Tips for Managing Common Concerns in the Fourth Trimester

For nine months, babies are nestled securely in the womb. They are comforted by their mother’s heartbeat and gently rocked by the sway of her walk. Then they are born into a world of bright lights, strange noises, and new experiences. It is a time of great change for parents and child, especially during the first 12 weeks after the birth of the baby. Many people now refer to this time as the “fourth trimester.”

As a pediatrician and mother of two children, Stanford Medicine Children’s Health pediatrician Jennifer Kaufman, MD, has a particular interest in newborns and the issues that parents face.

Here, Dr. Kaufman shares tips to calm some of the common fears of new parents and in a recent Stanford Medicine Children’s Health podcast.

What new parent has not gazed at his or her sleeping baby and watched the baby breathe? Babies are often noisy or fast breathers, so it is helpful to know what is normal and when to worry. It is a common worry and one of the first questions Dr. Kaufman gets from parents.

She explained that babies naturally breathe twice as fast as adults. They may have spurts where they breathe really fast for a short time and then take a break. So, if it seems like your little one is panting, it’s not automatically cause for concern. Most likely it is a normal pattern called periodic breathing.

Nighttime brings about other worries when it comes to baby’s breathing. Babies may make noises that can be very distressing. They may sound very stuffy or congested without having any visible blockage. This often happens because babies have very small noses, and they get congested very easily. While an adult would simply start breathing through the mouth, babies will not do that unless it is an extreme situation.

“The stuffier they get, the noisier they get. Most babies spit up. When they spit up a little bit, it tends to clog the back of the nose a little bit, and that causes some congestion,” Dr. Kaufman said. “It sounds very, very noisy when babies are breathing, and you’ll frequently hear these kinds of snorting noises or very congested noises. But this is not something to be concerned about. Honestly, almost all babies do this, and they do it a lot more at nighttime than they do it during the day, but it’s not dangerous.”

Another common concern is gas and reflux. Babies have weak abdominal muscles because they did not need to use them while they were in the womb. That, combined with all the air they swallow during feedings or crying, can contribute to a gas buildup.

“All this air is getting collected into their bellies, and yet those muscles inside are extremely weak and extremely poorly coordinated at moving that air through,” Dr. Kaufman explained. “For that reason, almost all babies are gassy. This is one of those things that can lead to crying. … The more they cry, the gassier they get, and it becomes a little bit of a vicious cycle.”

There are some over-the-counter medications to help with gas. However, Dr. Kaufman recommends a tummy massage or moving the legs in a bicycle motion to make babies feel better. All babies will have gas and spit up at some point. But there is a difference between those and true reflux.

“If we have a baby that is spitting up and crying during the spitting-up process, or if we have a baby that’s eating and they seem really, really hungry… They really want to eat, but every couple seconds they stop and they cry like it’s actually hurting them to swallow,” she described. “Those are the times where we’re really starting to think about acid reflux and that you definitely want to speak to your pediatrician about.”

According to Dr. Kaufman, there will often be times when a new parent feels overwhelmed or scared about the health of his or her child. This is all perfectly normal, and she stressed the importance of relaxing and enjoying the moment.

“One of the most important things about being a new parent is recognizing that you can do this, and that the best thing for you to do really is to remain calm. It’s so important. Calm and happy and empowered parents make the best parents,” advised Dr. Kaufman.