Caring for Your Newborn

As pediatricians, we encourage nursing your newborn and recognize its advantages. As a women and mothers, we also recognize just how overwhelming this simple task can seem, especially to the first time mother and that not all women are comfortable with the concept or logistics of nursing.

The choice of whether to breast feed or use formula is entirely up to you. If you are ambivalent about nursing, we encourage you to give it a try, as most women are successful, and breastfeeding your baby is a marvelous gift to your newly born. On the other hand, if you have decided to formula feed, do not feel remorseful as you will not be depriving your baby of love and nourishment.

The birth of a new baby is a momentous occasion, and many people may be coming to greet you and your new baby. This can make it a challenge to have quiet time while initiating breast feedings. We encourage you to give you and your new baby the chance to get to know one another and protect the feeding time as bonding time.

Newborn infants should be fed every 2 to 3 hours. If you are feeding formula, the quick rule of thumb is 1 to 2 ounces of formula every 2 to 3 hours for the newly born. Though every family member, friend, or text may say something different, we will offer you our pediatric suggestions based on physiology. Though it may sound fantastic to be able to sleep through the night, this is not a recommended practice with your newborn. After about four hours, the sugar supply for your baby declines and the newly born baby’s liver is not very good at breaking down the sugar source (glycogen). Therefore, the newly born baby should not go more than 4 hours without a feed, unless recommended to do so by the physician.

Feeding during the first days may be discouraging as many infants are just not interested in feeding. It may take your baby three or four days to wake up enough to feed effectively and to master the coordination of their sucking and swallowing reflexes. All babies lose weight during the first five days of life, so do not become concerned if your baby is losing and not gaining weight during this period. We will be monitoring your baby’s weight closely both in the hospital as well as after you are able to go home with your baby.

We would also like to mention that although we often are monitoring a baby’s weight to make sure they are growing adequately, excessively frequent feedings and overweight infants can have negative outcomes. Overfeeding may cause digestive disturbances in the infant, as well as effect the emotional relationship between you and your baby. Overfeeding may be as harmful as underfeeding.

Breastmilk is the preferred feeding for all infants , including premature and sick  newborns, with rare exceptions. Breastmilk provides advantages with regard to general health, growth and development, while significantly decreasing risk for a large number of diseases including obesity. Breastmilk has been shown in many studies to decrease the incidence of diarrhea, respiratory infections, ear infections and allergic diseases (including atopic dermatitis). Breastfeeding has also been related to the  possible enhancement of brain and cognitive development.

Breastfeeding should begin as soon as possible after birth, usually within the first hour. An adequate milk supply takes a few days to get established, but your body already is producing colostrum, which is rich in protein and very nutritious for you baby. The colostrum or “early milk” is a clear to yellowish liquid which becomes replaced by breast milk by the third or fourth day after delivery. It may take a day or two longer for some women who have had C-section.Newborns should be nursed whenever they shows signs of hunger such as increased alertness or activity, mouthing or rooting. Crying is a late indicator of hunger. Newborns should be nursed approximatively 8 to 12 times in a 24 hour period until satiety, usually 10 to 15 minutes on each breast. This means being fed every 2 to 3 hours… and if a feed takes 30 min in total, then you are really putting the baby to breast as often as every 90 minutes! In the early weeks after birth, non-demanding babies should be aroused to feed during the day if four hours have elapsed since the last nursing.

During the first few days of nursing your breast may feel full, hard, tender and tight, commonly called “engorgement.” This temporary engorgement is normal and will resolve with continued nursing. Air drying your nipples and applying a thin layer of  colostrum or breast milk to your nipples after feeding may alleviate the discomfort during this period. We highly recommend also applying Lansinoh Cream before and after each feed so as to prevent and/or treat cracked nipples. If your nipples are very sore, and you are having a hard time with nursing because of the pain, it may be that you could benefit from a nipple shield and/or a lactation consultant. We are here for you and can guide you to a helpful assistant. Bear in mind that most breastfeeding “failures” happen because women do not get the support that they need. That is why we will be there for you every step of the way.

There are many tips on how to breastfeed. First, find a position for nursing that allows you and your baby to relax. Using a “boppy” or a pillow for the baby to lie on her side can be very helpful. Cradle your baby in your arms at 45 degree angle. You can bring out your baby’s “rooting” reflex by touching her cheek closest to you with your nipple, and your baby will open her mouth. Make sure you get your whole areola well into her mouth so that your baby is not just sucking on the tip of your nipple.

During the first days at home you may want to record the  time of each breastfeeding and its duration, as well voidings and stoolings. Once your breast feeding is established, by day 5 to 7  of life, babies should at least have 5 wet diapers in 24 hour period. Initially, no supplement (water, glucose, water or formula) needs to be given unless a medical indication exists.

To produce an adequate supply of breast milk , drink about four glasses  of any fluid over and above your usual daily intake. There are many cultural beliefs and “old wives tales” telling what you can and can not eat. We simply give you the general advice of maintaining a reasonable, well-balanced diet, and to simply eat anything that agrees with you. Although it is uncommon for food eaten by a nursing mother to bother her baby, anything that makes you gassy could potentially make your baby gassy, and may need to be avoided. You should not smoke, especially when you are nursing your baby. Also, it is a good idea to avoid an excessive amount of caffeine and alcohol. That being said, yes, it is now okay to have that cup of coffee that you were waiting to have for the past 10 months!

Most medications taken by a nursing mother have little or no effect on the baby, however you should first check with your physician before taking medications. Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth. Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the  breast milk diet. It is recommended by the American Academy of Pediatrics that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.

For the exclusively breastfed infant, the infant will need to be started on Tri-vi-sol vitamin solution to make sure that the infant receives an adequate amount of vitamin D. This will be discussed at your first visit to us after being discharged from the hospital.

Breast milk can be at room temperature for 3-5 hours and is still considered good. Breast milk can be stored in the back of the refrigerator for 3-5 days. Breast milk can be stored in the back of the freezer for 3 months. Chilled or frozen breastmilk can be warmed for the baby to eat by running warm water over the bottle or by putting the bottle in a warm bowl of water. Never use a microwave because microwaves can heat unevenly, leading to the possibility of harm to your baby.

The commonly used formulas, such as Similac or Enfamil, are cow’s milk based, modified to be close in composition to human milk. They provide 20 calories per ounce, the same energy value as breast milk. Formulas are available in several different preparations, including

1. “Ready to Feed” cans and bottles
2. Concentrated liquid to which water is added.
3. Powder to which water is added.

The first two are more convenient and likely more expensive. Except in the case when one is using  well water, sterilization is not necessary. If you make your bottles up in advance, the formula should be refrigerated for not more than 48 hours. Before feeding, warm the bottle by running warm tap water over it for a few minutes. Do not warm formula bottles in the microwave! .Most bottle fed babes will finish a feeding in 20 to 30 minutes. The quantity taken will vary with different infants of the same age, and with the same infant at different feedings. It is a good practice to put a half-ounce more in each bottle than the infant is expected to take. Initially, the baby will take 1 to 3 ounces per feeding. Increase the amount of feeding according to your’s baby demands. If he finishes the bottle and still seems hungry, you may offer him more. Most babies take between 18 to 32 ounces per day. He starts to “ spit up” frequently or to have a frequent loose tools, you may be overfeeding.

Washing bottles and nipple will be easier if you rinse them in cool water immediately after feeding. Bottles can be put in the dishwasher or washed by hand with warm, soapy water. Nipples and caps should be carefully cleaned, especially to remove any milk remaining in the nipples.

Formula fed babies do not need additional vitamins, as it is already in the formula.

Spitting up small amounts of milk or formula after feeding occurs commonly and is not cause for alarm. Not only does it seldomly suggest trouble, it also does not mean that the milk or formula does not agree with the baby. Hiccups are a common, normal occurrence. They do not harm the baby and there is no need for special treatment. In many cultures, people believe that hiccups are the beginning of an illness, though this is not an idea supported by the American Academy of Pediatrics.

Most babies swallow some air, but the amount of air swallowed varies from baby to baby and from time to time, depending on the eagerness with which the baby takes the milk. Some babies need to be burped after every ounce, and  other babies require this only once at the end of feeding. Sometimes your baby will not burp because it is just not necessary. Do not force the baby to burp if the initial attempts are not successful.

Many babies have fussy periods at one or more time during the day, usually in the late of afternoon or early in the evening. It is important to remember that babies cry for reasons other than hunger and do not require feeding each time they cry. They may be comforted  by sucking, and not need nourishment. This is what is termed a non-nutritive sucking. A pacifier may be extremely helpful in this situation. Avoid giving  small frequent feedings in an attempt to pacify your baby.

You may add solid food to the diet between 4 and 6 months of age. Do not feel compelled to rush into giving solids. The plan for feeding solids will be discussed during your infant well baby office visits.

Your baby’s umbilical cord will come off spontaneously, usually by two weeks of age. Until it does, you can dab the base of the umbilical stump with rubbing alcohol a few times a day. Keep the plastic outer liner top of  the diaper off of the cord. There may be a slight discharge or a few drops of blood from the umbilical stump while it is separating or just after it has fallen off. Do not be alarmed, fo this normal. If there is a redness of the surrounding skin, foul-smelling discharge, or if the drainage has not disappeared by 3 to 4 days, please let us know.

Babies may only have a “sponge bath” until their cord has come off. Once it has come off, then the baby may be fully bathed. A good time to give a bath is just after your baby awakens before the next feeding. The most important part of the bath experience, is to get all of your soaps and towels ready before the bath begins. It is so important to never turn your back on your baby “just to get something” as it only takes a few seconds for the baby to be harmed by the water. Bathing is really only needed a couple of times a week during infancy. Click here for more information on bathing your infant.

Most newborn girls will have a mucous vaginal discharge during the first week of life. This is the result of maternal hormones. Occasionally a baby will have a small amount of bloody drainage, like a bloody “ show”, which will occur between the fifth and tenth day. It will only last for day or so, and all you need to do is to cleanse the area with warm water. Avoid wipes as they may contain alcohol and be irritating. When bathing your daughter, gently wash between the lips or labia or the vagina, washing from front to back, from the vagina towards the rectum.

Babies of either sex may have some swelling of the breast(s) and possibly a clear fluid drainage from the nipple. This is normal. You should not attempt to squeeze out this fluid.

Babies and infants vary greatly in their bowel movement patterns. While one baby may have a bowel movement after each feeding, another baby may have a bowel movement every 5 or 6 days. Either one of these pattern can be  normal. We define constipation and diarrhea on the basis of the character or consistency of the stool rather than the frequency. A constipated stool is very firm or hard, while diarrhea indicates a liquid stool with little substance. Breast fed babies tend to have thinner and more frequent stools during the first week of life than do formula-fed babies. The color of the bowel movement may vary from bright green to yellow to brown. The color is a reflection of the transit time or activity pattern of the intestine and is not a sign of illness. If you see blood in the bowel movement, you should notify us.

The baby’s room should be kept warm but not hot. Temperature between 65 ° and 70° F is preferred. A window may be kept open in warm or hot weather as long as the baby is not in a draft. Most babies have cool hands and feet. Therefore, feel the chest before deciding that the baby is underdressed. If he is perspiring, there is  too much clothing on.

The slats or your baby’s crib should be spaced closely so that the baby cannot get his or her head between them. If it is an older crib, make sure that it has not been decorated with paint containing lead. Use a firm mattress. Avoid toys or fluffy bedding in the crib.

The safest position for a baby to sleep is on his back. There is no greater likelihood of choking or problems with spitting up. In fact there is less of a chance of breathing difficulty and a significantly lower incindence of crib death (SIDS) when babies are put on their backs to sleep.

After the baby is week old, you can take the baby outdoors, weather permitting. Be sure the baby is not exposed to direct sunlight or wind. Avoid crowds of people, e.g shopping centers, for the first eight weeks
Visitor and visiting:
Once you feel up to it, there is no reason not to have visitors. However, it is important to make sure that no one smokes in your apartment or house and that the visitors are not ill. There is firm evidence to show that babies living in apartments or houses with smokers have more respiratory infections.
If you want to go visiting family or friends, there is no problem as long as the above guidelines are followed and your baby uses a car seat.

It is essential, that children be restrained in car seats or use a seat belts. Until a child is 20 lbs, he should be placed in a rear facing car seat in the back seat. Car seat are to be used up until a child reaches 40 lbs. When he can  then use a booster seat. Due to the danger of injuries from air bags, children under 12 years should not be allowed  in front seat.

Signs of illness which should be reported to us are:

Fever with temperature of 101 ° F or over. Any fever in a baby less than 3 months of age. A fever defined  to>100.4 ° rectal. For more information see AAP about Fever or Fever info from Bodhi Medical.

1. Vomiting repeatedly ( not just spitting up) or refusal of feedings several time in row
2. Excessive crying without obvious cause
3. Listleness
4. Frequent fluid bowel movement ( with mucus, blood, or foul odor)
5. Any unusual rash

If a medication has been prescribed for your child, to insure that medications are given correctly, you should:

1. Understand what the medication is and for what it is
2. Understand the exact dose and require the duration
3. Keep the bottle refrigerated if so stated on the label
4. Measure the label accurately. Use the measuring spoon or calibrated dispenser. One teaspoon equals 5 cc(ml) and one tablespoon equal 15 cc(ml)
5. Give an antibiotic for the full time for which was prescribed. If the bottle “runs out” before it should, check with the pharmacist.
6. Never give antibiotics prescribed for one child to another unless directed.

Children who balk at taking medications may do a lot better if the medicine is disguised. You may mix liquid medications with apple sauce, sauce jam or pudding or dilute it into a small volume of fruit juice. With smaller infants, use your vitamin dropper to put medicine into the side of the mouth, or let the baby suck the medication out of the nipple. Tablets may sometimes be crushed in a spoon with another spoon and mixed with something thick and tasty. The entire contents of capsule may be emptied into a spoon …. Served over ice cream.
Rectal suppositories should be moistened with water and inserted using your index finger wrapped in plastic food wrap.
Gently hold the buttocks  together for several minute to prevent expulsion. Nose drops and eye drops are best instilled with the infant lying on his or her back and gently restrained.
Finally apply all ointment and creams sparingly. Thick layers give no extra benefit and only waste medication.
NOTE: KEEP ALL MEDICATIONS FAR OUT OF CHILDREN REACH

Normal temperature is 98,6 degrees F and orally 100.2 degrees (F) rectally. See conversion to centigrade.

METRIC TEMPERATURE CONVERSION

Centigrade (C) degree	37	37.8	38.4	39	39.6	40	40.6
Farheinet (F) degree	98.6	100	100.1	102.2	103.2	104	105.1

Body temperature varies and may normally be 1 to 2 degrees below this level, usually in the morning and up to 2 degrees above this level, especially after active play. An elevation of temperature by itself is not an illness but only an indication that an infection may be taking place. Unless the temperature is greater than 106 degrees, fever itself is not harmful. It is important to remember that the height of the fever is not related to the severity of the infection. This is especially true in the case to the children 6 months to 5 years of age who often have fever high temperatures with common viral illness.
If fever occurs in any infant under 6 months of age, we should be notified. For children over 6 months of age who have fever but not other signs or symptoms of illness, it is usually safe to administer an antipyretic such Tylenol Liquid. This will make your child more comfortable and enable you to observe for ever evidence of illness. If fever persists for over 24 hours, contact our office. The following guidelines will assist you in treating your child temperature elevation.

1.Tylenol: is an acetaminophen preparation. This may be administered every 4 hours for temperatures of 101 and above. Dosage should be according to weight. It is important that the temperature should be checked BEFORE the medicine is given.
Aspirin should not be given unless advised by a physician. Aspirin should be specifically avoided during the flu or chicken pox.
If acetaminophen does not adequately control your child’s fever, your physician may recommended children’s Advil or Motrin, which are preparations of ibuprofen. Ibuprofen is administered every 6 hours for children with temperature elevation of over 102.5

2.LUKEWARM Water baths temperature of 103 and above. Bath for at least 20 mn or as long as the child will tolerate. Mottling of the skin may occur. If the chills develop, remove child from tub. Alcohol should not be used.
3.Dress child lightly. Do not cover with blankets.
4.Keep room temperature normal or slightly cooler
5. Encourage fluids.Clear liquids are usually  best.

Note:

* Fever medications may be used at the same time as antibiotics.
* Occasionally, in children one to five years, fever may cause a brief convulsion. Should a convulsion occur, lay your child on his side or stomach, and protect him from harm. Do not attempt to force anything into his mouth. The episode will last only a few minutes.
NOTIFY US IMMEDIATELY