Week 4

Days 22 to 28 · 3 weeks 0 days to 3 weeks 6 days old · about 3 weeks This week a typical baby measures about 53 cm (21 in) and weighs about 4.1 kg (9 lb). Babies vary widely, and what matters is that your baby keeps to their own curve on the growth chart. Your baby is more alert and more aware, and for many families that also means more crying, especially in the evenings. For you, the early weeks of recovery are behind you, but sleep loss is adding up and feelings can run high. This week looks at why crying increases and how to soothe, blocked ducts and mastitis, the plan every carer needs for the moments when crying becomes too much, postpartum depression and anxiety, and how partners can share feeds and nights.

Day 22 · 3 weeks 0 days old

Crying often increases from now

If your calm, sleepy newborn has started crying more, you are seeing something almost every baby does. Crying usually rises from about 2 weeks of age, peaks at around 6 to 8 weeks, and then eases off by about 3 to 4 months. At the peak, many healthy babies cry for two to three hours a day in total, and some cry more.

Much of this crying clusters in the late afternoon and evening. Some of it has a clear cause: hunger, a wet diaper, tiredness, too much noise, feeling too hot or cold, or wanting to be held. Some of it has no cause you can find. That is not a sign that you are doing anything wrong. It is a stage of development, and it passes.

It helps to know the pattern in advance. Expecting the evening fussy period can make it less frightening, and lets you plan help for those hours. Call your baby's doctor if the crying sounds different from usual (very high-pitched, weak or moaning), your baby has a fever, is feeding poorly, vomiting, has fewer wet diapers, seems floppy or unusually sleepy, or if you feel something is wrong. Trust that feeling. In a baby under 3 months, a temperature of 38.0 °C (100.4 °F) or higher needs a doctor right away. Try this: Jot down when your baby cries most over the next three days. Knowing your baby's fussy hours makes it easier to line up help.

Day 23 · 3 weeks 1 day old

A sore lump in the breast needs care, not force

If you are breastfeeding, you may notice a tender, firm area in one breast, sometimes with redness over it. This is often called a blocked or plugged duct. It is now understood to be mostly swelling and inflammation narrowing the milk ducts, rather than a plug that must be pushed out. Keep feeding your baby as usual, including from the sore side, but do not pump extra or feed more often to "empty" the breast, as that can make the swelling worse. Avoid deep, hard massage. Instead, use very light strokes over the skin toward the armpit, cold packs between feeds, and a bra that is not tight. An anti-inflammatory pain reliever that is compatible with breastfeeding can help: ask your pharmacist.

If the inflammation goes on, it can become mastitis. The breast becomes red, hot, swollen and painful, and you may feel achy, shivery and feverish, like flu. Sometimes there is a bacterial infection that needs antibiotics. Most antibiotics used for mastitis are safe while breastfeeding, and your milk remains safe for your baby.

Call your care provider if you have a fever or flu-like symptoms, the redness is spreading, you are not starting to feel better within about 24 hours, or you have a hard, very painful lump that does not shrink, which can be an abscess.

Try this: Keep a couple of cold packs or bags of frozen peas wrapped in cloth in the freezer, ready for the next time a breast feels sore.

Day 24 · 3 weeks 2 days old

Soothing is a toolbox, not a trick

Start with the basics: is your baby hungry, wet, tired, too warm or too cool? If those are covered and the crying goes on, try calming tools that mimic the snug, noisy, moving world of the womb. What works on Tuesday may not work on Wednesday.

Hold your baby close, skin to skin or on your shoulder. Babies are often calmed by being held on their side or tummy in your arms, but always put them on their back to sleep. Try steady rhythmic movement: walking, gentle swaying, a slow bounce on an exercise ball. A low "shhh", or white noise from a fan or app, kept at a moderate volume and away from your baby's ear, can help. Sucking calms many babies, at the breast or on a clean finger or pacifier.

Swaddling soothes some babies. Use a thin blanket, keep it snug around the chest but loose at the hips so the legs can bend up and out, and never let a swaddled baby sleep on their side or tummy. Stop swaddling once your baby shows signs of starting to roll.

A change of scene often helps: a warm bath, a walk outside in the carrier or stroller, a different room. Try one thing at a time for a few minutes before switching.

Try this: Next time your baby fusses, try holding them close, swaying and shushing for five full minutes before moving on to anything else.

Day 25 · 3 weeks 3 days old

Postpartum depression is common and treatable

The baby blues fade by about two weeks. When low mood, worry or numbness lasts longer than that, or starts later, it may be postpartum depression. It affects roughly 1 in 7 people who give birth, and can begin in pregnancy or at any time in the first year. It is an illness, not a weakness, and not a sign you love your baby any less.

Signs include feeling sad, empty or hopeless most of the day; losing interest in things; feeling irritable or angry; trouble sleeping even when your baby sleeps, or sleeping all the time; feeling worthless or guilty; struggling to bond with your baby; and trouble concentrating. Some people feel flat rather than sad.

It is more likely after past depression or anxiety, a difficult birth, a baby in intensive care, feeding problems, stress or little support, but it can happen to anyone.

Treatment works. Options include talking therapy, peer support groups and medication. Many antidepressants are compatible with breastfeeding. Tell your doctor, midwife, or public health nurse or health visitor how you really feel.

Get help right away if you have thoughts of harming yourself or your baby, feel your family would be better off without you, or cannot care for yourself or your baby. Call your local emergency number or a crisis line. Try this: If you have felt low for more than two weeks, tell one person today, and book an appointment with your doctor or midwife.

Day 26 · 3 weeks 4 days old

If you have had enough, put your baby down

Every parent reaches a moment when the crying feels unbearable. You are exhausted, nothing works, and you feel frustration or even anger rising. Those feelings are normal. What matters is what you do with them, and having a plan before you need one.

The plan is simple. Put your baby down on their back in their crib or bassinet, which is a safe place. Leave the room and close the door. Take some slow breaths, drink a glass of water, step outside for a moment, or call someone. A baby crying in a safe crib for ten or fifteen minutes will come to no harm. Go back and check on them once you feel calmer.

Never shake a baby, not even for a second. A baby's head is heavy and the neck muscles are weak, so shaking makes the brain move violently inside the skull. It can cause bleeding in the brain, blindness, seizures, lifelong disability or death. Throwing, jerking or tossing a baby in frustration is just as dangerous. Most shaking injuries happen during bouts of inconsolable crying, often by a carer who did not mean to hurt the baby.

Get help right away if a baby has been shaken, even briefly, or becomes floppy, very sleepy, vomits or stops breathing normally. Call your local emergency number.

Try this: Talk through the "put the baby down and walk away" plan with your partner or support person today, and share it with every person who looks after your baby.

Day 27 · 3 weeks 5 days old

Anxiety and frightening thoughts deserve attention too

Postpartum anxiety is at least as common as postpartum depression, and the two often come together. It can look like constant worry you cannot switch off, a racing heart, tight chest, nausea, being unable to sleep even when you have the chance, checking your baby's breathing again and again, or panic attacks that come out of nowhere.

Many new parents also have intrusive thoughts: sudden, unwanted images of the baby being hurt. These thoughts are very common. They horrify you because you do not want them to happen, and having them does not mean you will act on them. When they become frequent and lead to avoiding your baby or to rituals of checking and cleaning, it may be perinatal obsessive-compulsive disorder, which responds well to treatment. A traumatic birth can also leave flashbacks that need care.

Talking therapy, especially cognitive behavioural therapy, works well for anxiety, and medication can help too. Tell your care provider what is happening,.

Postpartum psychosis is rare, about 1 to 2 in 1,000 births, and usually starts in the first weeks. It is a medical emergency.

Get help right away if you or your partner notice confusion, seeing or hearing things others do not, strange or suspicious beliefs, feeling unusually high or driven, or not sleeping for days. Call your local emergency number. Try this: Name one worry out loud to someone you trust today. Saying it often shrinks it, and if it does not, that is useful to know.

Day 28 · 3 weeks 6 days old

Feeding and nights can be shared

Partners and support people can form just as deep a bond with a baby, and much of it comes from ordinary care. Bathing, burping, changing diapers, carrying your baby in a carrier, and time skin to skin on your bare chest all build that connection.

If your baby has formula or expressed milk, you can share feeds. Hold your baby close and fairly upright, look into their eyes and let them set the pace. If your baby is breastfed, you can bring them to the feeding parent, settle them afterwards and do the diaper change. Many families wait until breastfeeding is going well before adding regular bottles, and a later entry, at around 6 to 9 weeks, looks at introducing one.

The nights are where sharing matters most. Some families take shifts, so each adult gets one stretch of four to five hours of unbroken sleep. The person off duty sleeps in another room with earplugs. Others split the night at a set time. Whatever you choose, agree on it in daylight, not at 3 a.m. One safety rule for tired carers: if you might fall asleep, do not feed or hold your baby on a sofa or armchair. Put your baby in their own sleep space first. For your partner: Offer to take one full night shift this week, from settling to the next feed, so the birth parent can sleep without listening for the baby.