Congratulations on Your New Baby

Our prenatal visit and your baby’s hospital physical exam have been our introduction to you and your baby.  After you and your child are discharged home from the hospital, your care will be centered at Sunrise Pediatrics.  We are committed to providing excellent pediatric care and advice to your family.  Our role, as a health information resource, will be to encourage your growing self-reliance as parents.  The first office visit is at one-to-two weeks of age and is scheduled by you when you arrive home from the hospital.  At this time, you should also call your insurance company to add the baby to your policy.  It is helpful to come to the well child visits prepared with a list of concerns.  At the two week visit, we will give you written information regarding immunizations, which will start at 2 months of age.  We see the children at 2 month intervals until age 6 months, at 3 month intervals until 18 months, at age 2 years and annually after that.  We follow the recommended visit schedule of the American Academy of Pediatrics, and this dovetails with the immunizations given and routine screening tests.

Routine immunization is recommended to prevent serious infections, illnesses and their complications.  The benefits of immunizations far outweigh the risk of side effects from them.  We will discuss the possible side effects and their management at the time of vaccinations.  From time to time, our office is selected to participate in clinical trials for upcoming and advanced immunization combinations and you may be given the opportunity to participate.

It is very important that you keep a record of your child’s immunizations.  Many forms will require you to provide these facts and they should be readily available.

Normal Newborn Features

Your newborn should be able to hear your voice.  New York State now requires hearing tests in the nursery.  Newborns may follow your moving face or a bright object, and see best at 12-15 inches, the distance from being cradled in your arms to your face.  They especially notice the contrast in patterns, even on your clothes, and have many facial expressions, including “practice smiles”, and with time, will smile socially at your face.

Newborns must breathe through the nose (unless they are crying).  Sneezing is normal and is their way of clearing the nose.  Hiccoughing is also normal and probably occurred before birth as well.  It is caused by a spasm of the diaphragm muscle and it will occur less often as the baby matures.  Hiccoughs don’t require any treatment.  Coughing may represent the baby clearing his throat, which is fine.  If a cough is present and it is ongoing, please check with our office.

Many newborns have fine peeling/flaking of their skin after birth.  The lips very often get calloused and they may also peel.  Many babies get a pimply, acne type facial or neck rash temporarily.  This starts at about 3 weeks of age and is usually gone by 6 weeks or so.  No special treatment or lotion is needed for these rashes.  Please refer to the bathing recommendations for more hints.

All newborns will cry and some will be very intense in their crying repertoire.  Crying may be related to hunger, sleepiness, needing a diaper change, a position change, needing a burp, needing energy release, needing to suck, because of discomfort, or no clear reason at all.  With time you will be more comfortable with which cry it is.  If your baby continues to cry in spite of running through the above reasons, give your support person an opportunity to give you a rest.  Some reasons for discomfort may be external; for example, a hair or fiber around a finger, toe, or genital area, elastic for an outfit’s cuff stretched between fingers/toes, or a scratch by the baby himself of the face or eye.

Sleeping

Most newborns sleep a lot, sometimes up to 18 hours a day.  New recommendations are to lay the baby on his/her back for sleep.  If the child spits up often, using the right side down position just after feeds may be helpful.

Infants more than a few months old will begin to nap more formally instead of catnaps, and it is advisable to put the baby in his crib when he is still awake.  This can encourage the child to fall asleep on his own and may carry over to enable your child to go back to sleep on his own when he awakens overnight.

Clothing

Your baby does not require any more clothing than an adult.  Dress him according to the temperature.  Some babies are sensitive to certain material so watch for rashes in clothing contact areas.  Cotton is the easiest on baby’s skin.  Try not to over bundle your baby.

Outdoors

A fairly good rule to follow is to take your baby out whenever the weather is pleasant.  As soon as your baby is released from the hospital, you may take the baby out.  Your baby is at no greater risk outside your home than in it.  Your baby may go out any time as long as he is well protected from the elements.

Bathing

Bathing your infant not only keeps him/her clean, but gives a wonderful opportunity for interaction.  A bath will relax some infants; others who cry during their bath may find it easier to settle down when finally dressed.  The room should be warm with no drafts.  Keep bathing supplies together to save steps.  Until the navel (and circumcision) are healed, wash baby by sponging and rinsing.  After healing, you can use a tub.  Routine daily bathing is not recommended, especially in the winter.  The natural body oils may be washed away by daily bathing and predispose the skin to chafing and possible infection.  The scalp, forehead, and genital area may be washed daily with water.  If the skin is irritated, products that are gentle, such as cetaphil cleanser and lotion may be helpful.

Face

Wash with plain water and a soft cloth; no soap.

Navel

The cord clamp is removed after the first 24 hours of life.  The dried cord will fall off within 2-4 weeks.  If the skin around the cord is very red and sore, if there is a significant foul odor or drainage, or if fever is present, call the office.

Circumcision

You may sprinkle the circumcised area with lukewarm water during the bath and at diaper changes.  Call if the baby’s ring slips back onto the shaft of the penis or it there is excessive swelling or drainage.  Usually the ring will fall off by the 8th day.

Vagina/Female Genital Area

Sticky, whitish mucus is normal vaginal discharge.  During the first week, it may appear blood-tinged briefly.  During diaper changes, don’t attempt to wipe away the protective mucous discharge.  Always wipe front-to-back and remove all apparent stool.

Fingernails

Newborn’s fingernails are thin but quite sharp.  After trimming them straight across, use a non-abrasive emery board once or twice over each nail to smooth the edge.  Never bite them off!   Sometimes it is easier to trim nails when your baby is asleep.  Toenails rarely require trimming in the first few months.  Occasionally they may look ingrown- in the absence of tenderness and redness, this is normal.

Growth

Almost all infants lose weight in the first week of life.  After that, they gain an average of 5 ounces a week for the first 5 months.  Many babies have minor growth spurts along the way.  Most infants will double their birth weight by 5 months of age and triple their birth weight at about 1 year of age.

Breastfeeding

Breast milk or formula is the best nutrition for the baby, and in addition, it may help protect your infant from infections.  Prior to feeding, guide the whole areola and nipple into the baby’s mouth.  Keep the breast from pressing against your baby’s nostrils because it may make baby’s breathing difficult.  In order to facilitate nursing, you can gently stroke his cheek nearest the breast and he will usually turn his head and look for the nipple.  Usually 15-20 minutes at each breast is long enough to nurse, although your baby will probably take most of the milk in the first few minutes of each feeding.  The hind milk at the end of the feeding has the highest fat content and will satisfy the baby and encourage weight gain.  The only way for the baby to tell you to make more milk at each feeding is to nurse more often (temporarily).  This will happen as the baby’s growth spurts occur.  Usually he will then go back to his previous schedule.  It is important to eat healthy and drink lots of fluids while nursing.  It is a good idea to drink some water every time you nurse.  It is not necessary to drink milk to make milk, but calcium intake is important along with the other nutrients, and it is a good idea to continue your prenatal vitamins while breastfeeding.  Most breastfed babies will nurse 7-8 times in a 24 hour period.  If a breastfed baby is still sleeping at 3 ½ hours during the day, wake him up by changing his diaper, etc, and then nurse.  If he goes a longer stretch overnight, let him sleep.  Some breastfed babies will have one longer 4-6 hour sleeping stretch and we can encourage it to be overnight.  A breastfed infant will usually void more than 6 times daily and may have a stool nearly every time he nurses.  This stool may be mustard-colored and seedy and may be thick liquid in consistency (but not watery).  Initially, there is a reflex that allows the rectum to empty whenever the stomach fills.  After a few weeks of age, this reflex pattern matures and there may even be days without any stool.  When the infant does have the stool, the consistency should be the same as it was previously, only the volume may be larger.  If your breastfed baby’s mouth is moist with saliva, there are frequent urinations, and you hear/see milk being swallowed, you can be reassured that the milk is in and that the baby is well hydrated.  Mother’s breast milk usually takes 3-4 days to come in.  Once milk is in babies should have 5-6 wet diapers per day.  If this is not happening please call.  It can take up to 3 weeks to fully establish the milk supply and we will recheck the baby’s weight if we are concerned.  Moms can continue to nurse if they get a cold or fever, but they should increase their fluid intake.  If a medication is prescribed for you, remind your physician that you are nursing.  Call our office if you have other breastfeeding concerns.

Burping

Babies often feel distress after swallowing air and burping can best be accomplished by holding him upright over your shoulder and gently patting or rubbing his back.  Some babies require more frequent burping than others.  Spitting occurs very commonly during the first few months of life.  Although it may seem excessive to parents this is a normal occurrence and generally does not interfere with the baby’s growth and happiness.  If your child spits up in a projectile manner on a consistent basis or it there is very frequent nonforceful spitting up, please contact our office.  We may want to weigh and examine your baby.

Pacifiers

Babies need to suck for non-nutritive reasons as well as for feedings.  Some babies will suck on their own fists, hands, fingers, or even your own pinky.  Some families will provide a pacifier to their baby.  If a pacifier is used, boil it every few days to avoid spread of infection.  Pacifiers can be removed by parents to allow the children to talk, develop, etc!  So don’t feel that there is any reason they would still be using it after infancy.  Try not to have your child learn to fall asleep with the pacifier.

Visitors

Please have visitors to your home wash their hands upon arrival.  Anyone who is ill should avoid visiting until they are better.  Infants under 2 months of age who become ill are more aggressively evaluated and so limiting exposure to illness is important.

Solid Feedings

Breastmilk or formula is all the nutrition a child needs in the first 6 months of life.  Some infants will seem ready for solid food at 4-6 months of age.  They may wake more at night, be ready to grab your food from you, and they must be able to take food from a spoon without spiting it back out.  Another sign that a child is ready to begin solids is if they are consuming over 40 ounces  of formula or breast milk daily.  We will discuss feeds at the 4 month well child visit.

One approach to giving solid foods  follows:

  • 4 month old    1 meal/day
  • 5 month old    2 meals/day
  • 6 month old    3 meals/day

Typically, the child would still nurse (or get a bottle) in the early morning, after the solid food meals, and the rest of the day including bedtime. The main foods you will begin with are cereals, fruits and vegetables.  Two notes to remember: 1) Don’t give two new foods at once.  If they have a reaction you won’t know the cause.  2) You may add a new food every 4 or 5 days.   

  • Cereals:  rice, oatmeal, barley, then mixed grain cereal.
  • Fruits:  bananas, pears, peaches, etc.
  • Vegetables:  yellow/orange, then advance to greens.
  • Juices:  You can dilute with water- no more than 4-6 ounces per day.

There is nothing magical or special about commercially prepared baby food.  You can cook fresh fruits and vegetables and puree them yourself.

When you begin introducing solids you can pick one meal time and start with rice cereal mixing with either breast milk or formula.  Feed your baby the solids first, and then bottle or breastfeed once they are done.  You advance to 3 meals daily.

Between 6 and 9 months, most infants begin to use a cup and advance toward table foods and finger foods.  At 9 months, introduce dairy such as yogurt, cheese and cottage cheese.  At 12 months, transition to whole milk.

Remember all infants are individuals.  Please use common sense and caution not to advance too quickly.

Finger Foods and Table Foods

I:  6-8 months old

  • Mashed bananas, Cheerios (1 at a time), toast
  • Some soft foods you might want to introduce:  cooked cereals, mashed potatoes, mashed vegetables, noodles, macaroni and other pasta, tender meats chopped, ground or mashed.

II:  9 months-1 year

  • Eggs, apples- peeled and sliced, orange sections, peaches, yogurt.
  • Soft cheeses, soft-cooked carrots and other vegetables.  Rice, toast, tender meat cut into small pieces, spaghetti, meatballs, beans, fish without bones, soups, small pieces of sandwich.
  • Keep foods Cheerio-sized or smaller.

III:  Foods for babies 1 year and older

  • Vegetables- carrot sticks, cauliflower, tomatoes, lettuce, asparagus, beans, broccoli, mashed potatoes, sweet potatoes, peas.  A vegetarian diet is fine as long as the child gets enough protein and iron.

Meats:  Keep pieces small and provide a small quantity at a time and then refill your child’s plate.

Dairy:  Small cubes of cheese, hard boiled eggs, cottage cheese, yogurt.

Fruits:  Apples- peeled and sliced, peaches, pears, oranges, bananas, fruit cocktail, strawberries, blueberries, cantaloupe.

Breads and Cereals:  Toast, saltines, zwieback, graham crackers, cold cereals (avoid sugar-coated), bagels, macaroni, spaghetti, bread.

Foods to avoid for children under 12 months:  Corn, cucumbers, chocolate, onions uncooked, nuts, popcorn, honey, peanut butter.

Choking Hazards:  Hot dogs, marshmallows, nuts, popcorn, candy, raisins, and anything being eaten on the run.  Small bits of food can easily be inhaled if kids are eating while playing, running, etc.

Please avoid giving your child nuts or popcorn until they are more than 2 years old and are more careful.

Teeth

Many infants begin to drool at several months of age which announces the start of the teething process.  Many will not get teeth until much later, usually between 6-12 months old.  Ambesol and other products don’t stay on the gums and tend to get drooled out, so they don’t have much value to most babies.

Rubbing the gum with your finger or a cool washcloth, or use of teethers,  is comforting to most babies.  A freezing injury can occur if teethers are frozen, so avoid this.  Some children will get specific symptoms for themselves each time they teethe, but there is no universal symptom (i.e. rashes, fevers, loose stool, etc).  Once the teeth erupt they must be cleaned every day with a wet gauze or washcloth.  After 4-6 teeth erupt, use a soft toothbrush with water with your child lying on your lap, looking up at you, and you will see the teeth easily.  Never put your child to bed with a bottle, for this can cause severe decay of the upper front teeth.  Breastfed babies who fall asleep while nursing can also get cavities after the teeth erupt, so wipe the infant’s teeth daily.

General Safety

At each visit we will be discussing the importance of safety at each particular age.  Some items you can get started with are:

  1. We do not recommend the use of microwaving formula because it tends to heat unevenly, causing “hot pockets” of formula that can burn severely.
  2. Turn down the water temperature in you hot water heater to less than 120 degrees.
  3. Make sure that the slats in you crib are less than 2 3/8 inches apart.
  4. Always make sure there are no cords near the crib or the baby’s neck.
  5. Never leave the baby unattended.
  6. Be very cautious about visitors who may have medicine in their purses and older siblings who may have small chokeable playthings, and clumsily bump into the infant seat.
  7. Keep pets out of the crib.
  8. Car safety:  Be aware of and follow the NYS car seat laws.
  9. Help your child learn to sleep in his own crib, not your bed- day or nighttime.