Baby’s first 24 hours

Becoming a parent for the first, second, or third time is a wonder and nerve-wracking at the same time. There is an extra person in the world - and that person is now your responsibility. Those first hours are a step into the unknown. Read on to learn what to expect in the first 24 hours after birth to help you relax and give your baby the best possible start in life.

As a father of three and a Pediatrician, these are (some of) the things, I wish I had known when we had our first child.

Skin-to-skin contact

Skin-to-skin contact initiates bonding and stimulates the production of oxytocin in the mother which stimulates breastfeeding. Skin-to-skin calms the baby and the mother. Skin-to-skin contact can also be with the father.

Feeding

Immediately after birth, your baby may be very alert and responsive. This is a good time for initiating breastfeeding, as term infants should be breastfed within the first hour after birth - if breastfeeding is possible. After the first feed, your baby may sleep for some hours. Sleeping as much as 18 hours of the first 24 hours is normal, but your baby should feed every 3-6 hours and may need to be woken up for feeds.

On a side note - Your baby consists of about 75% water. For term babies, a weight loss of about 5-10% of the birth weight is expected in the first 3-5 days of life. Term babies should regain birth weight by 7-10 days of life.

Temperature

Don’t let your baby get cold. Hypothermia will stress your baby and is associated with negative consequences. The newborn baby’s response to cold stress includes breathing up, poor feeding, and irritability, all of which can be confused with sepsis and bacterial infection. The best way for a newborn baby to stay warm is skin-to-skin with a parent. Also, have some clothes ready and use a blanket to wrap your baby.

Breathing

The respiratory rate in a newborn should be less than 60 per minute and while intermittent grunting sounds can be normal, persistent grunting is not

Infants are nose-breathers so clear any secretions, if needed you can use a few drops of sterile water

Some periodic breathing is normal, but if the rate is consistently above 60 per minute, if there is ongoing grunting, or if your baby is working hard to breathe this is abnormal and requires immediate medical attention.

Heart rate

If you feel your baby’s heart beating, it will be very fast compared to your own heart rate, perhaps leading you to wonder if this is normal. The normal heart rate in babies is faster than in older children or adults, roughly 80-180 beats per minute would be normal depending on the state of your baby - that is, lower when sleeping and higher when crying. The rhythm should be regular, but a few extra beats are normal.

Peeing & Pooing

[Urine] 90% of healthy babies void by 24 hours of age and 99% by 48 hours. The most common reason for ‘lack of urine’ in the first 24 hours is undocumented urine void in the delivery room but also physiologic stress after a difficult birth can stress the kidneys. If no urine is seen within 24-48 hours you should contact a doctor

[Stools] 98% of term infants pass the first stool by 24 hours of age. The first stool is meconium, the bowel content of the fetus which can be black or dark green. Delayed passage of meconium can have different reasons ranging from benign to serious and you should contact a doctor if there is no stool after 24 hours. Especially if there is also abdominal distension and vomiting this could be a sign of intestinal obstruction.

General Appearance

The single most important thing to pay attention to is the general appearance of your baby. It is also the most difficult thing. Particularly with your first child.

[Alertness] While sleeping for extended periods of time is fine, your baby, when awake should be alert to the world. This means interacting with you, crying when unhappy, and wanting to feed.

[Muscle tone] The normal resting posture of a term newborn is flexion of the arms and legs and there should be spontaneous movement of the limbs. There is no need for you as a parent to test your baby’s reflexes, but if you touch the roof of the baby’s mouth with a finger, pacifier, breast, or bottle nipple then the infant should begin to suck - this is the suckling reflex.

[Skin] The color of the skin, according to ethnicity, should have a pink undertone. For newborns, peripheral but not central cyanosis, meaning a bluish tint to the skin, may be normal. Jaundice, a yellow glean, is abnormal in the first 24 hours. Later it may be normal, but if your baby becomes increasingly yellow you should see a doctor to check the level of bilirubin, the cause of jaundice. This is particularly true if your baby becomes drowsy and less interested in feeding or jittery. Many rashes are normal, the most common being erythema toxicum, with numerous small areas of skin with a yellow-white papule in the center. This usually resolves spontaneously in a few days. Not counting more rare diseases associated with skin changes, the most important thing to identify is an infection in the skin. This would generally be red, warm, swollen, and evolve over time. Bleeding in the skin may also be of concern.

[Umbilical stump] The umbilical cord stump typically sloughs off at around 7-10 days.

Rounding up

Hopefully, by 24 hours you have a baby that is feeding, sleeping, and cuddling with you. Enjoy the journey :-)

Disclaimer

This is not medical advice. The content provided is for informational purposes only. It is not meant to be a substitute for professional medical advice, diagnosis or treatment. Always seek professional medical advice for any questions you may have regarding a medical condition or treatment, and before undertaking a new health care regimen. Never disregard medical advice or delay in seeking it because of something you have seen or read here.