New Baby

General

Enclosed are general guidelines only. All babies are individuals with varying needs. It is expected that all new parents have questions and concerns about their baby’s health, growth, and development – no matter if this is your first baby or your sixth. Friends and relatives all mean well and frequently want to help you, but do not depend on them for answers. Childcare practices change over time, and they may not have the right answers. I am happy to answer all your questions during office visits and on the phone.

Hospital Care

After delivery, I will be happy to see you and your baby. After a complete physical examination, we will talk about common newborn issues, such as feeding, bathing, etc.

Before discharge, blood will be taken by a heelstick from your baby and sent to the State of Illinois for testing for several diseases that can be serious if not detected early, such as hyperthyroidism and certain enzyme deficiencies. The state will notify you and I if a concerning result is found on these tests. Also a hearing test will be done in the newborn nursery prior to discharge.

Circumcision

Circumcision is a personal decision. There is absolutely no medical indication for circumcision. Infants who have potential problems that may make lifelong penile hygiene difficult may benefit from circumcision. If you opt for circumcision, you may apply Vaseline with gauze to optimize healing. If the circumcised area develops redness, warmth, or pus, and infection may have developed, and your baby needs immediate medical attention.

If you decide not to circumcise your baby, then cleaning includes gentle, never forced, retraction of the foreskin. Complete retraction is often not possible in neonates.

Office Visits

Please call my office as soon as you get home from the hospital to make an appointment. Generally, I see newborns for the first time when they are 1-2 weeks old. Breastfed infants may be seen sooner than formula fed babies, so that we can review how things are going and to make sure your baby is gaining weight.

Following is the recommended schedule for office visits from birth through age 6 years. At each visit, I will physically examine your baby. In addition, we will administer immunizations and tests. Many vaccines are in development, so be aware that this list may change before we can update this booklet.

In addition to the scheduled immunizations, many school districts require lead testing before entrance to school. Many daycare settings require periodic TB and/or lead testing.

Key

• DTaP: Diptheria, Tetanus, Acellular Pertusis (whooping cough)
• Hep B: Hepatitis B vaccine
• Hep A: Hepatitis A vaccine
• HiB: Haemopholis influenzae vaccine
• IPV: injectable polio
• MMR-V: Measles, Mumps, Rubella (German Measles), Varicella (Chicken Pox)
• TB: Tuberculosis test
• Pb: Lead test
• Hg: Hemoglobin test
• PCV: Peneumococcal conjugate vaccine
• Rotavirus: Optional Rotavirus vaccine

For a complete list of immunizations and tests past 2 years of age, see this page.

Telephone Instructions

I encourage you to call with any questions of concerns. You may want to keep a running list of questions at home so you do not forget anything. Whenever possible, call during normal office hours with questions of routine care. If you have an emergency in the evening or on the weekend, call the office immediately. An answering service will take your message and relay it to me or an associate of mine if I am unavailable. Calls are generally returned within an hour. Many (if not most) emergencies can be handled over the phone. However, if you have an emergency and are having difficulty getting in touch with me in a timely manner, proceed to the Emergency Room at West Suburban Hospital. A physician there will evaluate your child and contact me.

Home Care

Signs of Illness

All babies and children will get sick from time to time with coughs, colds, and fevers. Most of these are not serious and resolve without treatment. However, the following signs and symptoms should be reported to me:

1. Fever of 101° F (38.3° C) or more by rectal or ear thermometer, or 100° F (37.7 °C) axillary measurement (under the arm). Infants under 6 months should always have temperatures measured rectally.
2. Vomiting (not just “spitting up”) or refusal of food several feedings in a row.
3. Excessive crying, especially if inconsolable.
4. Listlessness of inability to wake up.
5. Loose, watery bowel movements, especially if you see blood, mucous, or a bad smell.
6. Any unusual rash.
7. Refusing to walk.
8. No urine output for 6-8 hours when ill or less than 4 wet diapers per day.
9. Difficulty breathing, especially if you see chest retractions, flaring of the nostrils, of hear wheezing.

Visitors

It seems like everyone – from your parents to the newsboy – wants to see your new baby. I recommend limiting your baby’s visitors for the first few weeks, especially children. This includes taking babies out into crowds like shopping malls and parties. You may not know who has a cough, sore throat, or other infection.

Babies are Babies

All babies sneeze, yawn, belch, have hiccoughs, pass gas, cough, and cry. They may occasionally look cross-eyed. Sneezing is the only way a baby can clean his or her nose of mucous or milk curds. Hiccoughs are little spasms of the diaphragm muscle. You can often stop them by giving a few swallows of warm water. Coughing is your baby’s way of clearing the throat.

Crying

Crying is a baby’s way of saying, I’m hungry, or I’m thirsty. I want to turn over, I’m too hot, I’m too cold, I have a stomach ache, or I’m bored. You will gradually learn to know what your baby means. Even a well baby will probably cry for a little while each day and could cry for an hour or so occasionally without doing any harm.

Feeding Your Newborn

Breast milk is the best food for babies during the first year of life. Breast milk provides just the right balance and amount of nutrients that babies need for good growth and development. It contains substances that may help protect babies against certain illnesses and allergies. If you choose not to breastfeed or if you stop nursing before your baby’s first birthday, infant formula provides the best alternative to breast milk.

You should keep your baby on breast milk or formula until his first birthday. Cow’s milk in any form – whole, 2% or skim – should not be given until the child is a year old, and 2% or skim should not be given until the child is at least 2 years old. Cow’s milk doesn’t supply the balanced nutrition your baby needs, and it’s often hard on the baby’s sensitive digestive system.

Feeding Times

Babies differ in their feeding needs and preferences, but most breast-fed babies need to be fed every 2 to 3 hours and nurse 10 to 20 minutes from each breast. Formula fed babies usually feed every 3 to 4 hours and finish a bottle in 30 minutes or less. Bottle-fed infants drink about 2 to 4 ounces at first; by the time they are a few weeks old, their formula consumption has generally doubled.

Your new baby may cry as through asking to be fed as often as every 2 hours. Keep in mind, though, that babies don’t need to be fed every time they cry. When a baby cries for a short time on a regular basis, the baby may just need more milk at each feeding. Alternatively, the baby may be protesting wet diapers or uncomfortable temperatures. It is best not to get into the habit of offering frequent small feedings to please a fussy baby. So, before you offer a breast or bottle, be sure your baby is not crying for some reason unrelated to hunger.

Let your newborn set her own feeding schedule: don’t watch the clock. Your baby knows how much she or he needs to eat. Don’t wake up your baby for feeding unless it has been at least 5 hours since the last feeding.

How Much Is Enough

How can you tell whether your baby is getting enough breast milk or formula? The best gauge of good nourishment is growth. This is measured by weight and length. Each time your baby comes in for a check-up, I will weigh and measure him. It’s one reason your baby needs regular checkups in the first 2 years.

Signs of a Well-Fed Baby

• Looks and acts satisfied after feedings
• Wets 6 or more diapers daily (after 4-5 days of age)
• Has yellow stools or frequent dark stools

Most new babies weigh between 5.5 to 10 pounds, averaging around 7.5 pounds. During the first days of life, infants generally lose 4-10 ounces; breast-fed babies may lose a little more. This is no cause for concern: it is all a part of your baby’s adjustment to the outside world. In fact, most of the weight loss is water. By age 10 days, most babies gain back the weight they lost. Healthy, well-fed babies usually double their birth weight by 5 months and triple it by 1 year.

Breast-Feeding

The first few days of nursing will be a time of learning for you and your baby. Neither of you may accomplish a lot on your first few tries, but that is all right. Your first milk will be a clear, yellowish fluid, called collostrum. This milk is extra rich in nutrients. Although the amount will be small, it’s close to what your newborn’s stomach can hold. At first, your new baby will nurse often – 8 or more times in 24 hours.

We suggest the following method for breast-feeding. Before feeding the baby, rinse the breasts with plain water and dry thoroughly. Place 2 fingers on each side of the nipple and press slightly so that the nipple sticks out. You will then be able to guide the nipple into the baby's mouth and, at the same time, be able to keep the breast from pressing against the baby's nose to interfere with her/his breathing.

Sometimes you may need to encourage your baby to nurse. Do not push her/him toward the breast. Instead, gently stroke her/his cheek nearest the breast ... she/he will usually then turn his head to hunt for the nipple.

You baby not only sucks at the breast ... she/he also milks it by chewing on the base of the nipple. This is most easily done when the nipple is drawn far back into the infant's mouth. If the breast is too full or swollen, it may be hard for your baby to milk in this way. If there is any doubt about the amount of milk you baby is getting, weigh him before and after each feeding. Write the weights down for me to see.

The milk flow will be greater if both breasts are well nursed by a hungry infant. You can give a feeding at one breast or if your baby wants more, at both, but is important to completely empty one breast before nursing at the second. If you have used both breasts at a feeding, it is best to begin the next feeding at the breast where the last feeding was completed.

As long as you're holding your baby in the correct position and nursing is comfortable, there's no need to limit the time your baby nurses at each breast. If your baby does not take all the milk available in the breast, the excess milk should be expressed manually, until your baby's demands adjust to your supply of milk.

Eat a Balanced Diet

As a nursing mother, you'll need to eat a balanced diet that contains 500 to 600 calories more per day than the diet you needed before pregnancy. Your daily food intake should contain a lot of protein foods and at least one quart of milk; these foods provide you with enough calcium for both you and your baby. If you're unable to drink milk or eat high-calcium foods, ask your doctor to recommend a calcium supplement. Continue Prenatal Vitamins while breast feeding.

Foods in mother's diets rarely have a disturbing effect on their babies. It does happen, though, with certain foods such as tomatoes, onions, cabbage, chocolate, and spicy foods. If your baby has loose stools, colic, or excess gas for no reason that you can think of, review your diet for the previous 24 hours. Try eliminating foods on the above list and see if it helps.

Beware of Medications!

Medications taken by a mother can pass into her breast milk. This applies to both prescription and over-the-counter drugs. Examples are sedatives taken for sleep, tranquilizing agents, other mood-altering drugs, laxatives, and antibiotics. If you are breastfeeding, please check with me before taking any medication - even seemingly harmless nonprescription drugs. I can tell you whether a medication will reach you baby through your milk.

Formula Feeding

Seated comfortably and holding your baby with his head supported, tilt the bottle so that the neck of the bottle and the nipple are always filled with formula. This helps your baby get formula instead of sucking and swallowing air. If she/he doesn't waste energy sucking air, she/he's more likely to take enough formula. Air in her/his stomach may give him a false sense of being full and may also make her/him very uncomfortable.

You baby has a strong, natural desire to suck. For her/him, sucking is part of the pleasure of feeding time. Babies will keep sucking on nipples even after they have collapsed. So take the nipple out of the baby's mouth occasionally to keep the nipple from collapsing. This makes it easier for the baby to suck, and lets her/him rest a bit.

Never prop up the bottle and leave the baby to feed her/himself. The bottle can easily slip into the wrong position. Remember, too, baby needs the security and pleasure it gives her/him to be held at feeding time. It's a time for her/him and you to relax and enjoy each other.

Use the Proper Nipple Hole Size

The size of the nipple hole should be large enough to let milk drip through at a steady rate without forming a stream. If the milk doesn't form separate drops, throw the nipple away. If the hole is too small, enlarge it by pushing a sterilized needle or clean toothpick through the hole.

Wash and Sterilize

Cleanliness is important for small babies, especially when it comes to things that go in their mouths. So you'll need to be careful about keeping formula containers, bottles, nipples, and utensils free of germs. Everything must be washed thoroughly in hot soapy water and rinsed with plain hot water. You may also run the bottles, nipples, pacifiers and any mouthed toys through the dishwasher on the top rack. Utensils must be kept off unclean surfaces. You should wash you hands well with soap and water before beginning formula preparation.

You can prepare enough formula for one feeding or for a whole day. Store prepared formula in the refrigerator.

Warm and Test Formula

Just before feeding, remove a bottle from the refrigerator. Warm it in a pan of hot (not boiling) water for a few minutes. Or, use a bottle warmer. Do not touch the nipple.

Test the temperature of the formula by shaking a few drops onto the inside of you wrist. It should feel warm but not hot.

DO NOT USE THE MICROWAVE TO WARM A BOTTLE! This can cause serious burns.

After each feeding, rinse the bottle and nipple with cool water. If you rinse the milk away before it can form a film, washing will be easier later.

I usually recommend that the infant starts on formula with iron, or that iron be supplemented with infant vitamins with iron.

When you baby comes home from the hospital, she/he'll probably take 2 to 4 ounces of prepared formula at each feeding. When she/he's able to empty the bottle within 15 minutes, start adding another ounce.

Burping

Burping your baby helps remove air swallowed during feeding-. You can wait until the end of the feeding or burp at intervals during the feeding. You'll soon be able to tell if your baby needs frequent burping. Here are three good methods:

• Hold your baby so her/his head rests on your shoulder and her/bis chest is against yours. Pat her/his back or rub it upward with your band.
• Lay your baby face down on your lap. Rub or pat her/his back.
• Hold your baby in a sitting position on your lap, with her/his side toward you. Support her/his head and back with one hand, chin, and chest with the other. Then gently rock her/him back and forth as if helping her "take a bow."

Your baby may spit up small amounts of formula or breast milk too. No cause for alarm. It happens to all babies. You may be able to reduce the spitting up by burping your baby more often or longer during and after feedings.

Common Feeding Problems

Fussiness, crying, gas, diarrhea - babies occasionally develop one or more of these symptoms. If your baby has any of these, call the office. Be prepared to describe the symptoms your baby is experiencing, when they occur, and how long they last.

Food Allergy

A true allergy to a food is not very common in infants, and can be controlled by changing the formula or diet. The best way to help your baby avoid allergies is to breastfeed. Occasionally a formula-fed baby may develop symptoms that might indicate an allergy, such as colic, severe rash, eczema, or diarrhea that won't clear up. If there is a history of allergy in your family, these symptoms are even more likely to indicate an allergy.

If you're planning to wean your baby from breast milk, first consult the office. If allergies run in your family, I may recommend that you extend the period of allergy protection as long as possible by continuing to breastfeed, even if it is only part-time. If a formula is needed, I may recommend avoiding potential allergy-causing substances such as cow's milk protein. In fact, cow's milk protein is the leading cause of allergies in infants.

Solid Foods

Many parents are proud of the day their baby begins to take solid foods, including cereals. They view it as an accomplishment. As a result, many babies are started on solid foods before their digestive systems are really ready. From a nutritional standpoint, solid foods are not necessary during the first 4 to 6 months of life. Breast milk or full-year formula provides all the nutrients a baby needs. In fact, the earlier any food is introduced, the greater the chances are that the baby will have problems.

New foods should be introduced one at a time. When a new food is introduced, no other new foods should be given over the next week. Unless instructed by me, you should not change formulas at the same time that you are introducing solid foods. If the food causes diarrhea, constipation, or a rash, you should stop giving it. By introducing new foods slowly, you give your baby's system a chance to adjust, and it's easier to trace problems back to the source. If a food doesn't agree with your baby, try it again when the baby is older. Generally, baby cereals are started at age 4 months, baby vegetables and fruits are started at 4-5 months, and baby meats are started at 9 months.

Baby Care

Bathing

Until the navel (and circumcision) is healed, wash your baby by sponging. After healing you can use a tub or bathinette. Once your baby is ready for full-fledged baths, be sure the room is warm, with no drafts, and the water is about 85° F. When you stick your elbow in the water, it should feel warmer than your skin but not actually hot.

• Face: Wash with plain water and soft cloth and no soap.
• Eyes: To clean eyes, use cotton dipped in cool water
• Nose and Ears: Cleanse outer areas only with a moist, not wet, cotton-tipped applicator. Do not attempt to cleanse the inside of either nose or ears.
• Head: Baby's head should be lathered gently. Work from front to back to keep soap out of his eyes. Be careful of the soft spots, but give them a good soaping
• Body: Use any mild soap, be sure to wash in the creases, and rinse well. I recommend Dove or Tone. Ivory is NOT a mild soap.
• Skin Protection: You may use a little baby oil and baby lotion, baby oil, baby powder, or cornstarch (avoid excess in the creases).

Bowel Movements

Your baby may have a bowel movement after each feeding or may have one to two stools a day. Some babies may go 48 hours without a stool and be normal. The consistency and color varies from day to day. Usually, breast-fed infants have liquid, yellow, or mustard-colored stools. If you're breastfeeding your baby, don't take runny stools as a sign of diarrhea. The stools of formula-fed infants are yellowish-tan. All babies sometimes have green, brown or gray-colored stools. However, if the stool is green, runny, and frequent, it's usually a sign of diarrhea.

Your baby may strain when he has a stool, but unless the stool is hard and pellet-like, this is perfectly normal.

If your baby's stools are small and pebble-like, he may have constipation. Constipation has nothing to do with frequency of stools. Don't given her/him an enema, suppository or laxative until you've talked to me.

Care of the Diaper Area

Change your baby's diaper as soon as possible after each bowel movement or wetting. After each bowel movement ... and as often as possible after wetting ... wash diaper area clean with a warm, wet cloth. Generally, I recommend using a plain wet washcloth over packaged baby wipes, as they are expensive and may contain perfumes or other additions that may irritate the baby's skin.

Diaper Rash

Some babies are more prone to diaper rash than others, but almost all of them get it at some time. Babies who wear disposable diapers are more likely to get diaper rash than those who wear cloth diapers, which allow the skin to breathe. Plastic pants worsen diaper rash.

To treat your baby's diaper rash:

• Change her/his diapers often. Keeping the area clean and dry allows it to heal.
• Expose her/his bottom to air several times a day. Blow warm air from a hair dryer (low setting) on her/his bottom for 3 minutes
• Avoid plastic pants for a while. At night, use disposable diapers that pull moisture into the diaper and away from the skin.
• Wash your baby's bottom with warm tap water if diapers contained only urine. Use a mild soap if there was a stool. Rinse thoroughly and pat dry.
• If your baby's bottom is very raw, have her/him soak in a tub of lukewarm water for 15 minutes three times daily.
• Don't use special creams or ointments unless I prescribe them.
• If you use cloth diapers and launder them at home, use a regular detergent during the wash cycle. Then run a second wash cycle with warm. water and I cup of bleach added. (Vinegar does NOT kill germs). Follow with the normal rinse cycle.

If your baby’s diaper rash lasts more than 3 days, call my office. You should also call if the rash spreads beyond the diaper area or if any blisters, pimples, boils, pus, or yellow crusts form on the baby's buttocks.

Sleeping

Newborn babies sleep a lot, usually waking up every 2 to 4 hours for feedings. At about I to 2 months of age, they generally start sleeping though the night, although a few cooperative babies start sooner. You may have heard that starting solid food will make a baby sleep though the night; there's no evidence that this is true.

Between 5 and 7 months of age, your baby may disappoint you by starting to wake once again during the night. This isn't backsliding. It's a normal developmental phase. Let her stay in her bed, comfort her, pat her on the back, and change her if needed. The pattern of nighttime sleeping will soon return.

Position: Babies should be placed on their back or side for sleeping. A rolled up blanket placed behind a baby's back gives support to a baby sleeping on his side. Do NOT place your baby on his belly for sleeping.

Bedding: The baby's mattress should be firm and flat. No pillow should be used. Protect the mattress with a waterproof cover. Next comes a soft baby sheet and one or two cotton blankets. Do not wrap the baby in a blanket because this interferes with the baby’s freedom to kick.

Colic

Colic is a common problem in babies, especially those younger than 3 months. It has a variety of possible causes and a number of different symptoms. If your baby has bouts of prolonged crying and extreme fussiness, colic may be responsible. You should call me at the office.

Colic usually goes away by the fourth month. Nothing you've done has caused it, though you probably find it very frustrating. It is important for you and I to work together during this difficult time.

How to Help a Colicky Baby

• Soothe the baby with a motion - rocking, walking around the room, and so.
• Amuse the baby with a rattle, music, or some other distraction.
• Offer a pacifier or bottle.
• Darken the baby's room at naptime to make sleeping easier.
• Don't let the baby go hungry for long. If the baby has just eaten and has colicky symptoms, offer a pacifier.
• Stay in touch with me; avoid herbal teas and other home remedies suggested by well-meaning friends and family members.

Special Conditions in the Newborn Period

Umbilical Cord

Your baby's umbilical cord will fall off by itself in I to 4 weeks. If the navel oozes spots of blood or a clear fluid for a while after the cord drops off, don't worry. This is natural. But if the oozing persists more than 2 days, if the discharge smells particularly bad, if the skin around the cord gets red, or if your baby gets a fever, notify me. You may clean the navel, once the umbilical cord has fallen off, with a cotton swab and soap with water.

Genital and Breast Areas

Many newborn girls have a whitish or bloody discharge from the vagina. This is normal and no cause for worry. Just clean the area with a cotton ball soaked in water.

A thin discharge form the nipples is seen in some babies, both male and female. They may have enlarged or swollen breasts. No treatment is necessary, since the condition will go away by itself However, if you notice any redness of the swollen areas, notify me.

Scalp

It's normal for newborn babies to have white dandruff-like flakes on their scalps. The flakes are old skin being shed and not a dry scalp condition. So, don't use oils, lotions, or Vaseline. They "paste" these flakes on the scalp and make the condition worse. Thick yellowish scales are called cradle cap, a very common condition in infants. It, too is associated old, dead skin, and is only made worse by oils, lotions, and so on. Shampooing the hair with Sebulex or Selsun Blue Shampoo or Cetaphil Cleanser will help clear up cradle cap, but you only need to use it 2-3 times a week.

The soft spot on your baby's head (fontanelle) is an area where the skull bones haven't yet joined. The soft spot is covered by thick, tough tissue that protects the brain tissue underneath, so you needn't worry about hurting it. If you sometimes notice pulsating of the soft spot, this is normal. You may also see small lumps, bumps, and irregularities. These are normal too.

Eyes

Many babies look slightly cross-eyed at birth. Usually, this is caused by muscles that are temporarily out of balance. Also, the wide skin area that babies have across the nose can make the eyes look crossed when they're not. Crossed eyes are a concern if they persist beyond 4 months of age, at which time we should discuss the need for further investigation.

Skin

Some babies have little white dots on their noses. They're called milia and go away without treatment. One of the most common newborn rashes is newborn acne, which disappears in 6 to 8 weeks. It's helpful to wash the area with a mild soap once or twice daily. Don't apply oils, lotions, or creams; they only worsen the problem.

Carseats

Car accidents are the leading cause of death for children through age 14! When it comes to car safety, children are not just little adults, because, among many other reasons, their bones are softer and less protective. Your baby should always be placed in the appropriate-sized car seat when being driven, and never in an adult's lap! Besides, not properly restraining your baby is a good way to get a needless traffic ticket, because it's the law in all states. Always err on the side of using weight when deciding which car seat to use. Our recommendations are as follows:

Age and Weight Type of Car Seat

• 0- 12 months (or <20 lbs): Infant-Only Seat, rear-facing in the middle of the back seat (for maximum protection from both sides and the from the front), never in the front seat with a passenger-side air bag
• 1-5 years (or 20-40 lbs): Convertible Safety Seat, front-facing in the middle of the back seat
• 5-8 years (or 40-60 lbs): Belt-Positioning Booster with lap/shoulder belt OR Shield-Booster with lap belt
• 8 years and up (or > 60 lbs): Lap/shoulder Belt with shoulder belt across the chest, lap belt low and snugly across the thighs

Index

• General
• Hospital Care
• Circumcision
• Office Visits
• Telephone Instructions
• Home Care

1.  
   • Signs of Illness
   • Visitors
   • Babies are Babies
   • Crying

• Feeding Your Newborn

1.  
   1.  
      • Eat a Balanced Diet
      • Beware of Medications!
   1.  
      • Use the Proper Nipple Hole Size
      • Wash and Sterilize
      • Warm and Test Formula
   • Feeding Times
   • How Much Is Enough
   • Signs of a Well-Fed Baby
   • Breast-Feeding
   • Formula Feeding
   • Burping
   • Common Feeding Problems
   • Food Allergy
   • Solid Foods

• Baby Care

1.  
   • Bathing
   • Bowel Movements
   • Care of the Diaper Area
   • Diaper Rash
   • Sleeping
   • Colic

• Special Conditions in the Newborn Period

1.  
   • Umbilical Cord
   • Genital and Breast Areas
   • Scalp
   • Eyes
   • Skin

• Carseats