Growth and Development, Newborn

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. Most newborns gain about 4 oz (113.4 g) to 8 oz (226.8 g) per week and grow about 1 in. (2.5 cm) to 1.5 in. (3.8 cm) in the first month.
• 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 behaviors, 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, including brain growth and intelligence.¹ 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 behavior. 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. Newborns normally have checkups scheduled 3 to 5 days after they go home from the hospital, and by 1 month of age.

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.

Frequently Asked Questions

What to Expect

Expect your baby to develop in five key areas:

• Physical development. Your newborn gains about 0.7 oz (19.8 g) per day, or about 4 oz (113.4 g) to 8 oz (226.8 g) per week in the first month. He or she grows about 1 in. (2.5 cm) to 1.5 in. (3.8 cm) in length by age 1 month.²
• 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 negotiate their world.
• Sleeping and eating patterns. A newborn's main routines center 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 parents 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 issues in this first month include:

• Umbilical cord care. Basic care of your baby's umbilical cord is keeping it clean and dry. Gently clean the umbilical cord stump and the surrounding skin at least one time a day and as needed during diaper changes or baths. Gently pat the area dry with a soft cloth. The stump should fall off within a couple of weeks, although sometimes it takes longer.
• 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. Generally, 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 neighbor 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 breast-feeding mothers. As long as your baby feeds regularly (every 2 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. During your well-child checkups, your doctor will monitor your baby's weight gain and growth. Also, be aware of general signs that your baby is getting enough breast milk, such as wetting about 6 to 8 cloth diapers-or 4 to 6 disposable diapers-and having at least 1 or 2 bowel movements in a 24-hour period.
• 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 or fiber-optic blankets, may be used if bilirubin levels are too high. Keep your baby's well-child appointments with your doctor, or call anytime if you are concerned about jaundice. For more information, see the topic Jaundice in Newborns.
• A misshapen head. Immediately 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. But 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 well-child 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. For more information, see the topic Craniosynostosis.

It is also 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.
• 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. Labor 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.
• Preparing for sibling rivalry. If you have an older child, prepare him or her for the arrival of a new baby in the home.

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 furniture and equipment (What is a PDF document?) .
• 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 traveling 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 near the phone. Include information about how to reach your doctor, friends, and neighbors. Keep your local Poison Control Center number handy, too. Older siblings sometimes give newborns medicines or other dangerous substances.
• 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 immediately if you feel that you or another caregiver might hurt your baby. Call 911 if it is an emergency. Call your health professional, friend, relative, or parent hotline if you are feeling overwhelmed to the point that you feel you are not able to care for your baby.

For more information, see the topics Shaken Baby Syndrome and Health and Safety, Birth to Age 2.

When to Call a Doctor

Call your doctor immediately if you notice anything that concerns you. You are the expert on your baby. Although usually everything is fine, do not be afraid to contact your health professional for any reason.

Physical problems to watch for in your newborn include:

• An umbilical cord stump that looks infected, as is indicated by pus or reddened skin at the base of the cord.
• Signs of dehydration, such as not urinating at least 4 times in 24 hours.
• Not having regular bowel movements. Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes longer between bowel movements. It's usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable.
• Jaundice (hyperbilirubinemia) that has not improved by 4 days after birth. For more information, see the topic Jaundice in Newborns.

Be sure to call your health professional if your newborn:

• Cries in a peculiar manner or for an unusual length of time.
• Son 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 his diaper or wound dressing, or indications of infection (such as swelling and redness). For more information, see the topic Circumcision.
• Has a rectal temperature less than 97.8 °F (36.6 °C) or more than 100.4 °F (38 °C).
• Is rarely awake and does not wake up for feedings, or seems too tired or uninterested to eat.

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 are unable to emotionally connect with your newborn. Although it is normal to feel some distance at first, you should develop increasing feelings for your baby during the first week or two.
• You think you might be depressed.

Routine Checkups

Birth examination

Your baby's first checkup begins in the hospital 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 monitored during the baby's first 6 hours. Your baby may also have the following soon after birth:

• A hearing assessment. Many states require hearing screening on all babies who are born in hospitals because speech and language have a better chance of developing normally when hearing problems are caught and treated early. The United States Preventive Services Task Force recommends that all newborns be screened for hearing loss.³
• A thorough physical exam. 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.
• Injections, such as vitamin K, and possibly some immunizations, such as for hepatitis B. For more information, see the topic Immunizations or the childhood immunization record (What is a PDF document?) .
• Antibiotic eyedrops. Because newborns can get eye infections from bacteria in the birth canal, some states require that antibiotic eyedrops or ointment be given.
• Newborn screening. Your baby has a sample of blood taken from the heel. This sample is used to test for phenylketonuria and other inherited diseases.

Well-child visits

In the first weeks after birth, your baby begins a series of exams by a health professional, sometimes called well-child visits. Health professionals have individual approaches to the timing of these appointments. Newborns normally have office appointments scheduled 3 to 5 days after they go home from the hospital, and by 1 month of age. 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 exam. 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 behavior.
• A blood sample taken from the baby's heel (called a heel prick) to test for certain inherited diseases such as phenylketonuria (PKU). Although your baby may have been tested for PKU at birth, there is a risk of inaccurate test results when the test is done within 48 hours of delivery. A second PKU test should be done several days later, usually at your baby's first well-baby visit. For more information, see the topic Phenylketonuria (PKU).
• Immunizations. Individual and series immunizations are started or continued at these well-child visits. Your health professional will provide you with a schedule so that you know how many injections to expect at each visit. For more information, see the topic Immunizations.

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 concerns (What is a PDF document?) .

Other Places To Get Help

Books

Online Resource

Organizations

Related Information

• Birthmarks
• Bottle-Feeding
• Breast-Feeding
• Circumcision
• Colic
• Craniosynostosis
• Crying, Age 3 and Younger
• Early Disease Detection
• Gastroesophageal Reflux in Babies and Children
• Group B Streptococcal Infections in Newborns
• Head Injury, Age 3 and Younger
• Immunizations
• Jaundice in Newborns (Hyperbilirubinemia)
• Newborn Rashes and Skin Conditions
• Phenylketonuria (PKU)
• Postpartum Depression
• Problems After Delivery of Your Baby
• Rash, Age 11 and Younger
• Scalp Problems
• Shaken Baby Syndrome
• Speech and Language Development
• Sudden Infant Death Syndrome (SIDS)
• Umbilical Cord Care

References

Citations

1. Green M, Palfrey JS, eds. (2002). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 2nd ed. Arlington, VA: National Center for Education in Maternal Health.

2. American Academy of Pediatrics (2004). The first month. In SP Shelov, RE Hannemann, eds., Caring For Your Baby And Young Child: Birth to Age 5, 4th ed., chap. 6, pp. 143-176. New York: Bantam.

3. U.S. Preventive Services Task Force (2008). Screening for newborn hearing loss. Available online: http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm.

Other Works Consulted

• Blasco PA (2005). Motor delays. In S Parker et al., eds., Developmental and Behavioral Pediatrics: A Handbook for Primary Care, 2nd ed., chap. 54, pp. 242-247. Philadelphia: Lippincott Williams and Wilkins.

• Thilo EH, Rosenberg AA (2007). The newborn infant. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., chap. 1, pp. 1-64. New York: Lange Medical Books/McGraw-Hill.

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