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Brand‑New Baby, Brand‑New Questions · Meaningful Medicine with Novant Health

• 0:04
  Amanda Wilde (Host): Meaningful Medicine is a Novant Health podcast bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  In this episode, we’re focusing on pediatrics and newborn
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  care with pediatrician, Dr.
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  Soren Johnson from Novant Health.
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  We’ll talk about what happens at that very first visit, how to know your baby
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  is thriving, and what new parents really need to know in those first few weeks.
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  I’m Amanda Wilde, your host.
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  And Dr.
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  Johnson, welcome.
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  Thank you so much for being here.
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  Soren Johnson, MD: Yeah.
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  Thank you.
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  I'm glad to have the opportunity and thanks for having me.
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  Host: Well, I don't know the answer to this very first question
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  that I'm going to ask you.
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  When should that first appointment take place exactly?
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  In other words, how quickly after birth should a newborn
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  be seen by a pediatrician?
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  Soren Johnson, MD: Yeah, I mean, it's pretty universal.
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  We generally want kids right out of the hospital to see their pediatrician
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  either the next day or maybe at most two days later, just because
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  it's a kind of a vulnerable period.
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  And, don't worry, we're not going to leave you hanging very long.
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  They'll tell you in the hospital, with your baby, they'll say, "Look, we really
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  want you to be seen tomorrow" or, "Go ahead and schedule for two days from now."
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  They'll give you some guidance.
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  But that would be a reasonable expectation.
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  Sometimes rare cases, you know, it's going to be a holiday in there or something,
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  you might have to stretch it a day more.
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  But most of the time, one or two days.
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  Host: So, kind of right away.
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  And that's actually reassuring, I think, especially for new parents.
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  What are the key things you check during a newborn's first pediatric visit?
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  Soren Johnson, MD: There's kind of two main parts in my mind.
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  One is just establishing that connection of what's hopefully going to be a great
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  long-term supportive relationship.
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  And it's why pediatricians go into pediatrics, is to watch kids
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  grow and to get to know families and to get that bond going.
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  And it's important the other way.
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  You want to have somebody you trust.
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  So, just building that relationship is really key from the get-go.
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  So, it's a little bit of get to know you.
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  So, expect some questions, some personal questions probably.
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  You know, "Hey, what do you do for work?
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  How long is your maternity leave or paternity leave?"
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  You know, just getting a sense of the lay of the land at home and
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  getting to know the family structure.
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  And then, the second piece is more the medical oriented towards the baby.
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  You know, what do we need to be focused on?
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  What concerns do you have as a parent already?
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  What's come up in the hospital?
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  There'll be some work done ahead of time, before I even meet the family
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  of reviewing the records and seeing what was the pregnancy course, were
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  there any issues, things discovered on prenatal ultrasounds and whatnot.
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  And the hospital's going to be really good about sending
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  communication in most cases about what specifically needs to be followed up.
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  So, the parents generally don't need to, you know, be really, really rigorous
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  about keeping track of everything because they're overwhelmed, and we know that.
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  It's a new experience, and you're kind of deer in the headlights with
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  most of the time your first baby.
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  So, don't worry, a lot of this is happening behind the scenes.
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  But then, in the room with the family, that's the other aspect
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  of it that I'm assessing in my head is, "How's baby doing?
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  How's mom doing?
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  What are the mechanics of making sure everything's making the
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  transition to the real world?
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  Host: So, thinking about that piece, how do you assess whether a baby is
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  eating well, feeding well, and gaining enough weight in those first few days?
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  Soren Johnson, MD: The biologic questions, number one, yeah, how is feeding going?
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  And that's generally one of my first kind of medical questions.
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  And so, really the subjective experience is important.
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  Obviously, the big choice there and,
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  you know, you can do both.
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  But it's are you formula feeding or are you doing breastfeeding?
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  So, there's going to be a different sets of questions with each of those.
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  And they're not mutually exclusive.
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  Sometimes, you know, you do a bit of both until the breastfeeding really
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  takes off if that's your desire.
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  And breastfeeding takes a lot of work.
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  So, a lot of times we make sure we connect you with support kind of regardless.
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  If it's your first time breastfeeding, we're going to make sure you have
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  lactation support and kind of know what to expect along the way or other tips.
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  So, that's a big piece of it.
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  We want to be sure you're feeding regularly.
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  That's universal, no matter how you're feeding, every three hours,
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  at a kind of minimum interval is pretty standard recommendation.
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  And yeah, we just take it as it comes.
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  I think probably the most important thing to know ahead of time
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  is that weight loss is normal.
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  That's how Mother Nature designed the system.
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  And for whatever reason, babies come out after delivery and
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  they're going to lose some weight.
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  So, that's not a failure.
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  You're not doing anything wrong.
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  That is just supposed to happen.
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  And then, mom's milk might not really be coming in till day four, you know,
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  maybe day three at the earliest if you're lucky with a first baby.
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  And then, it's going to continue to come in stronger from there.
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  So, just knowing that expectation that things are not necessarily
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  going to go like gangbuster, you know, fire hydrant at the breast
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  right out of the gate on day one.
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  Host: So besides support and resources, which are so important, you also help
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  parents manage those expectations.
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  I think eating and sleeping are usually the main concerns about a
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  newborn, but what else do you check?
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  Do you check physical features, reflexes?
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  Do you have some ways to check neurological development?
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  Soren Johnson, MD: Yeah, absolutely.
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  I mean, we're going to do a head-to-toe exam on that first day as well.
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  And the baby will already have had that in the hospital, but it's good to
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  have a new pair of eyes, a new brain, you know, looking for any issues that
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  might present challenges down the road.
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  Listening to the heart and lungs, is everything sounding correct?
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  The anatomy of the blood circulation takes a lot of—there are a lot of changes
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  from being a fetus in the womb to how the blood circulates through the heart, then
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  out of the womb in breathing in room air.
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  So, we want to make sure that process is going fine and everything sounds good.
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  Neurologically, it's kind of intuitive.
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  Is your baby crying?
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  Do they have a strong suck?
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  Are they able to latch on, whether that's to a breast or a bottle
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  or even a finger in the mouth?
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  Do they have kind of your typical baby reflexes, which are they should
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  kind of do this instinct to reach out their arms and grasp, if they
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  have the sensation of falling?
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  And don't drop your baby.
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  That's important.
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  Don't do that.
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  But that's part of our exam, and sometimes that makes babies cry,
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  and we want to see them cry.
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  We want a vigorous baby that will make a little noise and
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  move all their arms and legs.
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  And then, generally, just their strength and tone and, you know, are all the
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  muscles seem appropriately strong.
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  Host: So, just a little more detail on that.
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  What developmental milestones or behaviors do you expect to see, not only in those
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  first few days and the first visit, but the first few weeks of a baby's life?
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  Soren Johnson, MD: Yeah.
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  Initially, it's just kind of an instinct to suck, so you
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  want the suck reflex there.
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  And they're going to be sleeping a lot.
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  So, they're not necessarily going to do a ton.
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  But it's the key vital functions, you know, are you eating?
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  Are you sleeping?
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  Are you peeing?
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  Are you pooping?
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  How are you breathing?
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  All these vital functions of life that should all be happening.
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  And the transition of, like, milestones along the way, they should periodically
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  open their eyes and you should have the sense that they're looking at
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  you or, you know, looking at things.
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  Babies can't see very far and their vision's probably a little bit blurry,
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  so they're not going to necessarily track as well as a bit of an older infant.
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  But some sense of, "Okay, when I'm holding them in my arms, you know,
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  they're looking at my face," is key.
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  We don't really get smiles necessarily till closer to a month or two old.
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  I mean, sometimes you'll get it really young, but don't expect
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  that right out of the gate.
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  Same with laughter, that's going to come a little bit later.
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  So, those are probably the key things.
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  Host: Do you discuss vaccinations and schedules for
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  vaccinations on that first visit?
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  Soren Johnson, MD: Yeah, absolutely.
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  I think a lot of times it's already come up.
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  So in the hospital, we generally recommend for all infants a hepatitis B vaccine.
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  And so generally, that parents will have either already gotten that.
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  Sometimes they prefer to wait until they get it in the pediatrician's office.
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  But if there's hesitations or questions, absolutely, this is a great
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  time to talk about it, bring it up.
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  And I think it just goes to that one of those fundamental, kind of foundational
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  things that we do in pediatrics, is we want to do things to anticipate
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  health challenges, anticipate risk.
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  And vaccines are a huge part of that.
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  I mean, it's one of the best tools we have to give someone a medicine
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  that could prevent potentially something that might be deadly.
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  So, you want to be sure you're seeing eye to eye and have trust in
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  the information that you're getting from the pediatrician, but also that
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  that pediatrician is respecting and supporting your values and hopes for
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  how you want to go on that process.
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  So, it's a great time to ask those questions and make sure
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  you have alignment there.
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  If the pediatrician is saying things that are way off base from what you kind of as
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  parents want for your child, then it's a good time to figure that out early rather
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  than, you know, six months down the road.
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  Host: Yeah.
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  Are there things parents should think about to get the most out
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  of that visit, that first visit?
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  Soren Johnson, MD: I generally would say just bring your
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  baby and all your questions.
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  And we'll take it from there.
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  I don't think you necessarily need to come with a huge checklist of things.
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  There are always some logistic questions that you might have answers about, and
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  you can ask the pediatrician those.
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  You might also be able to ask the office, when you make the appointment or
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  when you check in some of the logistic questions like, "What are your hours?"
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  You know, "Do you have weekend hours?
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  What do I do if I have a question?
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  Who do I call?"
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  You know, "Who's going to answer my call?"
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  Those kind of things.
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  And so, that's going to be handled a little bit differently at every office
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  Host: So Dr.
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  Johnson, what other areas or topics do you typically discuss?
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  The medical health of the baby obviously, and some questions the parents may have.
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  You mentioned the logistical ones.
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  Are there any other topics you cover?
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  I'm thinking, "Well, parents have a lot of anxiety, or there may be
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  postpartum depression, or maybe they're just dealing with that lack
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  of sleep that comes for all parents."
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  Do you advise people on those topics?
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  Soren Johnson, MD: Absolutely.
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  I mean, you know, the baby is not like an independent being yet, you know?
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  So, I have to make sure and get a sense of what's the whole family support
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  structure and how are you guys doing as parents, how are you adjusting?
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  It's all important.
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  So yeah, you may get some questions about that type of thing,
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  like, "Who else lives at home?
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  Tell me about that."
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  Because yeah, I want to do everything I can to make sure that baby's going
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  to thrive and do great and not in a judgmental way, just in a like, you
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  know, do you need any extra support?
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  And so, you mentioned postpartum depression.
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  That's certainly a great thing to be aware of that is super common and
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  there shouldn't be guilt or shame associated with admitting like,
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  "Wow, the hormone shifts have been crazy after delivery and I'm having
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  anxiety," or "I'm feeling really down and depressed and I don't know why."
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  Those are great opportunities to bring up those things.
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  And sometimes everything's just a whirlwind in the first visit.
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  So, maybe some of those things don't pop up until a couple weeks down
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  the road or even a couple months down the road, but just knowing
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  that that's normal and common.
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  Feeding ties in a little bit with jaundice, which is when babies can
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  get kind of a yellowish hue to their skin, because right at delivery you get
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  typically a bit of a transfusion, a bit of an extra kind of salvo of blood from
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  the placenta into the baby's circulation.
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  And that's great because it helps you give, you know, more fluid, but also
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  transport oxygen well for the baby.
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  But that blood that kind of transfers at that time doesn't last very long and it
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  breaks down in the body fairly quickly.
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  And as those red blood cells break down, they kind of get
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  metabolized into this yellow pigment.
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  And a little bit is normal, but too much is not good and can be
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  dangerous for the developing brain.
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  So, that's another kind of really common thing that we're keeping
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  a close eye on in the first few days, first few weeks sometimes.
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  So, that'll be something on your pediatrician's mind.
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  And, along with weight and feeding and jaundice, those are the two biggest
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  factors that dictate when I'm going to tell that family to come back.
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  So, sometimes I'm saying, "Hey, you need to come back tomorrow because
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  I'm worried the baby's weight is a little bit too low," or, "Oh wow, your
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  jaundice level is a little bit higher than maybe I would like at this age.
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  Let's keep a close eye on that."
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  So, those are common issues.
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  Fatigue and how to kind of just still be a human and try to function on what
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  little sleep you're going to get, because the baby's going to be waking up and
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  feeding every three hours is exhausting.
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  But don't worry, it doesn't last forever.
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  You know, it is a time-limited thing.
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  It's generally only for a week or two that families are having
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  to maintain that schedule.
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  Host: And pretty soon, they'll be in high school and you won't
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  be able to get them out of bed.
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  Soren Johnson, MD: That's right.
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  That's right.
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  And then, other safety stuff, like a fever is a huge deal.
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  You really don't want to take that lightly in a newborn.
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  They do not have great immune systems in terms of they're kind
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  of immunosuppressed a little bit, if you could think of it that way.
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  Because otherwise, the baby's immune system would attack mom's immune
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  system in the womb and vice versa.
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  So, that's kind of why that is the way it is, and it takes time to develop the
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  immune strength and the immune response.
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  But that's why we take any fevers really seriously.
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  So, anything over 100.4
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  is the magic number, or 38 degrees centigrade Celsius.
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  Those would be reasons to go right to the emergency room.
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  Do not give Tylenol, do not give ibuprofen, do not give other medicines.
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  It's not a, "Hey, wait 24 hours and call me tomorrow."
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  It's a right now issue.
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  Just trying to keep the baby safe from an infection standpoint.
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  Just kind of some of those risks and safety concerns are things that
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  we try to bring up just in case there's other questions or concerns.
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  Anyone who's sick should not be around the baby.
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  I don't care if it's grandmom or your neighbor or a friend
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  from work or whatever.
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  If they're sick, they can wait to meet him or her.
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  There's no point in taking a risk for just a social hello.
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  Host: Those are really important reminders to keep our babies safe
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  and healthy, especially as newborns.
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  And I think, Dr.
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  Johnson, I get the impression from our conversation that the pediatrician is
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  really the parent's medical resource, but also partner in care and telling us
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  what is normal and what to be concerned about and what to know to expect as well.
• 15:21
  How rewarding do you find it to, as you mentioned at the beginning
• 15:24
  of our interview, connect with families and be able to watch the
• 15:28
  children grow and develop over time?
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  As a pediatrician, you may follow them from birth to adulthood.
• 15:34
  Soren Johnson, MD: Yeah.
• 15:34
  I mean, it's the best.
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  It's absolutely the most rewarding part of the job.
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  And, you know, hopefully, we don't run into issues, but trying to anticipate
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  problems before they happen is great.
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  Yeah, and absolutely don't hesitate to use your pediatrician as a resource.If
• 15:51
  you have questions, call.
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  If you're a new parent, you haven't done it before by definition,
• 15:55
  and that's why your pediatrician is there to help support.
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  So, don't feel like you're burdening the office if you have questions.
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  Just fire away.
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  And if we think, "Okay, well, that seems like it needs a visit,"
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  hey, we're going to tell you that over the phone and come on in.
• 16:10
  You know, in regards to feeding too, I feel like I have to say this,
• 16:13
  like we're always pro-breastfeeding because there's that extra benefit of
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  immune support and there's, you know, some good evidence to support that.
• 16:20
  But I also feel like moms really just get hit over the head with the guilt of
• 16:25
  like, "This is the most important thing that you can do for your baby," et cetera.
• 16:29
  And while we support it, it's not the definition of parenthood or of motherhood.
• 16:35
  Your baby needs your love and attention and care, and you have that in spades.
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  So, if breastfeeding is just a major challenge and it's
• 16:42
  not going well, it is okay.
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  Like, formula works really great too.
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  So, I don't want people to go into it just feeling like they're a failure
• 16:52
  if that doesn't just take off.
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  So again, I'm pro-breastfeeding, don't get me wrong.
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  But I also have faced a lot of families that just are really
• 17:00
  upset when it's not going well.
• 17:02
  So, I like to just preempt that with saying, "Look, it's okay."
• 17:06
  Host: Yeah.
• 17:06
  The anxiety only makes things much worse for the parent, and the baby's
• 17:12
  going to pick up on that as well.
• 17:13
  As you said, it's love and support that they need.
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  And in the case of breastfeeding, bottom line, nutrition is what they need.
• 17:23
  So, if it's too difficult to do breastfeeding, it's just nice to have
• 17:27
  someone there, a medical professional, to take that weight off of a parent's mind.
• 17:34
  Soren Johnson, MD: And it is.
• 17:34
  It is so special to be invited into these young families' lives.
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  And, as you said, consult with them.
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  I really do view myself there for coaching and guidance and consultant more than,
• 17:47
  you know, the directive like, "You have to do this this way," or whatever.
• 17:52
  That's not my style and probably not most pediatricians' style.
• 17:56
  Host: And you give parents resources as well so that we
• 18:00
  have other pillars to rely on.
• 18:03
  Dr.
• 18:04
  Johnson, thank you so much for all this important information and just
• 18:07
  the consistent support and care you give babies and their families
• 18:12
  Soren Johnson, MD: Yeah, my pleasure.
• 18:13
  Thanks for having me on the podcast
• 18:16
  Host: That was pediatrician Dr.
• 18:18
  Soren Johnson from Novant Health.
• 18:20
  To find a physician, visit novanthealth.org.
• 18:23
  For more health and wellness information from our experts,
• 18:26
  visit healthyheadlines.org.
• 18:29
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