Your Baby Week Four

1
Taking Your Baby Out

Mother holding milk bottle
dapan photography/Moment/Getty Images

Newborns have immature immune systems and can be prone to getting sick fairly easily. Newborns also haven't received many vaccines yet. Add in that pediatricians are often very aggressive when a baby has a fever and it is easy to see why experts often recommend that you not take your baby out in her first few months.

In fact, your visits to the pediatrician may be the only time that you have taken your baby out, so by the time your baby is four weeks old, you may be getting a little stir crazy spending so much time at home.

Avoiding Infections

The risk of catching a

cold

,

RSV

, the

flu

, or another infection, is the main reason that you don't want to take your baby out much during her first few months. Since these infections are spread by contact with other people, the more people you are around, the greater your baby's risk of getting sick.

While it seems to some people like you are being over-protective, if it helps keep your baby from getting sick with a fever, ending up in the emergency room and needing a spinal tap, then you will be glad that you kept your baby in and waited a few months before showing her off and taking her out.

Taking Your Baby Out

Of course, you can't always avoid taking your baby out.

Some tips to help when you do have to take your baby out include:

  • avoid crowds by going out during off-peak hours
  • don't let a lot of people hold, touch, or 'kiss on' your baby, especially if they seem sick
  • carry your baby in a wrap or sling so that she will have some protection from other people
  • encourage people to wash their hands before holding your baby

And remember that it is more people, and not really just being out, that you want to avoid. So feel free to go for a walk or to visit a small number of family or friends during your baby's first few months.

2
Pumping and Storing Breastmilk

A Medela Pump In Style Breast Pump and Supplies
A Medela Pump In Style Breast Pump and Supplies. Photo © Vincent Iannelli, MD

Four weeks is often when breastfeeding mothers begin to think about pumping and storing extra breastmilk. By now, most babies are breastfeeding well, and you can usually be less concerned about nipple confusion from taking a bottle of pumped breastmilk.

What are the benefits of pumping?

One benefit is that you will have breastmilk to feed your baby if someone else is watching her. This is especially helpful if a breastfeeding mother is going back to work, and can help avoid formula supplements.

Pumping can also be helpful to boost your breastmilk supply. Remember that breastmilk production is mostly based on 'supply and demand.' So any extra pumping you do, in addition to your baby's nursing, can simulate an increased demand and help increase your breastmilk supply. Just be sure to pump right after your baby is done feeding. If you pump too soon before your baby is going to nurse, then you may take breastmilk away from a feeding.

Are there any downsides to pumping?

The main downsides are the possible discomfort of pumping if you are not doing it properly, the costs involved in purchasing a breast pump, pumping supplies, and bottles. There is also the time involved in pumping and cleaning the breast pump and bottles.

Storing Breastmilk

If you have a good supply of breastmilk and your baby is nursing well, you may quickly build up a supply of pumped breastmilk that you now have to store safely.

Common breastmilk storage guidelines state that breastmilk can be safely stored for:

  • 4 to 6 hours at room temperature
  • up to 24 in a cooler with ice packs
  • 5 to 8 days in the refrigerator
  • 2 weeks in the freezer (if the freezer compartment is inside the refrigerator)
  • 3 to 4 months in the freezer (a separate freezer compartment)
  • 6 to 12 months in a deep freezer

3
Your Baby's Eating Habits

A Well-Satisfied and Well-Fed Breastfed Baby
A Well-Satisfied and Well-Fed Breastfed Baby. Stockbyte / Getty Images

Unfortunately, there is not really a rule for how much your baby should be eating at this age. Instead of an absolute amount or length of time for feedings, you should usually just look for signs that your baby is eating enough, include that she:

  • has regained her birthweight by two weeks and is now steadily gaining about one-half ounce to one ounce each day
  • is urinating regularly and is having at least six soaking wet diapers each day
  • is having two or three soft bowel movements each day

Is My Baby Getting Enough Breastmilk?

In addition to the signs above, you can be confident that your breastfeeding baby is getting enough to eat if your baby is latching on well and you notice the characteristic 'suck, pause, swallow' that

breastfeeding babies

often have.

If your baby is outside the typical range of 8 to 12 feedings a day, which usually includes at least one feeding during the night, be sure to talk to your pediatrician and consider having your baby weighed.

Is My Baby Getting Enough Formula?

While it is often easier to tell exactly how much your baby is eating when she is drinking from a bottle, that doesn't really mean that you know it is enough. While some four-week-olds are already drinking five to six ounces of formula from a bottle, others are still at only three or four ounces.

The American Academy of Pediatrics, in the book Your Baby's First Year, states that 'most babies are satisfied with 3 to 4 ounces per feeding during the first month, and increase that amount by 1 ounce per month until reaching 8 ounces.'

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4
Spitting Up

You are asking for trouble these wearing outfits without protection if your baby spits up a lot.
You are basically asking for trouble wearing outfits like these without protection if your baby spits up a lot. Photo © Leigh Schindler

Parents often look forward to the day when their babies will stop spitting up. Unfortunately, it is often when they are much older than four weeks. In fact, many babies don't stop spitting up until they are six to nine months old.

Keep in mind that spitting up, besides being messy, often doesn't cause a problem for most babies.

Signs that spitting up or reflux is causing a problem include that a baby:

  • is often fussy or irritable
  • frequently chokes or has wheezing or difficulty breathing
  • often refuses to eat (dysphagia)
  • arches her back during or right after feedings
  • has a chronic cough
  • has a hoarse voice or cry

If your baby is feeding well, isn't fussy, and is gaining weight well, then she may likely has simple reflux or what is called being a "happy spitter." These babies often don't need any treatment for their reflux and should eventually outgrow their spitting up.

If a child is spitting up and has any of the symptoms listed above, then she may have gastroesophageal reflux disease (GERD) and likely needs further evaluation and treatment from her pediatrician.

These reflux treatments can include:

  • lifestyle changes, such as changing the position that you hold your baby after feedings, elevating the head of your baby's crib about 30 degrees, using a tucker sling and wedge, and frequently burping your baby
  • continuing to breastfeed if you are breastfeeding
  • thickening your baby's formula if you are not breastfeeding
  • taking an acid reflux medication, such as Zantac or Prevacid

5
Week Four Care Tips

Your baby's umbilical cord has likely come off by now and so you are likely looking forward to graduating your baby from sponge baths to "real" baths.

Since your four-week-old baby doesn't have much head control, you won't actually be able to put your baby in much bath water though. And you won't actually be putting your baby in a regular bathtub. Instead, use a smaller baby tub or basin, and only put an inch or two of water in your baby's bath for the next few months.

Baby's First Bath

Where and how you bathe your baby often comes down to convenience and a parent's personal preference.

You do want to make sure that you bathe your baby safely though, including that you:

  • prevent scalding burns by setting the temperature of your hot water heater to 120.
  • keep in mind that most babies only need a bath two or three times a week. If your baby really enjoys taking a bath and doesn't have dry skin, often spits up, or has a lot of dirty diapers, then a daily bath may be necessary.
  • not leave your baby unattended, even for a second, when you are giving her a bath.
  • support your baby's head and neck while she is in the bath and wash her with your other hand.

6
Week Four Q&A

Q. Is it necessary for a newborn to drink water, or is formula enough? When I had my daughter twenty-five years ago, I gave her Sparkletts water and her formula. My daughter's doctor is telling her that she does not need to give her baby any extra water. I totally disagree.

A. What I think your granddaughter's pediatrician really means is that she doesn't need any 'extra' water. A baby gets should get all the fluids she needs from her formula, or breastmilk if she is breastfeeding. She wouldn't usually need extra water, though.

Another situation where you would give an older child extra water would be when they were getting overheated, but that shouldn't be happening to a newborn or infant.

Changing Advice and Opinions

Ideas and opinions over things like this change over the years. I am sure that there are other things that you did for your daughter, who likely turned out just fine, that we don't recommend now. Some of these things are extremely important, like the new recommendations to keep newborns and infants sleeping on their backs to reduce the risk of

SIDS

, and others are less important, like this one about water or some of the stricter guidelines about the order of

introducing solid baby foods

.

When you disagree about something like this, it might help to go along to your granddaughter's well child visits to her pediatrician so that you can discuss things and try to get your point across and to understand her doctor's view.

So When do Babies Need Water?

After they are six months old, infants do begin to need some fluoride, and so that is a good time to introduce some extra water into their diet.

But before six months, the average healthy baby doesn't need any extra water.

7
Week Four Medical Issues - Colic

A crying baby with colic often prompts a call to the pediatrician.
A crying baby with colic often prompts a call to the pediatrician. Stockbyte / Getty Images

Colic

Does your baby have any symptoms of

colic

yet? Although colic often begins when a baby is three weeks old, it sometimes doesn't start until they are four to six weeks old, so you may not be out of the woods yet. Remember that symptoms of colic typically include a baby, who is feeding and gaining weight well, cries for several hours, usually in the early evening, for no obvious reason.

Almost worse than having a colicky baby is hearing the phrase "it's just colic," which implies that there is nothing you can do about it. And while there is no known treatment or cure for colic, that doesn't mean you shouldn't try to calm your crying baby. Most newborn babies who are crying like to be swaddled, many like to be rocked, while others enjoy being sung to or going for a walk. You may just have to figure out what works best for your baby though.

8
Week Four Medical Issues - Gas

Burping a baby well can sometimes help prevent gas and gas pains.
Burping a baby well can sometimes help prevent gas and gas pains. Photo © Brett Williams

Gas

Is

gas

a medical issue? It can be when your baby has other symptoms too, such as foul smelling stools, poor weight gain, difficult feeding, or fussiness. More often though, it is normal for your baby to have some gas - or even a lot of gas.

Instead of worrying about how much gas your baby has, think about whether or not she has any true gas pains. Does she cry for long periods of time when she has gas? If not, and she is happy and feeding well, then she likely has normal "baby gas."

Parents of babies who drink baby formula often make a formula switch at the first sign that their baby is having some gas. This is usually unnecessary, but is likely prompted by formula that has been 'designed' for babies with gas, such as:

  • Enfamil Gentlease LIPIL
  • Enfamil LactoFree LIPIL
  • Enfamil ProSobee LIPIL
  • Similac Sensitive (formally Similac Lactose Free)
  • Similac Isomil Advance Soy Formula
  • Nestle Good Start Supreme Soy DHA & ARA
  • Parent's Choice Gentle Infant Formula

Changing from a milk-based, iron-fortified formula is sometimes necessary, but much less often than most parents realize when babies have gas. So talk to your pediatrician before changing your baby's formula.

Gas and Breastfeeding

As with a formula-fed infant, breastfeeding moms should usually only consider gas a true issue if it is excessive or accompanied by other symptoms. Before restricting your diet too much when your breastfed baby has gas, consider eliminating all milk and dairy products from your diet for a week or so. Again, talk to your pediatrician before avoiding a lot of other so called "gassy' foods, such as cabbage, broccoli, or beans.

9
Sibling Rivalry

Getting siblings to help in age-appropriate ways can avoid sibling rivalry.
Getting siblings to help in age-appropriate ways can avoid sibling rivalry. Stockbyte / Getty Images

Parents often think that their second, third, or even fourth baby will be easy. After all, they will be experts at most issues that come up.

While experienced parents may not be surprised every time their baby cries, has gas, or even has a fever, they may have another problem to deal with -- jealous siblings.

They may even have been prepared for some sibling rivalry when they first brought their baby home and likely took steps to prevent it, such as:

  • preparing their children during their pregnancy
  • not making any other big changes around the time of the baby's delivery date, such as a move to toddler bed, starting potty training, or changing preschools
  • making sure that friends and family spent time with them when they came to see the baby

Many parents aren't prepared for the fact that sibling rivalry may get much worse or may not even start until your baby is about four weeks old. Why? Your baby is likely a little more alert and awake now and so is requiring a little more of your time. That means a little less time for you to spend with your other kids.

In addition to trying to spend as much quality time with each of your other children, you can help prevent and decrease sibling rivalry by:

  • having your kids help in age appropriate ways, such as holding the baby, getting diapers, and putting clothes away, etc.
  • being prepared for changes and regression in your child's behavior and development, such as having more temper tantrums or having some accidents when he was just potty trained
  • encouraging friends and family to spend time with your other kids when they offer to help with the baby, or letting them help with the baby so that you have more time for your other children
  • sticking to your usual routines as much as possible, including mealtimes, naps, and bedtimes

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