Once upon a time in a sunny land near the sea lived a beautiful Mommy and Daddy who were planning to have their first child. They were very happy and excited. One day their doctor took his magic looking glass and delivered them great news. They were going to have twins, a boy and a girl! Mommy and Daddy were overjoyed. They went home and called lands far away to share the great news with all of their family and friends.
The Fairy Godmother from the East told them to start planning for their babies and find a doctor to help them on their journey. Mommy and Daddy searched and searched until they arrived at a castle gilded with gold in a town filled with kings and.
On the door was a sign which read Beverly Hills Pediatrics and inside they met two royal doctors, one withgolden hair and the other with eyes as green as emeralds. “Welcome,” announced Dr. Bess and Dr. Scott with smiles. “Congratulations! We know this is an exciting time in your life and you have years of laughter and joy ahead of you. But there may also be times that you feel tired and overwhelmed. We want to help you make this experience as easy and fun as possible. We will be with you every step of the way.”
Mommy and Daddy were so pleased. They left the castle and were driving home when Mommy’s belly began to rumble,so they drove to the best hospital in the land where Mommy delivered two healthy, beautiful children: a boy and girl. Mommy and Daddy were so happy! They named them Prince and Princess. The caring nurse came in and said, “I’m going to take your children to the nursery.”
“Why do you have to do that?” Mommy asked looking concerned.
“Don’t worry,” said the nurse with a warm smile. “We’re going to paint their umbilical cords blue to keep them dry, place a ribbon of magic eye ointment in their eyes to prevent infection, and give then an injection of vitamin K to help their blood clot. Finally, we’ll give them each a bath so they are clean and happy when you get to your room.”
“Thank you,” Mommy and Daddy said in unison. “We know they are in good hands.” Mommy and Daddy sat in their room holding their new son and daughter. They were elated with the new addition to their lives. It was a perfect day. Then with a musical knock at the door appeared Dr. Bess and Dr. Scott. “Hi,” Dr Bess said with a grin as she hugged Mommy. “Congratulations!” cheered Dr. Scott as he high fived Daddy. “How are you feeling?” he asked. “I feel great,” answered Mommy “Look how beautiful my babies are, but I was wondering why they look the way they do. Their heads are oddly shaped, their skin is dry and bumpy, and their eyes are swollen.”
“Don’t worry about a thing” Dr. Bess said warmly, “Let’s do a physical exam together and check out everything from head to toe.” The babies were undressed and placed on the bed next to Mommy. Daddy sat on the edge of the bed inquisitively and the doctors leaned over to inspect their tiny bodies. “Ten fingers, ten toes” said Dr. Bess. “Two ears, two testicles” said Dr. Scott,“Perfect!” they announced in unison. “Strong heart, clear lungs, soft belly,” continued Dr. Bess and Dr. Scott with gleaming smiles. “This is called ‘molding’,” Dr Scott said gesturing toward their pointy heads. “Don’t worry, it won’t affect their dating lives, it will even out in no time. And this soft spot on the top of their heads will allow their brains to grow.”
“You may notice their eyes look puffy and barely open,” Dr. Bess added. “This is normal swelling from delivery and will improve in the next couple of days. But amazingly they already recognize the shape of your faces.” She pointed to the cracked skin on their baby’s body. “Many newborns have dry peeling skin especially on the hands and feet.
They were just in liquid for 9 months, now they are in air and their skin needs time to adjust. Flaking and peeling is normal and will go away on its own. They also have these red bumps that look like flea bites which can be anywhere on their body and may come and go over the next couple of weeks. Although the name, Erythema toxicum sounds horrible, the rash is normal and nothing to worry about.”
“Oh look at this,” Dr Scott said as he lifted Prince into the air, “he has a birthmark.”
“She does too,” commented Dr. Bess.
They pointed to the red splotch on the nape of Princess’ neck and a blue one on the base of Prince’s back.
“The red birthmark on your daughter is called a ‘nevus simplex’ or ‘Stork’s Kiss’ and is one of the most common things seen on the skin of a newborn. It may be there all her life or fade over time, but you won’t notice it under her hair. The blue birthmark on your son’s back is also very common and is called a ‘Mongolian spot’. It may also fade over time or be there all his life, but it will never cause any problem.”
“I have a Stork’s kiss,” said Mommy as she lifted her hair.
“I have a Mongolian spot,” chuckled Daddy,” but I won’t show you where.” They all laughed in unison. Prince got startled and his arms flailed briefly. The new parents looked at their baby with concern. Seeing this, Dr. Scott interjected, “the ‘Moro reflex’ or ’startle reflex’ caused Prince’s arms to splay in the air like he is trying to give a big hug. He will do this whenever he is startled until he is about 4-6 months old. All newborns have this reflex.” Daddy let out a sigh of relief and looked lovingly at his son while their daughter slept soundly beside him.
“Now, let’s look inside their diapers,” Dr. Bess said. “You will notice that Princess’ labia are swollen and darker in color because of Mommy’s hormones in her system and they will gradually return to a normal color. She may also have a little whitish vaginal discharge or small amount of spotting like a mini period for the first few weeks due to these same hormones.”
“Is that blood in her diaper?” asked Mommy pointing to a pink stain in the diaper.
“No, that salmon color is due to urate crystals in Princess’ urine which react with the diaper and turn it pink. Urate crystals are common in newborns because they are slightly dehydrated. But don’t worry, it will go away when your milk comes in,” reassured Dr. Bess.
Dr. Scott explained that Prince’s scrotum looked swollen and tight because there was fluid around the testicles and this fluid would be absorbed by the body during the first year of life. Mommy and Daddy asked if Dr. Scott would perform the circumcision. “Oh no,” he said, “the Obstetrician’s perform circumcisions right here in the hospital within a day or two of delivery, or you can have a mohel perform the circumcision at home during a ceremony called a bris.
After the circumcision, it is important to keep the penis coated with an ointment such as Vaseline or Neosporin for at least one week to help aid in the healing process.” Mommy and Daddy were pleased with the explanations they heard. They felt confident that their son and daughter were healthy and there was nothing to worry about. Just then the twins began to cry in unison.
“I think they are hungry,” said Mommy.
“You’re right,” said Dr. Bess, “Let’s talk about breastfeeding. You can either nurse them at the same time with one child on each breast or, nurse them one at a time. Another option would be to let Daddy help out by using a bottle filled with either pumped breast milk or formula.”
Daddy said, “I’d like to be involved in feeding them.”
Mommy looked at Daddy lovingly and said, “How about if I breast feed one of them while you give the other a bottle and then we can alternate each feeding?”
“That sounds like a great idea,” remarked Dr. Scott.
Mommy picked up Princess and held her against her chest. “Like this?”
“Good,” said Dr. Bess guiding her through the process. “First, let’s make sure you are comfortable.” Dr. Bess placed a pillow under Mommy’s arm to support it. “Next, hold Princess like a football along your side or cradle her across your chest, whichever is more comfortable.” Mommy cradled Princess across her chest.
“Excellent, now with your other hand support your breast and bring the baby gently to you. Remember her mouth has to fit over the entire areola, otherwise if she latches on to your nipple, you will be very sore and she will not get any milk.”
With Dr. Bess’ help, Princess opened her mouth wide and latched on perfectly.
“You both did great!”
“But how do I know that she is getting anything?” asked Mommy.
“Well, in the first couple days you are producing colostrum. Colostrum is like a high mineral shake, it has everything she needs, just not a lot of volume. As a result, you may notice feedings are more frequent and she may lose up to 10% of her birth weight in the next couple of days.
Within 3 to 5 days you will start seeing signs that your milk is coming in. Your breasts will feel heavier, you may have some leaking from your nipples, and she will start gulping at the breast because the volume has increased. Princess and Prince will also show signs that they are getting your milk. Their poops and pees will increase and the poop will change color from tarry black meconium to a yellow, mustard seed like consistency. And by 2 weeks they should regain their birth weight.”
“Great. But how long should I keep her on my breast? It seems like she has already fallen asleep.”
“Keep her on one breast for 15 to 20 minutes and if she is still drinking vigorously offer her your other breast. It is very common that she will feed for a couple of minutes and then fall asleep and then continue when she wakes up. In order to maximize her time on the breast and prevent you from becoming sore do whatever you can to wake her up when it is time to feed. Taking off her clothes so she feels your skin, changing a diaper, or even wiping her face with a cool wash cloth may help.”
Dr. Bess and Dr. Scott watched as Princess lay contentedly at her mother’s breast while Daddy sat in the windowsill with Prince in his lap feeding him a bottle of formula.
“How much formula should I give him?” asked Daddy gazing at his son.
“Offer a 4 ounce bottle and let him take as much as he wants. He will probably take 2-4 ounces every 2-4 hours, but don’t be surprised if sometimes he takes a little more or a little less,” said Dr. Scott.
Mommy and Daddy smiled as the babies slept peacefully in their arms. Everyone looked relaxed and happy.
“Don’t worry about a thing. One of us will be here every morning to see how you are doing and answer questions. We just want you to relax and use all the help around you and we will be back tomorrow,” said Dr. Scott.
Mommy and Daddy worked on feeding all night and enjoyed their new family.
As the sun rose the next morning, they heard a familiar musical knock at the door. “Good morning,” sang Dr. Bess and Dr. Scott. “How was your night?”
“Great,” Daddy replied, “they ate every 3 hours just like you said. We didn’t get much sleep but it was worth it. It will be nice to get back home and sleep in our own bed.”
Princess sneezed as if in agreement and Prince started to hiccup.
“Uh Oh, asked Mommy, “Does she have a cold?”
“No, sneezing and hiccups are very common in newborns. Sneezing allows Princess to remove dust and mucous. You may also notice that she sounds snorty and snufflly when she breathes and her breathing changes pace. This is because unlike you and me, newborns alternate between breathing fast and then slow. This is called periodic breathing and is normal. Newborns are also nose breathers and have small nasal passageways so you hear them breathing. Placing a vaporizer in their room will help loosen up secretions and make it a bit easier for them to breathe,” said Dr. Scott enthusiastically.
Dr. Bess and Dr. Scott examined the babies again with their parents watching. Everything was perfect. The twins were feeding well, pooping and peeing, and had only lost a little weight. “Look,” said Dr. Bess, “Prince has a little yellow discharge coming from his left eye. “This discharge is due to a clogged or blocked tear duct. A newborn’s tear ducts are small and prone to blockage throughout the first year of life.“
“What should we do? How do we know his eye isn’t infected?” asked Daddy.
“You’ll notice the white of his eye as well as the surrounding area is not red as would be seen with an eye infection. Place some breast milk in the corner of the eye. This will lubricate the duct and help prevent infection. You can also massage the duct to help unplug the obstruction,” said Dr. Scott.
Daddy took his little finger and gently massaged the inner corner of the eye near Prince’s nose.
Then Dr. Bess said, “Today, we are going to talk about what to expect when you go home, so that nothing is a surprise.
Let’s start with feeding. Your children will let you know when they are hungry by crying or rooting (turning towards the source of food) so feed them on demand. They will likely feed every one to four hours. They may feed more frequently if they are breastfeeding. As long as they are feeding regularly during the day (every 1-4 hours), you can let them sleep as long as they want at night.”
“Hallelujah!” Daddy remarked.
“I wouldn’t let them sleep longer than 4 hours in a row during the day, because they might have their days and nights reversed. And you can be certain that if they are sleeping longer stretches during the day, you will be up more often at night,” explained Dr. Scott.
“We don’t want that,” laughed Daddy.
“Also, in about 2-3 weeks when you feel comfortable breastfeeding, you may begin pumping your breast milk. Often times it’s best to pump right after breastfeeding. The babies don’t usually fully empty your breast and by pumping out the remainder of your milk your body will signal your brain to produce more. This will make feeding easier and also allow you to store your breast milk for subsequent bottle feedings. Then you can get some rest while Daddy gives a 3AM feeding or leave the house if you would like. Make sure not to pump after every feeding, this can cause engorgement and may be stressful, two things that can affect your breastmilk,” explained Dr. Bess.
“Sounds great.” exclaimed Mommy, “but how do I store the breastmilk?”
“Easy,” said Dr. Scott, “a simple rule to follow is the rule of fives. Breast milk is good for about five hours if it freshly pumped, 5 days in the refrigerator or 5 months in the freezer. It doesn’t matter if you serve your milk cold or hot as long as the babies take it. And remember, NEVER heat up breast milk in the microwave, it kills all of the good antibodies in the milk.”
“That is great advice.”
“Next, let’s talk about their umbilical cords. The nurse is going to take these white plastic clamps off of their umbilical cords before you go home. In the olden days we used to rub alcohol on it to keep it dry, but now we know to just leave it alone until it falls off. This usually happens within the next two weeks. When it does, there will be some thick yellow goop underneath that has an unpleasant odor and looks like vanilla pudding. This is normal. Give it a couple more days until it is totally dry and then you can bathe your child normally. Until then, sponge bathing your twins will be the best way to clean them and also keep the cord dry. They don’t need a bath every day. Once every two or three days is enough, they don’t have smelly armpits yet!” joked Dr. Bess.
“My parents told me I turned yellow when they brought me home. Do we need to worry about this happening to our babies?”
“Good question. Over half of infants turn yellow or jaundiced in the first week of life. Most commonly this is due to the liver’s inability to remove bilirubin from the body in the first couple of days of life. Once the liver is revved up, the jaundice starts to disappear. Physiologic jaundice, as it is called, occurs in happy and healthy newborns and is nothing to worry about. However, occasionally jaundice will be caused by other factors such as certain blood type incompatibilities or dehydration. If their skin or eyes look very yellow at any time please call us so we can check it in the office. The yellow tends to start on the face and move down the body,” said Dr. Scott.
“When can we take them outside with us?” asked Mommy.
“Soon,” explained Dr. Bess, “But you have to be careful. If your babies get a fever in the first two months of life we need to treat it very seriously. We may need to hospitalize them and check their blood, urine and spinal fluid for infection.
That is why you should avoid crowded areas such as the Grove on a Friday night, a crowded movie theater or a restaurant, where they have a greater chance of being exposed to sick people. Instead, take a walk around the block, or have (healthy) friends visit you at home. Make sure that everyone washes their hands before they hold your babies.
You can carry around Purell for when you’re not near water. Anyone who is coughing, sneezing or has fever should stay away until they are better. Fever is a temperature of 100.4F or higher. Take your child’s temperature rectally in the first 2 months only if something seems wrong, not randomly like they do in the hospital. And call our emergency line for any fever during the first two months of life.”
“We want to do everything we can to keep our babies safe. Are there any other special precautions we should take?” asked Daddy.
“Always put them to sleep on their backs in order to prevent Sudden Infant Death Syndrome (SIDS). You can place them on their tummies while they are awake for tummy time. Make sure that the babies are buckled up in their car seats anytime they are in the car seats, especially when you are driving. The car seat should be in the back seat, preferably middle, and facing toward the rear until they are 1 year old and 20 pounds,” explained Dr. Scott.
“We just had our car seats installed at the LA fire department,” said Mommy.
“Great,” said Dr. Scott, “Also, when you get home, check that your water heater is set to 120 degrees or less. I know you will be checking the water temperature prior to baths but a water heater set higher than 120 degrees can cause scalding burns within a couple of seconds.”
“Done and done,” exclaimed Daddy.
Right then a loud toot sounded from Prince’s side of the room, “Like father like son,” Daddy said and everyone laughed.
“Gas is very common in newborns,” Dr. Scott said with a grin. “If you think the gas is bothering him, try placing him on his back and gently bending his knees into his stomach. You can also try Mylicon drops or Gripe water. Mylicon drops are like gas-X for babies and may help him push out the gas. It may not work all the time, but it doesn’t hurt to try.
Before using medications try placing your baby on their back and lifting their legs or massaging their bellies.
“Can we give them to Daddy too?” asked Mommy. “Very funny,” Daddy replied kissing Prince’s head. “I have noticed he pushes a lot especially when he is pooping, and his face turns red,” said Mommy.
“Pushing and turning red while making bowel movements is normal as long as the poop comes out soft. He strains because he is trying to figure out what muscles he has to push to get the poop out. Pooping may start off occurring every feed then decrease to once a day or once every couple days especially in breast fed babies. Breastfed babies tend to have softer poop than formula fed babies. It may look soft, liquidy, mushy, mucousy, play-doughy, or seedy. The color, smell and texture of their poop does not matter unless you see red (new blood), black (old blood), or it is hard pellets. ” explained Dr. Scott.
“There may also be times they are fussy and you just can’t figure out why. This is called colic and is common between 2 weeks and 3 months of age. The fussiness often increases in the early evening which has been nicknamed the “witching hours”. Positioning may work the best. Try swaddling them tightly in a blanket, laying them on their side in your arms, and rocking them gently side to side in large pendulum motion while making a shooshing sound. These movements mimic being inside Mommy and are very comforting. You can also try Gripe Water and Hylands Colic Tabs which are mixtures of ginger and phenyl, and may be soothing to the stomach. An ounce of chamomile tea with a pinch of sugar (No honey) sometimes works as well. Try one at a time and see if they work,” added Dr. Bess.
“This has been extremely helpful,” Mommy said beaming.
“I feel very comfortable taking our babies home,” added Daddy excitedly.
Prince and Princess cooed as if in agreement.
“Excellent!” gleamed Dr. Bess and Dr. Scott. “Remember, call if they look yellow, are feeding poorly, or if they have fever, and of course if you have any other questions. Otherwise we will see you when your babies are 2 weeks old. Have fun and enjoy your new family.”
“Now it’s time for you to depart,” said Dr. Bess
“Don’t forget to make your first appointment,” added Dr. Scott
Before the royal doctors left the room, they sprinkled magic mommy and daddy dust on the new parents and transformed them into a King and a Queen. King Daddy and Queen Mommy smiled, placed Prince and Princess into their car seats, got into their horse drawn carriage and drove home to a castle of their very own castle gilded with gold and began their new journey there as a family.