Questions?
Many parents prepare for labor and delivery by reading books, listening to podcasts, or taking birth classes. But as a newborn nurse, I’ve found that far fewer parents know what to expect in the hospital once their baby is born, especially on Day 2.
Day 2 is when things start to change. Having a general idea of what’s normal for a newborn on Day 2 can help parents know when to speak up if something seems off.
Some warning signs on Day 2 may point to serious medical problems, including birth injuries. While not all complications are preventable, some are caused by mistakes by health care providers during labor and delivery. Here are a few things to look for.
1. Newborn Sleepiness
Newborns are often wide awake after the excitement of delivery, showing signs of hunger like rooting (moving their head side to side looking for food), crying, or smacking their lips. Some may not appear full after a feed for the first two hours.
After that initial period, it’s common for babies to become very sleepy and hard to wake for feeds until they’re about 24 hours old. That’s when I often hear things like, “My baby doesn’t want to feed,” or “She fed for only three minutes but seems full.”
In reality, newborns rarely wake on their own on Day 1 — and if left undisturbed, they’ll sleep through feedings, which can lead to low blood sugar and deeper drowsiness.
In rare cases, excessive newborn sleepiness could be a warning sign of a more serious medical issue like hypoxic-ischemic encephalopathy (HIE) or another condition caused by a lack of oxygen during delivery.
Sleepiness is usually normal, but if your baby is too tired to feed or hard to rouse — especially on Day 2 — don’t wait to ask your nurse for help.
Similarly, if your baby seems jittery or shakes frequently, especially when sleeping, alert the nurse. It could be a normal reflex or a sign of low blood sugar, seizures, or another serious issue.
2. Newborn Feedings
Not only are newborns often very sleepy during their first day of life, which can make feedings more difficult, but many also lack the coordination needed to feed properly right away. While some babies are born with a strong, rhythmic suck, others may need time and support to figure out how to feed effectively.
Feeding challenges are usually developmental, but in some cases, they may signal something more serious, like infant brain damage leading to cerebral palsy (CP). CP can interfere with a baby’s ability to latch, suck, or swallow properly.
Since conditions like CP may not be immediately apparent, parents should monitor for feeding problems from Day 1 and beyond, especially if the baby seems weak, not interested in feeding, or physically struggles to latch. Early feedings are a key window into their health.
Tell your medical team about any concerns. Failure to recognize poor feeding cues or lack of timely intervention can lead to preventable complications. In some cases, these oversights may even be grounds for a medical malpractice claim if a newborn is harmed due to improper care.
3. Baby’s Appearance
One of the most surprising things to expect with a newborn is how different they may look from what you imagined. Their appearance can change a lot in those first few days, and while many features are normal, others may be warning signs.
A few things to keep an eye out for include:
- Brachial plexus injuries may cause one arm to appear limp or weak, especially after a difficult birth.
- Bruising on the face or scalp can appear after a tough delivery, especially if forceps or a vacuum extractor were used. Deeper bruises may be tied to serious trauma or underlying injuries.
- Caput succedaneum is soft swelling on the scalp caused by pressure during delivery. It’s often harmless but should be closely watched, especially if it worsens or doesn’t improve.
- Long or cone-shaped head can be normal after a vaginal birth. But if it’s paired with other symptoms, like poor feeding or seizures, it may be worth a closer look.
- Pale or bluish coloring around the lips or torso may point to oxygen issues or brain bleeds, like intraventricular hemorrhage. This requires immediate medical attention.
I’ll never forget walking into a hospital room to check on a newborn. A family member was attempting to feed the baby. But when I looked at the infant, I saw that his face was subtly blue and had stopped breathing. I acted fast and provided respiratory interventions to stabilize the baby and get him breathing again.
While that baby recovered, not all infants are as fortunate. Oxygen deprivation in a newborn, even for a short period, can lead to severe and permanent birth injuries.
Understanding what to expect with your newborn can help you know when to speak up if you’re concerned. Always talk to your nurses about your infant’s appearance if something appears abnormal.
4. Breathing Problems
Newborns breathe faster and more irregularly than adults, but certain signs may point to a serious problem.
Watch for these possible signs of abnormal breathing:
- Breathing faster than 60 times per minute
- Chest pulling in under the ribs or around the neck (retractions)
- Flaring nostrils
- Grunting with each breath
- Noisy breathing that happens with every breath
A comment that I have heard from parents is that their baby “sings” and “makes cute noises” when they breathe. If I don’t observe it at the moment, I will ask them to record a video the next time it happens and educate them that sometimes babies can make noise, but if it is in tune with every breath, it can be abnormal.
If you notice any signs of abnormal breathing in your newborn, tell your nurse or doctor right away. Breathing problems can sometimes signal serious complications, including infant brain damage.
5. Abnormal Stool
A newborn’s first few stools are called meconium. They are thick, sticky, and black. After a few days of feeding, the stool should change to a yellow-brown color with a loose, seedy texture.
Stool changes that may be a cause for concern include:
- Black stool after the first few days (could signal bleeding)
- Bright red stool (may mean active bleeding)
- Chalky white or pale stool (can point to liver or gallbladder issues)
- Dry, pellet-like stool (can be a sign of constipation or dehydration)
If these signs are missed and a baby becomes seriously ill, it may be a sign of medical negligence resulting from a failure to monitor or respond in a timely manner.
Always alert your care team if something feels off. Early action can help prevent serious complications.
Final Thoughts: Knowing What’s Normal and What’s Not on Day 2
As a newborn nurse, I believe that parents should be empowered with information. The first days of your baby’s life are full of new experiences, but knowing what’s normal and what’s not can help you feel more confident as you care for your newborn.
While many of the things I’ve described are perfectly normal, some signs may point to more serious concerns that require immediate medical attention.
Hospitals have a responsibility to monitor your baby closely after birth, especially if there are known risk factors. But as a parent, you’re also your baby’s first advocate. If something doesn’t seem right, speak up and ask for help. Your instincts matter.
If you’re wondering whether your baby’s condition could have been prevented with better medical care, the Birth Injury Justice Center can help. A registered nurse like me can listen to your story and help you figure out what happened.
If medical negligence may have occurred, you could be eligible for financial compensation to help cover your child’s care costs.
Call the Birth Injury Justice Center at (800) 914-1562 or get a free case review to learn more about your options.
