Behavior ChangesA change in behavior may be one of the first signs of illness in a newborn. Although a baby's activity level, appetite and cries normally vary from day to day, even hour to hour, a distinct change in any of these areas may signal illness.
Generally, if your baby is alert and active when awake, is feeding well and can be comforted when crying, occasional differences in these areas are normal. Consult your baby's physician if you have concerns about your baby's behavior. Some behavior changes may indicate an illness is present including the following:
o Feeding difficulties due to a sucking problem may show up when a baby starts out at birth with a strong, vigorous suck and gradually becomes less effective at feedings over time, or when a baby starts out with a weak suck and does not eat effectively. This is especially common if he or she was born prematurely. Babies with a weak suck may not pull strongly or have a good latch while breastfeeding. The mother may not hear the baby swallowing or gulping during feedings. A mother's breasts may not feel full right before a feeding or she may not notice her breasts getting softer (emptying) after a feeding. Bottle-fed babies with a weak suck may need the bottle nipple "worked" or pumped to stimulate a suck. Feedings with either breastfed or bottle-fed babies with a weak suck may take a very long time, often more than 45 minutes.
o After the first day or so, most newborns are ready to eat every three to four hours and show signs of hunger by sucking on fingers or a hand, crying, and making rooting motions. A sick baby may refuse feedings. A baby who sleeps continuously and shows little interest in feeding may be ill.
o Spitting up and dribbling milk with burps or after feedings is fairly common in newborns. This is because the sphincter muscle between the stomach and the esophagus (the tube from the mouth to stomach) is weak and immature. However, forceful or projectile vomiting or spitting up large amounts of milk after most feedings, can indicate a problem. In formula-fed babies, vomiting may occur after overfeeding, or because of an intolerance to formula. In breastfed or formula-fed babies, a physical condition that prevents normal digestion may cause vomiting. Discolored or green-tinged vomit may mean the baby has an intestinal obstruction.
o Weight loss up to about 10 percent of birthweight is normal in the first two to three days after birth. However, the baby should have gained back to his or her birthweight by 10 or 11 days old. Signs a baby is not gaining weight may include a thin, drawn face, loose skin and decreased number of wet or soiled diapers. Most physicians want to see a newborn in the office at the end of the first week to check his or her weight. Lack of weight gain or continued weight loss in a young baby may be a sign of illness or other conditions and needs to be treated.