by Lori McAuliffe M.D.
I have 4 children … “spaced” over 4 years. My oldest is a son, I have boy-girl twins sandwiched in the middle, and my youngest is a daughter. When I became a mom, I found I had countless questions that even my training as a pediatrician couldn’t help me to answer: Whose breasts are these and how do I use them? Is that a normal poop? How do all these snaps work? And most frustrating of all….Do I know what I’m doing and will the baby be okay?
There are a gazillion books out there about child-care — some of which are probably on your shelf. When I had a question, what I really wanted was a quick answer that was reliable and easy to understand. As a pediatrician, I was embarrassed to always be calling my child’s doctor. Wasn’t I supposed to know this stuff?
I hope that this quick 26 point review will help you and your spouse prepare for your new baby and reliably answer your not-as-stupid-as-you-think questions.
A car seat is something you will need to obtain before you go into labor. It’s a little late to go shopping after (!), and the hospital cannot release your baby until you have one. Your child will face the rear of the car until he is 20 lbs AND at least 2 years old. The seat should be placed in the middle of your car’s back seat because that is the safest location. Never, never, never place a car seat in the front seat with a passenger side airbag. Airbags can be lethal to little people. Some cars have airbags you can disable, but I wouldn’t risk it with my own children, so I can’t recommend that you do. Most children will remain in some supplemental car seat/booster until 5th grade. The American Academy of Pediatrics now recommends that children under 12 years should never ride in the front seat.
There are many types of car seats available, and improvements keep coming every year. A good first seat is an Infant Car Seat/Carrier. The base stays in the car while you carry your infant in the removable seat – which means that you don’t have to wake your child getting into or out of your car. You can even snap the seat into grocery carts to allow you to shop with your beautiful baby! This seat can accommodate a child up to about 6 months of age or 20 lbs.
A Convertible Safety Seat is one you can position reclined and rear facing until your child reaches 2 years of age AND at least 20 lbs, and then “convert” to forward facing until your child reaches the maximum weight rated for the chair, usually 30 – 40 lbs. If your baby reaches 20 lbs. before one year of age, he should still face the rear because his neck muscles are not developed enough to support his head in a rear-end collision (the most common type.) Use this seat as long as your child fits in it (ears below the top of the seat and shoulders below the seat strap slots). Most fire departments will be happy to inspect your seat for you to ensure your baby’s safety and AAA also has a car seat inspector.
The safest car seats have a 5-point safety harness. Of course, the seat is only safe if it is properly connected to the car. If you have trouble buckling the seat to the car, or if you’re unsure about the connection, stop by your car dealership or a fire station to have them double check the connection. Many new cars have special mounting hooks for the seats to attach to, and you’ll want to use them if they’re available. Once your child has squirmy, curious hands you’ll have to make sure they have not unhooked the seat belt.
Use a booster seat when your child has outgrown a convertible seat but is still too small to fit properly in your car’s seat belt. If the bend in your child’s knee does not reach the edge of your car’s seat AND he is not 58 inches tall and over 80 lbs, then he is not ready to be out of a booster seat. As with other things in life, just because his friends do it, doesn’t make it safe. It is now the LAW that ALL CHILDREN be buckled up ALL THE TIME.
In a moving car, it is NEVER okay to hold your child in your lap, breastfeed your child, or remove your child from his car seat or seat belt.
Breast milk is the BEST nutrition for your baby. It contains antibodies that protect your child from disease and allergies. Formula does not. Breast milk is always the right temperature, there are no bottles to mess with, and it’s absolutely free. What’s more, breastfeeding gives you an indescribable bond with your infant.
The breast usually fills with milk by the third day after delivery. Before that, your baby will get small amounts of an antibody rich fluid (called colostrum) that also acts as a laxative to help your baby poop. Put your baby to breast as soon after delivery as you are able. Hold your baby with his tummy to your tummy. Hold your breast between your thumb and forefinger. Tickle your baby’s lower lip with your nipple, and when he opens his mouth, draw him toward you so that your entire nipple and most of the brown area (areola) are in his mouth. He will naturally begin to suckle. You can end the feed by putting your finger in the corner of your baby’s mouth to break the seal; this is much more comfortable than simply pulling the baby off your breast.
Initial nursing should last about 10-15 minutes per breast every 1 ½ to 2 hours day and night. DO wake your baby every 2 hours to get onto a schedule early on. DON’T let your little one doze off when it’s feeding time. Stimulate him by stroking under his chin and briskly rubbing his feet or head to keep him awake and sucking; or try burping and changing his diaper before feeding from the other breast. Time your feeds from the end of the last feed to the start of the next (i.e. if you finish feeding at noon, plan to start again by 2pm).
The more frequently you offer the breast, the sooner your milk will come in and the sooner your baby will master the art of breastfeeding. Remember, the more you nurse, the more milk you will have. Once your milk is in (this is NOT subtle-your breasts will become VERY engorged and tender) and the baby is back to birth weight, you will no longer need to wake the baby at night to feed. Get your rest when you can! Keep in mind that most breast fed babies do not “sleep through the night” (longer than 4-6 hours) until they are about 4 months old. Please remember to drink, drink, drink to keep up your milk supply. Try to drink a full glass of water every time you nurse your baby.
Try not to become frustrated with early breast feeding. There are no empty bottles to hold up at the end of the feed to know that your baby “got milk.” Just know that anything that comes out in the diaper is a direct result of what you put into his mouth.
It is best not to use a bottle during the first two weeks of breast-feeding as this can create “nipple confusion.” Your baby has to position his tongue differently to get milk out of the breast than he does to get milk out of a bottle. Milk also comes out faster and easier from some bottles than from the breast, so try not to introduce this “lazier” way to eat until your little one has mastered the breast. Avoid pacifiers for the first two weeks for the same reasons. Offer instead your (or daddy’s) clean, short-nailed pinky finger for your baby to suck when he is fussy but it’s not yet feeding time. Once your baby is breastfeeding well, it is fine to offer a pacifier if you choose.
If you want to breast feed but are having trouble-don’t give up. You are not alone. It’s a lot harder than it looks. There are breast feeding (lactation) consultants whose job it is to provide you with the “owner’s manual” to your new breasts. She will help you position the baby and to help him latch onto the nipple correctly. Ask to speak to one while you are still in the hospital. You will find her a tremendous resource when you have questions about sore nipples or a super hungry baby. Do your breasts a favor and apply lanolin cream (like Lansinoh) to your breasts after feeding. This moisturizer will help to prevent dry, cracked, painful nipples and it’s non-toxic to your baby. All Children’s Hospital has a team of experts to help you succeed at breastfeeding; call the B.E.S.T. team at (727)767-8686.
If you are a working mother, ask your doctor about getting a breast pump. These electric, dual pumps can “extract” a full feeding in about 5 to 10 minutes. A hand held pump is okay for occasional, emergency use, but is too tiring to use every day. You can buy an electric breast pump for about $200 (Medela Pump In Style) or rent one from your local hospital for about $30 a month. Your breast milk can be stored in the freezer for up to 6 months, or in the refrigerator for 24 hours (warm under the faucet before feeding). It is best to breast-feed for the full first year of life, but if you can’t or choose not to, even just the first 6 – 8 weeks will make a tremendous difference to your beautiful (and grateful) little baby.
Breastfeeding is not possible for everyone. Should you decide to supplement your breastfeeding, or to bottle feed, it is very important that you use an iron fortified formula. Iron is needed for your baby’s rapid growth and to prevent anemia. Iron does not cause colic or constipation. Also start with a milk based formula (like Similac) rather than a soy formula (like Isomil).
If you choose to use powdered or concentrated formula, you will need to add water. The Academy of Pediatrics recommends that any water used to mix formula be boiled first for the first 4 months of life. This can be accomplished by using distilled water. NEVER microwave your baby’s milk as heating is uneven and “hot pockets” can cause serious burns.
A formula fed baby will usually eat 1-2 ounces every 3-4 hours at first. Try to get your baby to burp after each ounce. Please consult your doctor before feeding whole or goat’s milk (which cause anemia and iron deficiency in babies) or before changing formulas. There is no reason to feed water or juice (other than if your doctor recommends prune juice for constipation) to a baby under 6 months, and doing so can cause serious illness.
Do not “prop” any bottle that you feed to your baby. Hold the baby in a semi-upright position and hold the bottle yourself. This is especially true at naptime or bedtime when it is tempting to let your baby hold the bottle himself, or to prop it against the side of the crib. Your baby WILL GET CAVITIES if you do this. It is only a matter of how many and how soon. If you must put your baby down to sleep with a bottle, and the baby is over 6 months, please only offer water.
As for types of bottles, glass bottles are the safest except that they can break if they fall. There are some recent concerns with plastic bottles because some of them contain a chemical called bisphenol A (BPA). If you choose plastic bottles, I like the Dr. Brown’s bottles and Avent. Be sure to check the “recycle triangle” and avoid any that contain the number 7. Number 1 is best. In general, it is best to avoid clear plastic bottles or containers with the recycling #7 and the letters “PC” imprinted on them as many contain BPA.
I also recommend slow flow nipples which empty most like the breast.
Looking ahead – babies will usually start eating “solids” at about 4 months of age. You will start with Rice Cereal and Stage 1 pureed baby foods.
An ounce of prevention: Thrush is a yeast infection that causes a white coating to develop on the tongue and inside of the cheeks. It can be prevented by scraping the inside of your baby’s cheeks and tongue twice a day with a clean, damp wash cloth fitted over your index finger. If thrush develops and your baby becomes fussy, she may need to be treated with medication and, if you are breast feeding, so will your nipples.
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A new baby brings with her countless questions and worries. In most situations, common sense will dictate what you should do. It may be hard to think straight when your little bundle of need is crying, but stay calm. Work through the basics: When did she eat? Did she burp? Is her diaper clean? Has she slept recently? Is her nose clogged? If everything checks out, turn on the charm: rock, hug, sing, walk, and hold. Remember, crying is your baby’s way of communicating.
If your baby is over 1 month of age, excessive crying may be due to something called “colic.” A colicky baby will have a fussy period in the early evening that lasts several hours. She may draw up her legs and pass gas. Her face may get beet red and she may be difficult to console. She might respond simply to being picked up and held, or she may need rocking or an automobile ride to break the spell. If it is just colic, she should still feed well and act bright and alert between episodes. It is okay to try 0.3ml of Mylicon Infant Anti-Gas Drops several times a day to see if this relieves some of your baby’s discomfort. However, if she won’t eat and isn’t acting normally, it is not colic and you should call your doctor.
Also use common sense to protect your newborn’s health, and your sanity. It is best for your baby not to be around lots of visitors in the first week or two of life to prevent exposure to illnesses. This time is better used for rest and to get to know your child. After that time, simply supervise those handling your infant, but insist that they wash their hands first – doctor’s orders! It is fine for your baby to go out of the house with you; she is part of your family now. Just don’t leave your common sense at home.
You may find yourself getting lots of parenting advice from well meaning friends and relatives. It is usually a good idea to get the answers to your questions, or theirs, from your pediatrician. This will save you lots of confusion and aggravation.
Common sense will help you keep your child safe. Never leave your baby unattended. Crawl through your own home on your hands and knees (drapes drawn please!) to see what hazards are beneath tables, in cabinets, behind furniture … your baby will find them. Test bath water and formula temperature every time to prevent bums. Never hold your baby while drinking hot liquids. Install smoke detectors throughout your home. Be sure your crib is safe. DON’T buy or use a walker. Buy or borrow an Exersaucer. This is MUCH safer than a walker. DO NOT EVER allow smoking inside your home. Fence your pool in on FOUR sides. And if toys, even gifts, look like junk that might easily come apart and become a choking hazard – throw them away.
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Diaper Do’s and Don’ts:
The battle of diapers vs. the environment continues, but unless you’re unbelievably committed to environmentalism, you should probably go the disposable route. The convenience, effectiveness, and sanitary nature of the disposables usually tip the scale in their favor. However, you’ll still want some cloth diapers on hand for accidents, wet-burps, and your protection at the changing table. Cloth-like diapers tend to be the kindest to your baby’s skin because they allow the skin to breathe.
Be sure to clean your baby thoroughly with a non-perfumed baby wipe each diaper change. Diaper rashes are usually due to irritation to the skin from wearing a damp diaper. Every baby gets a diaper rash at one time or another. Applying Vaseline, Desitin Creamy, or Triple Paste to the skin and creases with each change will help to prevent this. Pure cornstarch baby powder is another great product for preventing diaper rashes. Do not use powder with TALC because, inhaled, it has been linked to several cancers.
Mucus can collect on your baby’s eyelids and eyelashes. You can wipe this away with a moist washcloth. Wipe from the nose side outward. If your baby’s eyes seem goopy or if one eye seems excessively watery, ask your pediatrician about it. It is not unusual for a tear-duct to be blocked, preventing the eye from draining normally. Your doctor can show you a simple massage to improve this, and may want to use an antibiotic drop to prevent infection. If the white of the eye or the skin around the eye looks red or yellow, let your doctor know about it.
Your baby’s eyes will seem to cross and uncross during the first few weeks of life. This is normal as your baby learns to focus, and usually lasts about 1 month. By the way, you can guess all you want, but eye color doesn’t start to set until 6 months of age and can continue to change for up to a year (or more!).
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Your baby girl is exposed to mom’s hormones before birth. It is not unusual for her to have enlargement of one or both breasts or to have a milky discharge from the nipple (called Witch’s milk). You may also see a thin white vaginal discharge and possibly a small amount of blood coming from the vagina (Mom’s hormones causing a mini-period). All of these changes will disappear as your hormones are excreted by the baby.
It is fine for you to use a baby wipe in between her labia and skin folds when changing her. Always wipe from front to back to lessen the risk of infection. If your baby’s labia and vaginal opening seem irritated it is okay to apply Vaseline or Neosporin. Desitin here will typically sting. If the vaginal opening appears “closed,” let your doctor know as labial adhesions are common in baby girls and easy to treat.
In the early weeks of parenthood, your baby’s growth will be your greatest reward for all the hours spent sleepless and frustrated. At every well-visit, your pediatrician will weigh your baby and measure her length and head circumference. Ask your doctor to show you the growth curve so that you can see with your own eyes that she is growing well. Good growth is the best indicator of good health,
Most babies lose about 5 -8 % of their birth weight during the first few days of life, so expect this. Breast-fed babies take a little longer to “get back to birth- weight” (10 days) than their formula fed peers (7 days), but tend to later surpass them. For this reason, breast-fed babies may have additional visits to the doctor for “weight checks” in the first few weeks of life. As a rule of thumb, babies gain about one ounce per day during the first months of life.
FYI: Thriving, healthy babies do not need supplemental vitamins – with one exception. If you are solely breastfeeding your baby (i.e. not offering any formula) you will need to start your newborn on Vitamins A, D, and C (available over the counter as Tri Vi Sol and Poly Vi Sol). If you live anywhere where your water is NOT supplemented with Fluoride your doctor will want to start your baby on this supplement at 6 months. The only other vitamin routinely offered is iron, if your baby is SOLELY breast fed after the 6th month of life (meaning not receiving any iron fortified solids).
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Have On Hand:
There are certain items which you will want to have on hand as you welcome your new baby:
1. A blue rubber bulb syringe to suction out your baby’s nose (you will be given this at the hospital where you have your baby, don’t forget to take it home with you!)
3. Protective diaper cream like Desitin Creamy or Triple Paste
4. Pure Corn Starch Baby Powder (avoid powders with talc)
5. Rubbing Alcohol and Q-tips for cord care
6. Baby Oil for softening cradle cap
7. Neosporin for Circumcision care
8. Aquaphor Ointment for dry skin
9. Important phone numbers in a visible location (like Dr. McAuliffe, Pharmacy, Poison Control, and nearest Fire/Rescue unit)
10. A Rectal Thermometer (since others may be unreliable in infants)
11. Infant Tylenol (do not use in under 2 – 3 month olds without your doctor seeing your baby)
12. Baby nail scissors (cuticle scissors work best)
It is also a good idea to start to keep all cleaners, medicines, and other potential poisons up high and/or in a locked place. Money saving tip: Cut your diaper wipes in half before using them during the first few months. Little butts do fine with little wipes.
Infant Blood Tests:
Your baby will get blood drawn from his heel twice in the early days of life. This blood is tested for several diseases which are treatable if detected early. Many refer to this as the “PKU test” (PKU is a disease that causes mental retardation if untreated), but the screen also looks for thyroid disease, problems with digesting sugar, sickle cell disease, cystic fibrosis, and a potentially fatal hormone deficiency. These test results are typically available to your doctor by the end of the second week of life.
Your pediatrician may also want to know your baby’s blood type and whether it is different from yours. She may order additional tests if Mom had a fever or illness around the time of delivery, if the baby is especially large or small, if the baby was born early, or if the baby appears yellow.
A baby is born with more red blood cells than he needs to live outside Mom. Jaundice is the result of the breakdown of those extra cells (in an adult, that is what makes the poop brown). In a baby, the liver is immature and so the pigment from the blood (which is yellow) makes its way into the skin, eyes, and gums until the baby is stooling more frequently.
A slight degree of this can be normal and no cause for alarm, especially if you are breast feeding (which tends to increase jaundice). It is your doctor’s job to be sure there is no disease or infection causing the jaundice. Remember that the more often your baby eats, the more often he will poop. The more often he poops, the faster the bilirubin is excreted, so feed, feed, feed a jaundiced baby.
Indirect sunlight (through a closed window) may also help to decrease jaundice, but do this carefully to avoid increased temperature or sunburn.
In the event that the pigment level (bilirubin) is too high, your doctor may want to keep a special light (phototherapy) shining on your baby to help to bring the level down. This is done because very high bilirubin levels are thought to be associated with learning disabilities later in childhood. Phototherapy may keep your baby in the hospital longer than you expected or bring him back in once discharged. If available, your doctor may arrange for this light therapy to be done in your home. Keep in mind that the level of bilirubin peaks between the 3rd and 5th day of life for a full term baby, and later for a preterm baby (one born before 37 weeks gestation).
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Learn CPR and the Heimlich maneuver for infants before your baby is born. This may save your baby’s life. Most Hospitals and fire departments will offer monthly classes.
Find a magazine you like that addresses the kinds of parenting and health questions you have. Read about the dangers of second-hand smoke, what “colic” is and isn’t, and what things put your child at risk for sudden infant death syndrome (SIDS).
Keep a child-care guide approved by the Academy of Pediatrics as a supplement to your doctor’s advice (like Barton Schmitt’s Your Child’s Health). However, avoid the temptation to use reference materials when what you need is a trip to your doctor’s office.
Never use home remedies or folk-medicine without first discussing it with your doctor. Remember that children are NOT little adults. Please keep in mind that herbal medicines are simply another form of drug, and that these drugs are not regulated with respect to dose, efficacy, or side effect. They should be used with EXTREME CAUTION in children.
The University of Florida publishes a wonderful free monthly newsletter about the development of your growing child. I strongly recommend that you write to receive your free subscription (12175 125th St. North, Largo, FL 33774-3695).
Read and sing to your baby every day. Studies show that it actually raises his IQ. A baby’s favorite toys are his mom and dad. Spend time holding, rocking, and walking with your baby. If you’re busy in the kitchen, put him in a chair where he can see you working. A baby loves to stare at his parents. He takes comfort from being near them.
Self-esteem begins to build at this young age. Your healthy attitude towards your baby will help him to become a confident and secure human being.
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Before entering the hospital, make the circumcision decision. There’s no right or wrong choice. Circumcision is a surgical procedure which does cause some pain to the baby, but no lasting trauma. You might want to consider what other family members have done. My decision was based in part on the fact that I thought my son would like to look the same way his Daddy does, and that I never wanted to have to ask, “Did you clean your foreskin today?” Many insurance companies will cover the procedure only while the child is in the hospital. If you change your mind later it may cost you several hundred dollars.
Once your boy is circumcised, you will want to apply Vaseline or Neosporin to the head of the penis and then wrap it in gauze for 24 hours, changing the gauze with each diaper. This will keep healing skin from sticking to the diaper. You will also want to be sure your son has a forceful urine stream and that he urinates within 12 hours of the circumcision. It is normal for the head of the penis to appear very red, but if it is bleeding let your doctor know. It is not unusual for the skin around the circumcision to look yellow and thick in the first week after the procedure.
Testicles develop in the abdomen, and then move down into the scrotum. Usually both have descended by birth, but not always. Your doctor will examine the baby to be sure. In many cases, an undescended testicle will descend on its own. This is checked during well visits for the first six months and, if it continues to be absent, a referral is made to a urologist to determine when or if surgery is necessary. Your doctor will also check for fluid around the testicle (hydrocele) which can make the testicle (s) appear enlarged. This usually resolves spontaneously by 9 months.
A little boy is also exposed to his mom’s hormones before birth. It is not uncommon for him to have slight breast enlargement or a milky discharge from the nipples shortly after birth. Both will completely disappear as your hormones are excreted from his body.
Lastly, little boys have little penises. Don’t let Dad worry. Your doctor will check to be sure it is not smaller than is normal. Like the rest of him, it will grow.
In the first weeks of life, your baby breathes only through her nose (except when crying). If your baby is snorty or fussy with feeding, it may be because her nose is clogged. Sneezing is your baby’s only way to clear her nose. If mucus is thick or dried, you can help her to get it out by using a blue rubber bulb syringe to suck out the nose.
Squeeze the bulb, then insert it gently in the nostril, and release the bulb while withdrawing it. Do not use the bulb to blow air into the nose. When the nasal passage is clear, the bulb will open easily in the nostril and the baby will be more comfortable. If the mucus is very thick, you can drip a few drops of salt water (off your fingertip or an eye dropper) into each nostril and then suck it out with the bulb (you can make this by mixing 1/4 teaspoon of salt in 4 ounces of lukewarm water or buy them over the counter – like Little Noses or Ocean Drops).
A baby has very sensitive skin. He should be kept shaded at all times. Indirect sunlight, even in the shade, can still cause sunburn. After 4 weeks of age it is okay to apply a BABY sunblock #15 to exposed skin. Higher numbers are stronger chemicals and not necessarily appropriate for young babies. Keep his head covered with a cap, and take care to stay out of the sun from 10 am to 3 pm when the sun’s rays are at their strongest. Remember that it only takes ONE sunburn to tremendously increase the risk of skin cancer. It is also a good idea to protect his eyes with ultraviolet protection sunglasses which, of course, will make your baby look way cool!
You will want to dress your child sensibly depending upon the temperature. If you are comfortable in a light tee-shirt, chances are your baby will be too. It is usually a good practice to have a cotton blanket on hand, especially if you will be in and out of air-conditioned locations. If you notice a blotchy rash on your baby’s skin (mottling), it may be your baby telling you he is chilled … see section on common sense; you know more than you think you do!
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The only thing you MUST do before the baby is born is find one. Pediatricians (M.D.’s) are all trained pretty much the same way, so look beyond diplomas to find someone that you trust who is available when you are. Most pediatricians offer a prenatal interview free of charge for you to meet the doctor and learn about the practice. Ask about regular office hours and if they have evening or Saturday hours. Ask who is on-call after those hours and how you can reach that person. Find out if the doctor will visit your baby in the hospital’s nursery or have the Newborn Specialist (Neonatologist) examine your baby there. A neonatologist is a pediatrician who has trained for 3 more years solely in the care of newborn babies. This is who I had see my babies. Ask whether the doctor admits her own patients to the hospital or prefers to use specialists and hospitalists who are physically in the hospital 24 hours a day and who specialize in the care of hospitalized children.
Is the doctor a mother/parent? Does she know how to talk to kids? Is she Board Certified in the practice of Pediatrics? – Which means is she an M.D. who completed an accredited 3 year pediatric residency program and then passed a national exam? Is the office kid-friendly and clean? Are the staff members mothers/parents who are compassionate and knowledgeable? Will my child\ ever be seen by someone who is NOT A DOCTOR (nurse practitioner, physicians assistant, etc.)? Does the doctor employ a nurse (RN)? Ask who answers your phone questions during the day and whether you can see the same doctor each visit. Ask what is important TO YOU.
Each office is a little bit different, but your doctor will probably want to see your baby the day after you leave the hospital, at 1-2 weeks of age, and then each month or two. At each visit, she will review your baby’s growth and development, examine your baby, review any test results and, most importantly, answer any questions that you may have (don’t be afraid to bring a list!).
You will find in talking to friends and relatives that there are many different ways to approach the care of babies. There is not just one right way. Knowing this will allow you to participate more in the care of your child by choosing options that are best for you and your family.
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Write them down if they can wait until morning or the next doctor’s visit, or call if they can’t. Don’t lose sleep worrying about something that your pediatrician can address in two seconds. That’s our job. We work for you. Remember that. Know also that half of the pediatrician’s job is teaching you about your newborn – the other half is learning about your child FROM YOU. If your pediatrician is not a good teacher, or doesn’t make the time to answer your questions, find another one.
Newborns will have all kinds of spots and marks, lumps and bumps. Most of these are normal rashes that require no treatment whatsoever and go away completely in time. Others may grow or shrink, fade or darken, or come and go without rhyme or reason. This is one area where your pediatrician will be able to use her experience to put your mind at ease about normal skin changes, and to guide you through the treatment of those which require it.
Again, common sense will tell you that anything with pus or blisters or that looks infected should be seen by your doctor. Don’t mess with creams and ointments at home unless you are absolutely sure you know what you are dealing with.
It is not unusual for scratches to be mistaken for rashes. Your baby’s fingernails may be his greatest enemy. Keep them short and clean. It is okay to cut them as soon after birth as you think of it. This is easiest to do when your baby is sleeping.
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What is a spit-up and what is vomiting? There is a difference. A spit-up is a “burp gone wrong” – the stomach giving back a small amount of milk to release the air that was swallowed with it. This usually happens during or shortly after feeding.
One way to cut down on the amount of spit-ups is to use good burping techniques. Burp your baby after every ounce of formula or after each breast (breast fed babies tend to spit-up less often than their formula fed peers). Try not to burp your newborn up on your shoulder. Until neck muscles strengthen and your baby gets better head control, she will burp more easily if you sit her on your lap (facing one of your legs) and you support her head in your hand (cradled between your thumb and forefinger). Patting or rubbing the back, in this position, with have the same effect … burrrrrrp.
If your baby has a “wet burp,” try to assign an amount to it (like a teaspoon full, an ounce, or a cup-full) so that your doctor will have a better idea what she is dealing with.
Try not to overfeed. A formula fed baby will continue to drink from a bottle even after he is “full,” whereas a breast fed baby will usually stop suckling at the natural end of a feed. If your baby is having spit-ups on a regular basis, you may want to hold him more upright while feeding, or try elevating the head of his crib at night by inserting a rolled-up towel, blanket, or phone book under the mattress. Another approach is to add one teaspoon of Rice Cereal to each ounce of formula; this thickens the milk, actually making it heavier which helps gravity to hold the milk in the stomach. If you do this, don’t forget to make the nipple hole bigger and to let your doctor know whether or not these steps are helping. (Keep in mind that Rice Cereal is a constipating food and can be gas producing.)
Vomiting is a forceful spit-up that releases a greater volume of milk or stomach fluid. It is never normal. It may or may not occur around the time of feeding. Always report persistent, green (bile), bloody, or projectile vomiting (vomit that shoots out) to your doctor immediately. P.S. It is also not normal for your child’s head to spin all the way around!
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A baby under 2 months with a fever MUST be seen by a doctor IMMEDIATELY. Newborns can’t localize infections that older babies can which is why it is rare for an infant to have, for example, an ear infection. The infection could be in the urine or blood or spinal fluid (meningitis). For this reason, you should always report a rectal temperature of greater than or equal to 100.5 degrees to your doctor.
Have a rectal thermometer at home that you know how to use. If the baby feels warm to you, but you are not comfortable taking the temperature, see your doctor. If your baby has a fever, don’t panic. The best treatment for a HOT child is a CALM mother.
Know that a baby that does not FEEL well will not FEED well. This may be the only thing you’ll notice, so let your doctor know if you observe a change in how much or how often your baby is eating.
Should your newborn become ill, it is very rarely anything that you did or did not do or that could have been prevented. It remains your job to love your child in sickness and in health and to try to leave the worry to your pediatrician. There is no point in trying to lay blame or take on guilt. As in life, not everything goes as smoothly as we would sometimes like. Work together with your pediatrician to achieve the healthiest life possible for your new baby.
Remember that a baby who is kept in the hospital a few days longer than you expected is not a “sick baby.” The most difficult task you will have once he comes home is not treating him like he is one.
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Umbilical Cord Care:
The belly button cord will remain attached anywhere from 1-4 weeks. It is best to clean the stump with a Q-tip dipped in alcohol 2 -3 times a day. This will help to dry it out and to keep it from smelling. However, the cleaner you keep it, the longer it will stay attached. Do not be afraid to lift up on it to get the alcohol around the base of the stump. There are no nerves in the cord, so don’t worry that moving it will hurt your baby.
Should the plastic cord clamp still be attached when you leave the hospital, ask your doctor to remove it the next day. You may notice some small drops of blood when the cord falls off; this is normal. If bleeding continues, or if there is redness, pus, or a foul smell, call your doctor immediately.
Also called immunizations, these are the “shots” that will protect your baby from potentially fatal diseases. The first one will be given either before your baby leaves the hospital or at the 2 month check-up. It is the Hepatitis B vaccine, against a virus which causes liver disease – and even liver failure. There is no risk of infection or illness from this one. It causes little or no reaction at all. The first “real” shots, the ones that have potential side-effects like fever and fussiness, will be given when your baby is 2 months old.
Vaccines protect your child against serious illness and even death. They are not optional. The risks and side effects are minimal when compared to the devastation of these diseases. I follow the vaccine recommendations of the Academy of Pediatrics and I will only ever recommend for your child what I have done for my own.
Be sure your doctor explains what each shot is, what the potential side effects are, and reasons to call or come back EACH time a vaccine is given. Most doctors have handouts to reinforce this.
As long as the baby’s umbilical cord is attached, he should only be given a sponge bath so that the cord will not get wet. Use warm water and a soft washcloth. You want to be sure not to soak the cord because it will keep it from drying and increase the risk of infection.
It is all right to use any non-perfumed and non-drying soap or baby bath. Try to keep suds out of the baby’s eyes. Bubble baths are a hard habit to break. Kids love them, but they increase the risk of urinary tract infection so it is best to avoid them. Your baby’s skin has its own protective oils so commercial oils, lotions, and powders are usually not necessary – but for baby’s dry or peeling skin, I recommend Aquaphor ointment after bath.
Once the cord falls off you can give him a bath (either in a baby tub or on your lap in the bathtub). Bathing your baby every other day is usually sufficient. Of course, NEVER leave your baby unattended.
Wax in the ears will usually work itself out. There is no need to insert Q-tips or anything else into the ear canal. Oddly enough, the amount of wax is inherited. Clean only the outside of the ears, and don’t forget to wash behind them.
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Your baby needs lots of love. Don’t be afraid to hug and hold and kiss and coo. A baby who feels loved and wanted goes on to do great things.
Yuck, What’s In the Diaper?
The color of baby poop will range from tan-yellow to green-brown. If it is white (like chalk) or black (like tar) let your doctor know. There is a wide range of normal stooling patterns. Breast fed babies may poop every time they are fed, formula fed babies poop less often. There is no one normal amount of stool per day. What you want to recognize is a change in the number of stools for your baby. If you notice a big increase or decrease in amount, let your doctor know.
The baby’s first several days, she will pass a tar-like substance called meconium. This blackish green goop has supernatural powers of adherence and transfer. You can get this stuff off with a baby wipe or wet cloth. It may take you one wipe or it may be a 10 wipe alarm! Don’t be embarrassed to lift and inspect baby’s nooks and crannies. To prevent rashes (and odors), it is important to get the area completely clean.
Almost all babies will strain, get red, grunt, and generally appear uncomfortable when they poop. Ideally, a poop should be soft and mushy. If the stool is hard, or formed (like pellets), or seems to tear your baby’s skin, you should try to give her a half ounce of prune juice (15 cc) diluted in a half ounce of water once or twice a day. Once your baby is taking solids, you can offer foods which help him to Poop (peaches, pears, plums, prunes, and peas). If this does not help to soften the stools, tell your doctor. Do not use suppositories or laxatives or enemas unless directed to do so by your doctor. If the stool contains blood or mucus, let your doctor know. (P.S. God puts the smell in the poop after you start feeding solids!)
The best indicator that your baby is getting enough fluids in is that you are seeing fluids coming out, in the diaper. If your baby is wetting fewer diapers than is normal for her, let your doctor know. As a rule of thumb, a newborn wets between 8-10 diapers a day. If your baby is wetting less than one diaper every 8 hours, you need to call your doctor.
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Babies need to sleep. It gives them time to grow. A newborn will sleep 16-20 hours per day (not in a row, of course!). He should be placed on his back or his side for sleep (alternate which side so that one side of his head does not get flatter than the other). Keep him sleeping on his back or side (use rolled up towels as wedges) until he is strong enough to lift his head up on his own (usually by 2-3 months). Soon enough he will choose his own favorite position and roll to it.
At first it is best to place him in a bassinet (small and warm like the womb) and to prevent him from re-breathing his own air by not using pillows or thick blankets around him. Keep in mind that the biggest risk of SIDS is cigarette smoke in the home.
Babies need to interrupt their sleep (and yours!) to eat. Breast fed babies should be awakened every 2 hours to eat during the day, and if they sleep longer at night, count your blessings. Formula fed babies will usually go a little longer in the day, like 3-4 hours. Feeding your baby frequently in the day will help you both to get some rest at night. Expect, though, that you may not get a full 8 hours sleep before your baby is 2-3 months old. Believe me, the time spent up with your beautiful little baby is worth every minute!
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Important Facts About Fever
When your infant has a fever, the most important questions to ask yourself are these:
1. Does my baby look or act ill?
2. Is he eating and drinking normally?
3. Is he pooping and peeing normally?
If your child DOES look ill or IS NOT having normal intake or output, he SHOULD be seen by your doctor.
Fever is not a disease. It is a remarkably useful sign that alerts us that something (virus, bacteria, injury, etc.) is causing inflammation in the body. The height of the fever, however, does not necessarily indicate the severity of the illness. Some children respond to minor illness with considerable elevation in temperature. Other children, even with serious illness, may have little or no fever.
Q: What temperature is a fever?
A: Normal body temperature is 97.8-100.4 degrees rectally. The average is 98.6 degrees. Body temperature rises slightly throughout the course of the day so that normal in the morning is slightly lower than normal in the evening, which explains why most fevers are detected at night.
Q: What is the best method to measure a temperature?
A: Rectally is best, but also the most awkward. Tympanic (in the ear) is next best as it most closely approximates the rectal (core body) temperature. Oral temperature can fluctuate with technique and with the temperature of what the child recently drank. Axillary (under the arm) temperatures are about 1-2 degrees lower than core body temperature, unless of course your child is overdressed or in a hot or cold environment. The thermometers you tape on the forehead are basically useless.
Q: Should fever be treated?
A: Not always. Fever is one of the members of the body’s defense team – certain viruses and bacteria can no longer live or divide at high temperature. Fever is your body’s way of healing itself. Fever should only be treated when it is causing unacceptable discomfort, thus making an ill child feel worse.
Q: Will fever cause convulsion or brain damage?
A: Fever does NOT cause brain damage. Some children age 6 months to 5 years may experience a seizure with the rapid rise or fall of high fever. These are rarely preventable, nor do they cause any lasting effect. They are, however, horrible to witness – and as a result, there are some preventative measures available to those children known to be susceptible to this kind of seizure which can run in families.
Q: Will penicillin or other antibiotic control fever?
A: Remember, fever is a symptom and NOT a disease. Therefore, fever is not “cured” by a shot or an antibiotic my mouth. This is true unless the infection CAUSING the fever is a BACTERIAL one. Your doctor has trained for at least 7 years after college to be able to distinguish between viral and bacterial illnesses. There are no drugs yet available which kill viruses. That being the case, there is no role for antibiotics in their treatment. Repeated unnecessary antibiotics can do your child harm – from diarrhea and allergy to resistance to treatment. That means that your child could later develop a bacterial infection that has no treatment because the bacteria responsible will have learned how NOT TO DIE in the presence of that overused drug. This is becoming a more and more serious problem in our country.
Q: Does teething cause fever?
A: As your child’s teeth work their way through the gums, they create inflammation. Fever is a sign of inflammation. While teething may be associated with a minimal elevation of temperature (less than 100.5 degrees), it will NEVER make your child look or act ill.
Q: What should I use to treat my child’s fever?
A: Tylenol (acetaminophen) is the drug of choice to relieve pain and fever in children. Never give Tylenol to a child under 2-3 months of age without first discussing it with your doctor. NEVER give aspirin to a child (it contains salicylates which have been linked to a life threatening illness called Reye’s Syndrome). Further, it is usually best to consult your doctor regarding your child’s condition before choosing to start an anti-inflammatory drug, like Advil or Motrin. Remember, fever is a sign of inflammation. The body is trying to tell us something. If you give a medicine that will take away that sign, your child may get sicker.
Q: When should I give an ice bath or alcohol rub or cool water enema or cover him with heavy quilts to bring out the fever?
A: NEVER, NEVER, EVER!
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After Hours Calls
When my office is closed, my phones will be answered by my answering service. The operator will then contact one of our doctors on call who will return your call personally and within 15-20 minutes. If your call is not returned within 20 minutes, please call back to be sure your information was forwarded correctly.
Try to keep a pen and paper nearby in case the doctor has instructions for you. It is also a good idea to have quick access to your pharmacy’s 24 hour phone number in case a prescription is necessary.
IT IS MY PRACTICE TO NEVER CALL IN ANTIBIOTICS WITHOUT FIRST SEEING YOUR CHILD. I would never want to hide signs of a worsening illness by prescribing a medicine which may be inappropriate – or make your child worse. I know that you wouldn’t want that for your child either.
I would like to thank you for choosing me as your pediatrician. I consider it an honor and a privilege to be a part of your child’s life, and I want you to know that your family is as important to me as my own.
DR. McAuliffe’s Well-Visit Schedule
1. The Neonatologist or hospital pediatrician will see your baby in the hospital each day that you are there.
2. I will see your baby in the office the day after you leave the hospital.
3. If your baby is breast-fed, I will see him/her at 1 and 2 week(s) of age.
4. If your baby is bottle-fed, and you do not have questions or worries, I will see him/her again at 2 weeks of age.
5. Thereafter, I will see your baby at 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, and then once every year until age 21.
Your child will be seen THE SAME DAY, ANYTIME you have questions or concerns – the above schedule is for WELL visits.