By day three, his stools should have changed from the dark green color they were at birth, passed through the transitional green/yellow stools, and turned into the seedy mustard yellow stools of a normal newborn. As for his wet diapers, a simple rule of thumb is that he should have the same number of wet diapers as days he is old plus one more. So a three-day-old baby should have four (3 + 1) wet diapers in twenty-four hours. This will level off at around eight to ten wet diapers a day.
Most babies are checked before they leave the hospital to see if the bilirubin level is too high. However, as mentioned, jaundice continues to get worse with an average peak around the fourth day of life. If your baby looks more yellow than expected when seen by your physician, the bilirubin might need to be checked again. Remember, the danger level for bilirubin depends on how many days old, how premature, and how sick the baby is.
What You Can Do
Bilirubin is processed by the liver and excreted through baby's pee and poop. To help avoid or lessen the jaundice, you need to feed your baby often (at least every two to three hours) during the first weeks of life to help him move the excess bilirubin out of his system.
There are several ways to check the bilirubin level. The first is just by seeing how yellow the baby is. (For babies with medium and darker skin tones, this visual checking is not as effective and transcutaneous bilirubin or blood tests are more accurate.) In general, jaundice starts in the face and moves down the chest and abdomen and then down the legs. While this is a crude estimate, jaundice to the lower abdomen but not the legs usually corresponds to a measured bilirubin level of 15.
In order to actually measure the bilirubin level, blood needs to be drawn from your baby. However, in the last few years, an alternative measurement called transcutaneous bilirubin has become common. This method is painless because it only involves laying a probe on your baby's forehead for several seconds to "measure" the color of the skin. In addition, this method is faster, with results under a minute. The blood test results take about an hour.
The slight drawback of transcutaneous bilirubin is that it is not as accurate as the blood measurement-the results vary by 2 to 3 points. Thus if the danger level is 19 and the transcutaneous bilirubin is 15.5, you can safely skip the blood test because 15.5 plus 3 points is still below the danger level of 19. However, if the transcutaneous bilirubin was 19.5, the actual blood level might be anywhere from 16.5 to 22.5. In this case, the doctor would do the blood test to find the actual bilirubin level and see if any action is necessary.
In the end, if the blood bilirubin level is above the danger level, your baby will need some intervention, usually phototherapy. This used to require hospitalization for one to two days, but recently outpatient phototherapy, also known as a "bili blanket," has become more available. A bili blanket has stiff plastic tubes running through it that emit the special blue light that treats jaundice. Your baby can be wrapped up in the blanket and get the required phototherapy at home. This often involves a lot of logistics to get the blanket and arrange for follow-up measurements of the bilirubin to make sure the phototherapy is working. For some families the effort is worth it to avoid staying in the hospital.
Once the bilirubin level is below the danger zone and heading down, you almost never have to worry about jaundice again. The body takes over processing the bilirubin, and the yellow color will resolve slowly over the next one to three weeks. So, if your physician says, by any measurement, that the jaundice is not significant, you have passed that milestone safely.