Baby Development in the First Month After Birth

By now, many wellwishers, childcare books and even medical staff might have warned you about the sleepless nights that follow childbirth. Knowing more about what to expect will only help you to deal with it better. So read on:

• Week 1: In the first week after birth, your baby will spend most of the day (16-18 hours) sleeping - waking up intermittently for feeds.
  At this stage, your baby doesn’t have a sense of day and night - he/she will have irregular sleeping patterns.
  Most babies sleep a total of eight or nine hours during the day and eight hours during the night - in batches of one to two hours at a time.
• Week 2: Your baby will sleep for 16-18 hours a day. This sleep is a good sign, as most growth spurts happen while the baby is sleeping.
  This is the right time to start developing a baby bedtime routine. Little by little, the routine will help you to regularise your baby’s sleep. It will also help your baby distinguish between day and night. Try a few different things to see what kind of routine works for your baby: you can take the baby to a quiet room, sing him or her a lullaby, turn off the lights or use soft music. Try not to let your baby fall asleep in your arms as this can build dependence later. Instead, very gently put your baby down in the crib as soon as he or she yawns.
• Week 3: Your baby will still sleep for up to 18 hours a day. This sleep is essential for his or her growth.
  Try to reinforce the sleeping routine for your baby in the third week: the routine will help your baby understand the difference between night and day, and he or she will eventually associate nighttime with sleep.
• Week 4: Your three-week-old baby will still sleep for 16-18 hours a day. This will consist of several short naps during the day and one or two longer ones in the night. Sleep will still be necessary for his or her growth. If your baby is healthy, taking his or her feeds properly and is gaining weight, there is nothing to worry about. Let your baby sleep as much as he or she wants and feed your baby when he or she demands.
  Avoid sharing a bed with your little one as it increases the chances of sudden infant death syndrome (SIDS). Sharing the room with your baby can help you keep an eye on him or her and be available whenever the baby needs you. But it is a good idea to put the baby to sleep on their back, in a separate bassinet - make sure there are no extra clothes, toys, blankets or pillows in the cot to avoid accidental suffocation.

The World Health Organization recommends that babies be breastfed exclusively up to six months of age. Breast milk is full of nutrients and antibodies, especially colostrum - thick, yellow breast milk that is produced in the first few days after delivery.

However, breastmilk does not contain vitamin D, which is necessary for strong bones and proper growth of the baby. Hence, new moms should continue taking vitamin D supplements while breastfeeding.

Latching is the most important part of breastfeeding. You can choose from various positions like the cradle hold, football hold and lying down to breastfeed your baby. Try everything and choose what suits you and your baby best. In the early days, follow these tips to encourage your baby to take the breast:

• Place your thumb and fingers around your areola. Slightly tilt back your baby’s head and encourage him/her to latch by tickling your baby’s lips with your nipple.
• Help your baby in scooping the breast into his or her mouth. Place your nipple on your baby’s lower jaw when he/she opens the mouth.
• Tilt your baby’s head forward and then place the upper jaw deeply on the breast. 

Here's what you can expect in terms of feeding your baby in the first month after birth:

• Week 1: Your baby will wake up for a feed every two hours or so. He or she will have 8-12 feeds a day. In the first two days after birth, a baby takes about half-an-ounce (about 15 millilitres or ml) per feed. This will change to two-three ounces (60-90 ml) by week 2.
• Week 2: You will need to feed your one-week-old every two to three hours. Latch your baby properly to your nipple. Don’t forget to burp your baby after every feed.
  There will still be no set feeding pattern and you will have to feed your baby when he or she demands.
  Sore or cracked nipples may make breastfeeding painful for you or you might get tired while feeding your little one numerous times a day. The process will become easier and smoother with time.
• Week 3: You and your baby are probably accustomed to breastfeeding by now. Due to your baby's rapid growth, he or she will now need more milk and will feed for longer durations. This will help to increase your baby’s sleeping hours and he or she will probably fall asleep while feeding.
  Your baby’s tummy is still small and you will still need to feed him or her on demand. The hindmilk you are now producing is rich in fats and is necessary for your baby’s growth. Try to make sure that your baby fully empties your breast.
  If you want to introduce pacifiers to your baby, this is the right time to do it. Keep in mind, though, that doctors do not recommend the use of pacifiers. Never use pacifiers as a replacement for your baby's feeds.
  It is best to breastfeed your baby. But if you want to or have to introduce your baby to the bottle or pump breast milk, then you can start this in the third week. Always freeze secure pumped breast milk and never reuse it.
• Week 4: By the fourth week, you will be able to tell whether your little one is getting enough to eat or if he or she is still hungry or sleepy. He or she will be gaining about half an ounce or even one full ounce of weight every single day. An ounce is about 28 grams.
  You can never tell how much your baby is consuming when you are breastfeeding. Track the length of every feed and just make sure that your baby empties the breast fully. This is because the hindmilk you are now producing is very rich in fats which are necessary for the healthy growth of the baby.
  Formula-fed babies normally drink three to four fluid ounces (88-118 millilitres) per feed in the fourth week. This gradually increases by about one ounce (29.5 ml) per month until they reach eight ounces (237 ml). The baby is the best judge of whether he or she is hungry and when he or she is full. So don’t force your baby to finish a bottle just because there’s some milk left. 
  Typically, at this age, you will need to feed your baby 8-12 times per 24 hours. Your baby will have six wet diapers a day, and will soil two to three diapers per day.

Read more: Feeding your newborn in the first 24 hours

Busy as you are, you may not notice it at the time: these days are crucial for your baby’s growth. Your baby is still trying to adapt to the world outside your cosy - and dark - uterus. Here's what you can expect in terms of baby development over the first four weeks after delivery:

• Week 1: Your baby will have his or her first doctor’s appointment within a few days after being discharged from the hospital. At this appointment, the doctor will measure your baby’s head circumference. Why? As it turns out, it’s a very important metric that helps the doctor gauge your baby’s brain growth.
  • Head circumference: In the first week after birth, your baby’s skull is still growing and fusing together. On average, your baby girl’s head circumference in the first week will be around 13.75 inches (35 cm); baby boys tend to have a slightly larger head (0.5 inch or 1 cm bigger than girls).
  • New skills: This week, your baby is working on fine-tuning the skills needed to survive outside your womb. The top priorities: suckling, digesting, and setting up the immune system and digestion system with good gut flora to develop a separate microbiome from mom.
  • Sensory development: Right now, your baby relies heavily on the sense of smell and touch. So it is important to have as much skin-to-skin contact as possible this week. You may also notice a lot of reflexes early on, such as appearing to startle or looking like they’re shivering—both are normal reflexes in babies who are just a few days old.
  • Breathing pattern: One key occurrence in newborns is their breathing pattern. At under one-week-old, your baby’s breathing will be irregular, with episodes of apnea (when they stop breathing altogether). This can seem scary at first but irregular breathing in newborns is actually normal, especially during sleep. That said, you should always monitor for a problem and follow safe sleep guidelines.
  • Tummy time: You can begin your baby’s tummy time as soon as you bring your baby home - this will help to avoid flat head syndrome. Your baby should have one hour of tummy time every day. This should continue until your baby is three months old. 
  • Baby weight: Your baby will lose weight in the first few days. He or she may lose almost 10% of their birth weight. But there is nothing to worry about as your baby will regain it in the following days.
  • Baby temperature: Babies’ hands and feet can look slightly blue in the early stages. This is probably because their blood circulation is still developing. Before you give your baby another blanket, touch his or her neck to see if it is cold. If not, the baby needs just one extra layer over what you have on. Try not to overheat your baby with too many blankets or layers.

Read more: Skin-to-skin contact beyond the first hour after birth

• Week 2: Expect your baby to become more active and curious this week.
  • Baby's eyesight: Your baby still cannot see beyond 25 centimetres. He or she will be spending most of their time with you and will be fascinated by your face. Your baby will try to study your features and your facial expressions. Try to keep your face as close to your baby as possible. Your facial expressions may amuse the baby at this stage, and he or she will try to imitate them. 
  • Baby weight: Most babies continue to lose their birth weight in the second week. But this should not worry you. This process will stop once breastfeeding is established. If your baby is active, has a good skin colour and needs six to eight wet nappy changes in a day, then he or she is healthy and fine. Stay relaxed, your baby will begin to regain his or her birth weight by the end of the second week.
• Week 3: Your two-week-old baby is growing fast. You will be amazed to see how he or she does not fit into the clothes which were perfect for him or her in the previous week.
  • Baby's eyesight: At this stage, your baby can see up to 30cm away. Your baby still loves to study and observe you and will continue to be amused by your facial expressions and your voice.
    Tell your doctor if your baby is not curious about changes in light, colour or in observing your face and things around him or her.
  • Baby's hearing: Your baby may not be able to understand what you are saying at this stage but this is the right time to start developing his or her language skills.
  • Head movement: The baby will now be able to lift and turn the head from one side to another.
  • Colic baby: Your baby may develop colic at this stage. A baby is considered colicky if he or she is otherwise healthy and well-fed but cries for three or more hours, at least three days of the week (in older babies, there is one more condition: babies who cry for three or more hours, three or more days a week for at least three weeks are considered colicky). While it can be stressful to hear your babies cries, you can try and help your baby in a few ways. For example, if you are breastfeeding and your baby is gassy, try to change your diet. Colic usually goes away on its own by the time the baby is five months old. Do not give gripe water to your baby.
• Week 4: Your baby will learn to recognise faces this week! Here are some more things you can look forward to:
  • Better hearing: The hearing abilities of your baby will be fully developed by this week. He or she will start responding to all types of noises and will listen attentively to the sound of your voice.
    This is a good time to develop his or her language skills. Talk to your baby as much as you can. Produce different kinds of noises to play with your baby. And see how happily he or she responds to your voice. Your baby will also try to follow the sounds.
    Tell your doctor if your baby is not interested in different sounds or where they are coming from.
  • Baby's eyesight: At three weeks (and maybe a few days) of age, your baby will be able to see more clearly now. With developed focus, he or she will be able to recognise faces. Your face will still be his or her favourite, though.
  • Head movement: Your baby’s neck bones will be stronger by week 4 and he or she will try to lift the head or move it side to side. Your baby will have grown by an inch, and gained 7-8 ounces of weight every week.

  • Baby's arms and legs: It is perfectly normal for your baby to look a bit scrunched up after birth. He or she won’t be able to fully extend the arms and legs in the first month. The limbs will straighten slowly as he or she gets used to the outside world.
    If your baby was in the breech position at birth, it may take him or her a little longer to stretch out. This is because his or her feet were up by the ears, so it may be a few days before your baby is ready to straighten the legs.
    If your baby looks bow-legged, don’t worry. It’s part of the stretching-out process and should take care of itself by the time he or she is two years old.

A lot of this may feel new and overwhelming if this is your first baby. Enlist the help of older relatives, so you can get both guidance and rest during these important weeks. That said, here's a list of things all new parents should do from the moment they bring their baby home till the end of week 4:

• Week 1: You may be tired, excited and nervous at the same time this week. It might help to know what you need to prioritize:
  • Taking care of the umbilical cord: The umbilical cord will dry and fall off by the end of the first week. You should try to keep it dry and clean until it falls off to avoid any infections. There is no need to put any antibiotic or alcohol on it if no infection develops.
    Read more: Caring for your baby’s umbilical stump
  • Sponge bath: The baby does not get dirty at this stage, and you don’t need to bathe him or her daily. Give your baby a sponge bath till the umbilical cord dries and falls off, to keep infections away. The baby will have a waxy coating called vernix. This coating protected your baby in the womb and extended him or her some protection against infections immediately after birth. You can wipe it off now.
    Read more: How to clean your baby’s genitals
  • Baby poo in the first month after birth: Your baby’s diapers will still be soiled by dark, sticky, tar-like meconium. Though it can be challenging to clean meconium, don’t worry about it as it is a mixture of cells and amniotic fluid which your baby had gulped during the gestation period. Your baby’s stool will change from meconium to yellowish-green and then to yellow soft stool during this period.
  • Burping your baby: Burping your baby after every feed is important as it helps the baby avoid stomach gas and stomach ache. Formula-fed babies need to be burped more often than breastfed babies as there are fewer chances of the latter taking in air during feeds.
  • Breastfeeding your baby: Your baby will be uninterested in any kind of feeding during the first 24 hours as he or she will be tired after the journey of taking birth.
    For the first two-three days, your breasts will produce a thick yellow substance called colostrum. Colostrum is very important for your baby’s health as it contains antibodies that protect your baby from various infections. You will start to produce regular milk after two or three days.
    Breastfeeding can be uncomfortable in the beginning as the breast gets filled up with milk. But in case of any fever or severe breast pain, you should consult the doctor.
    Make sure to nurse your baby from both breasts. This will improve the milk supply in your breasts and ensure that your baby gets the full nutritional value of the feed.
    Take help if you find it difficult to latch your baby. Observe your baby and follow his cues. Feed him when he demands.
    Read more: Benefits of breastfeeding
  • Trim your baby's nails: Trimming the nails of your little one is absolutely necessary as they may scratch their face or worse, hurt their eyes. Use a baby nail clipper or baby filer to trim the nails.
  • Jaundice: A common concern among newborns, jaundice arises due to higher levels of bilirubin in the body. Babies are born with extra red blood cells. The body breaks these extra red blood cells down, producing bilirubin. The bilirubin gets eliminated through bowel movements. A baby develops jaundice when his or her system fails to keep up with this process and the bilirubin gets deposited in the body.
  • Encourage sibling involvement: You and your family members must have gotten over the frenzy of welcoming a new member in your family. If you have older children, they may now find it difficult to adjust with the new baby as they will have to share your love and time with the newborn. Also, week by week, the newborn will become more fussy and demanding. This unwanted sharing may make the siblings jealous. The best way to avoid or tackle this jealousy is to encourage sibling participation in baby care. You can ask them to help with the baby massages or they can be helpful with the diapers. Family participation will help to keep things light and the ambience happier, and you will be able to sail through this period easily.
• Week 2: By now your baby's umbilical cord will have fallen off. Chances are that you and your baby are also getting better at breastfeeding. Here are a few things that need your attention this week:
  • Your baby is ready for baths: Once the umbilical cord falls off on its own, you can give your baby regular baths in a baby bath tub or the sink. Splash water on your little one and see if he or she enjoys this too. The bath water should be lukewarm. Be ready with all the bath accessories like a washcloth, mild baby soap, baby towel and diaper before taking off the baby’s clothes for a bath.
    Just like most babies, your baby may also not like taking baths. So try to keep the bath time short. Your little one will gradually learn to enjoy the splash. Take special care of your baby’s skin folds: clean them and dry them properly to avoid any fungal developments.
    Take special care to keep the umbilical stump dry.
  • Time to develop a sleep routine for your baby: This is the right time to develop a routine for your baby. The routine will help you to mould your baby’s sleep pattern and help the baby to distinguish between day and night.
  • Make sure the baby's neither hot nor cold: Your baby’s internal “thermostat,” which causes sweat or shivering when the baby is too hot or too cold, won’t still be working properly for some time. This doesn't mean that you weigh your baby down with too many clothes or blankets. He or she will only need one extra layer of clothing than you in the same weather conditions. 
• Week 3: At three weeks, your baby is growing fast, is more active, and possibly crankier and fussier than ever before. Though your baby can look quite different from when he or she was born, it’s still too early to say if he takes after the mom or dad!
  • More supervised tummy time: During this week, you can increase the frequency of tummy time - stick to it even if your child doesn’t seem to like it initially, as tummy time is essential for muscle development and it helps to avoid flat head syndrome.
  • Reinforce bedtime rituals: Babies like boundaries; show them the difference between day and night. Associate certain places in the home with sleep, and make sure the baby only sleeps in his or her crib.
  • Step outside with your baby: Though your baby’s abilities to see and hear the outside world are limited, they are expanding rapidly. Consider going out for a stroll in the park to expand his or her world a little bit more each day.
    It is a myth that babies and new moms should not step out of the house for 40 days. Barring any special conditions and recommendations by your doctor, new moms and babies can step outside within a few days after normal delivery, if the new mom is comfortable. Doctors also recommend that new moms who have had a Cesarean, should try to stand and walk indoors as soon as they are able to, as this helps to reduce the risk of blood clots.
  • Your baby may develop colic at this stage. Colic is not a health issue and will end by the fifth month. But handling a colic baby can leave you in tears. You can take the following steps to soothe your colic baby:
    • Change your diet: If you are breastfeeding and your baby cries or spits after every feed or is gassy, then track your diet. Something in your diet may be the cause of the colic.
    • Soothe your baby with an evening routine: Colic babies tend to cry in the evenings. You can set a soothing evening schedule like an evening massage or a gentle bath to calm your colic baby. Gripe water is not the answer to colic. It is better to avoid it as it actually harms the baby. 
    • Take a break: Handling a colic baby can be very difficult. Failed attempts to soothe your baby can leave you exhausted and teary-eyed. Don’t push yourself too hard. It is okay to take a break if you feel tired. Just put your baby in a safe spot and give yourself a much-deserved break.
      Take the help of your doctor if you feel worried.
• Week 4: See how the time flies. In-between all those sleepless nights and restless days, your baby has entered the fourth week of his or her life. Just a few weeks ago he or she was kicking inside your tummy and now your little one is playing in your lap.
  Your baby is almost one-month-old now, and with your love and care, he or she has finally adapted to this new world and is growing fast. You should be proud for getting everything right up till now: you are probably a perfect diaper-changer now and you know when your baby is crying for his feed and when he just wants you to hold him. Well done! Let this feeling of accomplishment sink in.
  Now take a deep breath and smile as you prepare to move forward and learn a little more about your baby this week.
  • Diapers and diaper rashes: You are probably great at changing diapers now. It is important to check your baby's diapers or nappies regularly and change them if they are soiled or wet to reduce the chances of diaper rash. Use diaper rash cream if you are taking your baby out with you for a long day. Give your baby some nappy-free time every day to enjoy some fresh air.
  • Burp your baby: Babies mostly take lots of air inside when they cry and while feeding. This makes them gassy. Make it a habit to burp your baby after every feed. This releases the extra air from their system.  If you are breastfeeding, then try to track your diet. Some food items can also make your baby windy. Formula-fed babies have this problem more often than breastfed babies. Try changing their feed formula.
  • Introduction to a baby gym: Your baby will be attracted by bright colours, contrasting patterns and music. This a good time to introduce your baby to a baby gym with many small toys suspended from it. The different colours, textures and sounds will stimulate your baby. It will be best to buy a baby gym with music and light features. Babies love to hear different noises and see high-contrast patterns. You can attract their attention with black and white toys, musical mobiles with strong colours, and colourful picture books. Babies are also sensitive to bright light. Your baby may blink, turn to the window or look at shadows on the wall to avoid the bright light. Try to incorporate shadow play in your playtime with the baby.

Every baby is different, with their own personality traits and growth patterns. However, consult your doctor if your baby displays any of the following symptoms:

• Is not interested in feeding
• Not responsive to sound and noises
• Doesn’t blink to the bright light 
• Has loose or stiff limbs
• Unfocussed eyes
• Is unable to follow objects moving from side to side

Your baby will have his or her first vaccination in the first week, starting with the hepatitis B birth shot even before you get discharged from the hospital. This vaccine will keep him or her safe from many infections which he may catch from any relative.

According to the Indian health ministry, your baby must get the following shots soon after birth:

• BCG shot to protect against tuberculosis within the first 24 hours, or as early as possible within the first year after birth
• OPV0 for polio at birth or within the two weeks at the latest.

It is recommended to take your month-old baby to the paediatrician for a complete head to toe examination. Your baby will also get his or her second hepatitis B shot at this time. Feel free to discuss your doubts and your concerns with the doctor.

Of course, you can and should consult your medical advisor if anything worries you before this scheduled visit.

The next major round of vaccinations starts at six weeks of age.

Your baby will go through a growth spurt in the first month: your newborn's head circumference will grow from about 13 3⁄4 inches (35 cm) to about 15 inches (38 cm) this month. Your baby will lose half of his or her birth weight in the first week, but will gain this weight back in the second or third week. Babies usually gain 2 pounds of weight in the first month. Your baby will gain 1-1½ inches of length in the first month. Baby boys will be heavier and taller than baby girls. 

• If your baby had scalp bruises or swelling of the eyelids at birth, these will vanish by the end of the first week or two.
• Between ten days and three weeks after birth, the stump from the umbilical cord should have dried and fallen off, leaving behind a clean, well-healed area. Keep the area dry and only clean it with rubbing alcohol if your doctor recommends.
• Any red spots in your baby's eyes will disappear by the third week.

Your body may be sore for a few days after birth - if you suffered a vaginal tear or had a Cesarean delivery (C-section), then you may have scar pain. Ask your doctor if it is safe to massage the area or ice the area if you find it difficult to sit.

Your muscles may also feel weak and wobbly. Pelvic floor issues are common after delivery - if you constantly feel like something is about to fall out of your vagina, you may have a pelvic organ prolapse. Visit your doctor immediately.

Some women can experience urinary incontinence when they laugh or get up from the bed after birth. Physical therapy may be required to fix this. Some women can also experience pain during sex soon after delivery. If this is the case, try non-penetrative types of sex for a while. If the problem persists, talk to your doctor about it.

Your uterus will take another six weeks to shrink back to normal and your hormones will be out of balance for a few weeks - this can cause mood swings, irritability, depression, among other symptoms. Give yourself time to heal and reach out to friends, family and medical professionals as and when you need help.

Baby blues are real. Understand your emotions, talk to your partner if you feel teary and tired all the time. Enlist the help of family and trusted friends to watch the baby while you catch up on your sleep and regain your strength. Baby blues usually don't require treatment and the symptoms pass within two weeks after giving birth. If your symptoms of sadness and moodiness persist, talk to a doctor.

This is not the time to worry about losing your pregnancy weight - anyone who tells you otherwise isn't helping! Instead, take care of yourself. Eat healthily. Start walking as soon as you are able. When you are comfortable, step out into the balcony. When you are ready, take your baby out for a stroll. If you have had stitches, check with your doctor about when you can resume regular activity. Focus on staying happy.

If you are breastfeeding, you may also experience some discomforts. Ask your doctor for safe medicines for nipple pain and breast pain, in case you need them. Keep an eye out for any clogging in the breasts. Despite the discomforts, breastfeeding is good for you and your baby. Research shows that women who breastfeed are likely to hit menopause later in life. This is great news, as periods protect women against diseases like heart disease.

Read more: Periods after pregnancy: when do they start and what to expect?