Hello mamas and welcome to Week 4 with your baby. My own baby Bracey is still in the NICU but inching closer to his arrival home (fingers crossed). Let’s first look at a full-term baby at 4 weeks; then at you, mama; and finally, I’ll talk about premature babies and give you an update on Bracey.

4-Week-Old Baby: Growth & Development 

During the first month, most infants will gain approximately 5 to 7 ounces (150 to 210 grams) per week from their birth weight (some gain an ounce (30 grams) a day!) and grow about an inch to an inch in a half (2.51-3.84 centimeters). Many newborns go through periods of rapid growth at around 7-10 days and again at 3 weeks. These periods can be accompanied by cluster feeding episodes, during which babies want to eat very frequently. That said, your pediatrician will be looking at your baby’s individual growth curve, measuring your baby for height and weight against similarly aged babies. In fact, the Center for Disease Control (CDC) recommends that health care practitioners follow the recommendations of the WHO (World Health Organization) regarding infant growth from 0 to 24 months, which is based on infants who are breastfed in six countries including the US. At two years old, the CDC recommends that health care professionals follow the CDC recommendations.

1 Month Baby Checkup 

At 4 weeks, most babies will have a checkup appointment with their pediatrician. Your pediatrician will be asking you a lot of questions about how often your baby is pooping and peeing, and how he’s sleeping. I kept a log of all this with my first baby but by the time I got to four weeks, my doctor said I didn’t need to worry about keeping this new baby journal anymore. I still have the log, though! In addition to height and weight, your pediatrician will be checking for alertness, reflexes, your baby’s hips —to make sure your baby does not suffer from a congenital condition called dysplasia, eyes for cataracts, and the soft spots on your baby’s head. There are actually two soft spots: one at the top of the head (called the fontanelle, which remains until just past a child’s first birthday) and the other in the back (which closes within a few months of birth).

CDC Vaccine Calendar

The CDC recommends that your baby receive the first dose of the Hepatitis B (Hep B) Vaccine at one month of age, so this will take place at your baby’s 1-month-old doctor’s visit. For a full schedule of the Hep B vaccine and other vaccines, check with your individual pediatrician.

4-Week-Old Baby: Newborn Vision and Hearing Development

At 4 weeks, your baby’s hearing has fully developed, so you might see them responding to noises or the sound of your voice. Their vision has improved and they can see about 18 inches from their face. Although their vision will still be blurry, they might recognize and respond to the sight of YOU, and they might start following objects with their eyes. Make funny faces and smile a lot at your baby! Your baby might start making cooing noises at around this stage.

4-Week-Old Baby: Grasping, Rooting and Sucking Reflexes 

Four-week-old babies are preoccupied with watching their own hands squeeze up into a fist and expand and love placing their hands in their mouths. The rooting reflex — whereby your baby opens their mouth wide and turns their head from side to side looking for food — often is accompanied by a sucking reflex. You’ll see your baby chewing on their own fist, which is a sign of hunger. Wash your hands and put your pinky into your baby’s mouth and you’ll realize how strong this sucking reflex is. Your baby will grasp onto your fingers very tight and not want to let go. Rooting, sucking on fingers or the whole hand, and crying are common signs of hunger and your cue to feed your baby.

Newborn Head Control 

By the end of week 4, most babies are able to hold up their heads up for a few seconds at a time and also to raise their heads while on their stomachs. To encourage your baby’s neck and back muscles to grow stronger, remember to practice tummy time a few times a day (which I review in Week 3). Remember to never leave your baby unsupervised on their stomach.

Newborn Brain Development Activities 

While your baby is becoming more responsive and reacting when you make noises or speak, you should be starting your ongoing dialogue with your baby. Studies show that infants’ brain development is directly related to how many words they hear beginning very early in life. Studies also show that the first five years of a child’s life are the most crucial in terms of their intellectual development. Narrate what you are doing to your child, employing as many words and as rich a vocabulary as you can. Buy some small baby books and start reading for 10 minutes a few times a day. Also, play classical music and sing to your baby. I just made Bracey his first playlist.

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4-Week-Old Baby: Signs of Colic 

When a healthy baby cries or fusses for more than three hours a day, three times a week, they might have colic. Colic generally starts to rear its ugly head at around 4 weeks of age and can be frustrating and exhausting for parents. Many experts think it has to do with indigestion or gas and encourage formula feeding parents to sample other formulas and breastfeeding mothers to look at their diet and perhaps cut out milk or nuts. Other experts think that colic can stem from overstimulation. To handle colic, you can try any of the following: burping, rocking (in a swing), vibration (in a bouncer seat), swaddling, singing, placing baby next to a washing machine or the dryer, shushing baby or singing (if you have a better singer voice than I do, mine would make any baby cry harder!). You have to sample these various tricks and see if any of them work. Consult with your doctor and make sure to hand your baby off into someone else’s loving arms and head out for a break once in a while. In most cases, colic subsides by 3 to 4 months of age.

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4 Weeks Postpartum

Postpartum Symptoms for Mom

At Week 4, you might still be finding yourself tearing up or having what is called “the baby blues.” I had a tearful episode yesterday. At around week 4, you can hit a wall. You’ve been surviving on adrenaline: getting up at night, running yourself ragged during the day. All of a sudden, everything hits you. The visits have curtailed. There are no more flowers or gifts. Your partner likely has gone back to work. Real life sort of sets in and there you are at home holding a screaming newborn who doesn’t even allow you the time to go to the bathroom. It’s tough. I’ve been there. Once you have a good cry (you might have one every day) you have to strategize. Here are some of the things I have done that help. One, I take a lot of showers. First thing in the morning and then anytime I am feeling exhausted and gross. Hot shower, some nice body lotion, change the yoga clothes, and I feel a lot better. Two, plenty of water and tons of hot herbal teas with honey. Three, healthy food and great snacks. Four, try to call a close friend every day even for a short time, and just vent. Five, get outside with the baby and walk. Six, treat yourself to one lovely dessert or Starbucks every day. Six, 15 minutes of yoga or stretching. Seven, tell yourself that this to shall pass. Following a newborn feeding and sleeping schedule as a general guide really helped me to feel some semblance of control over my life.

Other postpartum symptoms such as vaginal bleeding, swollen ankles and legs, and constipation have hopefully subsided by this point. I get into more detail on those in Week 1 and Week 2. If you are still experiencing those symptoms, talk to your OBGYN.

4-Week-Old Baby: Sleeping and Breastfeeding Schedule 

Most 1-month-old babies are still eating every three hours during the day and night. However, if your baby is growing well, your pediatrician might tell you at your 4-week appointment that you can stop waking your baby up at night and allow them to wake up on their own. So your schedule might look something like this:

• 7am — sleep 8:30-10am.* 
• 10am — sleep 11:30-1pm. 
• 1pm — sleep 2:30-4pm.
• 4pm — sleep 5:30-7pm. 
• 7pm — sleep 8:30-10pm.
• 10pm — sleep 11:30pm-1am.* 
• 1am — sleep 2:30-4am * (ask your doctor if you can allow your baby to wake up on their own, in which event this feeding might take place at 2am).
• 4am  — sleep 5:30-7am** (ask your doctor if you can allow your baby to wake up on their own, in which case this feeding will be at 6am, and your day will begin a bit earlier).

*Mom tries to sleep too!

If your day begins a bit earlier or later, adjust the feeding time accordingly.

Length of Breastfeeding Sessions

At Week 4, your baby’s feeding times may be shortening and this can mean more time between feedings and more free time for mom. Your baby is growing stronger and is more alert and less sleepy, so you will need to spend less time keeping them awake to feed, and also you will find them eating more efficiently. Mine ate so much more quickly over time that I found myself asking “is my baby getting enough breastmilk.” If your baby’s growth is on target, you are getting enough wet and poopy diapers, and at the end of a feed your baby is awake, has burped, and is rejecting more foods (thereby appearing satisfied), there’s no reason to worry.

Newborn Breastfeeding Challenges

For help getting a good latch, and with blisters, fissures, clogged ducts, mastitis or milk blebs or pimples, check out my Week 1, Week 2, and Week 3 videos. After every time you nurse or pump, coat your areola in breast milk and allow your areola and nipple to air dry.

Breast Pumping after each Feed with a Newborn

I go into more detail on this in Weeks 1, Weeks 2, and Weeks 3, but consider pumping after each breastfeeding session for 5-10 minutes. In addition to stimulating breastmilk production, pumping evens out what each breast is producing and allows you to store up milk. Getting organized with the pump and accessories ready to go (including a strapless pumping bra) as you burp your baby makes this a quick and easy thing to do.

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4-Week-Old Baby: Bottle and Formula Feeding Tips

How much Formula for a 1-Month-Old Baby?

Babies under 6 months should be taking 2 to 2 1/2 ounces of formula per pound of body weight over a 24 hour period. So if your baby weighs 10 pounds, that would equate to 20 to 25 ounces of formula a day or approximately 3-4 ounces of formula per feeding. 

4-Week-Old Baby: Bottle Feeding and Sleeping Schedule 

For formula feeding babies, at this stage, I recommend feeding no less frequently than every four hours from the beginning of a feeding following a schedule that looks something like this:

• 7am — 9am nap
• 11am — 1pm nap
• 3pm — 5pm nap 
• 7pm — 8pm bedtime
• 11pm — right back to sleep 
• 3am — right back to sleep 

You want to clean and sterilize your bottles. Follow these guidelines or invest in a bottle sterilizer and warmer.

Best Baby Bottles for Newborns

The bottle market is constantly evolving and there are a wide variety of bottles and nipples available. Try a few different brands to see which one your baby prefers and if you notice your baby being gassy, slow the flow rate of the nipple. If you’re pumping and giving pumped breast milk, you might find it easier to attach a nipple to the bottles you pump into. Make sure the plastic you use is safe and double-check whether your bottles and parts can be washed in the dishwasher.

How to Care for your 4-Week-Old Baby

Cradle Cap Treatments 

Week 4 is a good time to discuss cradle cap. A couple of my babies had intense cases of cradle cap. While I was nursing them, I would look down and see these dry, peeling scales all over their scalp. After a bath, I would rub these gently with a towel. Considered by doctors to arise due to an excess of oil glands in a baby’s skin that is linked to the mother’s hormones, cradle cap is a normal part of development and like the umbilical cord, and you don’t need to treat it with any particular creams, lotions or ointments. Just let nature take its course and at some point, the cradle cap will have disappeared. If the cradle cap is bothering you and you want to treat it, you can massage your baby’s scalp with baby shampoo and use a soft comb to dislodge the cradle cap before rinsing off the shampoo. You can also rub coconut oil on the scalp and leave it on for 20 minutes before rinsing it off. Or, you can massage breast milk into the scalp, which some mothers swear by. If your baby’s cradle cap lasts beyond the first few months, consult with your pediatrician.

Breastfeeding a Premie

Premature babies are born at different stages, so you can’t generalize regarding their development, but let me say a few words regarding a 34-week-old baby in terms of gestation, which is the age Bracey turned today. At 34 weeks, a baby starts to develop the ability to latch on and suck while breathing. This, however, is very touch and go because babies tend to suck and then get tired. My mantra (having experienced this again and again over the past few days) is: “If at first you don’t succeed, try try again.” And to quote Winston Churchill: “Never give in, never, never, never give in.” What has worked for me is to try and get Bracey to latch on with a wide mouth and then just to leave him there. He hangs out and at some point, he starts sucking. He doesn’t start sucking right away the way a full-term baby would. You have to give him time and be patient. He has only sucked for a total of 5-10 minutes as of now.

Breast Pumping Tips for a Premies

Breastmilk is especially important for premature babies since it fortifies their immune systems, protects them from infections (especially in their gut), and provides hormones, nutrients, and growth factors. Breastmilk also is easier for premie babies to digest than formula. So if you’ve had a premie, you’ll want to try to pump at least eight times a day and at least once during the night. As I explained in Week 1, I grew concerned about my milk supply early on with Bracey. Although the NICU nurses recommended pumping for 15 minutes every three hours, that wasn’t working for me. I began pumping for an hour every three hours on a low setting, and that worked well. However, I did develop mastitis three times, and am just finishing a week-long dosage of antibiotics. Having gone through this, I recommend the following for pumping mamas: massage your breasts for at least 5 minutes each before pumping, do not go longer than 4 hours without pumping, and try to push gently into the edges and sides of your breasts while pumping to stimulate the outer glands.

What Size Breast Shield should I Buy for the Breastpump?

I would also pay careful attention to the size of the breast shield. Only your nipple (not the areola) should be pulled into the breast shield. If your areola is being pulled into the shield, switch to a smaller size. I did this and things are working much better.

How much should I Pump during the Night?

I also cut down the nightly pumping to 30 minutes. So I now pump for an hour in the morning and during the day, especially during the late afternoon and evening when I have less milk supply, but during the night I only pump for 30 minutes.  This is a highly personal decision and one you need to make sure works for you. If you’re pumping for a premie, consider renting the Medela Symphony pump for home use, investing in your own Medela accessories, and buying the Medela Easy Expression Hands-Free Pumping Bra, which frees you up to hold your premie at the same time.

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Bracey Update

The doctors lowered Bracey’s food intake during Week 4 (which is something that is routinely done) because he had been growing rapidly and when this happens, doctors want to ensure that premie babies do not overwhelm their lungs. So Bracey’s milk quantity was lowered to 32 ml a feed and for two days, his weight did not increase. Yesterday, the doctors increased Bracey’s milk quantity to 41 ml per feed and he gained 50 grams. On his one month birthday, Bracey weighed 2.060 kilos which is approximately 4.5 pounds. He’s more alert and spends time looking for the light in the NICU. He continues to hiccup for much of the day. He enjoys kicking back and putting his feet up since all of the beeping sounds and a rigorous feeding schedule can wear you out.

We can’t wait to bring our little cool guy home.

Thanks for reading and watching and see you next week for Week 5!

Resources

Verywellfamily.org

Parents.com

Mamanatural.com