Caring for Your Newborn: The First Weeks, and What Actually Needs a Call

Two things belong at the top of this page, because everything else can wait and these cannot.

A fever in a baby under one month is an emergency

A rectal temperature of 100.4°F (38°C) or higher in a baby under one month means call us immediately or go to an emergency room, whatever time it is. Even if they seem well otherwise. Even if it is the middle of the night.

A young baby’s immune system cannot localise an infection the way an older child’s can, so a fever may be the only sign of something serious, and it needs assessment within hours rather than overnight. Do not give fever medicine and wait to see. Use a rectal thermometer — forehead and ear readings are not reliable at this age.

Safe sleep, every sleep

Alone. On the back. In a crib or bassinet.

On their back for every sleep, including naps, until their first birthday. On a firm, flat surface with a fitted sheet and nothing else in it — no blankets, pillows, bumpers, positioners, or toys. Not on a sofa, armchair, inclined sleeper, or adult bed. Room-share without bed-sharing for at least the first six months; the same room greatly reduces risk, the same bed increases it.

These are the recommendations with the strongest evidence behind them in all of infant care, and they are worth following even on the hard nights. Especially on the hard nights — an exhausted parent falling asleep holding a baby on a sofa is one of the higher-risk situations there is, which is an argument for putting the baby down rather than for staying awake.

Everything below is the ordinary version of the first weeks.

Feeding, and how to know it is going well

The question underneath most new-parent worry is whether the baby is getting enough. You cannot measure it directly, so watch the outputs instead.

Reassuring signs: by around day five, six or more wet nappies a day; stools that have turned from dark and sticky to soft and yellow; feeding eight to twelve times in twenty-four hours; a baby who is alert when awake and settles after most feeds; and weight back to birth weight by around two weeks. Most babies lose some weight in the first days, which is expected.

Call us if: fewer wet nappies than that, no stool for an unusually long stretch in a young baby, feeds that are consistently very long or very short, a baby too sleepy to feed, ongoing weight loss after the first week, or a baby who never seems satisfied.

On breastfeeding and formula. Breastfeeding has real benefits and it is also genuinely hard for many people at the start — painful latch, supply worry, and cracked skin are common and mostly fixable with proper help. Ask early rather than pushing through, because early help changes the outcome far more than late help.

And formula is not a failure. A fed baby, a recovering parent, and a household that is coping matter more than the method. We will help either way and we are not keeping score. If feeding is not working, that is a reason to call us — not a reason to feel judged.

Sleep, realistically

Newborns sleep sixteen to seventeen hours a day in short stretches, with no regard for whether it is dark. Day and night confusion is normal and sorts itself out.

What helps: daylight and activity in the day, dim and quiet at night, and putting the baby down drowsy rather than fully asleep when you can. What does not help: any attempt at a schedule in the first weeks, or sleep training — newborns should not be left to cry it out. Their needs and their wants are the same thing at this age.

One expectation worth setting honestly: sleeping through the night is not a developmental milestone and not a sign of good parenting. Some babies do it early, most do not, and the difference is mostly the baby.

Tongue-tie and lip-tie, honestly

One of the posts this page replaces was about this, and it deserves a straighter answer than it got.

Tongue-tie is real, and a release procedure genuinely helps some babies. When a tight frenulum is physically preventing a baby from latching — and there is feeding difficulty, poor weight gain, or significant nipple pain and damage — releasing it can transform feeding.

It is also diagnosed and treated far more often than the evidence supports, including “lip-tie”, for which the evidence is considerably weaker. Diagnoses have risen steeply, and many babies undergo a procedure whose feeding problem had another cause — positioning, latch, supply, or simply a slow start — which the procedure cannot fix.

So the order matters: a proper feeding assessment first, procedure second if it is indicated. A skilled feeding evaluation by someone who watches the baby actually feed — an IBCLC lactation consultant, or us — finds a fixable cause much of the time. A tight frenulum visible on examination is not by itself a reason to cut; the question is always whether it is causing a functional problem.

If someone recommends a release, reasonable questions are: what specific feeding problem is this expected to solve, what was tried first, and what happens if we wait? We are happy to give a second opinion, and we would rather you asked.

The ordinary practical things

Umbilical cord. Keep it clean and dry, fold the nappy below it, and let it fall off on its own in one to three weeks. A little dried blood at separation is normal. Redness spreading onto the belly, pus, a bad smell, or fever is not — call us.

Bathing. Two or three times a week is plenty; more dries the skin out, which matters here. Sponge baths until the cord is off. Skin does not need much: a fragrance-free moisturiser if dry, and nothing scented. Peeling skin in the first weeks is normal.

Nails. File rather than cut in the early days.

Jaundice. Some yellowing is very common in the first week and usually harmless. Call us if it appears in the first 24 hours, spreads to the belly, arms or legs, gets deeper rather than fading, or comes with sleepiness and poor feeding. If your baby looks yellow in natural daylight and is feeding poorly, that is a same-day call.

Crying. Newborn crying peaks at around six to eight weeks and then declines — a normal pattern that often gets called colic. It can reach a few hours a day in a perfectly healthy baby.

Things that help sometimes: holding, motion, swaddling, a dummy, white noise, a change of scene. Things that do not: blaming yourself.

And the part that must be said. When a baby will not stop crying and you feel your temper going, put the baby down somewhere safe and walk out of the room. A crying baby in a crib is safe. Get someone else. Call us. Never shake a baby — it causes catastrophic, permanent brain injury, and it almost always happens to a loving parent at the end of their rope rather than to a cruel one. Knowing in advance that walking away is the right move is what makes it possible in the moment.

Visitors and illness. Hand washing, no one unwell, and it is entirely reasonable to ask people to wait — including family. Keep a young baby away from crowds in respiratory season. Ask us about RSV protection and about who around the baby should have a whooping cough booster; protecting a newborn largely means vaccinating the adults who hold them.

Your own health is part of this

Postpartum depression and anxiety are common, treatable, and consistently under-reported, and they affect the baby directly rather than abstractly.

We screen for this at your baby’s visits, and it is a real part of the appointment rather than a formality. Sadness, anxiety, anger, numbness, intrusive frightening thoughts, or simply not feeling like yourself — say so. It is not weakness, it is not a reflection on how much you love your baby, and it responds to treatment.

If you are having thoughts of harming yourself or your baby, or thoughts that frighten you, call or text 988 — any hour. Tell us too. This is common enough that we ask everyone and treatable enough that asking is worth it.

Partners get postpartum depression as well, and are asked about it far less often.

Call us if

• Any fever under one month — see the top of this page
• Poor feeding, or fewer wet nappies than expected
• Deepening jaundice, or jaundice in the first day
• Vomiting that is forceful and repeated, or green
• Breathing that is fast, noisy, or looks like hard work — flaring nostrils, or the chest pulling in between the ribs
• Unusual floppiness, or being very difficult to wake
• Redness, discharge, or smell around the cord
• No weight gain by two weeks
• Feeding is painful or not working — call early
• A tongue-tie release has been suggested and you want a second opinion
• You are not coping, or not feeling like yourself
• Something feels wrong and you cannot say what. Call anyway. You are not wasting our time, and parental instinct about a newborn is a genuinely useful clinical signal.

Go to an emergency room for

Fever of 100.4°F (38°C) or higher under three months · difficulty breathing, or pauses in breathing · blue or grey lips or face · a seizure · unresponsiveness or extreme floppiness · any fall or head injury · forceful projectile vomiting or green vomit · a baby who cannot be roused to feed.

Visits in the first months

We will see your baby frequently at first — typically in the first few days after leaving hospital, then at regular intervals through the first two years, tied to growth checks and immunisations. Those early visits are weight, feeding, jaundice, development, and you.

Bring your questions written down. Nobody remembers them at the appointment, everyone remembers them at 3am, and there is no question too small for these visits.

Sources

33. How to Keep Your Sleeping Baby Safe: AAP Policy Explained — American Academy of Pediatrics, HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
34. Newborn jaundice — MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/001559.htm
65. Your Newborn’s First Week: How to Prepare and What to Expect — American Academy of Pediatrics, HealthyChildren.org. https://www.healthychildren.org/english/ages-stages/prenatal/delivery-beyond/pages/bringing-baby-home.aspx

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