¨ Nutrition will never be more important than during infancy. Whether you are breastfeeding or bottle feeding your baby, together we will decide if and when you need to make the feeding change. Do not be confused by ads that say you should change what you feed your baby at a certain age. The formula that is right for your baby's early months is still right until your baby's first birthday. If you think that you want to make a change or that one is needed, please talk with us first.

¨ Your baby should have his or her first office check-up a few days after discharge from the hospital unless, of course, the child needs attention before then. For your convenience, please call the office for an appointment shortly after leaving the hospital.

¨ Reminder: Your child will receive his/her 1st Hepatitis B vaccine at the 1 st check-up in our office. At that time you will be given a brochure with information about this vaccine.

¨ EMERGENCIES:

o Should an emergency arise, call us immediately. Whenever your doctor is out of town or otherwise unavailable, an associate will be designated to help you.

SIGNS OF ILLNESS:

¨ Signs of illness which should be reported to us:

o Fever 10TF or over, rectally for babies 6 months of age or younger.

o Vomiting (not just "spitting up"), or refusal of food several times in a row.

o Excessive crying.

o Listlessness.

o Loose, runny bowels (mucus and foul odor).

o Any unusual rash.

¨ Infant car seats can prevent the leading cause of death in children: Auto Accidents! OBTAIN ONE NOW!

o Car seat must be facing backwards until your child is 20 Ibs. AND 1 year old in order to support his/her head during a sudden stop or collision. The back seat is safer than the front seat for your infant car seat.

FOREWORD

¨ This webpage is intended to help you in the care of your new baby. It is purposely brief, so that you can more easily remember the facts it contains. It has suggestions and recommendations rather than rules, for common sense is usually the best guide in any given situation, and no two babies are ever exactly alike.

¨ Baby care is really not difficult at all, and you can be confident that you will get along well. Do not worry about trivial matters. Maintain a relaxed and confident attitude, relying on your own common sense and judgment, rather than on the often-confusing advice of friends or relatives. If your baby is normal, you may be sure that the baby is hardy and will make his or her wants known.

¨ A proper attitude is very helpful. First and foremost: Try to relax. Remember that human mothers have inherent natural instinctive ability to raise babies just like animals know how to care for their young. Do not expect everything to be perfect at first. Relax a little and enjoy your baby and don't be afraid of him or her.

¨ The emotional and physical health of the baby is dependent upon the active participation of both the father and the mother (if both are available) in the infant's care. The baby who lives in warm, affectionate and relaxed surroundings will respond to them in a like manner. Likewise a baby will sense tenseness and nervousness in those that handle him. This may result in a fretful, irritable infant.

¨ The Pediatrician's aim is two-fold: A happy mother and a healthy baby. You should enjoy this first year of watching your baby progress from the crying, hungry, fussing infant through all the stages of smiling, sitting, standing, walking and talking.

¨ The path is not always smooth — and each baby will require individual attention. The following pages are intended as general rules regarding your baby's care. Your common sense in their interpretation is the most important factor in raising your baby with the minimum amount of worry. If there is a problem, call us.

¨ During the next few days, most of your time will be spent in resting and regaining your strength. You can put this time to good use by getting to know some of the simple things which will help to make your life with baby easy and fuss-free.

¨ Your child is an individual from the day he or she is born. We will be happy to give you guidance and answer your questions while you are in the hospital and later by phone and during your visits to the office.

BABY'S HOME ENVIRONMENT

Baby's Room:

Some parents feel more secure if the baby sleeps in their bedroom. However, it is perfectly safe and preferable to have your child in another room if your sleep is disturbed. The baby should learn to sleep through the usual household noises. After all, your child is only one of the family and should begin to adjust to his or her new environment quite early. The room in any event should be light, airy and comfortably warm. It should be easily accessible. You may wish to use baby monitors.

Room temperature:

The room should be around 70 degrees, with 65 or 68 degrees at night. If the room feels comfortable to you, it is usually right for the baby. Weather permitting, have a window open in the room. If the weather is cold or windy, have ventilation from an open window in an adjoining room.

Visitors:

Discourage visitors, particularly children, during the first few weeks at home. Visitors are exhausting for you, interfere with daily routines and are a dangerous source of infection for the baby. Grandparents are welcome of course. The tactful grandparent tries to be useful, remains a little in the background, and does not remain long enough to wear out his or her welcome.

Brothers and Sisters:

Some thought must be given to instilling a "pride of ownership" and enthusiasm for the new baby into the older children. If you focus too much of your attention and affection on the baby, you will foster jealousy and antagonism, particularly in the two or three year old. The moment of your arrival from the hospital is an important one, for your children will have missed you very much. I suggest that you let your husband carry the baby, while you go on ahead to greet the children enthusiastically.

No matter how "grubby" the older child looks, he or she should be allowed to see and touch the baby (although having your child wash hands first is logical, and it impresses on the child the importance of being clean around the baby). Allow your older child to share by helping in the baby's care when possible. If you let your older child hold the baby occasionally, he or she is less likely to try to do so at times when you are not around. It is quite safe for your older child to hold the baby, if he or she is seated in the middle of a double bed with you nearby.

Equipment:

You will need quantities of shirts and diapers and very little else in the way of actual clothing. Pull-over, buttonless, cotton stockinette shirts are most practical, and be sure to get them plenty big, for they are soon outgrown. Absorbent gauze-type diapers are soft, and dry most readily. Cotton night gowns are useful, and you will need 6-8 of the thin cotton

receiving blankets. Dresses, caps, stockings, and booties are unnecessary and difficult to launder. Southern California babies seldom need bonnets or booties. These are strictly gift items.

Bed and Bed-Clothing:

You may wish to use a bassinet, but the baby may go directly into a "six year size" crib. "Bumper" pads around the inside of the crib are advisable. The mattress should be waterproof. On top of the mattress should be a sheet of rubber or plastic to further protect the mattress, and over that a cotton sheet. Finally, on top of the sheet, you will want a quilted cotton pad. Diapers serve well for bassinet sheets, and "contour" sheets are ideal for the crib.

Furniture:

You will require a crib, a chest of drawers, tub or bathinette and a rustproof diaper pail. Playpen and high chair are useful later.

Fresh Air:

In most cases, it is permissible to take your baby outdoors whenever the weather is pleasant. It is important to protect the baby from prolonged periods of direct sunlight. You should use sunscreen (of at least 15 SPF).

THE DAILY ROUTINE

BREASTFEEDING:

Advantages for Mother:

1. The uterus returns to its pre-pregnant size faster.

2. No daily formula preparation.

3. There is less incidence of breast cancer for women who breastfeed 6 months or longer.

4. Mothers lose pregnancy weight faster because it takes 500-1000 calories per day to produce breastmilk.

5. The lactating hormone PROLACTIN gives mothers a feeling of relaxation and well-being.

6. Breastfeeding costs less than commercial infant formulas.

7. Baby has sweet smelling stools.

Advantages for Baby:

1. Breastmilk is nutritionally complete and superior to any alternative, and it fulfills all of your baby's nutritional needs during the first 4-6 months of life.

2. Breastmilk contains a variety of anti-infectious factors and immune cells.

3. Breastmilk is bacteriologically safe, always fresh and available.

4. Breastmilk has the least allergic reactions of any infant nourishment available.

5. Breastmilk promotes good jaw and tooth development.

6. Breastfed babies have less diarrhea and are rarely constipated.

7. Breastfed babies have a lower incidence of respiratory infections, ear infections and pneumonia (especially important for children in day care).

MAKING IT WORK

Nurse your baby in the Delivery Room or Recovery Room if possible since babies are most alert during the first 1-2 hours after delivery.
Room-in with your baby to ensure frequent, unsupplemented feedings around the clock.
Newborn babies need to be fed frequently at first. Babies are born full of amniotic fluid. They may not recognize hunger. The first several days, the baby nurses to meet his or her sucking need and begins to associate with getting milk and feeling good. For this reason, mothers should wake their new babies regularly for feedings.
Most babies need to nurse on both breasts at each feeding. Babies suck fairly vigorously when they are hungry and soften their suck as they get fuller, so it is a good idea to begin nursing on the breast on which the baby finished the previous feeding — it may feel heavier and fuller.
Breastfeed 8-12 times daily. Most breastfed babies need to be fed every 2-3 hours during the day and 2-5 hours during the night.
Breastfeed approximately 10-15 minutes on each breast. Some babies may take more or less time to complete the feeding.
Use proper latch-on and positioning techniques to ensure efficient sucking at the breast and to protect the nipples. For the "cradle hold":

A. Your baby should be positioned so the child does not have to turn his or her head to reach your breast. Turn the baby on the side so that the child's tummy touches your tummy.

B. Be certain your baby is held as close to you as possible.

C. Baby's head should be in the bend of your arm.

D. Your baby's lower arm should be wrapped around your waist.

E. With your arm supporting the baby, hold the baby's buttocks or upper leg with your hand.

F. Babies are born with a rooting reflex. This can be stimulated by tickling the baby's lower lip with your nipple.

G. Wait for your baby to open his/her mouth very wide before attempting to latch-on.

H. Get as much of the nipple and areola into the baby's mouth as possible. Aim the nipple to the back of the mouth and the baby's tongue will come out to pull in the nipple. The mother can use her thumb to push the nipple further into the baby's mouth to keep the breast from pressing on the baby's nose.

I. If the baby has trouble getting the tongue cupped under the breast and is "biting" the nipple, firmly pulling down on the baby's chin after he or she begins sucking will make the mother more comfortable and get the baby more milk.

J. To take the baby off the breast, the mother should slide a finger into the baby's mouth between the gums. Leave the finger in the baby's mouth as he or she is moved away from the breast. Newborns have a reflexive bite when their heads are moved.

Babies can be nursed in different positions.

A. Cradling position: Lay the baby in the arm nearer the breast on the side facing the breast. (Not on the back with the head turned.) A pillow under the arm which is holding the baby will help support the weight of the baby and prevent a backache for the mother.

B. Football hold: Put a pillow from the mother's lap out to her side. Lay the baby on the arm nearer the breast with the child's head in her hand and child's body beside her (as a football player carries a ball at his side.) The child will be tucked up under her arm, with her hand positioning the child's shoulders and head.

C. Lying down: Put the baby on the side facing the mother. The mother's arm cradles the baby close to her and guides the child's head.

The mother needs to be comfortable with her back and arm supported in all positions. Using one or more pillows under the mother's arm keeps the baby securely close to the breast.
If the baby is sleepy, the mother may need to spend several minutes talking and playing with the child while massaging the child's chest and back to rouse him or her for feeding. If the baby is crying and frantic, the child needs to be calmed down before beginning a feeding.
Although breast milk does not generally come in until 3-4 days, colostrum is readily available for the baby. Colostrum is the ideal food for your baby's first few days. It is both perfect nutritionally and important for protection against infection since it provides both protective white blood cells and high levels of antibodies. Colostrum is also beneficial in stimulating the baby's 1st bowel movement.
Avoid bottle feeding or pacifiers until the milk supply is well-established, unless recommended by your pediatrician.
Be in frequent contact with a supportive person.
Consider attending a breastfeeding class.
Have confidence in your ability to nurse your baby.
On discharge home, plan for rest and relaxation.

Avoid stressful situations and people.
Streamline obligations by performing only those household duties that can not be postponed.

SUGGESTIONS FOR COMMON BREASTFEEDING PROBLEMS

Care of Sore Nipples

Wash your hands before nursing, not your breasts.
Shorter, more frequent feedings (every 2 hours).
If it hurts to nurse, remove baby and reposition until not painful (jaws should compress areola, not the nipple).
Begin nursing on the least sore side.
After nursing, allow the nipples to air dry (by leaving bra flaps down or use hair dryer on warm/low setting).
If using cream, use only the types that do not have to be washed off (lanolin, A&D ointment, vegetable oil)
Avoid bras that are too tight.
Keep bras clean and dry.
If you use nursing pads, make sure that they do not have plastic liners.
Massage breastmilk into the nipple.
Use breast cup or shells to protect the nipple between feedings.
Get help if soreness persists. Breastfeeding should not hurt!

Relieving Engorgement

Long and frequent feeding (at least every 2-3 hours for 15-30 minutes of good suckling).
Position and latch-on properly (tummy to tummy or football hold, mouth wide open, tongue flattened).
Hot shower or warm moist compresses before nursing while gently massaging the breast and hand expressing the milk should start a stream of milk flowing out.
Express enough milk only to soften the areola prior to nursing so that the baby may grasp the areola.
Change baby from breast to breast every 10-15 minutes.
Make sure baby is alert for feeding.
If necessary, before or after feeding, express milk (using handpump, electric pump, or manual expression) to assist in emptying the breast.
Make sure that the baby's mouth position is not causing soreness on the nipple area through improper suction or position; trauma to nipple should be corrected immediately through correct positioning and latch on technique.

Enticing the Reluctant Nurser/Sleepy Baby

Make sure baby is awake and alert.

Stimulate through undressing baby for more skin to skin contact.
Do not let baby be too warm and cozy while nursing as this lulls the child to sleep.
If all else fails, sprinkle baby with a few drops of cold water or sponge bathe.

Avoid excessive use of pain medications (this may make baby drowsy or reluctant to nurse).
Avoid using artificial nipples.
Avoid engorgement.
Avoid bad tasting breast creams..
Gently express a small amount of breastmilk into the baby's mouth.

Showing Artificial Nipple Preference

Avoid using artificial nipples (bottle or pacifier) until breastfeeding is firmly established (usually by 3 weeks).
Avoid engorgement.
Avoid bad tasting creams.
Hold baby firmly with control, in either football hold or cradle hold.
Gentle hand expression of milk to the tip of the nipple and touch or tickle baby's lips.
Wait until baby opens mouth wide (tongue troughed) to insert areola.
If mouth is around areola, express, gently, a small amount of milk into baby's mouth, or use an eye dropper at the corner of the baby's mouth and deliver a few drops of water.
Hold baby's head firmly in place.
BE PATIENT AND BE CONFIDENT!!! YOU CAN DO IT!!!

Increasing Your Milk Supply

1. Drink to satisfy your thirst.

2. Eat nutritious well-balanced foods.

3. Nurse every 2-3 hours (or more frequently for as long as baby wants).

4. Offer both breasts at each feeding.

5. No supplements of formula, water or juice are needed.

6. Avoid the use of a pacifier (decreases baby's need to suckle).

7. Get more rest.

A. One or two naps per day. Try to sleep when baby sleeps.

B. Cut down on the non-essential activities.

8. Avoid medications which interfere with milk supply (parlodel, tace, birth control pills, antihistamines). Check with your physician, pharmacist or lactation consultant for any concerns about medication for you and your baby.

SUGGESTIONS FOR THE FIRST FEW WEEKS:

New babies are new people and they do require some adjustment. Expect the first few weeks to have highs and lows until the new baby fits into the family routine. It is important to keep some perspective and to know that things will improve as the mother feels better and the baby matures. Most mothers feel very relaxed and nurturing as they nurse their babies.
Babies cry for reasons other than hunger. The baby's only language is crying. If the baby is fussy less than 2 hours after the start of a feeding, look for other causes for the crying before offering the breast. Other causes of crying include soiled or wet diapers, gas,
discomfort, too cold or too hot, irritated diaper rash, need to suck but not necessarily feed, normal baby fussiness, etc. At times, babies do nurse just for comfort, but they also have other needs. Some babies need to fuss (not hard crying) for several minutes before drifting off to sleep, even just after a feeding.
Most newborns need to nurse every two to three hours for about 10-15 minutes on each breast for at least several weeks. Some may need to nurse for much longer than 15 minutes.
What comes out must have gone in. If a baby is only nursing (no bottles) and is having at least 6 wet diapers and 1-2 bowel movements in 24 hours, the child is usually getting enough. Most babies have many more wet diapers than this. Don't bother to count them unless there appears to be a problem.
Babies need sucking more than feeding. They will often suck their fists, a finger or a pacifier. This does not mean they are still hungry. Healthy babies will not be satisfied with non-nutritive sucking when they are hungry.
Although all babies usually lose weight for the first several days after birth, an average weight gain of 4-7 ounces per week after that is normal until the baby doubles birth weight. Most babies will regain their birth weight by 2 weeks of age, and will then double their birth weight by 4-6 months of age.
As they get older, some babies will nurse only a short time per breast or take only one breast at a feeding and still gain weight adequately. This is due to more efficient suckling and your breasts becoming adjusted to making enough milk.
Babies go through growth or appetite spurts at fairly predictable times.

1. During a growth spurt a baby will fuss to nurse very frequently (twice as often as usual) for about 2-4 days to meet his or her increased needs.

2. Growth spurts usually occur at 2 weeks, 6 weeks, 3 months and 4-6 months. By using the supply meets demand system, the baby will increase the mother's milk production to meet his or her needs.

Breastfeeding mothers can continue the nutritious diet they followed during pregnancy.

1. A basically well-balanced diet need not be expensive. A good source of vitamin C and adequate calcium are important for most mothers. The calories in an additional glass of milk and a peanut-butter sandwich are sufficient to support the lactation for most women.

2. 2. Most nursing mothers drink 2-3 quarts of liquid per day to satisfy thirst. This may be water, juices, milk, soups, fruits, vegetables, etc. Mothers do not need to drink milk to make milk. However, milk is a convenient and good source of calcium, protein and liquids. If a mother does not drink milk, other sources of calcium are needed. J. What is eaten does affect the milk and may affect the baby.

§ Caffeine, nicotine, alcohol and drugs all go through milk in varying quantities and with varying effects.

§ Food affects the milk 4-24 hours after it is eaten. So if the baby seems fussy, first think back one meal and then a full day to discover possible causes. Most breastfeeding mothers find that very few foods, if any, need to be avoided.

Breastfed babies' stools are about the consistency of watery cottage cheese and the color of mustard. As they get older, some babies still have a dirty diaper at each feeding and some have a "mud slide" once a week. Both can be normal when the baby is older. However, the typical pattern is a couple of bowel movements per day during the early weeks.
Many women may prefer to wear a bra or some form of support during the first few months of nursing. You may wear breast pads to absorb the milk that leaks out.
It is not unusual for the breasts to leak during intercourse. Nursing beforehand will empty the breasts and decrease the chances of being interrupted.
Some women find that they need extra lubrication for intercourse because of the lower levels of estrogen during lactation. Usually K-Y Jelly is sufficient.
While it is true that breastfeeding usually delays menstruation, it does not prevent pregnancy. Therefore, breastfeeding is not a reliable form of birth control.

HOW TO DEAL WITH FAMILY AND FRIENDS

¨ New mothers frequently find that establishing breast feeding at home goes more smoothly if the mother, father and infant are left alone during this two week period so that they can work out methods of feeding which are mutually beneficial to the mother and infant. This is the time that mother, father, and infant learn each other's personality traits. It is a time of bonding (cementing their relationship). The mother should find a room or place in her home where she is comfortable and content to breastfeed. She should not be pressured to breastfeed before family or guests if she is not comfortable in this capacity. She needs complete ease with her relationship to her baby and her environment.

¨ A house full of relatives with helpful suggestions is sometimes self defeating for two reasons. The first reason is the conflicting advice that is frequently given to the mother. The second reason is that a guest in the home imparts responsibility for entertaining and conversation. The new mother knows that three complete meals must be served and she must maintain a clean house, which will increase her fatigue and stress. Preferably, relatives should plan only a brief visit with the parents when the baby is born, while the mother is still in the hospital. From past experience, relatives usually want to take care of the new baby and leave the house work to the new mother. When the relative leaves, the mother has to learn how to take care of the infant, herself and her home and she is usually exhausted and resentful. It takes several days of personally caring for a child before the parents realize that the infant is their baby. When this responsibility is taken over by someone else, the mother especially feels cheated of this experience. She is hostile because she feels that she is still being viewed as a child and is not accepted as a mature, responsible adult. No matter how helpful relatives want to be, a stipulation should be made before they arrive that the mother and father will assume the care of the infant and the relative will do the housework, cooking or washing as their part of being helpful.

¨ If help with the housekeeping is needed, it is frequently best to hire outside help or establish a co-op with a friend who is expecting or has delivered recently to assist in those housekeeping chores which are a concern to the new mother. Rather than expending energy cleaning her home, the new mother should spend her time bathing and nursing the infant and let the house go because the house work will still be there in 2 weeks. She should be able to rest when she wants to and sleep in between feedings if so inclined.

¨ Enough infant clothes should be purchased so that washing every 3-4 days or so is all that is necessary. Several meals can be prepared ahead of time and frozen to ease meal preparation. After two weeks, relatives can be invited to come and spend an extended visit with the family and the new infant, now that the mother is comfortable in the role of a nursing mother.

FORMULA FEEDING

1. If you decide not to breastfeed, then you may choose either a cow milk-based formula or a soy-based formula. Formulas such as Enfamil Lipil or ProSobee provide all of your baby's nutritional needs for the first 4-6 months, you may begin solid foods but you should continue to use formula throughout the first year.

2. As with breastfeeding, infants vary tremendously in their feeding schedules so be flexible! Newborn infants usually consume about 1-2 ounces of formula per feeding when they are discharged home from the hospital. This volume will gradually increase with time and many babies will take 3-4 ounces per feeding after a few weeks. Some will take more and some will take less. As long as your baby is gaining sufficient weight, he or she is getting enough so do not focus on the number of ounces per feeding.

3. Formula-fed babies will usually feed less frequently than breastfed babies, usually every 3-4 hours but be flexible! Some babies may want to feed every 2 hours, while other babies like to sleep a lot and would go for 7-8 hours without a feeding if not woken up. We recommend that you feed your baby every 2-4 hours on demand during the day, but at night, you may let your baby sleep up to 5 hours in between feedings. This will allow parents to catch up on needed sleep and will help the infant learn to take his or her long sleep when everybody else does. If your baby sleeps during the day and is up a lot at night, you should keep your baby up during the day so he or she will be tired and sleep more at night. Babies need a certain number of hours of sleep in a 24 hour period and it does not matter to them if their sleep time is during the day or night, but it certainly matters to you.

4. Iron-fortified formula has not been shown to cause any adverse gastrointestinal side effects despite the widely known "wives' tale" that iron causes constipation in babies. Therefore, we recommend that you use iron fortified formula in order to prevent iron deficiency.

5. You may use either the concentrate powder or Ready-To-Use formula as long as you follow the package instructions carefully. It is very important that you use the right amount of water while preparing either the powder formula or the concentrate. You may store open cans of concentrated formula or ready-to-feed formula in the refrigerator for up to 48 hours. Opened cans of powder formula should be covered and stored in a cool, dry place, not a refrigerator, and it may be stored for up to 1 month. DO NOT SAVE FORMULA LEFT IN A BOTTLE AFTER FEEDING YOUR BABY. Some of the formula that has come into contact with the baby's mouth is re-introduced into the remaining formula causing it to be no longer suitable for storage.

6. Once formula is prepared, it can remain in a covered bottle at room temperature for up to 3 hours. When you use an un-opened can of ready-to feed formula that has been stored at room temperature, you do not need to warm the formula. You can heat bottles of infant formula that have been prepared and refrigerated in a pan of hot, but not boiling, water or by running hot tap water over the bottle. Always test the temperature of heated formula before feeding by letting a few drops fall on the inner side of your wrist. The liquid should feel warm not hot. DO NOT HEAT YOUR BABY'S BOTTLE IN THE MICROWAVE OVEN. The liquid may become extremely hot although the bottle itself remains cool to the touch. Drinking the hot liquid could burn the baby's mouth or throat. Also, steam may form which could build up and cause the bottle to explode.

7. Formula should flow through the nipple and drop. If the flow is too rapid, use another nipple. If the flow is too slow, enlarge the hole slightly with a hot needle or toothpick, or unscrew the nipple slightly. Hold your baby comfortably with the baby's head a little higher than the body. Tilting the bottle to fill the nipple with formula will reduce the amount of air your baby might swallow. YOU SHOULD NEVER PROP YOUR BABY'S BOTTLE TO LET THE CHILD FEED BY HIMSELF/HERSELF. Bottle propping not only deprives your baby of the physical contact but it may also be dangerous to small infants who may choke on formula or water if left unattended.

8. Once or twice during the feeding and after feeding, try to burp your baby to help remove swallowed air. Hold your baby upright against your shoulder or face down across your lap. You may also hold your baby upright on your lap, supporting the head and chest with your hands. Then, gently pat or rub your baby's back for a minute. Babies do not always burp after a feeding, so don't insist if your baby does not burp readily.

9. Water and bottle sterilization is not necessary when safe water, such as tap water or bottled water is used. You may choose to boil water prior to mixing with formula powder or concentrate, although it is not necessary. Bottles may be properly cleansed with soap and hot water but you may boil them if you so desire.

10. Supplemental water is not necessary for breastfed or formula-fed babies. Excessive feeding of water may result in water intoxication. You may give the baby small amounts of water in-between feedings on extremely hot days but it should not be given in place of a normal feeding.

NEWBORN APPEARANCE

Many parents have concerns about the following newborn appearances. In most cases, they are normal or can be remedied by simple methods.

Head

¨ White dandruff-like flakes are often found on the scalp of infants. These flakes are the result of normal shedding of old, dead skin, and they do not indicate a dry scalp condition. Do not use oils, lotions, or Vaseline. They can only stick these flakes to the scalp and make the condition worse.

¨ If you notice thick yellowish scales, this is cradle cap. It is very common in infants and it results from the accumulation of old dead skin. This condition can occur in spite of washing. Oils, lotions, or Vaseline make this condition worse. You can treat cradle cap by removing the scales with a soft brush.

¨ The soft spot, or fontanel, on an infant's head is a normal gap where the skull bones have not yet joined. The spot is covered by a thick, fibrous tissue and is very tough. You do not need to fear hurting the soft spot. Sometimes you may notice pulsating of the soft spot. This is normal.

¨ The skull bones contain many normal lumps, bumps and irregularities. This is also normal. Many babies have localized areas of swelling on the head or even a cone-head appearance. This usually resolves within a few days after delivery.

¨ Babies are able to turn their head to the side but when they try to hold it up, it usually bobs forward and backward for the first few months.

Ears

¨ Yellow-orange discharge from the ears is called cerumen or ear wax. It is a normal product of the ear canal lining and will periodically discharge itself to the outer ear. It can be wiped easily from the outer ear with a cotton swab. Babies are able to hear sounds; they may be startled by loud sounds or soothed by consoling sounds.

Eyes

¨ Many infants appear to have slightly crossed eyes. This is most often caused by temporary muscle imbalance. Also, sometimes the wide skin area across the nose makes the eyes appear crossed when they are not. Crossed eyes will generally correct themselves by the end of the first four months. It is common for babies to have swollen eyelids for the first few days. Many babies commonly have a crusty eye discharge, please call us if this persists. In the meantime, you can wipe it with a moist cotton ball. Also, eye color (of the iris) may change within the 1st year. Babies are able to see objects best when placed 6-18 inches in front of them.

Skin

¨ Some infants have white dots over their nose. These are called milia. They are harmless and will disappear without treatment. Pimples on the cheeks or chin are called newborn acne and are the symptom of one of the most common newborn rashes. This rash will resolve itself in 6 to 8 weeks. Oils, lotions, or cream will worsen the problem. Babies commonly have dry, peeling skin especially on the hands and feet. This usually does not require any treatment but you may use a moisturizing cream.

Birthmarks

¨ Many babies have a dark "Mongolian spot" found on the lower back or buttocks. Babies commonly have various red-colored birthmarks found on the face (eyelids, forehead), scalp, back of the neck, and anywhere else on the body. These will gradually fade but may take months to years.

WEIGHT GAIN AND WEIGHT LOSS

¨ Most newborns weigh between 5-1/2 to 10 pounds, with the average weight being about 7-1/2 pounds. During the first days of life, infants generally lose 4 to 10 ounces before they start to gain weight. Breastfed babies may lose slightly more weight at first without cause for concern. This weight loss is from the loss of excess body water, and is perfectly normal. Most infants will regain their birth weight by 2 weeks, double it by four months, and triple it by one year.

NORMAL ACTIVITY

¨ The range of activity of a newborn baby is quite limited. The baby is totally dependent upon the mother in the first months of life to fulfill his/her needs and desires, and only has a few ways to express those needs. The most frequent activity of a newborn baby is sleeping. At this age, the child may sleep 18-21 hours a day, leaving very little time for feeding and diaper change.

VITAMINS

Your baby will be given a proper vitamin supplement (usually Tri-Vi-Flor) when necessary.

BABY'S BATH

¨ The new baby may be bathed daily. Before the cord is off and the navel healed, the bath should be a sponge bath using soap and water. As soon as the navel and circumcision is fully healed, the baby's body may be immersed in lukewarm water and thoroughly soaped. Any mild, white, non-medicated soap is satisfactory — Ivory, or any of the standard brands of soaps for infants. A "bathinette" is very convenient but not essential. The dishpan or sink may be made to serve satisfactorily.

¨ The male genitals may be washed thoroughly with soap. The female genitals should be cleansed with plain water only. No soap should be used. Use a ball of cotton and be very gentle — never use a rough washcloth since the skin in this area is very sensitive. After drying, baby lotion may be used, but sparingly.

¨ The ears should be washed, but do not attempt to remove wax from the ear canal. Clean only as far as you can reach with the finger. Be careful to clean the crease behind the ear. Occasionally, a little oil is necessary if the skin cracks at that point.

UMBILICUS (Navel)

¨ The navel should be cleansed several times daily with rubbing alcohol on a cotton applicator and left exposed to the air. Do not be disturbed if the cord looks black and occasionally, a few drops of blood may be seen at the base. If there is a great deal of oozing and redness around the navel, or if there is a foul odor, notify me at once. It is not necessary to cover with a gauze or binder.

BREAST ENLARGEMENT

¨ Breast engorgement is frequently seen in the newborn boys and girls. This is a physiological process. The engorgement may be considerable and a milk fluid may ooze from the nipple. Leave this strictly alone. Do not massage, squeeze or anoint with oil. This disappears after a few weeks.

CIRCUMCISION CARE

Leave the bandage on for 24 hours. You may apply Vaseline to the exposed tip of the penis or to the bandage in order to keep it moist. In 24 hours, or if the bandage falls off before then, start the following routine with every change:

1. Cleanse with water.

2. Push the skin back with a wet Q-tip or your finger so you can see the groove around the base of the head of the penis. Do this gently like you are pushing back a cuticle.

3. Apply Vaseline.

4. This is the basic care. Done properly, it will promote good healing and a satisfactory result. Following are a few pointers which will be helpful and answer most of your questions.

5. Bleeding — a few drops of blood may be expected. If you see a spurting vessel or a steady ooze, place the penis up on the lower abdomen and with a gauze or cloth pad over the penis, APPLY FIRM, DIRECT PRESSURE TO THE PENIS FOR TEN MINUTES BY THE CLOCK. DON'T PEEK.

6. Bathing - the condition of the umbilical cord will determine when you can immerse him in a bath tub. Even if the cord has fallen off, wait for 5 or 6 days.

7. A soft yellow scab is often confused with an infection or pus. It is normal. It usually forms on the head of the penis or where the skin was clamped. You may cleanse this area with a Q-tip and Peroxide and try to tease it off gently. If it doesn't come off, don't worry.

CARE OF THE GENITALS IN FEMALE

¨ Some vaginal discharge is present in the newborn female. This may be white mucoid material or bloody. Both are normal and last only a few days. Wipe off with cotton moistened with sterile water.

DIAPER RASH

¨ The best cure for diaper rash is prevention. Change your baby's diaper as soon as possible after each bowel movement or wetting. Wash the area with plain water, and apply diaper-rash cream or Vaseline.

¨ Some babies are prone to diaper rash. The following suggestions may help:

— Leave the diaper off for about 15-30 minutes 4 times daily to air-dry the area.

— Substitute cloth diaper if you are using disposables.

— Use a mild soap to wash the diapers, and add 1/2 cup of white vinegar to the final rinse cycle.

— Do not use bleach or fabric softener.

— If the rash contains "whiteheads" or pus, wash the area 2 to 3 times daily with a mild soap and apply ointment.

— Call the office if the rash continues to spread or is not resolving with the above methods.

BOWEL MOVEMENTS

¨ If your baby seems happy and content, the child is eating normally, and has no symptoms of illness, then do not worry about minor stool changes. Changes in number of stools, consistency, or color are normal.

¨ The number of stools a baby has daily varies. Some babies may have a stool with every feeding — that is 6-8 stools per day — or they may have one stool 36-48 hours. The consistency and color of stool will also vary from day to day. Breast-fed infants usually have very liquid, yellow or mustard-colored stools. All babies will occasionally have green, brown or gray-colored stools.

¨ Babies often strain, grunt, grimace and turn red in the face when having a bowel movement. This is not a sign of a problem.

¨ Constipation is present when stools are small, hard and pebble-like. Constipation has nothing to do with the number or frequency of stools. Do not use enemas, suppositories or laxatives until you have talked to me. You may give your baby brown sugar mixed in water for constipation.

BABY'S SLEEPING HABITS

¨ Do not worry about the exact amount of sleep as long as your baby seems content and is gaining weight, and is given enough opportunity to sleep. Most babies have one wakeful period during the day — usually of about four hours duration.

SLEEP POSITION

¨ Based on careful evaluation of existing data, indicating an association between Sudden Infant Death (SIDS) and placing infants to sleep on their stomach, i.e. prone position, the American Academy of Pediatrics recommends that normal infants, when being put down for sleep, be positioned on their side or back. If babies vomit frequently, have chronic respiratory problems, or are premature, please ask your physician for further instructions.

HANDLING THE BABY

¨ You need have little fear when handling the baby. However, the head is heavy and the neck muscle is weak, so the head should be supported when you pick the child up. The child will not be injured if the head falls back. The "soft spot" is covered with a tough membrane which protects it. Baby has an instinctive fear of falling and prefers being held firmly when picked up. Sudden movements also frighten the baby and cause an instinctive clutching movement of the arms and hands.

DRESSING THE BABY

¨ In general, baby should be lightly but warmly clothed. Common sense prevails. Do not bundle your baby up when you are comfortable in shorts and blouse. One more layer of clothing is required during sleeping periods than when awake. Dress the baby as you dress yourself. Do not overdress your baby on a hot day.

GOING OUTSIDE

¨ The baby may be taken out of doors anytime after he or she is home from the hospital. Care should be taken to ascertain that the child is properly dressed (neither too warm, nor too cold). The child should be protected from cool breezes, the sun and insects. Avoid crowds of people. Do not let anyone who is sick come near your baby. Do not allow anyone to handle your baby without first washing their hands.

COMMON COMPLAINTS

1. Crying:

¨ There are many causes for crying during the first few months, as you will discover for yourself. The most important is hunger, and you will soon get used to what a hunger cry sounds like. The thing to do is feed the child.

¨ The next important cause is a wet or soiled diaper. This is easy for you to investigate and while you are at it, be sure there isn't an open safety pin.

¨ The baby may have some indigestion after a feeding. Try burping the child again.

¨ On occasion, baby is more irritable and requires more comforting and handling. If so, a little attention or rocking often helps.

¨ Other times your baby will cry just for the sake of crying. The child is expressing his or her individuality. Don't pick the child up every time he/she cries, but if after five or ten minutes the baby hasn't stopped, then you may pick the baby up and soothe him or her.

¨ If the child cries longer than 10 minutes, after a feeding, try a little rocking. This is relaxing and will not spoil him. Try to maintain a cheerful, confident and casual manner with all problems that affect the baby. This helps keep the baby relaxed. A tense attitude on your part likewise tends to make a tense and unhappy baby.

¨ Individual babies have different temperaments; some cry a lot, and some cry very little. Crying may last a number of hours per day and it usually peaks by 6 weeks of age.

¨ If you can not find any cause for the child's crying and it persists for a prolonged period no matter what you do, be sure to call the doctor.

2. Colic:

¨ Colic is a poorly-understood disorder in which babies have a period of unusual and unexplained fussiness of several hours duration, usually in the evening. They may stiffen or draw their legs up as if having abdominal pain, although we do not know if this is the case. The cause is unknown. Some babies are helped by a warm cloth on their bellies or by feeding them one or two ounces of warm water when they are colicky. If you think your baby is colicky, make sure you are burping the child thoroughly, especially if your baby is a vigorous feeder. If you are nursing, make sure you are not eating or drinking a source of caffeine and try eliminating cow's milk in your diet. If this doesn't relieve the baby's symptoms, please call to discuss it with us.

3. Coughing and Sneezing:

¨ All babies cough and sneeze fairly frequently. This is normal, being their way of keeping the respiratory passages clean.

¨ Hiccoughs are common, harmless, and self-limited. No treatment is necessary.

4. Spitting Up:

¨ All babies regurgitate small amounts of formula occasionally. This is harmless unless it occurs too frequently or in too large quantities.

5. Colds:

¨ A runny nose, nasal congestion or mild cough — unless they are accompanied by vomiting or high fever — can usually be handled at home. Most newborns have an increased amount of nasal mucus during the first one to two months of life that can result in sneezing and noisy breathing. The nasal bulb syringe you were given at the hospital should be used to remove the mucous. A vaporizer (cool mist type) in your baby's room at night also may help as well as a non-medicated saline nose spray.

6. Noisy breathing:

¨ It is very common for babies to have noisy breathing, especially while feeding. Babies in the beginning are obligate nose-breathers and will commonly have nasal congestion with noisy breathing due to normal nasal secretions which accumulate inside the baby's small nasal passages. You can use the bulb syringe to suck out these nasal secretions. If it appears that your baby is having a hard time breathing, please call us.

7. Periodic Breathing:

¨ It is very common for young infants to have periods of fast, shallow breathing alternating with periods of slower deeper breathing.