This is my fifth newborn, and the main thing I've learned is that the list of things that matter is very short. I spent the first four working out what was on it.
This isn't everything you could do. It's what matters, in the order you'll meet it.
Feeding comes first, and takes longer than you expect
A newborn feeds eight to twelve times in twenty-four hours, and that's normal for the first weeks. Cluster feeding in the evening is normal too, and it doesn't mean anything has gone wrong. Feed when she shows you she's hungry, not by the clock. Stirring, turning the head, mouthing and hands to the mouth all come well before crying, and a baby who's already crying is harder to latch. If she's asleep and it's been more than about four hours in the first fortnight, wake her. The most helpful thing you can do in the first weeks is have somebody watch a whole feed in person: a midwife, a lactation consultant or a nurse. Most feeding problems have a fixable cause, and you almost never find it by reading at two in the morning. I've skipped this step and I've taken it, and the difference was huge.
Diapers tell you more than anything else
Without a scale at home, diapers are your measure, and a good one.
From about day five: six or more heavy wet diapers a day, and at least two yellow stools. Stools start black and sticky, turn greenish, and are yellow and loose by the end of the first week if she's breastfed. Weight loss of up to about ten percent in the first days is normal, with birth weight regained by around two weeks.
Act on fewer wet diapers than usual, dark urine, or a baby who's hard to wake.
Sleep, and where it happens
Newborns sleep sixteen to eighteen hours a day, in stretches of two to four hours. For the first six weeks or so they can't tell day from night, because the body clock hasn't started yet.
The safe-sleep rules are short, and this is where getting it right matters most: on her back for every sleep including naps, in her own clear flat firm space with nothing else in it, in your room for the first six months, smoke-free, and never on a sofa or in an armchair with an adult.
Everything else about sleep in the first six weeks is negotiable. Those aren't.
The cord stump
Keep it clean and dry, and leave it alone. No antiseptic, no covering, and no cleaning unless it's dirty. If it is, use plain water and dry it carefully.
Fold the diaper down below it so air can reach it. It comes away somewhere between five and fifteen days and a little bleeding as it separates is normal. Spreading redness on the skin around the base, a smell, pus, or a baby who seems unwell alongside it needs a doctor the same day.
Bathing, less often than you think
Two or three times a week is plenty, with a daily top-and-tail in between: face, neck folds, hands, diaper area. Newborn skin loses water quickly and washing strips the oils that hold the barrier together.
Water at about 37°C, tested with your elbow. Five to ten minutes. Plain water for the first weeks. Get the room warm and the towel open before you start, because the cold on the way out is what most newborns are objecting to. Or so I think, though Melissa may simply object to baths.
The first-week basics
Skin things that are normal
A lot happens to newborn skin in the first month, and almost all of it clears up without treatment. Knowing that in advance saves a lot of worry.
- Peeling, particularly on hands and feet, in the first two weeks. Nothing needed.
- Milia, the tiny white spots across the nose and cheeks. They go by themselves and shouldn't be squeezed.
- Newborn acne at two to four weeks, which looks alarming and clears on its own.
- Cradle cap, which is greasy yellow scale on the scalp. Soften with a little oil and brush gently; don't pick it off.
- Mottled or blotchy skin, and hands and feet that are cool and slightly blue. Both are normal circulation in a new baby.
- Mild yellowing from day two to three, peaking around day five. Common and usually harmless, but see below.
Jaundice is the one on that list to be careful with. Yellowing that appears in the first twenty-four hours, deepening after the first week, spreading to the arms and legs, or a baby who's sleepy and feeding poorly with it, all need assessment promptly. Look at the skin in daylight, never under a lamp.
Handling and soothing
Support the head and neck every time, and lift with two hands from underneath. A newborn has no head control at all for the first weeks, so the neck needs protecting. Never shake a baby, in frustration or in play.
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When it's three in the morning and nothing is working, put her down somewhere safe and step out of the room for two minutes. That's always the correct call and it's never a failure.
When to get help urgently
Learn these now, while all is calm.
- A temperature of 38°C or above in a baby under three months, which is an emergency regardless of how well she seems.
- Difficulty breathing: fast breathing, grunting, flaring nostrils, or the skin pulling in between or under the ribs.
- Blue or gray lips, tongue or face, which needs emergency care immediately.
- Unusual floppiness, or a baby who's very difficult to wake.
- Refusing feeds, or markedly fewer wet diapers than usual.
- A rash that doesn't fade when pressed with a glass, which needs emergency care immediately.
- A bulging or noticeably sunken soft spot.
- Persistent inconsolable crying that is unlike her usual cry, particularly with legs drawn up and vomiting.
And one about you. If you feel numb, frightened of being alone with her, persistently low, or you're having thoughts that alarm you, tell a doctor or a midwife. It's common, it's treatable, it's asked about routinely, and saying it out loud doesn't put your baby at risk.
Questions from the group chat
How often should a newborn feed?
Eight to twelve times in 24 hours, and often more, following the baby's cues and not a clock. Evening cluster feeding is normal. Very sleepy newborns should be woken for feeds at least every three to four hours until birth weight is regained.
How often does a newborn need bathing in the first weeks?
Two or three times a week is enough, with topping and tailing in between. Plain water for at least the first month, newborn skin is still developing its barrier and daily washing with products works against it.
When does the umbilical cord stump fall off?
Usually between five and fifteen days. Keep it clean and dry, fold the diaper below it, and don't pull it. Redness and swelling around the base, pus, a bad smell or a fever all need a doctor.
What newborn symptoms are emergencies?
A temperature of 38°C or above under three months, any difficulty breathing or pauses in breathing, blue or mottled skin, being very hard to wake or unusually floppy, not feeding, no wet diaper for 12 hours, or a rash that doesn't fade under pressure.
The evidence
This guide is general information, written to help you understand a topic and ask better questions. It is not medical advice and does not replace your own doctor, midwife or paediatrician. Anything that worries you about your baby belongs with them.