Topic Overview

What kinds of development occur in your baby's first month?

Babies are called newborns during their first month of life. Although your newborn sleeps a lot, powerful changes are occurring in the five major areas of development.

• Physical development. Watching your baby grow in size is part of the fun of being a new parent. Don't be alarmed if your newborn loses some weight shortly after birth. This weight usually is regained within 10 to 12 days. Healthy growth is different for every child, and your child will grow at his or her own pace.
• Cognitive development. Cognition is the ability to think, learn, and remember. Your newborn's brain is developing rapidly. You promote healthy brain growth every time you interact in a positive way with your baby.
• Emotional and social development. Newborns quickly learn to communicate. They seek interaction with you and express how they feel with sounds and facial expressions. At first, instinctual behaviours, such as crying when uncomfortable, are your baby's ways to signal his or her needs. Soon your newborn starts to subtly communicate and interact with you. For example, your baby's eyes will track your movements. And his or her face will brighten when you cuddle and talk soothingly. Even at a few days old, your baby may try to mimic you sticking out your tongue.
• Language development. Your newborn is listening to and absorbing the basic and distinct sounds of language. This process forms the foundation for speech.
• Sensory and motor skills development. Newborns have all five senses. Your newborn quickly learns to recognize your face, the sound of your voice, and how you smell. Your newborn's sense of touch is especially developed, particularly around the mouth. Your baby also has a strong sense of smell. After a few days, your newborn hears fairly well and responds most noticeably to high-pitched and loud sounds. Your baby recognizes and prefers sweet tastes to those that are sour, bitter, or salty. Vision is developing quickly but is believed to be the weakest of the senses. Motor skills develop as your baby's muscles and nerves work together. Movements are mostly controlled by reflexes, such as the rooting reflex, which is when a newborn's head turns and his or her mouth "reaches" toward a touch. Hands are tightly fisted when the baby is alert.

How can you help your newborn grow and develop?

The most important way to help your baby grow and develop is to communicate with him or her. Use a high-pitched voice, gentle touch, hugs, and kisses. An environment that is rich in stimulation, comfort, and loving attention enhances many areas of a baby's development. Research shows that babies who are talked to throughout their first few years usually learn language skills more easily than those who are not. Newborns are more interested in their caregivers than they are in toys or other objects.

How do you know if you are caring for your newborn correctly?

You may feel overwhelmed during your baby's first month and wonder "Am I doing this right?" No previous life experiences prepare first-time parents for this new role. It is completely normal to be confused and frustrated by your newborn.

You will become familiar with your newborn's needs by paying attention to his or her behaviour. For example, a fussy cry and turning away usually means "Change what we are doing." And an alert, bright-eyed look means "I am interested in what's going on." Trusting your instincts—to cuddle and rock a crying baby or to talk to your baby in a high-pitched "baby talk" voice—is usually the "right" thing to do. You will begin to develop a rhythm with your baby, where you will be able to read each other's needs and moods.

What kinds of checkups should your newborn have?

Your baby's doctor will likely recommend a specific schedule of routine newborn visits. These visits are important to check for problems and to make sure that your child is growing and developing as expected. In some areas, your child may see a public health nurse for routine checkups and immunizations.

Do not be afraid to call your baby's doctor any time you have concerns about your newborn's health or general care. It is normal and expected for parents of newborns to have questions and to make frequent visits and calls to the doctor.

What to Expect

Expect your baby to develop in five key areas:

• Physical development. Your newborn gains about 20 g (0.7 oz) a day, or about 115 g (4 oz) to 230 g (8 oz) a week in the first month. He or she grows about 2.5 cm (1 in.) to 3.5 cm (1.5 in.) in length by age 1 month. Healthy growth is different for every child, and your child will grow at his or her own pace. Your child's natural growth rate may be slower or faster.
• Cognitive development. Newborn thinking begins with simple inborn responses to needs.
• Emotional and social development. Your newborn immediately initiates interaction with you—for example, by moving his or her arms and legs—and expresses himself or herself.
• Language development. Your newborn listens to the sounds, patterns, and rhythms of language, which lay the foundation for speech development.
• Sensory and motor development. The five senses, reflexes, and nervous system all play a role in how your newborn acts and reacts to the world around him or her.

You may wonder whether your baby's daily patterns are typical. During your baby's first few weeks, most of your time will be spent simply making sure your baby is fed every few hours, comforted, and held, and has his or her diaper changed. Pay attention to cues. You will begin to discover your baby's individual needs and preferences.

The following information can give you an idea about what to expect about your baby's:

• Reflexes. Babies are born with a number of automatic physical responses that help them handle their world.
• Sleeping and eating patterns. A newborn's main routines centre around these two activities, although by about 3 weeks of age, he or she begins to socialize more.
• Diaper habits. You can expect to change your newborn's diaper frequently. The specific number of times a day varies and in part depends on whether you feed your baby breast milk or formula.
• Crying. Newborns cry when they are hungry, tired, overstimulated, or otherwise uncomfortable. They may also cry for no apparent reason and be difficult to console.

Common Concerns

Although you may feel prepared for your baby, the reality of the constant care a newborn needs can shock many parents. A newborn affects your life in ways that simply can't be anticipated. It is only through experience that you can fully understand the impact of these new responsibilities and how your expected roles change. It is normal to shift frequently between feeling confident and ecstatic one minute, and drained, scared, and unsure the next.

When you realize that your baby is physically completely dependent on you, you may worry whether you are giving your baby the best care. Common concerns in this first month include:

• Umbilical cord care. Basic care of your baby's umbilical cord is keeping it clean and dry. The stump usually falls off within a couple of weeks.
• Your newborn's sleepiness. Especially in the first few days after birth, your baby may seem to be in a distant world, only pausing long enough in this one to wake you up for a little snack or a diaper change. Your baby will become gradually more alert throughout the month. By the end of the first month, your baby will likely begin developing sleeping and eating patterns. In general, your baby will likely have periods where he or she is awake for 2 or 3 hours straight. Around 3 months of age, the patterns will become more predictable.
• Your exhaustion and sleep deprivation. Although newborns sleep a lot, they also wake up a lot for brief periods and need feeding, diapering, and attention. Nights of long, restorative sleep can seem a foggy memory to parents. This may be especially true for mothers, who start with a deficit after the physical exertion of and recovery from giving birth. Be sure to ask for help when you need it. Don't hesitate to ask a family member, friend, or neighbour to help you with daily tasks, such as laundry, cleaning, or making meals. This can help you to nap while your baby sleeps instead of doing chores.
• Worry over whether your baby is getting enough to eat. This is especially a common concern among breastfeeding mothers. As long as your baby feeds regularly (every 1 to 3 hours in the first few weeks, then 2 to 4 hours over the next few weeks), he or she should be fine. Sometimes you may need to wake a sleepy baby to eat. It's good to check your baby's diaper for signs that your baby is getting enough breast milk. For example, your baby may have 3 wet diapers a day for the first few days. After that, expect 6 or more wet diapers a day throughout the first month of life. During routine checkups, the doctor will monitor your baby's weight gain and growth.
• Urine colour. The urine should be yellow. Don't be alarmed, though, if you notice a pink colour to the urine during your newborn's first 3 days of life. It is common for newborns to pass crystals in the urine (highly concentrated urine) which makes the urine look pink. If the pink colour lasts, or if at any time your baby seems to be in pain while urinating, call your doctor or nurse advice line.
• Newborn jaundice. Many babies get jaundice (also called hyperbilirubinemia) in their first few days of life. Jaundice is a condition in which the skin and the whites of a baby's eyes appear yellow because of a buildup of bilirubin in the blood. Bilirubin is a yellow-brown substance produced by the breakdown of red blood cells. Although jaundice should be monitored, it most often does not require medical treatment. Usually, increasing the number of feedings helps reduce jaundice. Phototherapy, in which a baby is placed under special lights, may be used if bilirubin levels are too high. Keep your baby's routine checkup appointments with your doctor, or call anytime if you are concerned about jaundice or your baby's skin. For more information, see Jaundice in Newborns.
• Skin care. In general, use mild shampoo or soap when you bathe your baby. Avoid lotions and other skin care products unless your doctor tells you otherwise. Newborns have sensitive skin, and healthy newborn skin doesn't need skin care products applied. For more information, see Newborn Rashes and Skin Conditions.
• A misshapen head. Right after birth, especially after lengthy vaginal deliveries, your baby's head may look misshapen. This is normal, and your baby's head will most likely take on a more normal shape within a few days to weeks after delivery. In rare instances, a misshapen head can be a sign of an abnormal condition, such as craniosynostosis. After your baby is born and during your baby's routine checkups, your doctor will monitor your baby's head shape and skull growth. If you are concerned that your newborn's head has not returned to a normal shape within several weeks of delivery, talk with your doctor.

It is normal to question your feelings for your baby. A bond doesn't necessarily happen the moment you set eyes on your child. But you will develop stronger feelings and love for your baby every day. For some parents, it takes time to develop this bond, especially when the baby's physical demands take a great deal of time and energy. Talk to your doctor if you do not feel that you are bonding with your baby in the first week or two.

Also keep in mind:

• Your baby will soon be able to engage with you. But this first month, your baby may seem to be in a semi-conscious state. Sleeping and eating are a newborn's main activities. He or she will gradually emerge from this groggy state, and you can rest assured that your loving care will be rewarded with interaction very soon.
  • Quick Tips: Getting Baby to Sleep
• Gradually within the first month, your newborn will begin to look more "baby-like." Although many parents don't like to admit it, even to themselves, it is common to feel disappointed that their baby isn't as cute as they had hoped. If you feel this way, don't despair. Labour and delivery takes its toll on your baby's appearance. He or she may have an odd-shaped head, swollen or squinty eyes, blotchy skin, and a flattened nose in the first few weeks. Soon, these irregularities will fade away and your baby will start to develop more normal-looking features.
• Your baby may have a birthmark that is noticed at birth or within this first month. Most birthmarks need no treatment. They often fade as a child grows older. But sometimes a birthmark needs treatment or close monitoring. Talk to your doctor if you have concerns. For more information, see the topic Birthmarks.

Although you will go through some major adjustments to this new little person in your life, your baby's first month is also a period of amazing growth and change. Treasure these first weeks as you gradually introduce your baby to the world.

Promoting Healthy Growth and Development

For healthy growth and development, newborns need physical and emotional care. You enhance development and give your newborn a sense of security and being loved by:

• Feeding on demand. Respond to your baby's hunger cues, no matter how frequent.
• Encouraging emotional bonding. Your baby needs to be close to you and to anticipate that you will respond to his or her needs.
• Stimulating learning and communication. Your newborn learns through bonding and interaction.

Although your baby's needs are basic, it is important to respond promptly to his or her cues and to recognize safety issues.

• Reduce the risk of sudden infant death syndrome (SIDS) by always placing your baby to sleep on his or her back (not on the stomach). Make sure that the crib mattress is firm and covered by a sheet and that there are no pillows or blankets that could block the baby's mouth or nose. For more information, see the topic Sudden Infant Death Syndrome (SIDS).
• Make sure all safety standards are met for your baby's nursery items. Visit the Government of Canada's webpage on baby product safety at www.canada.ca/en/health-canada/services/nursery-products.html to learn more information.
• Support your newborn's head. In the first few months, your baby's neck muscles are weak, and the head needs to be supported at all times.
• Buy a car seat that is appropriate for a newborn, and use it properly. And always use a car seat when travelling with your baby on an airplane.
• Do not leave your baby alone with a pet.
• Never leave your newborn alone or in the care of an older child while the baby is:
  • In the bathtub.
  • On a changing table or other place where he or she could fall or get injured.
• Post emergency numbers in several places throughout your house. Or store them in your cell phone. Include numbers for your doctor, friends, and neighbours. Keep your local Poison Control Centre number handy, too.
• Never shake your baby. A baby's skull is not developed enough to protect it against injury. Shaking your baby in anger or frustration can lead to shaken baby syndrome. Get help right away if you feel that you or another caregiver might hurt your baby. Call 911 if it is an emergency. Call your doctor, a friend, a relative, or a parent hotline if you are feeling overwhelmed to the point that you feel you are not able to care for your baby.

Call your doctor if you think you or your partner has postpartum depression. It can make a mom feel very sad, hopeless, and worthless. And she may have trouble caring for and bonding with the baby. For more information, see the topic Postpartum Depression.

When to Call a Doctor

Call your doctor right away if you notice anything that concerns you. You are the expert on your baby. Although usually everything is fine, don't be afraid to contact your doctor for any reason.

Physical problems to watch for in your newborn include:

• An umbilical cord stump that looks infected. You may see pus or reddened skin at the base of the cord.
• Signs of dehydration, such as having no wet diapers for 6 hours.
• Not having regular bowel movements.
• Jaundice that has not improved by 4 days after birth.

Be sure to call your doctor if your newborn:

• Cries in an odd way or for an unusual length of time.
• Has circumcision problems. Signs may include greater-than-expected bleeding at the circumcision site, a bloodstained area larger than the size of a grape on the diaper or wound dressing, or signs of infection (such as swelling and redness).
• Has a rectal temperature that is less than 36.6°C (98°F) or that is 38°C (100°F) or higher.
• Is rarely awake and does not wake up for feedings, or seems too tired or uninterested to eat.

You can also take your baby's temperature from his or her armpit (axillary), but for children younger than 5, rectal temperatures are the most accurate. Call your doctor if your newborn has an armpit temperature that is less than 36.5 C (97.8 F) or that is higher than 37.5 C (99.5 F).

Talk to your doctor if you are concerned about the following:

• Your baby seems to be acting odd, even though you can't identify exactly what concerns you.
• You feel that you are unable to nurture your newborn.
• You feel that you can't emotionally connect with your newborn. It's normal to feel some distance at first. But you should develop increasing feelings for your baby during the first week or two.
• You think you might be depressed (postpartum depression).

Routine Checkups

Birth examination

Your baby's first checkup begins right after birth when a health professional assesses the baby's Apgar scores. This test checks certain physical traits to help determine whether your newborn needs any interventions or special monitoring right away. Temperature and vital signs are always closely watched during the baby's first 6 hours. Your baby may also have the following soon after birth:

• A thorough physical examination. Within 24 hours of birth, a doctor will examine your baby, check his or her breathing and heartbeat, and assess the baby's ability to pass urine and stool.
• Measurements of length, head circumference, and weight.
• Antibiotic eyedrops. Because newborns can get eye infections from bacteria in the birth canal, hospitals may give newborns antibiotic eyedrops or ointment.
• Screening tests, such as hearing tests and tests that check for genetic diseases like phenylketonuria.
• Injections, such as vitamin K, and possibly some immunizations, such as for hepatitis B.

In some areas, your baby may be seen by a midwife or public health nurse in the first few days and weeks after birth for some of these examinations.

Routine checkups

In the first weeks after birth, your baby begins a series of routine checkups. Doctors have individual approaches to the timing of these appointments. In some areas, your child may see a public health nurse for routine checkups and immunizations. During one or more of these visits, your baby will have:

• Length, weight, and head circumference measurements taken. These measurements are plotted on a growth chart and are compared to previous and later markings to make sure the baby is growing as expected.
• A physical examination. The doctor examines your baby thoroughly for any problems. The doctor also assesses the baby's reflexes and general development and observes how you and your baby interact. You are asked questions about how the baby and the rest of the family are doing, how the baby is eating and sleeping, and whether you have noticed any changes in behaviour.
• Immunizations. Your doctor can provide you with a schedule so that you know how many vaccines to expect at each visit. For more information, see the topic Immunizations.
• Screening test follow-up, if needed.

Routine checkups are a good time for parents to ask about what to expect in the weeks to come. You may find it helpful to go to your baby's checkups with a prepared list of questions .