What to Expect the First Year (50 page)

The bottom line on binkies? Make moderation your motto. Consider bringing on a paci at sleep times (as recommended) and at fussy times (when your baby really seems to need relief … and so do you). Give one a try, also, if your little one has such a strong need for sucking that your nipples have become human pacifiers or if baby is taking too much formula because he's not happy without a nipple in his mouth. Just don't overuse it—especially if binky time is cutting down on feeding time or socializing time. Remember, it's hard to coo or smile when you're sucking. And try not to use it as a substitute for attention or other kinds of parent-provided comfort.

Most important, be sure to use the pacifier safely. Never attach one to the crib, carriage, playpen, or stroller, or hang it around your baby's neck or wrist with a ribbon, string, or cord of any kind—babies can be strangled this way. And have in mind a plan to ditch the pacifier down the road once your baby is approaching his first birthday, at which point the pros will start to be outweighed by the cons—and your little one will be better off trying to figure out how to self-soothe in other ways.

“The cord still hasn't fallen off my baby's belly button, and it looks really awful. Could it be infected?”

Healing belly buttons almost always look worse than they actually are—even when they're healing normally. Not surprising when you consider what an umbilical stump is—the remnants of the gelatinous, blood-vessel-filled cord that spent months nurturing and nourishing your baby but is now yucky, gross, and without a doubt, overstaying its welcome—not to mention, preventing the much-anticipated appearance of your baby's adorable belly button. (It pretty much goes without saying that there's nothing adorable about an umbilical stump.)

The cord stump, which is shiny and moist at birth, usually turns from yellowish green to black, starts to shrivel and dry up, and finally falls off within a week or two—but the big event can occur earlier, or even much later (some babies don't seem to want to give theirs up). Until it does drop off, keep the site dry (no tub baths) and exposed to air (turn diapers down so they don't rub). When it does fall off, you might notice a small raw spot or a small amount of blood-tinged fluid oozing out. This is normal, and unless it doesn't dry up completely in a few days, there is no need for concern.

Unsightly though that cord stump might be, it's unlikely that it's infected—especially if you've been taking care to keep it dry. But be sure to keep a close eye on your baby's healing stump if he was born premature or at a low birthweight, or if the stump falls off early, since research suggests these may increase the risk of a belly button infection.

If you do notice pus or a fluid-filled lump on or near your baby's umbilical-cord stump and a reddish hue around the stump, check with your baby's doctor to rule out infection, which is rare. Symptoms of an infection may also include abdominal swelling, a foul-smelling discharge from the infected region, fever, bleeding around the umbilical-cord stump, irritability, lethargy, and decreased activity. If there is an infection, antibiotics can be prescribed to clear it up.

“Every time she cries, my baby's navel seems to stick out. What does that mean?”

It probably means that your baby has an umbilical hernia—which (before you start worrying) is absolutely nothing to worry about.

Prenatally, all babies have an opening in the abdominal wall through which blood vessels extend into the umbilical cord. In some cases (for black babies more often than white), the opening doesn't close completely at birth. When these babies cry, cough, or strain, a small coil of intestine bulges through the opening, raising the navel and often the area around it in a lump that ranges from fingertip to lemon size. While the lump might look a little scary (and sound even scarier when you hear it's a hernia), it's likely to resolve on its own eventually, without any intervention. Small openings usually close or become inconspicuous within a few months, large ones by age 2. In the meantime, the best treatment for an umbilical hernia is usually no treatment at all. So definitely don't listen to old-schoolers and others who tell you to tape or bind the hernia down.

“My son was circumcised yesterday, and there seems to be oozing around the area today. Is this normal?”

Not only is a little oozing normal, it's a sign that the body's healing fluids are heading to the site to begin their important work. Soreness and, sometimes, a small amount of bleeding are also common after a circumcision and nothing to be concerned about.

Using double diapers for the first day after the procedure will help to cushion your baby's penis and also to keep his thighs from pressing against it—but this isn't usually necessary later. Usually, the penis will be wrapped in gauze by the doctor or mohel (a ritual circumciser of the Jewish faith). Check with your baby's doctor about continuing care—some doctors recommend putting a fresh gauze pad, dabbed with Vaseline, Aquaphor, or another ointment, on the penis with each diaper change, while others don't think it's necessary as long as you keep the area clean. You'll also need to avoid getting the penis wet in a bath (you probably won't be dunking your baby yet anyway, because the umbilical cord is not likely to have fallen off at this point) until healing is complete. Clearly it will get wet when he pees, and that's not a problem as long as you change diapers as needed.

“Our son's scrotum seems disproportionally huge. Should we be concerned?”

Probably not. Testicles—as you probably know—come encased in a protective pouch called the scrotum, which is filled with a bit of fluid to cushion them. And thanks to exposure to mom's hormones in utero and a little bit of normal genital swelling at birth, a newborn's testicles can look rather large—especially next to his baby-size penis. In some babies the swelling doesn't go down a few days after birth, likely the result of an excessive amount of fluid in the scrotal sac. Called hydrocele, this condition is nothing to worry about since it gradually resolves during the first year, almost always without any treatment.

Ask about your little man's parts at the next doctor's visit, just to be sure it
isn't an inguinal hernia (
click here
), which can either resemble a hydrocele or occur along with it. An exam can quickly determine whether the swelling is due to excess fluid or if there is a hernia involved—or both—or whether it's just baby scrotum business as usual. If you notice swelling that seems painful, tenderness, redness, or discoloration, contact the doctor right away.

“We were just told that the outlet in our son's penis is in the middle instead of the end. What will that mean?”

Every so often, something goes slightly awry during prenatal development of the urethra and the penis. In your son's case, the urethra, the tube that carries urine (and after puberty, semen), doesn't run all the way to the tip of the penis but opens elsewhere. This condition is called hypospadias and is found in an estimated 1 to 3 in 1,000 boys born in the United States. First-degree hypospadias, in which the urethral opening is at the end of the penis but not in exactly the right place, is considered a minor defect and requires no treatment. Second-degree hypospadias, in which the opening is along the underside of the shaft of the penis, and third-degree hypospadias, in which the opening is near the scrotum, can be corrected with reconstructive surgery.

Because the foreskin may be used for the reconstruction, circumcision (even ritual circumcision) is not performed on a baby with hypospadias who will require surgery.

Occasionally, a girl is born with the urethra opening at the wrong place, sometimes into the vagina. This, too, is usually correctable with surgery.

“I've been trying to keep my baby swaddled, like they showed me in the hospital. But she keeps kicking at the blanket, and it gets undone. Should I stop trying?”

Just because swaddling is standard procedure in the hospital doesn't mean it has to be standard procedure at home—especially if your baby's not a fan. Most newborns do love that cocooned feeling of being all wrapped up in a tight little bundle, and will sleep better on their backs when swaddled—especially because they'll startle less. Swaddling also helps ease colic in many babies. But even with all those potential perks, some babies just don't see it that way. For them, being wrapped up is too restrictive, and they'll fight it every time. A good rule: If swaddling seems to feel good to your newborn, do it. If it doesn't, don't. But before you give up on swaddling your little one altogether, see if using a velcro swaddler might keep her from kicking it off, or opt for a zip-up cocoonlike swaddler or a sleep sack (there are also hybrids—swaddlers that have velcro tabs on top and a sack on the bottom). Or try leaving her arms unwrapped to see if that gives her the freedom of movement she seems to crave (and giving her access to her fingers for the comfort she craves) while still providing her with extra stability on her back during sleep.

Once babies become more active, they usually start kicking off or squirming out of their swaddles, no matter what kind. That's a sign to call it quits on swaddling—especially during sleep, since a kicked-off blanket poses a suffocation risk. Continued swaddling can also keep a baby from practicing motor skills—so once a baby stops needing that snug cocoon (usually around 3 to 4 months, though some babies crave the swaddle for longer), it's time to unwrap your baby burrito for good.