Newborn Babies

Prenatal Visits

In both offices, we offer prenatal visits, where you may come and see our offices and meet one of our doctors. They are held three to four times a month, usually after regular office hours at 5 p.m. Please make an appointment at least a month before your due date. We look forward to meeting you and answering any questions you may have about our offices and the care of your newborn.

General Newborn Care

Congratulations on your new baby! Watching your baby grow and develop can be an exciting and rewarding experience. There are, however, many common problems and questions which arise that are upsetting and puzzling to new parents. You should realize that there are many approaches to various problems and these will vary from child to child. Remember, loving your child, common sense, and the ability to adapt to particular situations are the keystones to successful child rearing.

Feeding

We support the American Academy of Pediatrics recommendation to breast feed infants for the first year of life. However, the choice of whether to breast or bottle feed is up to you. Whichever you choose, we are available to support you and answer any questions you might have. Regardless of which method you choose, feeding should be a time that is relaxed, not rushed, and is a great opportunity to bond with your infant. Breast milk or formula is recommended for the first year of life for proper nutrition and growth.

Breast Feeding

Our physicians and nurses are very accustomed to answering questions about breast feeding and will be happy to answer any questions you may have.

In general, breast fed babies should be fed on a modified demand schedule. This means that the baby may be allowed to feed as frequently as he/she desires up to 10 - 12 times a day, but should be awakened if he/she sleeps beyond 4 hours between feedings during the day. After 10 or 11 p.m. do not awaken the baby; let the baby wake you. He’ll/She’ll let you know when he’s/she’s hungry. Expect your baby to breast feed eight to ten times a day in the first few weeks.

During the first few days of life, babies are often very sleepy and will require some encouragement to feed. To awaken a sleepy baby, you can undress him/her, rub his/her feet and hands, or put a cold cloth on his/her forehead. You may need to do this several times during a feeding.

Signs that your baby is hungry include:

• Rooting (where the baby turns its head to anything that touches its cheek)
• Sucking on its fists
• The late sign of crying

Signs that your baby is breast feeding well include:

• Having 4 or more wet diapers a day after the 3rd day of life, and 6 or more after the 5th day
• Having 3 or more bowel movements a day
• Hearing swallowing during the feeding
• Seeing milk in the baby’s mouth or on its lips after/during the feeding
• Feeling the breast soften during feeding
• Baby is content after the feeding
• Usually there is no need to supplement breast feeding with formula, unless your doctor tells you to. By solely breast feeding, you encourage your body to produce an adequate milk supply and maintain your infant’s preference for the breast rather than a bottle.

Breastfed infants do not require water supplementation in the newborn period, and water bottles are not routinely recommended until the baby is at least 4 months old.

Techniques for the Breast Feeding Mother

When you nurse in the sitting position, hold your baby on his or her side facing your breast, with the baby’s lower arm tucked around your waist. Hold your breast with your thumb above the areola (the dark skin around the nipple) and your other fingers below. Support your breast well back from the areola to avoid interfering with your baby’s latch. Your baby’s face, tummy, and knees should be facing you.

Gently touch the baby’s lips with your nipple and the baby will open her/his mouth to attach to your breast. Bring the baby to you (not the other way around), making sure your nipple and as much of the areola as possible are in the baby’s mouth. Pull the baby in close to a snug tummy-to-tummy position. If necessary, gently pull the breast away from the baby’s nose with your thumb.

Offer both breasts at each feeding. Your baby will empty most of the milk in your breast after 5 to 10 minutes of vigorous sucking, so nurse at least that long on the first breast. Your baby may wish to nurse longer—possibly as long as 30 minutes or more. As long as he/she is properly positioned and is not hurting you, this is fine. When the baby loses interest in the first breast, stop and burp the baby. Then offer the second breast for as long as you both want. Be aware that some babies will only nurse on one side each feeding. To change breasts, put your finger into the corner of the baby’s mouth between the gums, and the baby will open his or her mouth.  However, most babies let go on their own when finished.

Let your breasts completely air dry after nursing. Start with a different breast each time. Put a diaper pin or safety pin on your clothing to remind you which breast to begin with at the next feeding. Following breastfeeding guidelines carefully prevents or minimizes sore nipples. A mother who develops sore nipples should call the office.

If you need to be separated from your baby at feeding time, you can leave behind a bottle of milk that you expressed (pressed out) from your breasts by hand. Or you can express milk with the aid of a breast pump. Manual, battery operated, and electric pumps are available, each with advantages and disadvantages. Our staff will be happy to discuss this with you. Try to avoid supplemental feedings before 2 weeks of age unless we have specifically recommended you to do so.

If breast milk is not available, you can leave behind a bottle of prepared infant formula. Any feeding that a breastfed infant receives in place of a feeding at the breast is called a supplemental feeding. Should you need to supplement with formula, discuss the options with the baby’s doctor.

Bottle Feeding - Formula

Infant formula provides all the nutrients that a baby needs to grow well for the first year of life and offers an excellent alternative to breast milk. Formula comes in many convenient forms:

• Ready To Feed (If you decide to use ready to feed formula, you will have to give a fluoride supplement after the baby is six months old.)
• Liquid concentrate (To use you mix equal parts of water and formula.)
• Powder (To use you add water as instructed on the can.)

We recommend iron-fortified formula Similac Advance® with Iron. Vitamin supplements are not needed, since this formula already contains vitamins. Cow’s milk is not recommended for babies less than 12 months of age because it contains excess minerals, has proteins not easily digested by some babies, and may cause allergies.

Most formula fed infants will take 2 to 3 ounces every 3 to 4 hours for the first few weeks of life and gradually increase to 4 to 8 ounces by 1 to 2 months of age. After 10 or 11 p.m. let the baby awaken you for feedings at night.

Sterilization

It is not necessary to sterilize bottles or nipples if they are carefully washed and thoroughly rinsed. A dishwasher is quite satisfactory. You do not need to boil city water. If you use well water, it should be boiled and your baby will need fluoride supplements after 6 months of age.

Introduction of Solid Foods

For the first 4 to 6 months of life your baby can get all of the nutrients he/she needs from breast milk or formula. Solid foods are not necessary before 4 months.

At 4 to 6 months you may start rice cereal. Use dry fortified baby cereal and mix it with formula, expressed breast milk, or water to a mushy consistency. Start with one tablespoon and increase as tolerated. Cereal should not be put in your baby’s bottle, because he/she will not learn how to eat from a spoon. After cereals, you can begin fruits and vegetables. Introduce one new food at a time. Feed the new food for 3 to 4 days and watch for any intolerance. After your baby has tolerated foods individually you may give mixed food (i.e. peas and carrots together). Most babies will spit out a new food the first time it is fed because they are not familiar with the taste and texture, so do not assume your baby does not like it. On average it can take five to six feedings of a new food before the baby readily eats it.

As your baby grows his/her need for solid foods will too. By 9 months of age most babies are eating three solid meals a day. At 9 months you may introduce meats. Keep in mind that the breast milk and/or formula is still the most important source of nutrition in the first year of life.

Spitup

Almost all babies will spit up some, usually right after feeding and especially if not burped enough. A few teaspoons can appear to be several ounces when spread out on a cloth or the floor. The spit up does not bother most babies, and as long as the baby is gaining weight and is happy, it is nothing to worry about. If your baby seems to spit up frequently, try keeping him/ her upright after a feeding for at least half an hour and try not to bounce him/ her around too much. In addition, you can put the baby to sleep at a 45 degree angle by placing a wedge or layering a towel under the mattress (the baby should always sleep on a firm mattress). Occasionally, your doctor might recommend a formula change if intolerance is suspected, but always check with your doctor first.

If your baby’s spit up is very forceful, increasing in frequency or green in color they need to be seen as soon as possible by their doctor.

Sleeping

In the first months of life, and especially in the first few weeks of life, babies will spend a majority of their time sleeping, anywhere from 12 to 20 hours a day. Your baby should start to awaken for feedings by himself/herself after a few days of life. If your baby is running a fever or not awakening for feedings call the pediatrician’s office.

We recommend that you put your baby to sleep on his/her back, on a firm mattress, with no loose blankets, stuffed animals, or pillows. In the winter it is better to put your infant in warm pajamas rather than using blankets to keep the baby warm. By following these recommendations and preventing exposure to second hand smoke, the chances of SIDS (sudden infant death syndrome) will decrease.

Crying

On average, newborn babies cry three hours a day. Babies cry because they may be hungry, cold, wet, or too warm. They just may need to suck, or be cuddled, or they simply may be expressing themselves. You can not spoil an infant less than 4 months of age so do not be afraid to hold and comfort them.

If your baby’s cry seems different, you can not seem to comfort him or her, or the baby seems to be in pain, take a rectal temperature and call the pediatrician’s office.

Cord and Circumcision Care

The umbilical cord area may be kept clean by simply washing wth water. If there is any redness of the skin around the cord, call our office.

The circumcision should be cared for as instructed by the hospital.  Tylenol should only be given in the hospital newborn nursery for pain control after circumcision.  It sould never be given to an infant less than two months of age once home.  Please call the office immediately if your newborn seems excessively irritable, or has any temperature above 100.3F rectally in the first two months of life.

Immunizations

Immunizations are an integral part of preventative health care. We follow all the American Academy of Pediatrics recommendations for immunizations. Your baby’s first shots will be at the two-month visit. Please see our immunization section to read more about them.

Bathing

Sponge bathe your baby as needed with water and a mild soap until the cord has dropped off and the site is dry. Subsequently you may tub bathe the baby. Babies do not need to be bathed every day. Two to three times a week is usually enough.

Skin Care

Many babies have normal newborn rashes including white dots over their noses and chins, and small red splotches with a raised center that comes and goes over different parts of the body throughout the day. These require no special care and will go away on their own.

Heat rash is common in summer and winter and will occur over the neck, chest, upper back and in the creases. Avoid too warm a room, too heavy clothing, and treat by keeping the baby cool and dry.

Infant acne normally appears on the cheeks and nose as red and white bumps--it may be present at birth, but more typically appears after three weeks of age. It will go away on its own and you should continue to just use water to clean the baby’s face.

Diaper rash is very common and can best be avoided by changing the baby as soon as he/she urinates or has a bowel movement. Also, try to avoid using baby wipes in the first month of life--instead use water and a clean soft cloth (i.e. a wash cloth) to clean the diaper area. If your baby does develop a diaper rash apply a diaper cream like Desitin® or A&D ointment to help the skin heal. If the rash is getting worse or has red dots around the borders give us a call.

Contact dermatitis, an irritation of the skin, is common from using harsh laundry detergent, dryer sheets, and fabric softeners. These should all be avoided.

Birthmarks

These are extremely common. The faint red blotches on the eyelids, between the eyes, just under the nose, and on the back of the neck are termed "stork bites", and slowly fade away. No treatment is required.

Bowel Movements

Most parents will be able to tell when their baby is having a bowel movement, because he/she will typically be a little fussy, turn red in the face, and may grunt and cry and draw up their legs. If the stool is soft, the baby is not constipated. All newborn babies pass gas, more than most parents expect.

All babies will pass very dark black or brown meconium stools that are very sticky in the first few days of life. Lighter colored soft mushy stools will then follow these.

Most breast fed babies will stool several times a day. The stools usually are a yellow mustard color with some seed-like material mixed in. Nevertheless, in some breast fed babies, the stool may be a variety of colors such as fluorescent green and they may not stool every day. Around 2 months of age stooling patterns may change to much less frequent and larger volume stools.

Formula fed babies tend not to stool as often as breast fed babies. It is quite normal for a formula fed baby not to stool for three to four days at a time. As long as the stool is soft and not hard pellets, the baby is not constipated. The iron in the formula does not cause constipation, therefore we do not recommend the use of low iron formulas. The color and consistency of formula fed infants’ stool can also vary considerably.

Call the pediatrician’s office if you see any blood in the stool.

Temperature / Fever

Most of the time fever tells us that some type of infection has started. In most cases the fever is gone in a day and the child seems better. This is usually a short-lived viral infection and the fever helps fight off the infection.

A fever in an infant from 0-3 months of age is defined as a rectal temperature greater than or equal to 100.4 degrees Fahrenheit. If your child 0-3 months of age has a fever you should contact the pediatrician’s office immediately.

The most accurate way to take a temperature is with a rectal thermometer. We recommend purchasing one and becoming accustomed to taking a rectal temperature. You should take your newborn’s temperature if she feels warm or is acting unusually fussy or sleepy.

In older infants and children, higher fevers tend to be common. Please refer to our fever section.

Nasal Congestion

This is very common in infancy. Nasal congestion is most likely due to normal mucous and usually will improve as the baby gets older. The baby will frequently sneeze or cough to clear his/her nose. Use of a nasal aspirator and a cool mist humidifier may be very helpful. Saline nose drops before aspiration frequently will help. Remember, stuffy noses may last several weeks or may come and go every few days.

You should call the pediatrician’s office if the nasal congestion is interfering with the baby’s sleep or eating. Noisy breathing or congestion that does not affect the baby’s disposition, sleep, or the ability to eat need not be treated.

Sneezing and Hiccups

Newborns will often do both several times a day. There is nothing you need to do for either of these normal events.

Baby Products and Accessories

There is an amazing number of items you can purchase for a baby. Most are not necessary but may be convenient. Here is a list of some things we think are good investments:

• Rectal thermometer
• Nasal saline drops and a nasal aspirator
• Cool mist vaporizer
• A car seat and crib that meet the latest safety standards (see consumer reports)
• Good parenting books (see our references and resources section for recommendations)
• Often times new parents are offered used baby products, make sure you check to make sure the item has not been recalled. You can check at www.cpsc.gov

Smoking

Do not expose your child to cigarette, cigar, or pipe smoke. It has been proven that children exposed to smoke have more ear and respiratory infections, as well as diminished lung development and an increased risk for SIDS (sudden infant death syndrome).

Fresh Air

Fresh air is fine for a new baby. An infant may go out at one to two weeks of age. Take the baby out on a clear calm day and do not overdress. Avoid nurseries, shopping areas and other crowds of people for the first three months of life when young infants are more susceptible to contagious diseases.

Metabolic Screening Test

This is a test done on all babies for several diseases that are treatable if detected early in life. Although the diseases are rare, many of them can cause mental retardation and the baby will not show signs or symptoms until the damage is already done. This is why it is so important to detect them while the baby is still very young. All states have newborn screening programs and all babies should have a Metabolic Screening Test done in the hospital prior to discharge.

If the baby was discharged after 48 hours of age, the test will only need to be repeated if your doctor or the state lab request you to do so.

If the baby was discharged before he/she was 48 hours old the test must be repeated within 7 days at the pediatrician’s office. Please call for an appointment at least 24 hours in advance.

Infants who were on antibiotics in the hospital, or who were less than 5 lbs. when they were born, will need to have their Metabolic Screening Test repeated. Your doctor will tell you when is the best time to repeat the test.

You may receive a phone call from the pediatrician’s office or from the state lab requesting that the Metabolic Screening Test be repeated.  It is important that you bring the baby in within one to two days to repeat the test.

Expanded Metabolic Screening Test

Our office is currently recommending the optional expanded metabolic screening test, which may serve to rule out some other rare conditions. You can request to have this done while your baby is in the hospital or it can be done in our office after discharge.

SIDS, Sleep and "Soothies"