Babies and Diapers

How often do I change my baby's diaper?

I get asked this a lot. The answer is - it depends. It depends on how old your baby is and how much your baby is taking at each feeding and how often the baby feeds. Obviously, more food means more wet and messy diapers.

Just like we don't like wet or dirty clothes, neither does a baby. Their communication skills are slightly different from ours, so we have to be more alert about their condition. In addition to that, their skin is much more delicate and extended contact with a wet or dirty diaper will break down the skin and create a rash and/or sores. You want to make sure that doesn't happen.

Disposable or cloth?

This is a decision you should probably make prior to your baby's birth, so you can be prepared.

Disposable diapers

There isn't much preparation for disposable diapers, except to buy them. In infancy, disposable diapers are sold by size related to weight. If you have a premature baby, there are preemie diaper sizes. As your baby gets older, the sizes are based on approximately age. If you have a child well above or below the standardized norm for the age, just adjust accordingly. It's time to move up to the next size when you have difficulty fastening the tabs on the diapers - and definitely time to move up if they pop open by themselves!

Did you know you're not supposed to just throw away the disposable diaper, complete with contents? Solid waste is not supposed to end up in the trash and landfills. Solid waste should be tipped off the diaper and into the toilet before disposing in the trash.

Disposable diapers are engineered by very smart biochemists to provide a lot of absorbency and wicking away from the skin. To some, this might translate to "you don't have to change them as often." However, there is still moisture that's kept inside, against the skin, due to the outer layer that prevents everything from wicking all the way out. The rule of thumb would be - if it's wet, change it. You don't want moisture staying against your baby's tender skin because that's an invitation to diaper rash. And absolutely change any dirty diaper as soon as you're aware of it.

Cloth diapers

Cloth diapers take a little more work but many people feel it's worth the effort. Cotton is soft, absorbent and a renewable resource. However, it takes a lot of hot water and more work to clean them. Then again, they don't take up space in landfills.

The obvious choice, if you can afford it, is a diaper service. I used cloth diapers and a service for all of my babies. They supply the diapers and come once or twice a week (depending on the service you request) to pick up the hamper (which they also supply) and trade it for a clean one, with clean diapers. No muss, no fuss. The diapers are clean and soft. Because the service uses industrial-strength cleaning processes, they are cleaner than you would be able to get them in your own washer. That doesn't mean you can't get them clean yourself, but that's another article entirely.

Cloth diapers do need to be changed more frequently than disposable diapers. Although cotton is very absorbent, it is just cotton, not a carefully engineered paper product, like disposables. When you realize the diaper is wet, it needs to be changed. As with disposables, dirty diapers need to be changed immediately.

You will also need diaper covers and if I can find some really neat ones like I used to get, I'll share a link. There's an amazing stylish variety (which you can use with disposables, if you like) and they're very easily washed.

Diaper pins are a necessity, of course. I learned the "double pin" technique years ago when disposables were considered pricey and didn't work as well as they do now. Double pinning ensures a better fit and is easy to do. (Pictures when I can find one - I don't have babies any more, so I'll have to dig up an illustration of this technique because it really does work.)

One problem I did encounter with cloth diapers was that many day care providers don't want to have to deal with them, so if your baby is going to day care at some point, check and see if they will accept cloth diapers.

So how often do I change the diaper?

OK, back to the original question, right? Less with disposables, more with cloth. More with newborns, less with toddlers.

Always change a dirty (as opposed to wet) diaper immediately. In the first few days of life, your baby will have bowel movements that are black to green and stick. Don't panic! This is called meconium and it's standard issue (if you'll pardon my pun!). After passing meconium, breast-fed babies will have bowel movements that are yellowish and fairly loose, which is also normal. Formula-fed babies will have bowel movements that are darker and smellier than a breast-fed baby's.

As far as "just wet" diapers, don't wait until the diaper weighs 2 pounds, no matter how expensive diapers are! Use your judgment - all it takes is practice. If your baby is crying, food and wet or dirty diapers are the first things you should check.

In the first 24 to 48 hours of life, your baby should have at least one bowel movement, most probably meconium. If not, consult your pediatrician for advice. Wet diapers should be frequent. If you aren't changing wet diapers every couple of hours, it may be a sign that your baby may not be getting enough milk. It's harder to judge this when breastfeeding. Wet diapers are a sign of a baby that is being adequately fed, so check with your pediatrician.

Well-baby exams

Well-baby exams begin shortly after birth. Well, actually they begin in the hospital before you take the baby home, but we're not counting that.

Even with a normal, healthy baby, well-baby exams are important to measure growth and development milestones to make certain your baby is staying healthy. Make sure you have a pediatrician you trust and who will take the time to talk to you about your baby's growth and progress.

Measurements

Most well-baby checkups begin with measurements of your baby's length, weight and head circumference. You'll need to undress your baby, so keep a blanket handy.

Your pediatrician will have a growth chart and mark the baby's height, weight and head circumference measurements against a "normal" growth curve for age. Some babies will be "off the chart," or way above the growth curve for their age. Premature infants will fall below the growth curve, but there is an adjustment for "gestational age." If your baby is 4 weeks premature, they are considered "newborn" at one month. Some preemies catch up quickly; others take longer, usually depending on the amount of prematurity. If your baby is losing on the growth curve, your pediatrician may become concerned about failure-to-thrive or other factors, such as adequate feeding and sleep habits. Don't be fixated on the growth chart, however; a baby who's in the 95th percentile for height and weight isn't necessarily healthier than a baby who's in the 5th percentile. What's most important is steady growth from one visit to the next.

Physical examination

Your pediatrician will perform a head-to-toe physical examination of your baby at every visit. Some of the things they will look at:

• Head: Soft spots (fontanels) are areas on your baby's head that give your baby's brain room to grow. They typically disappear some time between 12 and 18 months of age, when the skull bones fuse together. The doctor will also check the shape of your baby's head. If there are flattened areas, you may be advised to place the baby in different positions. Don't worry - not everyone has a perfectly rounded skull!
• Ears. Ear infections are common in infants and toddlers and can cause hearing loss if not treated. Your doctor will check the baby's external auditory canal and then examine the tympanic membrane (eardrum) with an instrument to make sure it's pink and pearly and not bulging. Bulging and discoloration of the eardrum is an early sign of ear infection. (Watch for crying and tugging at the ears for early signs of ear infection. Ask me how I know this!) There should be no discharge from the ear, which is a sign of severe infection. The pediatrician will also check your baby's response to sounds, to make sure hearing is good. Hearing tests typically aren't necessary for well-baby exams.
• Eyes. Plugged tear ducts are a common problem in newborns. This can frequently be resolved by massage the duct area, which is very simple and painless; your pediatrician will show you how to do this if there are signs of tear duct plugging. If that doesn't resolve the problem, the procedure to clear the tear duct is very simple. Your doctor will also check the baby's eyes with an instrument to see inside the eye and test pupil response to light. As your baby gets older, the doctor will also check to make sure the baby tracks objects with his/her eyes without turning the head.
• Mouth. Thrush is a yeast infection very common in newborns. Your doctor will examine the baby's mouth for signs of thrush, which is easily treated. As your baby grows and develops, the exam will also look for teeth breaking through the gums on schedule.
• Skin. In the first few weeks after birth, the doctor will examine the umbilicus to make sure it is clean and that the residual cord is healthy and in the process of falling off. Make sure you keep it clean with a swab soaked in alcohol - the more you clean it, the faster it will fall off. Your doctor will look for unusual skin conditions, such as birth marks, rashes and jaundice (a yellowish discoloration of the skin and eyes). Jaundice is common in newborns and frequently disappears on its own; if it doesn't, light therapy may be recommended to clear it up. Make sure when you bathe your baby that you lift all the folds of skin and clean thoroughly, as rashes and sores may occur if dirt is trapped and irritates the baby's tender skin.
• Heart and lungs. Your pediatrician will listen to the baby's heart to make sure there are no abnormalities in the beat. Murmurs are not always a cause for concern but you may be referred to a specialist if your pediatrician is concerned. The pediatrician will listen to make sure lung sounds are healthy and normal.
• Abdomen. When your pediatrician palpates the baby's abdomen, he or she is feeling for enlarged organs or excessive gas or signs of tenderness. Some babies also have umbilical hernias; these are also common and typically resolve by 1 or 2 years of age.
• Genitalia. Your doctor will examine the genitalia to make sure they are clean and normal, without signs of discharge, lumps or tenderness. In boys, the testes will be examined to make sure they are normally descended.

Development milestones will be covered in another article.

Make sure you ask if you have any questions. Pediatricians generally schedule a generous block of time for well-baby exams, especially for first-time parents. It's important for both the parents and the baby to have confidence that what you're doing is what's best for your baby.

Colic in infants

Colic can be very frustrating, especially for first-time parents. Your otherwise healthy-appearing and well-fed child cries inconsolably and nothing you do seems to comfort him or her. Colic is typically defined as a baby that cries more than 3 hours a day, 3 or more times a week. It usually follows a pattern, occurring during certain periods of the day. This starts a few weeks after birth and starts to improve at 3 months of age. This can be distressing to you and your baby, but take comfort in the knowledge that it isn't permanent. Symptoms in addition to the crying include arching back, extended legs, fist clenching, belching, excessing passing of gas and difficulty passing stools.

There is no known cause for colic, although it is felt to be related to the stomach and/or intestines, so the treatment of it varies and consists of trial-and-error to find whatever will reduce the crying. It's felt to be related to the digestive tract because of the symptoms as described above, but not all babies with these symptoms have colic; it seems to be a catch-all for infants who exhibit these behaviors but are otherwise healthy. However, if your baby is running a fever, not eating or sleeping, or has other symptoms that point to an infection or other, more serious, conditions, you should see your pediatrician.

Twenty-five percent of infants display symptoms of colic, so it's a fairly common problem in the first few months of life. It goes without saying that smoking cessation during pregnancy is important for many reasons, and it is felt to be a factor in colic, with more infants of mothers who smoke having colic than those born to mothers who don't smoke. Otherwise, colic has no relation to a baby's birth order (first, last, middle) or gender. It occurs with the same frequency in all infants whose mothers are non-smokers.

Some babies comfort when held in a certain position. While this can be tiring for parents, so can excessive crying! Staying calm and not getting anxious is important in consoling a colicky baby.

If you are feeding formula and notice that crying occurs shortly after feeding, try switching to a different formula, such as soy; cow's milk formula is felt to be one cause of colic. If you are nursing and notice the crying occurs after feeding, evaluate your diet to determine if the baby is reacting to something you are eating that's passing through your milk. There is disagreement in the medical community about whether or not formula or a nursing mother's diet contribute to colic, but it doesn't hurt to look at whatever remedies may provide the easiest and most instant relief.

Try feeding the baby in different positions, such as sitting more upright (difficult when nursing) and burping more frequently. Gentle tummy rubs may also help. Some people find that a warmed blanket placed on the stomach during and after feeding helps.

It's never bad to give your newborn attention; you can't spoil a newborn. Newborns require a lot of attention and they can't tell us what's wrong. Just remember that this, too, shall pass and you will have one of the more difficult aspects of caring for a newborn behind you, along with more experience for the next time!