Caring For Your Newborn

 

Arnold Solof, M.D.

Archna Jain, M.D.

Olabode Ogidan, M.D.

 

Vineland Pediatrics, P.A.

1138 East Chestnut Avenue, Building 5B

Vineland, NJ 08360-5062

 

(856) 692-1108 (Voice)

(856) 692-2077 (Fax)

 

www.VinelandPediatrics.com

Vineland.Pediatrics@Verizon.net

 

October 18, 2005

 

 

 

 

 

 

 

INTRODUCTION

 

                Congratulations on the birth of your new baby!  This pamphlet is provided to help answer some of the questions that new parents ask most frequently.  If you have any questions about your baby or about the material in this pamphlet, just jot them down here and we will discuss them with you during the daily hospital visits.

 

Vitamin K

 

                Your baby received an injection of vitamin K shortly after birth.  This prevents a bleeding tendency babies sometime develop from a temporary deficiency of this vitamin.

 

Triple Dye

 

                The umbilical cord has been painted with this blue antiseptic to prevent infection.

 

Plastic Cord Clamp

 

                This is left on for one to two days to prevent bleeding and is then removed.  Be sure this has been removed before you take your baby home.

 

Pediatric Newborn Care

 

                This includes the following:

·         24-hour constant contact with the nursery staff

·         Complete physical examinations within 24 hours of birth and again on the day your baby goes home.

·         Daily evaluations of your baby and discussions with you.

·         Constant availability and intermediate level newborn intensive care capability should your baby become ill.  (Note: depending on the nature of the problem, the neonatologist may be consulted or requested to assume the care of your baby)

 

IEM (inborn errors of metabolism) Screening

               

                There are a large number of tests that are routinely performed on newborns to detect problems that might otherwise be difficult to diagnose rapidly.  The results of these tests become available by 2 weeks after birth.  You will be notified of these results only if a problem is detected.

 

Positioning Your Baby

 

                Studies indicate that the frequency of SIDS (Sudden Infant Death Syndrome) is highest in those babies routinely positioned on the abdomen/stomach.  The safest (and only acceptable) position for your baby is on his/her back. 

 

Circumcision

 

                If your baby has had a circumcision, the penis will be wrapped in Vaseline gauze for about a day.  When the gauze comes off, the penis often looks red, raw, and irritated.  Frequently there are areas of pus seen as it heals.  This is normal.  If there is excessive swelling and tenderness, or if it appears to be getting worse rather than healing, report it to us.  If the area appears raw, place Vaseline on it.  Wash the area gently with mild soap and water, as needed.

                If your (male) baby is uncircumcised, no special care is needed.  In a newborn, do not attempt to force the foreskin back.

 

Hearing Test

 

            All newborns have their hearing tested in the hospital.  The results will be either “pass” or  “refer”.  Because of occasional testing errors, babies who do not pass the test will be referred for retesting in 4 – 6 weeks.

 

Breast Feeding

 

                You may breast feed your baby as soon as you want to provided both of you are well.  Place two fingers on each side of the nipple and press slightly so that the nipple sticks out.  You will then be able to guide the nipple into your baby’s mouth and, at the same time, be able to keep the breast from pressing against your baby’s nose, which could interfere with his or her breathing.  Sometimes you may need to encourage your baby to nurse.  Do not push your baby toward the breast.  Instead, gently stroke the baby’s cheek nearer the breast.  Usually this will cause your baby to turn his or her head to hunt for the nipple.  Most women use both breasts for each feeding.  Start with a few minutes on each side and gradually increase to about 10 minutes on each side by five to seven days.  Most babies empty a breast in 5 to 10 minutes of active nursing.  Many babies have little appetite initially and may be exhausted from the stress of the delivery.  Your baby’s interest in nursing will increase daily over the first few days.  This is normal.  Water supplements are not necessary.  The nurses are available to help you with problems of breast-feeding technique.  Please do not hesitate to speak with them if you have problems or questions.

 

Formula Feeding

 

                Unless your baby has special feeding requirements, you may use Similac Advance, Enfamil Lipil, or Carnation Good Start formulas.  These come as “Ready to Feed”, concentrate, and powder forms.

 

Ready to Feed:

                This comes in 8-ounce and 32-ounce cans and also 4-ounce disposable bottles.  The disposable bottles are convenient if you are traveling.  Do NOT add water.

 

Concentrate:

                This comes in 13-ounce cans.  Add an equal amount of water. 

Example:      [4-oz. Formula] = [2-oz. Concentrate] + [2-oz. Water]

 

Powdered:

                To each 2 ounces of water placed in the bottle add one level scoop of powder.  Place the nipple and cap on the bottle, shake it thoroughly, and it’s ready to use.  Because of its long shelf life, powdered formula is excellent for supplementing breastfeeding (when needed), and as a lightweight supply of formula to keep available in a diaper bag along with some empty clean bottles and nipples-for when you are out of the house.

 

Preparation of Infant Formula

 

                All utensils used in preparing your baby’s formula must be kept clean.  Scrub bottles, nipples, and caps with hot, soapy water and a bottlebrush.  Always squeeze water through the holes in all nipples.  Rinse all parts thoroughly with hot water.  Nipples, caps, and bottles can also be washed in a dishwasher.  Use either city water or boiled well water in preparing infant formula.  When your baby is three months old, it is no longer necessary to boil well water (provided that your water supply is safe for adults). Protect the bottles from dust and dirt by putting them upside down on a rack or clean towel.  Put nipples and caps in a clean, covered container.  The formula comes already sterilized in the can. 

                Determine how much formula your baby usually takes each feeding and place that amount in each bottle.  Place nipples and caps on the bottles and place them in the refrigerator immediately.  You can prepare an entire can of Ready to Feed or concentrate formula for a day’s supply if you like.  If there is unused formula after a feeding, you may use it again provided that the total time the formula has been out of the refrigerator does not exceed 60 minutes.  Do not mix old partially used formula with new formula.

 

Warming Infant Formula

 

                Warming refrigerated formula is not necessary, but many babies prefer it warm (room temperature).  If you choose to warm it, use one of the following methods:

 

Ounces of Cold Formula     Seconds

1                                             5

2                                             10

4                              20

6                                             30

8                              40

                                                               

 

Burping

 

                Burping your baby helps remove swallowed air.  Burp your baby by one of the following methods:

 

Don’t be alarmed if your baby spits up a little when being burped.  It isn’t always necessary to interrupt a feeding to burp your baby.  Sometimes your baby will not burp because it simply isn’t necessary.  Do not try to force your baby to burp if the first few attempts are not successful.  After the feeding you can minimize spitting by positioning your baby upright at 45 degrees (holding the baby or using an infant seat).

 

How Much Formula

 

                Your baby should be allowed as much formula as he or she wants each feeding.  However, when he or she stops sucking and is no longer interested in feeding, do not force him/her to take more.

 

Flexible Feeding Schedule

 

                The schedule that works best for most newborns (and parents) is to feed the baby when he/she is hungry, any time from 2 – 5 hours after the previous feeding.  If your baby wakes up and cries less than 2 hours after a feeding, hunger is probably not the problem.  As your baby grows older, the amount consumed each feeding and the length of time between feedings will increase.

 

Nutrition

 

                Although done differently in past years, currently the best method for giving your baby the best nutrition is to keep your baby on breast milk or infant formula for the first 12 months of life.  Solids and juices should not be introduced until the baby is 4 to 6 months old.  When introduced, baby food should always be fed with a spoon.  To protect your baby’s developing teeth from cavities, a fluoride supplement will be prescribed from 6 months of age until 16 years of age (unless your water supply is fluoridated).  The fluoride will be combined with a multivitamin.

                Warning! Don’t give your baby honey before his/her first birthday.  Certain bacterial spores that are sometimes found in honey may cause a serious disease called infant botulism in the young infant.  Older babies don’t get this disease so feeding them honey is not dangerous.

 

Jaundice

 

                During the first few days of life, most babies acquire a temporary, slightly yellow color to the skin called jaundice.  This is due to a normal adjustment the baby is making after birth.  However, if this occurs before 24 hours of age or to an excessive degree, it is abnormal.  In that case, tests will be done to determine the cause.  If necessary, light treatments (phototherapy) will be prescribed to control it.

 

Office Visits

 

                Unless instructed otherwise, your baby should have his/her first routine office check-up at about 1 week of age.  Please call our office (856-692-1108) for an appointment.

                During this important first year, your baby should have regular medical examinations even though he or she appears well.  These visits will give us an opportunity to check on your baby’s growth and development and to talk with you about baby care and the many interesting things you can expect as your baby grows.

                Immunizations are very important and should be started when your baby is in the hospital (the 1st hepatitis B vaccine dose).  The next vaccine series is given at 2 months of age.  The routine vaccines given will protect your baby from diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella, HIB, chickenpox, flu, and meningitis.

 

Emergencies

 

                Should an urgent medical problem arise, call us immediately.  If the office is closed, you will hear a recorded message stating when the office will reopen and our answering service telephone number (for urgent medical problems.).  A message left with our answering service will be relayed to us or the pediatrician on-call.  In case of a life-threatening emergency, call 911 or go directly to the nearest emergency room.

 

Common Signs of Illness

 

                Signs of illness that should be reported to us are:

 

 

Visitors

 

                Because minor illnesses in newborns are sometimes difficult to distinguish from those that are life threatening, we recommend you do the best you can to limit visitors during the first two months at home.  Definitely, anyone who is sick should not visit the baby.

 

 

 

 

 

Normal Variations

 

                Your baby is an individual from the day of conception and has a unique personality.  As the baby’s parents you will come to know your baby best.  Trust yourself in deciding which advice to accept from well-meaning friends and relatives.

                Your baby will do many of the things that all babies do.  All babies sneeze, yawn, belch, have hiccups, pass gas, and cry.  Sneezing is how your baby clears his or her nose.  Hiccups should be ignored.  Crying is your baby’s way of saying, “I’m wet, thirsty, want to turn over, I’m too hot, too cold, I have a stomach ache, I’m bored, hungry, etc.”  You will soon recognize the meaning of the various cries.

                Almost all babies have fussy periods.  These may occur regularly, perhaps in the late afternoon or evening.  This is not colic, but a normal occurrence for which there is yet no explanation.

 

Colic

 

                Some infants suffer from recurrent bouts of abdominal cramps.  Typically these occur in the evening, but they can occur at other times as well.  The infant draws up his legs, turns red in the face and cries repeatedly.  These episodes can occur daily for weeks and last several hours.  They disappear by three months of age in almost all cases.  If the episodes are mild, they should just be ignored.  If the episodes are severe and prolonged schedule an appointment with your baby’s doctor to have the problem evaluated, to verify if it is colic, and not something else.

 

Bathing

 

                Bathing a baby in a tub bath right after birth is safe.  Also, babies given a tub bath don’t get as chilled as those who are sponge bathed.  The room should be warm, with no drafts.  Keep bathing supplies together to save yourself steps.  Use a mild soap (e.g. Dove, Tone, or a commercial baby bath product) and mild baby shampoo (e.g. Johnson’s).  Be sure to wash in the creases and rinse well.

                Lotions, powders, creams, etc. are not necessary. They are safe except for powder containing talc, which can irritate the lungs and eyes.

 

Nails

 

                Nails can be trimmed with baby scissors (blunt tipped), or filed with an emery board.

 

Umbilical Cord

 

                The umbilical cord will fall off sometime in the 1st four weeks.  Around the time it is falling off and for a few days afterwards it may bleed a small amount.  This is normal.  The navel will take a few days to dry after the cord falls off.  From birth until the umbilical cord has fallen off and the base of navel is dry, we recommend you wipe the navel several times a day with rubbing alcohol.  Move the cord side to side and up and down so that you can wipe the area at the base of the cord.  This helps it to dry up faster and prevents infection.

 

Vaginal Discharge

               

                White mucous discharge is normal.  Occasionally it becomes bloody for a few days during the first week of life.  This is normal and is caused by removing the baby from the stimulus of the mother’s hormones.

 

 

 

Bowel Movements

 

                There is considerable variation in size, color, consistency, and frequency of stools in normal newborn babies.  There may be eight bowel movements a day or one bowel movement every week. Stools may be yellowish, brown, or greenish and may be quite firm, loose, or pasty.  Most babies grunt and grimace occasionally when passing stools.  This is normal.  If the stools appear as hard, small pellets, the baby is constipated.  In that case, add one teaspoon of Karo syrup to four ounces of formula and give this to the baby once or twice a day until the stools appear normal.  The stools may become loose at times but should not be completely watery (diarrhea).

 

Care of the Diaper Area

 

                Change your baby’s diaper frequently; as soon as possible after each bowel movement, and periodically during the day (babies urinate about every two hours!).  Bowel movement and urine should be thoroughly cleaned from the area before replacing the diaper.

 

Diapers

 

                Most parents use disposable diapers because they are very convenient.  Cloth diapers are also acceptable and their use has the advantage of less pollution of the environment.

 

Room Temperature

 

            About 68° to 74°F is acceptable.  Your best guide is how you feel (cold, OK, hot), because you can sense humidity, wind or drafts, sunshine, etc., while the thermometer only measures temperature.  Dress your baby appropriately; not underdressed or overdressed.

 

Sleeping

 

      You may expect your baby to do a lot of sleeping.  It is best for the baby to have his or her own room right from the start, if possible.

 

Your Baby’s Safety

 

       The kinds and numbers of injuries a baby may receive change with age, so you continually need to consider and adjust your safety efforts.  No one can protect a baby from all hazards, but you can take some specific actions, starting the day your baby comes home from the hospital.

                Always use an approved car safety seat, on the first and every ride.  A baby can strike parts of the inside of the car or be thrown from it if just held in a passenger’s arms.

                Your baby’s crib should be an approved (National Safety Council) model with slats spaced closely so that your baby cannot possibly get his or her head between them.  If you are buying or borrowing an older model crib, be sure the slats are no more than 2 3/8 inches apart.  The mattress should be firm and flat, and should fit the crib snugly on all four sides.  If the mattress is not waterproof, it should have a waterproof cover.  Do not use a pillow.  Cover the mattress with a soft baby sheet.  Use one or more blankets (depending on the room temperature).  Do not wrap your baby in a blanket, because this interferes with freedom of movement.  Never put toys or other objects in the crib that your baby could be come entangled in or possibly swallow.  If it is fairly cool, dress the baby in a warm sleeper (or equivalent), because he or she may remove the blankets during the night.

                Keep small objects such as buttons and pins out of the baby’s reach so he or she cannot pick them up and swallow them.

                A baby’s delicate skin can be burned easily.  When you take the baby outside, shade your baby from the hot rays of the sun.  Set your water heater lower than 130°F.  Always test the temperature of the water before your baby’s bath to be sure it is not too hot.  Smoking cigarettes while feeding or playing with the baby is harmful to the baby’s lungs and dangerous because hot ashes could fall on the baby.

                Also, don’t hold the baby while cooking.  Hot food could splatter on the baby, or he or she could touch hot pans or their contents.

 

Outdoors

 

                Upon discharge from the hospital your baby may be taken from one place to another in a car provided he or she is appropriately dressed and uses an approved and properly installed infant car seat.  If weather conditions are mild, he or she may spend time outdoors right from the start.  If the weather is not mild, you should wait at least a month or two before taking the baby outdoors (rides from place to place in a car are OK).

 

Nasal Congestion

 

                Many babies have minor nasal stuffiness either as a normal variation, an upper respiratory infection (cold), or as a symptom of allergy.  If mild it should simply be ignored.  If the baby seems uncomfortable due to congestion, it can be relieved temporarily with salt-water nose drops (2 drops in each nostril as needed).  Salt-water nose drops can be purchased at a pharmacy (Ocean Mist), or you can make them by placing ¼ teaspoon salt in 8 ounces of water.  Also useful is an infant nasal aspirator.  Squeeze the bulb, insert the tip in the baby’s nose and then release the bulb (this removes mucus by suction).  This frequently works best when used after using the salt-water nose drops.  Finally, many infants with significant nasal congestion get relief from having a cool mist vaporizer placed near them.

 

 

 

“Good Luck and Enjoy Your Baby”