The second day is usually all about cluster feeding to stimulate your milk production. It takes time for the milk to come in. This is not the time to supplement with formula or any other source of nutrition. The goal is for the newborn to stimulate enough milk for you to help him grow and develop. On day 3 when the milk comes in with a force, it will be important to massage any areas of hardening in the breasts. There may be redness in the clogged areas which can respond to the massage, heat pads and ice packs after feeding. While the neonate feeds, massage the hardened areas to clears the ducts. It is not uncommon for the baby to have high bilirubin levels. The levels peak at day 4 or 5. If breastfeeding is established, the baby has a strong suck, is latching properly and you have now a good milk supply, avoid formula and feed, feed, feed. They may spill milk during this period as the flow of milk is strong and overwhelming for the baby. Because the opposite breast will leak copiously in the beginning, use a cotton nursing pad, ideally without a plastic liner to keep the baby from getting soaked. Make sure to change you both into dry clothing. Gathering the milk can be an option for extreme overflow but may stimulate an increase in milk production. Use an alarm to make sure you keep the baby well fed on intervals of 2-3 hours. Your milk supply will not be interrupted and the levels of bilirubin usually go down after day 5. If rare cases milk production may not be adequate and formula may be needed temporarily to flush out the bilirubin.
Before the umbilical remnant has fallen off, keep the front of the diaper folded and below it. Do not use any cream on it. Use a warm sponge bath to clean the baby avoiding getting the umbilical remnant wet right now. Check the diaper regularly to avoid chafing as during this early stage there is often poop after every feed. Find diapers that don not have mesh which sticks to the buttocks. This holds the poop against the skin and is a cause of diaper rash.
Be mindful already from the first week to alternate positioning from the back, with head on both right and left sides, to lying on the right and left sides. Then when the umbilical cord remnant falls off, place the baby on the stomach during the day with head on both the right and left sides. This should prevent flattening of one area of the skull.
The neonate from 37 weeks in considered full term. Dress them in a weight of clothes you feel comfortable in and add a layer. Their circulation is immature and they can be cooler in their extremities.
Many neonates are essentially unconscious during the first two weeks, so feeding can be a challenge as they need to be stimulated to wake up to feed on a regular basis. Breastfeeding is ideal, though it may be a challenge to continue if given formula early on. It is a good idea to introduce a pacifier early so they are not opposed to it later if needed.
The milk usually comes in fully on day three and the challenge can be the latch. Until then don’t doubt that you will have adequate milk to feed the baby. Don’t hesitate to reach out to a lactation consultant if feeding seems tricky. Ideally you avoid formula at this point, the baby is stimulating just how much milk they need from you. Formula is also hard to digest and can cause a wave of digestive issues as well as distress for the neonate. Be mindful to keep your upper body and particularly your breasts warm, avoid a chill. Getting a chill can lead to mastitis, an infection of the milk glands with fever, reddened streaks on the breast, and clogging of the ducts. In some cases, before a this process progresses and before the fever sets in, some women can successfully clear the ducts by breastfeeding that side, using an Epson salt water extraction with a pump. Some cases require antibiotics. Find a good probiotic for you and the infant to replace the good bacteria in the intestinal system.
Some babies that are fussy between feeds may be hungry or instinctively be working to increase the milk supply. That said, you should not be feeding all day. With cluster feeding nipples may get very sore. There are shields which can protect the nipple functioning as a barrier between the nipple and clothing. Be mindful that milk accumulates and can be a grow ground for bacteria which have easy access to the milk ducts. Mastitis may be experienced as tiredness at first, moving into achy, chills, and then fever. There are usually hardened areas in the breast and redness in the breast, the redness can be a general area but even redness as a streak. Before developing a fever, you can pump and preferentially feed from the affected breast. There are even pumps you can fill with warm water and Epson salts which draw the milk out and help loosen the clogging. Avoid wearing wet tops or wet pads for the breast. There is a passive unit that attaches to the breast and catches the overflow from the breast not being fed from, this reduces nipple exposure to wet clothing and possible infection. You should be drinking between 3 and 4 liters a day, ideally some with electrolytes. Avoid sugared drinks choosing instead a small amount of unsugared juice concentrate to flavor your water. If you have group B- Strep in your bladder and were treated for it during delivery with antibiotics, choose cranberry juice to reduce the risk for a urinary tract infection post partum. Take probiotics to replenish the health bacterial flora normally living in the gut. There are probiotic formulas for the infant as well. Mom’s that choose to breastfeed will need to supplement the infant.
Babies that have high bilirubin levels may develop jaundice. It is important for these infants to feed often to flush the system. If you have plenty of milk, continuing to exclusively breastfeed is perfect.
For some neonates, the digestive system can be a cause of distress or grunting. For some, the system is still maturing and they may experience gas as painful. Make sure you burp the baby well using firm clapping along the back with the infant upright. Avoid foods that make you the mom gassy and even those your husband has issues with. Depending on the extent of discomfort and skin condition of the infant, you may choose to restrict certain food groups commonly associated with digestive issues in the neonate and infant. milk protein and soy protein are cross allergens meaning if you don’t handle one of them, you should avoid the other. Milk and soy protein are the first foods to restrict. Restricting these means avoiding large portions, but milk in bread as an example is ok. You do this ideally for 4 weeks and see if there is a change in the following behaviors: reflux, vomiting, rash, eczema, diaper rash, mucous in poop or vomit, or copious vomiting. If there is a more severe rash or eczema, remove milk, soy and eggs. If the baby is formula fed, start with a hydrolyzed or extensively hydrolyzed formula that works.
Some babies need to be close, so resting with them at your side during the day can be calming. This is safe as long as you have not had any alcohol or drugs. Always be sure they have their own blanket so they do not get overheated. The summer offers challenges as the infant and young child have difficulty regulating their temperature. Avoid being out side for extended periods when the temperature is overe 30 degrees Celsius.