Latest posts by Emily Lesnak (see all)
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I love to see newborns in my practice and to be a part of this special time in a family’s life! As a naturopathic doctor, my newborn visits (and other well-child visits) are similar to any standard pediatrician, except my visits are typically longer. I spend a whole 45 minutes face-to-face with families, which allows me ample time to answer questions and concerns, as well as to review preventative care techniques for newborns or children.
When should newborns go to the doctor?
The timeline for well-visits depends on where the baby was born. If a baby was born in a local hospital, I recommend a well-visit on day 3 or day 4 of life. If a baby was delivered by a midwife, I recommend a well-visit either at the 2 or 4 week mark. (Note: some states have different guidelines for midwifery care, and require babies to be seen by a doctor within 24 hours of birth.) Babies born in the hospital will have their first visit with the pediatrician on staff and babies born with a midwife at home or at a birth center will have their first check-up by the midwife.
What questions will be asked at baby’s first visit?
Not only do parents ask a lot of questions, but I do too! I spend the first part of the visit gathering information about the birth: where the baby born, what type of birth it was (vaginal birth or c-section), as well as any complications or issues that arose during the pregnancy or birth. This information helps me to anticipate any health issues that the baby might encounter. For instance, if it is was an extended vaginal birth and mom pushed for hours, I might consider doing some gentle bodywork or referring baby to release any muscle tension from the birth. I often suggest that babies who were born via C-section take an infant specific probiotic to establish good bacteria in their intestines (this could be a whole blog in itself—more on this at a later time!).
Caring for Mamas, too!
Mom’s postpartum health is very closely tied to the health of her newborn. I also want to know what supplements Mom is taking and I usually recommend that she continue her prenatal vitamin, as well as a few other supplements: fish oil, probiotics, and vitamin D. Fish oil is high in omega 3’s and these healthy fats are important for baby’s brain development (if mom is breast feeding, baby will get these fats through her breast milk). The omega 3’s also support Mom’s mood. A probiotic increases good bacteria in the intestines and can also be transferred to baby through breast milk. Vitamin D is important for baby’s bone development. If Mom is not taking enough, I recommend that baby take an appropriate daily dose.
Checking in on Mom’s mood is important for the whole family. I always make sure to inquire about any postpartum anxiety or depression and will sometimes ask Mom to fill out a questionnaire if I have any concerns. Postpartum depression or the postpartum blues are very common and very normal. Often, moms will notice mood changes around the time their milk comes in and they usually pass, but many times they don’t. This is another reason why I have a longer time set aside for well-visits—it allows me to treat the whole family.
All about baby:
Your baby has a few job requirements to fulfill at this age: feeding, pooping, sleeping. It is my job to determine if they are meeting these requirements. I like to know how often the baby is feeding and if there are any issues taking a bottle or breastfeeding. Most often babies will feed every 3 hours, but this might change on a day-to-day basis.
Newborns start out with a few wet diapers per day and they should increase in number as your newborn grows. The very first poop that your baby has will be that thick, sticky, black meconium and as they begin to take formula or breastfeed, poops will change. Formula fed babies will have brown and pasty poops and breastfed babies will have runny, yellow, seedy looking poops. Knowing everything about your baby’s output helps me to assess whether or not they are getting enough to eat and if their digestion is on the right track.
I also like to get an idea of baby’s general sleep pattern at this time, even though there might not be any pattern yet. I talk about safe sleep (babies on their back to sleep!) and give some general guidelines regarding how to establish good sleep habits early on. Parents often have lots of questions about sleep—and when they will be getting more consistent sleep! I usually don’t talk about “sleep training” until the 4 or 6-month well-visit, but we do discuss getting baby on a flexible schedule at this time.
There are a few developmental check marks that I will evaluate at your baby’s newborn visit. I want to know if they respond to loud noises or react to bright lights to assess their hearing and vision. I also want to know if they are able to be comforted when they get fussy. I help prepare parents for the increased fussiness and gassiness that happens around the 2-week mark. We talk about how probiotics, tummy massage, and mom’s diet can help at this time. We also discuss vaccinations in detail and come up with a plan.
The second part of the visit is baby’s physical exam. I perform a full head to toe physical exam making sure that everything looks, sounds, and feels normal. I often conduct the exam in either parent’s lap, so baby can stay warm and comfortable. Baby’s height, weight, and head circumference will be measured and evaluated according to the growth chart. Growth charts and percentiles can be a source of stress for parents because it is often thought that if your baby is low on the growth chart, then they are not growing well—this is not always the case! Growth charts and percentiles are just a way for your pediatrician to monitor baby’s measurements at subsequent visits. It doesn’t necessarily matter where your baby is on the growth curve, as the growth curve gives your pediatrician a mark to assess if your baby has lost too much weight or gained too fast. For more information on using a growth curve see our article What to do if your child drops in their growth curve or is diagnosed with Failure To Thrive.
A number of screening tests are done shortly after birth, usually in the hospital or with a midwife, but some will be done with your baby’s pediatrician.
This test is often done in the hospital setting, so if your baby was born in the hospital it is typically performed before your family has been discharged. If your baby was born at home or in a birth center, it is recommended that their hearing is tested within six weeks of birth. The sooner hearing issues can be detected, the easier they can be treated.
This is known as the newborn screening test or PKU test and these tests will vary slightly from state to state. This will be a two-part test: one done in the first 24 hours of age and another between 7-14 days of age. This test is done twice because the second round can sometimes detect abnormalities that the first round was unable to catch.
This test will screen for metabolic issues like congenital (from birth) hypothyroidism (low thyroid gland function) and phenylketonuria (PKU), which processes phenylalanine in the body. Phenylalanine is found in many protein-rich foods. If baby has a problem processing phenylalanine, it builds up in the body and has the potential to cause brain damage (yikes!). The metabolic screen will also test for other enzymes and hormones. This test requires a blood sample, so your baby will have a heel poke in order to get the blood needed for the test.
Critical Congenital Heart Disease (CCHD) Screening:
This screening test will check baby’s blood oxygen level within the first 24 to 48 hours of life, usually done in the hospital or with your midwife. Even though this test checks oxygen levels in the blood, it is painless because no blood needs to be taken (special sensors are used to detect oxygen). It takes minutes to get results.
This test is important because some babies with a heart defect can appear normal at first. It is important to screen for CCHD before baby goes home because babies with a congenital heart disease may have symptoms that don’t surface until days or weeks after birth and often require emergent care. There are a number of congenital heart diseases, ranging from issues with the heart valves to the way the heart muscle works.
Jaundice is the yellowing of baby’s skin caused by increased bilirubin. Bilirubin is produced by the normal breakdown of red blood cells. It passes through the liver and is then released into the intestines. Babies can have higher levels of bilirubin as they increase their feeds and have more poops (bilirubin is released into the intestines it will exit the body through baby’s stool). Once babies feed more often and have more poops, they will get rid of more of that bilirubin. When their liver starts to fully mature they will also have an easier time processing bilirubin. Jaundice is initially assessed in the hospital or with a midwife. I also do a check for jaundice at baby’s well-visit by looking at their skin and the whites of their eyes. If we need to test baby’s bilirubin level, it will be done by collecting blood from a heel poke.
Whew! There is a lot that happens a newborn’s well-visit, huh? It is important to work with a pediatric provider that you trust, because they are managing several different aspects of your newborn’s care. I appreciate the time I spend with families during their extended well-visits. My goal is to develop a unique relationship with each family, so that I can tailor their care to their specific needs. As a naturopathic doctor, I look at all aspects of your newborn’s health and development, and provide a wide variety of options for care and treatment.
Want to find a naturopathic physician for your child’s pediatrician? Check out the Pediatric Association of Naturopathic Physicians!