2.5 The Newborn in Context

Bonding

The first few months after a baby is born are often called the fourth trimester because they are full of new discoveries and fast-paced development as the baby learns how to control their body, use their voice, and discover the world. However, babies still need others to care for them, because they are not yet able to see clearly, control their movements, or even feed themselves. All the physical, emotional, cognitive, and social milestones they will reach during infancy, and even aspects of social development beyond infancy, will depend on the bonding and attachment formed between primary caregivers, typically one or two parents, and the child (Joas & Möhler, 2021).

While attachment, the emotional connection a child feels toward their caregiver based on consistency and quality of care, takes longer to develop, bonding can start immediately. This is a one-way relationship consisting of a caregiver’s emotional connection to the infant. It can begin as early as minutes after birth, motivated by the release of oxytocin, which promotes feelings of affection (Scatliffe et al., 2019). If all goes well during delivery, new parents may be able to hold their child right away and start forming feelings of affection toward the baby. Even if not, they will still have time to develop a strong bond with their newborn during the first few months of life. For adoptive parents, bonding is still highly likely to occur over the early years following adoption (Goldberg et al., 2013).

A newborn’s brain starts to make new connections quickly as the baby takes in the world around them. One of the most important drivers of newborn brain development is the interaction between a newborn and their caregiver(s) (Figure 2.26). An infant’s brain will create new connections and attain nearly 90 percent of its adult size by the age of three years (Winston & Chicot, 2016), and caregivers, including family, babysitters, and siblings, all play a role in that development. These new connections are guided by the infants’ experiences. Interacting, playing, and communicating with infants helps drive those new connections and the infant’s ability to learn language, create memories, and think. Healthy bonding between caregivers and an infant can help increase social skills lasting into the preschool years (Joas & Mohler, 2021).

Figure 2.26 Mutually enjoyable interactions promote the parent-infant bond. (credit: modification of work “Father, Child, Love image” by “balouriarajesh”/Pixabay, Pixabay Content License)

Caring for an Infant

Newborns require constant care, and this often means a caregiver needs time off work. Most industrialized countries offer some variation of paid parental leave policies, often with government-subsidized allowances that let caregivers stay home to care for their infant. Employers are also able to add time to the governmental benefits if they so choose (Hernandez, 2018). In the United States, no federal policy mandates paid leave for parents, though twelve weeks’ unpaid leave is offered, and some states offer paid leave for various lengths of time (National Conference of State Legislatures, 2024).

What should parents expect after bringing their baby home? For the first few years of life, babies are completely dependent on others for their care. Some of the most important aspects of care include feeding the newborn, ensuring they are getting enough sleep, cleaning them, changing them, and interacting with them often. You will learn more about the physical health needs of infants in Chapter 3 Physical and Cognitive Development in Infants and Toddlers (Birth to Age 3), but here are a few basics of the first months.

Babies sleep most of the day and night, usually around sixteen hours a day, but initially only for a few hours at a time. Newborns benefit from getting adequate sleep in a safe environment (De Beritto, 2020). One safety issue, for example, is that they need to sleep on their backs and without soft bedding for the first year of life, to reduce the risk of sleep-related infant deaths (Moon et al., 2022).

Newborn babies need to eat every two hours, or between eight and twelve times within each twenty-four-hour period (Skinner et al., 2004). Breastfeeding, if desired and possible, should start within hours of birth. The mammary glands first produce colostrum, a nutrient-rich substance that is high in protective antibodies. Breast milk appears within a few days. Lactation consultants (who specialize in breastfeeding information and strategies) are available in many hospitals, and through organizations like La Leche League. If using formula, parents need to feed their baby one to two ounces at each feeding. Regardless of feeding style, babies typically lose a little weight during the first week of life and then start to gain weight thereafter.

Parents also need to make time to be close to their newborn and interact, including having “tummy time” sessions with them (Figure 2.27). These sessions, in which babies are placed on their stomach in a safe location while being supervised, help them build their neck, shoulder, and arm muscles so they can eventually lift their heads on their own and in time sit up, crawl, and walk. These sessions also help to prevent flat spots on the baby’s head (from spending too much time on their back) and help their overall motor development (Hewitt et al., 2020).

Figure 2.27 (a) During tummy time, an infant is placed on their stomach while an adult supervises, to help strengthen muscles and allow infants to practice controlling their muscle movements. (b) Swaddling is a way of wrapping a baby’s body in a breathable, soft cloth to help them feel calm and secure. (credit a: modification of work “Tummy Time” by Nate Grigg/Flickr, CC BY 2.0; credit b: modification of work “006, All swaddled up” by Bev Sykes/Flickr, CC BY 2.0)

Babies are experiencing the world for the first time, and though they can hear, touch, taste, and smell, they cannot see well yet, or in color. It takes one to two months for them to build the muscles that move their eyes in sync and focus on objects, and it also takes time for their brain to learn how to read the signals coming from their eyes (Johnson, 2010). With all these new sensations and still-developing bodies, babies can easily become overwhelmed and do not yet know how to self-soothe (Pinto & Figueiredo, 2023; Rothbart et al., 1992). It can be difficult for parents to know how to help, but using any or all of “the five S’s” can often calm the baby:

• swaddling (wrapping the baby snugly in a light blanket)
• putting the baby on their side or stomach (as long as they are awake)
• shushing
• swinging
• and sucking (letting them suck on a nipple or bottle) (Harrington et al., 2012)

Adjusting to a New Baby

Newborns do not come with straightforward instructions, and each is unique in the way they adjust to life outside the womb. Still, new parents face many challenges in common (Table 2.9).

New parents must also adjust to new roles within their relationship and learn new caregiving tasks. Their success can be hampered by lack of sleep and the need to adapt to new priorities. Caring for a newborn is not always easy, and some aspects of parenthood might not be what they expected. In addition, there can be stress to “get it right” and feelings of guilt when things inevitably don’t go as planned. New mothers often struggle with self-blame and maternal guilt if they feel they are not meeting expectations (Derella & Milan, 2021), so finding support and help is also important.

Often, however, new parents do not seek practical and/or emotional help early, and the stress of trying to cope by themselves can build up over time. Feelings of sadness and/or anxiety, often called the “baby blues,” are common among new parents, and they can also slow the process of bonding (Trigo, 2021). Baby blues is estimated to be present in up to 80 percent of new parents (March of Dimes, 2021). If these feelings don’t fade after several weeks, or if they become more severe, a birthing mother may be experiencing postpartum depression. Following are symptoms of this condition:

• intense feelings of sadness or despair
• anxiety or excessive worry experienced for no discernible reason
• loss of interest in activities previously enjoyed
• inability to sleep, eat, or maintain a daily routine
• feelings of panic
• frequent crying
• thoughts of harming self and/or the baby

Postpartum depression can disrupt the bonding process as well as interfere with daily life and quality of life for the mother (Hahn-Holbrook et al., 2018). It can occur at any time during the first year but typically appears around one to three weeks after birth (Hahn-Holbrook et al., 2018). Though the exact cause is not known, the onset might be related to hormonal changes that occur after birth, feelings of doubt about becoming a new parent, lack of support from family, and fatigue (Hahn-Holbrook et al., 2018). Fathers can suffer from postpartum depression as well. Some of the father’s risk factors are whether they or their partner have depression or anxiety, stress due to low socioeconomic status, an unhealthy partnership, lack of social support, and issues with substance use (Wang et al., 2021).

Research has estimated the prevalence of postpartum depression to be almost 18 percent of births globally (Hahn-Holbrook et al., 2018). It occurs most frequently in countries with higher levels of wealth inequity, decreased access to postnatal care, and new mothers working full time, which can increase stress on them (Hahn-Holbrook et al., 2018). In addition, a higher risk of postpartum depression exists for new parents living in disadvantaged neighborhoods, new parents of lower socioeconomic status, and Black mothers (Floyd James et al., 2023; Onyewuenyi et al., 2023). Early intervention and prevention efforts also tend to be less available for individuals facing neighborhood disadvantage or racial disparities (Liu et al., 2022; Onyewuenyi et al., 2023). Beyond postpartum depression, new caregivers may struggle with a range of emotions and/or mental health concerns (including anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder) following the addition of a newborn (Meltzer-Brody et al., 2018). In any case, talking to a health-care provider or mental health expert can be a wise decision to support a healthy new family for all. It is also recommended that health-care providers specifically screen for symptoms of postpartum depression and other health needs both before discharge from the hospital and at postpartum medical visits.