Newborns

Feeding

The choice of a feeding method for you child is a personal one. As Pediatricians, we recommend breastfeeding as the optimal method of feeding your baby, but commercially prepared formula is an acceptable alternative. There are both advantages and disadvantages to the method of feeding. The choice is yours.

Breastfeeding

Most women are able to breastfeed their babies successfully, but the establishment of a rewarding nursing relationship between mother and baby may require a week or two of adjustment and patience.

Ideally, the mother should nurse the baby after birth. The infant may have difficulty in early attempts at breastfeeding, or may nurse eagerly and proficiently. Initially, the mother should nurse the baby every one and a half to three hours, (at least during the day) or 8 to 12 feedings in 24 hours. This insures adequate calories, stimulates milk production, helps prevent jaundice and engorgement, and teaches the baby the difference between day and nights. Nurse long enough to stimulate milk production and allow time for the let-down reflex (10 to 15 minutes on each breast). Use both breasts at each feeding, alternating which one you start first. Try to burp the baby after each breast. The milk will usually come in about the third day. Babies may lose up to 10% of their birth weight during the first week, so do not be unduly concerned about a drop in weight.

Many mothers get sore nipples in the early days of nursing. To prevent soreness, make sure the baby grasps the nipple properly, getting as much of the areola as possible into the baby's mouth. Prevent sucking on the end of the nipple. Air dry nipples after each feeding. Alternate nursing positions frequently: Use the cradle hold, the football hold or the lying down position. Don't hesitate to ask the nurses in the hosptial for help when needed.

After the early weeks of breastfeeding, the baby should nurse on common sense "demand" schedule. Expect to feed the baby every two and half to three hours during the day, with four to six hour stretch at night. Avoid nursing more frequently than every two hours or you will bechome exhausted! Most babies will not need water in the first year as breast milk (or formula) has a high water content.

A breastfeeding mother should eat a nutritious diet (300-500 calories more than while pregnant) , drink to satisfy thirst and avoid gas producing or spicy foods, as well as caffeine (found in chocolate, coffee, tea or many carbonated beverages). Most foods will not upset the baby, but if your baby is fussier than usual, look back six to eight hours to see what you ate.

Bottlefeeding

Almost all bottlefed infants are given a prepared commerical formula which is available in powder, concentrate, or "ready to feed" forms. The preparation of formula varies. Please ask if you have any particular questions. Several things will apply to all however:

1. Water for the formula does not have be boiled if you are using purified city water or treated rural water. If you use well water, it must be tested for both bacteria and nitrates. Please call the environmental division of the county health department for information on testing. Well water should be boiled for the first two months. Bottles and nipples do not need to be sterilized, but should be carefully washed with hot soapy water and rinsed well. 2 The amount of formula offered should be just a bit more than the baby takes per feeding. One can approximate the amount to be fed but each infant will demand different amounts.
2. Give the bottle on a reasonable "demand" schedule. An infant should eat at least four hours during the day, but may want to feed more often. At night, feed only when the infant wakes up so all can get a good night's sleep.
3. The need for burpings varies with each baby. Plan to stop and burp after each ounce, and particularly at the end of the feeding. But don't be surprised if this doesn't always work for your baby.
4. Since there is adequate water in the formula, your baby will probably not need water. 6.Solid foods are usually started between four and six months. Late introduction of solids helps prevent alleriges, eczema and excess calories, which could lead to obesity later in life.

Baby Hygiene

1. Eyes: Clean with clear water and cotton.
2. Ears: Do not attempt to clean the car canals. Clean the folds with a washcloth. Do not use "Q-Tips".
3. Nose: Clean the visible secretions with a clean washclothe. For excess mucous, use a bulb syringe.
4. Mouth: No special care is needed.
5. Navel and Cord: Rubbing alcohol should be used on and under the cord or navel twice daily until complete healing has occured. (Continue to use alcohol for about a week after the cord falls off. This make take up to three weeks.)

6. Genitalia: Girls - Clean between the folds with a soft washcloth and soap and water, cleaning from the front toward the rectum. Some small amount of vaginal bleeding or discharge the first few weeks is normal. Boys - Circumcised infants - The circumcision requires no special care. The plastic ring will usually fall off in about five to eight days. There is usually a slight discharge a day before and a day after it drops off. Uncircumcised infants - The foreskin of the uncircumcised newborn requires little or no attention. If smegma appears, it may be washed off easily. One need not worry about pushing the foreskin back. It is not retractable at birth and you should not try to force it back over the glans of the penis.

7. Nails: Trim the fingers and toe nails closely and squarely across; do not shape the nail to the finger or toe.

8. Skin: The baby's skin in the first few weeks of life is usually dry and scaling. This is normal. Lotion may be used if desired, but is not really necessary. Do not use baby oil or Vaseline. For a rash on baby's bottom, use a cream like Desitin.
9. Face and Scalp: A moderate rash (red bumps with whiteheads) on the face is quite common and is due to plugged oil glands. Washing with soap and water will usually clear this rash. "Craddle Cap", a greasy scaling condition, can be controlled in most cases by brushing your baby's hair or scalp every day with a good baby brush. If your baby does develop "Craddle Cap", use a dandruff removing shampoo such as "Head and Shoulders".
10. Baby Clothing: Don't over dress your baby. A soft fabric such as cotton is preferable. Clothing should be loose fitting and not allowed to bunch or bind. Wash all clothes before putting them on your baby.
11. Diapers: Many parents prefer disposable diapers. They are not only convenient, but seem to cause less of a problem with skin rash. If using cloth diapers, soak soiled diapers in cold water in a covered container, wash in hot water with mild soap and rinse well, at least twice.

Baby's Room

The room temperature should be between 70-74 degrees Fahrenheit for the first two or three weeks. A greater variation is all right after this, permitting the room temperature at night to drop as low as 60 degrees. In general keep the temperature at a level you are comfortable with and dress the baby in the same way you are dressed.

Bath

Bathe the baby with soap and water. A daily bath is not necessary. In fact, daily bathing in cold weather causes additional drying of the skin. The bath may be given in the evening to help tire the baby out and straighten out days and nights.

General Information

1. Keep visitors to a minimum, and limit the time of each visit. The least handling and disturbance of the baby in the first month or two is best. This will give the family and baby a chance to adjust. People with colds or other infections should not visit the baby.
2. "Pacifiers" can be used at any time. Your baby may have a very strong sucking reflex and find a pacifier to be smoothing. This small gadget can give your baby emotional satisfaction with a minimal irritation.
3. Most babies sleep well on their back or side. Recent studies have shown that this is a safe position and reduces the incidence of Sudden Infant Death Syndrome.
4. Never leave the baby unattended on a flat surface or while changing the diapers. Even the newest baby has rolled off the changing table or couch.
5. Fever is a rectal temperature of 100.5. After taking the baby's temperature., tell the physician or nurse the number and how it was taken (rectal or under the arm). Please do not subtract or add any numbers from the reading. A fever is an important sign but it is not necessary to "break a fever" unless it is very high (over 104). We should see a baby under two months of age with any fever. An older infant should be seen if the fever is over 101, lasts more than 24 hours, or the baby looks ill to the parents. Again trust your common sense - you will not "miss" an important illness.
6. Bowel function is so variable that unless there is diarrhea (watery stools, 6-8 a day) there is no reason for concern. A breastfed baby will have stools that are much looser and more frequent than a bottlefed baby. If the stools seem unusual or constipation is a problem please call the office.

Recommended Reading

Your Baby's First Year Caring for Your Baby and Young Child What to Expect the First Year The Baby Owners Manual - What to Expect and How to Survive the First Year Little People - Guidelines for Common Sense Child Rearing Happiest Baby on the Block
On Becoming Babywise Solve Your Infants Sleep Problem

Follow-Up Care After You Go Home

The newborn screen is a blood test required for all newborns by State Law. The best time to sample the blood is after 24 hours of age. However State law requires it to be done at the time of discharge from the hospital. If your baby leaves the hospital before 24 hours of age, the test may have to be repeated. If you are notified, you will need to return to the hospital laboratory for another test.

All Babies

1. Bring the child to the office for a complete examination and weight check at about 3-4 days of age. Please call for an appointment soon after leaving the hosptial (537-9030)
2. Routine Exams are at 3-4 days, one month, two months, four months, six months, nine months, and one year.
3. If your baby is sick, call the office and, in most cases, the appointment will be made for that day.
4. When calling to talk with a doctor or a nurse, please give the receptionist a brief statement concerning your call. Many times a nurse is able to answer your question, although she may need to return your call. If not, the doctor will return the call as soon as he/she has time available. The doctor will not be called to the phone when he/she is with a patient.

Please call for routine appointments several weeks in advance.