Monday, March 1, 2010

Checking your baby's breathing

How often should I check my baby's breathing?

As often as you feel you need to. And if you feel compelled to check your baby's breathing all the time, you're not alone. Consider your vigilance a reflection of how seriously you're taking parenthood.

It may help to keep in mind that babies have various stages of slumber — sometimes deep and still, sometimes active, sometimes noisy and snuffly. Your comfort level should grow with experience, but it's okay if you continue to make nightly forays into your child's bedroom, just to check on his breathing, for years to come.

Danielle Buckley-Werner remembers feeling panic-stricken every time she put her son to bed during his first months of life.

"I was sure that if I wasn't there to hear him breathe, then he couldn't take a breath," she says. "I was so tired all the time because when he slept, I would watch him. I finally collapsed on the floor of the nursery one afternoon and realized that something had to give if I was going to have the energy to be a good mom."

Buckley-Werner started taking naps with her son and using a baby monitor when she couldn't. For the first three months, she and her husband, Daniel, kept the crib in their room so they could easily respond to any coughs, cries, or breathing emergencies — which, thankfully, never arose.

"I can't tell new parents that they shouldn't worry and that constantly checking breathing is insane," says Buckley-Werner. "But depriving yourself of rest and waking your baby up all the time will exhaust everyone. For me, keeping my baby close helped me overcome my fears that he'd stop breathing."

How can I stop worrying so much about SIDS?

It may calm some of your fears to know that sudden infant death syndrome (SIDS) is rare, afflicting fewer than 1 in 1,000 infants. What's more, 90 percent of SIDS cases happen before age 6 months, and the risk virtually disappears when a baby reaches his first birthday.

No one knows exactly what causes SIDS (although there are plenty of theories), and there's no surefire way to prevent it. Thankfully, the incidence of SIDS has dropped dramatically in recent years as more risk factors are identified and more parents learn to avoid them.

To help guard against SIDS, always put your baby to sleep on his back, and if you or another family member smokes, give it up. (Read more about reducing the risk of SIDS.)

It's also a good idea to learn infant and child CPR. Knowing CPR will help ease your fears and enable you to respond to any serious breathing emergencies throughout childhood.

Call the Red Cross or the hospital where you delivered to find an infant CPR class, or consider organizing an infant CPR party for yourself and other new parents in your area. Take your spouse and the babysitter along, too.

How can I tell if my baby has stopped breathing and what should I do about it?

Newborns do what's called periodic breathing: They breathe progressively more quickly and deeply, then more slowly and shallowly, then pause for up to 15 seconds, and then start up again with progressively deeper breaths. This is normal and will evolve into a more mature pattern of breathing, with occasional sighs, in the first few months of life.

If you suspect that your baby has stopped breathing or simply want to reassure yourself, touch or rouse him a bit to see whether he responds. If he doesn't, he may be experiencing something called apnea, and you should call 911 or your local emergency number right away.

If this happens and you know how to administer infant CPR, you should begin emergency treatment right away and have someone else call for emergency help. If you're alone with your baby, administer CPR for two minutes, then call for help, then resume CPR until help arrives or your baby starts breathing again.

It's not unusual for a baby's hands, feet, and skin around his mouth to be bluish. But if his forehead or the trunk of his body turns blue, it's another sign that he may be in danger.

In most cases, babies' irregular breathing habits are nothing to worry about. But babies who have had more than one apparent life-threatening event (ALTE) are at increased risk for long-term complications or sudden unexpected death. An ALTE is an episode in which a baby stops breathing. He may also become limp, turn blue, and choke or gag.


Baby sleep basics: Birth to 3 months

Typical sleep patterns at this age

Newborns sleep a lot — typically 14 to 18 hours a day during the first week and 12 to 16 hours a day by the time they're a month old. But most babies don't stay asleep for more than two to four hours at a time, day or night, during the first few weeks of life.

The result? Lots of sleep for your baby and a very irregular — and tiring — schedule for you. Your job is to respond to your newborn's cues, so you'll probably be up several times during the night to change, feed, and comfort him.

What's going on

Baby sleep cycles are far shorter than those of adults, and babies spend more time in rapid eye movement (REM) sleep, which is thought to be necessary for the extraordinary development happening in their brain. REM sleep is lighter than non-REM sleep, and more easily disrupted.

All this unpredictability is a necessary phase for your baby and it doesn't last long — though it may seem like an eternity when you're sleep-deprived.

What's next

At 6 to 8 weeks of age, most babies begin to sleep for shorter periods during the day and longer periods at night, though most continue to wake up to feed during the night. They also have shorter periods of REM sleep, and longer periods of deep, non-REM sleep.

Somewhere between 3 and 6 months, experts say, most babies are capable of sleeping through the night. They're not talking about eight hours, though — they generally mean a stretch of five or six hours.

Some infants sleep for a long stretch at night as early as 6 weeks, but many babies don't reach that milestone until they're 5 or 6 months old and some continue to wake up at night into toddlerhood. You can help your baby get there sooner, if that's your goal, by teaching him good sleep habits from the start.

How you can establish good sleep habits

Here are some tips for helping your baby settle down to sleep:

Learn the signs that mean he's tired.

For the first six to eight weeks, most babies aren't able to stay up much longer than two hours at a time. If you wait longer than that to put your baby down, he may be overtired and have trouble falling asleep.

Watch your baby for signs that he's tired. Is he rubbing his eyes, pulling on his ear, or developing faint dark circles under his eyes? If you spot these or any other signs of sleepiness, try putting him down to sleep. You'll soon develop a sixth sense about your baby's daily rhythms and patterns, and you'll know instinctively when he's ready for a nap.

Begin to teach him the difference between day and night.

Some infants are night owls (something you may have gotten a hint of during pregnancy) and will be wide awake just when you want to hit the hay. For the first few days you won't be able to do much about this. But once your baby is about 2 weeks old, you can start teaching him to distinguish night from day.

When he's alert and awake during the day, interact with him as much as you can, keep the house and his room light and bright, and don't worry about minimizing regular daytime noises like the phone, TV, or dishwasher. If he tends to sleep through feedings, wake him up.

At night, don't play with him when he wakes up. Keep the lights and noise level low, and don't spend too much time talking to him. Before long he should begin to figure out that nighttime is for sleeping.

Consider starting a bedtime routine.

It's never too early to start trying to follow a bedtime routine. It can be something as simple as getting your baby changed for bed, singing a lullaby, and giving him a kiss goodnight.

Give him a chance to fall asleep on his own.

By the time he's 6 to 8 weeks old, you can start giving your baby a chance to fall asleep on his own. How? Put him down when he's sleepy but still awake, suggests Jodi Mindell, associate director of the Sleep Disorders Center at Children's Hospital of Philadelphia and author of Sleeping Through the Night.

Mindell advises against rocking or nursing your baby to sleep, even at this young age. "Parents think that what they do this early doesn't have an effect," she says, "but it does. Babies are learning their sleep habits. If you rock your child to sleep every night for the first eight weeks, why would he expect anything different later on?"

Not everyone agrees with this strategy, however. Some parents choose to rock or nurse their babies to sleep because they believe it's normal and natural, because they enjoy it and their baby is thriving and sleeping well, or simply because nothing else seems to work.


Caring for your newborn's umbilical cord stump

What's the purpose of the umbilical cord?

Babies receive nourishment and oxygen in the womb through the placenta, which is connected to the inner wall of the mother's uterus. The placenta is connected to your baby by the umbilical cord through an opening in the baby's abdomen. After your baby is born, the umbilical cord is clamped and cut close to the body in a painless procedure, leaving an umbilical stump.

How long will my baby have an umbilical stump?

In about 10 to 21 days, the stump will dry up and drop off, leaving a small wound that may take a few days to heal.

Does the stump require special care?

It must be kept clean and dry. Fold the baby's diaper below the stump (or buy newborn diapers with a cut-out space for the cord) so it's exposed to the air and not to urine. When the stump falls off, you may detect a little blood on the diaper, which is normal. Avoid giving your baby tub baths until the stump falls off.

In warm weather, have your baby wear just a diaper and loose T-shirt to let air circulate and speed the drying process. Avoid bodysuit-style undershirts until the cord has fallen off. And never attempt to pull off the cord, even if it looks like it's hanging by a little thread.

Sometimes after the stump falls off some bits of lumpy flesh remain, which may disappear on their own or may need to be treated by your child's doctor. These "umbilical granuloma" are not serious and contain no nerves, so if treatment is required, it's painless for your baby.

As for the time-honored practice of swabbing the stump with rubbing alcohol, the waters have become murky. To prevent infection, your doctor or midwife will swab the cord with dye or another antiseptic when she clamps and cuts the cord. And for at-home care afterward, healthcare practitioners have long recommended cleaning the base of the stump with a cotton swab or gauze pad dipped in a little bit of rubbing alcohol once or twice a day.

Many pediatricians still support that practice, but others now suggest that it's more effective to let the cord dry naturally. That's because a 1998 study by the Hamilton Health Sciences Corporation in Ontario, Canada, found that untreated cords healed in eight days, while it took ten days for alcohol-swabbed cords to fall off. (None of the 1,800 newborns in the study developed an infection.)

Pediatrician Carol A. Miller, a clinical professor of pediatrics at the University of California in San Francisco, says she still recommends the alcohol cleaning because many parents don't like the odor and "goopiness" that sometimes result from not using the alcohol. "It's questionable whether the one- or two-day benefit of natural drying is worth it," she says.

If you're not sure which method to use, talk to your baby's doctor.


How many women attempt breastfeeding?

According to the U.S. Centers for Disease Control:

70% of new mothers initiate breastfeeding

36% are breastfeeding at 6 months

17% are breastfeeding at 12 months

(Numbers are for the United States only, and come from a 2003 survey.)