Your child is an individual from the day he or she is born. While each baby is unique and special, the information in this booklet will answer some common questions regarding newborn care and feeding. We will be happy to answer your questions while you are in the hospital, or later by phone and during your visits to the office. We look forward to watching your baby grow and develop into a healthy child.

• Health Supervision Visits and Immunizations
• Visitors
• New Babies
• Feeding
• Mother's Diet
• Bottle Feeding
• A Schedule with Flexibility
• Burping Your Baby
• Solid Foods
• Fluoride
• Sleeping
• Bathing
• Navel and Umbilical Cord
• Circumsision Care for Boys
• Vaginal care for Girls
• Skin Care
• Bowel Movements
• Fever and Signs of Illness

Health Supervision Visits and Immunizations

Your baby should have his or her first office visit at the age of two weeks unless special problems arise. After that, the schedule of health supervision examinations will be outlined. Visits will be at regular intervals and include:

• A review of your baby’s growth and development


• A discussion of any physical and mental problems your child may have


• A complete physical examination


• Anticipatory guidance regarding your baby’s growth and development in the coming months


• Appropriate immunizations and laboratory tests, and


• An opportunity to ask questions.

Immunizations are given according to the recommendations of the American Academy of Pediatrics. I will discuss the purpose of these vaccinations and possible side effects at the appropriate visits.
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Visitors

You and your new baby will have many visitors during the next few weeks. Although their intentions are good, they may unintentionally expose your baby to illnesses. Therefore, anyone who handles the baby should wash his or her hands first, and anyone with a cold or other contagious illness should not be allowed to kiss or hold your baby.

Grandparents, relatives and friends often have excellent advice and suggestions about baby and child care. However, knowledge changes from year to year and what was good advice for them may no longer be considered proper child care today. Check with me before accepting their helpful suggestions.


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New Babies

There are many things a baby may do that seem unusual or abnormal to new parents. It is, of course, important to be able to distinguish between signs of distress or illness and normal baby activities. All babies sneeze, yawn, burp, have hiccups, pass gas, cough and cry. They may occasionally look cross-eyed.

Sneezing is the only way babies can clean their noses of mucus, lint or milk curds. Many new babies will develop a stuffy nose although they have no signs of an actual cold. In these cases, babies usually nurse well and do not have fevers. This is common and not usually a sign of ill health.

Hiccups are little spasms of the diaphragm muscle. They are harmless and painless. If they occur during a feeding, the feeding should be continued. Coughing is a baby's way of clearing his or her throat.

Some babies spit up small amounts of milk during burping or after feeding; this should not be a cause for alarm unless large volumes are vomited with each feeding.

Babies cry for many reasons-some babies more than others. Crying can mean that a baby is hungry, too hot, too cold, needs a diaper change, is in pain, or simply that he or she wants to be picked up or carried. Sometimes babies cry for no apparent reason. It is important not to assume that a baby is hungry every time he or she cries. Rather than feeding a baby every time he or she cries, try to find out what is making him or her uncomfortable. You will gradually learn to know what the baby's cries mean. In any case, the crying itself will cause the baby no harm.


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Feeding

Feeding time, due to the nourishment and security that goes along with it, is one of the baby's first pleasurable experiences.

Breast feeding is generally recommended for babies for the first year of life. Breast milk contains the perfect balance of nutrients for your baby. It also contains antibodies that help to protect your baby against many common illnesses.

Breast feeding can be a very rewarding experience for both baby and mother. A comfortable position is essential; nursing is more likely to be successful if you and the baby are comfortable and in a quiet environment. During the first few days of your baby's life your breasts will secrete colostrum, a fluid that is good for babies but differs slightly from milk.

Initially, limit your nursing to five minutes on each breast to prevent your nipples from getting sore before they become accustomed to the baby's vigorous sucking. Gradually increase to 15 minutes per side over the first week if your nipples are not sore. Your milk will come in around the third to fifth day and your breasts may become temporarily engorged. After your nursing is well established, 10 to 15 minutes on each breast is usually satisfactory since the baby can empty nearly all your milk in that time.

Try to alternate the breast you start with at each feeding. When removing the baby from the breast, break the suction by inserting your fingertip between the corner of the baby's mouth and your nipple.

I would encourage you to avoid giving formula bottles during the first few weeks to successfully establish your breast feeding. After a few weeks, and certainly by 6 weeks of age, I would recommend offering an occasional bottle of expressed breast milk or formula so your baby will accept a bottle as an alternative method of feeding. Breast-fed babies will often refuse a bottle after several months of strictly being breast-fed. Pumped or expressed breast milk may be refrigerated two to three days or frozen for one to two months.

If your nipples become sore, limit your nursing to five minutes on each side, use lanolin cream or A&D ointment on your nipples to prevent cracking, and heat lamp treatments with a low-wattage bulb after nursing. If you suspect you have a breast infection, please consult your obstetrician.


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Mother's Diet

To establish and maintain an adequate milk supply, you need to drink eight to ten glasses of fluid per day, eat a well-balanced diet of 2,600 calories per day, and get plenty of rest. Lactating mothers need 1,200 mg of calcium daily. Everything you eat or drink, as well as medications you take, can affect your breast milk.

Foods in the mother's diet that commonly give babies gas include milk and dairy products, chocolate, "gassy" vegetables such as broccoli, brussels sprouts, cabbage, cauliflower, leeks and beans, tomatoes, onions, garlic and spicy foods. Not all babies are bothered by the above foods. Also, caffeine in large amounts can make the baby irritable.

Most over-the-counter medicines come through into your breast milk in small amounts but are safe to take while breast feeding. Please check with your own doctor or with me before taking a prescription medicine while breast feeding.
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Bottle Feeding

Bottle feeding is an acceptable alternative to breast feeding. Either expressed breast milk or formula may be given to the baby by bottle and can be served at room temperature or slightly warm. All your equipment should be kept thoroughly clean, but does not need to be sterilized.

Never prop the bottle and leave the baby to feed himself or herself. The bottle can easily slip into the wrong position. Your baby also needs the security and pleasure of being held. Also, propping the bottle for feeding can lead to ear infections and bad teeth.

Babies will keep sucking on bottle nipples even after they have collapsed. Take the nipple out of the baby's mouth occasionally to keep the nipple from collapsing and let the baby rest. Some babies will suck fingers or a pacifier for comfort.
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A Schedule with Flexibility

Feeding schedules are usually most satisfactory if the baby is allowed to eat when he or she becomes hungry. New babies usually need to be fed about every three to four hours. Breast-fed babies often want to nurse every two to three hours. If a baby sleeps more than four hours during the day, wake him or her for a feeding so that he or she is more likely to sleep for longer stretches at night. There is no need to wake the baby for feeding during the night.

The duration of nursing and the amount of formula your baby takes will vary. Babies, just like adults, are sometimes not hungry! Most babies feed for 15 to 20 minutes. Sometimes your baby will nurse both sides or take all of the bottle and sometimes won't. Don't worry. This is normal. As your baby grows and gains weight, he or she will need more breast milk.

When your baby seems unsatisfied with a feeding or cries for more, it may be time to increase the amount or frequency of daily feedings. Your breast milk production will gradually increase as your baby grows. The more often a baby nurses, the more milk your body produces.
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Burping Your Baby

Burping a baby helps remove swallowed air. Even if fed properly, both bottle-fed and breast-fed babies usually swallow some air and this can be relieved by burping. Hold the baby upright over your shoulder and pat or rub his or her back very gently, until he or she burps. You can also place him or her face down over your lap and gently rub the baby’s back or hold him or her in a sitting position on your lap with your hand supporting his or her chest.

Burping should be done once or twice during a feeding and at the end of the feeding. If you wait until the entire feeding is completed, enough air can accumulate in the stomach to cause discomfort and prevent the baby from having an adequate meal. It may also cause some spitting up.

It is not always necessary to hear a good burp after you finish feeding. Some babies will burp themselves, so if you do not hear a burp after five minutes you may stop trying. Shortly after putting the baby to rest he or she may fuss or cry; lifting him or her gently may produce another burp and a "Thank you, Mom" smile.
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Solid Foods

Both breast milk and formulas are entirely balanced sources of nutrition for babies for many months. I do not recommend starting any solid foods before four or six months and will provide further information during well-baby visits.
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Fluoride

All babies should have fluoride supplements beginning at 6 months of age, unless your water supply has fluoride added. Fluoride is a chemical that helps prevent dental cavities. It is available with and without vitamins and is available by prescription only. It must be given directly to the baby as it does not adequately cross into the breast milk of a nursing baby. I will prescribe this medication at the appropriate time.
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Sleeping

You may expect your new baby to do a lot of sleeping - about 18 hours a day. In general, I recommend the baby sleep in his or her own crib, not in bed with the parents. I also recommend placing the baby on his or her side or back for sleeping. Rotating position will prevent the development of a flat head. The mattress should be firm and flat, and no pillows should be used. Protect the mattress with a waterproof cover if necessary. Cover the mattress with a mattress pad, soft sheets and one or two cotton blankets.

Babies usually wake up several times each night for feedings during the first few weeks. Around 4 to 6 weeks of age, babies will begin sleeping at longer stretches at night and the night feedings will gradually be omitted.
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Bathing

Babies need to be bathed only once or twice a week. Before the umbilical cord has fallen off, babies should be sponge-bathed rather than bathed in a tub. After the cord has fallen off and the navel has dried, the baby can be bathed in the tub. Any mild type of baby soap or Dove soap is adequate.

Be sure to wash your baby well in the creases of his neck, arms and legs, and rinse and dry these areas thoroughly. Try not to clean the inside of a baby's ears with a Q-Tip. A Q-Tip will only force wax and other material deeper into the ear. Wash the baby's face with plain water and a soft cloth; avoid using soap.

Never leave your baby unattended during bathing!


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Navel and Umbilical Cord

The stump of the umbilical cord, which remains temporarily attached to the navel, should be kept clean, dry and free from diaper irritation. If the cord becomes soiled, wash it with soap and water and dry thoroughly. The cord may be cleaned once or twice a day with rubbing alcohol. When diapering your baby, fold the front edge of the diaper below the healing navel, so it does not irritate this area or add moisture.

Usually the stump will fall off between 7 and 14 days after birth, but may stay attached up to a month. After the stump has fallen off, there is often a pinkish discharge from the navel. This is normal and does not need any treatment. You should call the office if there is persistent bleeding, unusual discharge, redness, swelling, or bad odor.
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Circumsision Care for Boys

Vaseline on a gauze pad should be applied to the circumcision site with every diaper changing, and the area should be observed for signs of swelling, bleeding or infection. Should any of these signs occur, please call me. Healing is usually complete by 10 days.
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Vaginal care for Girls

Many baby girls will have a bloody discharge from the vagina during the first few days of life. This is normal and is caused by the disappearance of the mother's hormones from the baby's blood that occurs after the baby is born. The labia should be spread and the area cleansed gently after each bowel movement.
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Skin Care

Diaper rashes occur commonly in babies and are usually due to nothing more than being excessively wet. Often, just leaving the baby without diapers and exposed to the air will clear up mild diaper rash.

Desitin, A & D Ointment or Caldesene Powder can also help clear simple diaper rashes. If the rash persists and these medications are not helping, call my office for advice. A rash that is accompanied by fever should be evaluated in the office.
Baby acne commonly appears by the second to third week. It is a blotchy red rash with pimples that may occur on the face, scalp, and upper chest and back. The rash is worsened by heat and it is best to avoid oils on the face. If the rash on the face becomes very red, dry and scaly, call me for instructions.
Keep the baby's nails trimmed to prevent scratches; an emery board or scissors are usually safer than nail clippers.
Oil and talcum powder are not recommended. A lotion such as Lubriderm may be used if the baby's skin is very dry or cracking, fine peeling of the skin is common in the first two or three weeks and needs no treatment.
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Bowel Movements

Many parents become overly concerned with their baby's bowel movements. They anticipate that bowel movements will occur with a certain frequency and be a certain color or texture. These concerns are usually unwarranted. Normal bowel movements can be yellow, brown, green, or any mixture of these colors.

The normal frequency of bowel movements varies tremendously, ranging from 10 times a day (following each feeding) to once or twice a week, depending on the baby. Breastfed babies initially tend to have more frequent stools than bottle-fed babies, and the stools may be very watery.

Many babies will grunt and strain while having bowel movements. They may do this even if their stool is soft, and this alone does not mean they are constipated. This is usually just the normal amount of work that a baby has to do in passing stools. Constipation is defined by the consistency of the stools, that is, hard, dry stools, and not the frequency.

Breast-fed babies will not become constipated as breast milk is a natural laxative. Bottle-fed babies who are constipated have hard, pellet-like stools and should be given extra water during the day.
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Fever and Signs of Illness

Fever is not an illness itself but is a sign of illness. In a baby of less than 2 months of age, a rectal temperature of 101°F or above may indicate a more serious infection. If this occurs, you should call immediately. In older babies and children, it is safe to treat a fever with one of the liquid acetaminophen medications if the child is uncomfortable. How the child is acting is more important than the height of the fever in determining whether a serious illness is present.

Newborns may not always have a fever when sick. Excessive sleepiness, poor feeding, vomiting (not just spitting up) or excessive crying can be a sign of illness in a newborn.

It is important that you learn how to use a rectal thermometer. With the baby on his or her tummy, insert the Vaseline coated bulb end with a gentle rotary motion to no more-than a 1/2 inch depth. The normal rectal temperature is generally between 97.5 and 99.5°F (36.5-37.5°C)

You may occasionally notice some mucus in your baby's nose. If this mucus causes enough blockage of the nose to cause problems with feeding and breathing through the nose at the same time, you may use a nasal aspirator (2 oz bulb syringe) to suction the mucus out. Saline nose drop may also help to loosen the mucus.
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