Your New Baby
Your New Baby- advice from Dr. Simon
Welcome to the world of parenting
Congratulations on the arrival of your new baby! If this is your first, you are perhaps a little apprehensive at this point, but whether or not you have cared for a newborn infant before, remember that your most valuable asset is your own common sense. My job is to provide advice and reassurance and, in the face of often differing opinions from friends and family, to help you with decisions regarding the care of your baby.
Throughout your years as parents, remember that children of all ages have their own individual personalities and behavior patterns. Babies enter this world with their own unique temperament, and it is impractical to compare the reactions of your baby with those of other infants. Since the guidelines in this handout are very general, it is important that they be adapted to your baby and your family. As questions arise, please know that my office is available for you, and I look forward to discussing them with you.
When your infant is born, your obstetrician will notify me, and I will provide pediatric care during the hospital stay. The morning following delivery, I will examine your baby and visit the mother/father to answer questions and provide routine newborn counseling. Additionally, should you have any significant concerns not answered by hospital personnel, please call the office.
Baby's Skin Care
The appearance of babies varies quite a bit. At birth s/he may be dusky, pink, bright red, the extremities may look blue; s/he may be quiet or loud, calm or moving in all directions. The head may appear misshapen with bruises, scratches, or areas of swelling associated with the birthing process. S/he may be bald or have a full head of hair. The skin will likely be covered with a whitish coating called vernix. Beneath the vernix, there may be more or less hair than you expected, and silky smooth or possibly dry, cracked or peeling skin. Variations in skin pigmentation may be subtle or pronounced. The umbilical cord will have a clamp placed on it. Baby girls will often have some swelling of the genitalia and a white/pink discharge that will decrease in the first few days. Baby boys may have a collection of fluid around one of the testicles, known as a hydrocele, that will be absorbed within a few months after birth. Both boys and girls may have firm breast tissue associated with maternal hormones. All of these as well as many other findings are normal.
Enthusiasm for bathing varies among babies. Fortunately, they do very little to get dirty and the reason for bathing is a social event (playtime) more than one of hygiene. It is helpful to have the water lukewarm, towel, clean diaper, and clothes prepared before bringing the baby to the bath. A towel in the water under the baby prevents slipping. A small washcloth can be used to clean the face and creases in the neck, underarms, behind the ears, and in the genital area.
Soap and water is probably not the best way to bathe an infant. Soaps do not effectively remove the resident bacteria, but they do remove the lipid barrier that protects the skin. Once weakened, the protective skin barrier is more susceptible to flaking, cracking, and dermatitis. If soap is necessary because your baby is especially dirty, then a mild unscented product (e.g. Dove) should be applied at the end of the bath and rinsed promptly. Powders, oils and lotions are not necessary for most babies’ skin.
Sleeping position / General Safety / Going Out
Sleeping position / SIDS
Sudden infant Death Syndrome (SIDS) is the sudden, unexpected, and unexplained death of a baby during sleep. Infants between one and five months are highest risk. SIDS is the second leading cause of death among babies less than one year. Research has shown that the number of SIDS deaths can be reduced dramatically if babies are put to bed on their backs or sides, rather than on their stomachs.
To further reduce the risk of SIDS, DO NOT:
· Allow smoking inside your home or around your baby
· Overheat or over bundle your baby
· Put your baby to sleep on a sheepskin, waterbed, or natural fiber mattress
· Put stuffed animals or pillows in the crib.
General Safety Precautions
- Always assume that your baby can roll over and/or propel herself off a counter, bed, or couch Use only cribs, car seats, strollers, etc. that meet approved safety standards.
- Avoid walkers.Use only approved pacifier clips to secure a pacifier to your baby’s clothing.
- Avoid chains, strings, or necklaces around your baby’s neck that could result in injury.
- Maintain smoke detectors and fire extinguishers in working condition.
- Set the water heater and 120 degrees; always test bath water.
- If heating formula or bottled breast milk, shake gently and test the temperature before using. Be careful heating in a microwave, as “hot-spots” can develop.
- Remain with your baby, toddler, or young child when s/he is in contact with a pet.
Dressing and Going out
- Your own response to the outdoor temperature is your best guide to clothing your baby.
- Avoid direct sunlight in hot weather.
- Getting out with a baby for a walk or a ride in the car is good for everyone!
- Visiting with friends and relatives is important after the arrival of a baby. Remember, however, that it is best to avoid close contact with anyone who has a contagious illness. Additionally, encourage good hand-washing for anyone who will be holding your baby.
Colic and Spitting
Colic is a term used to describe a pattern of fussiness or crying in certain babies. By definition, colic is unexplained crying in an otherwise healthy infant lasting at least three hours a day and occurring at least three days a week. Colic is rarely a problem before a few weeks of age and, fortunately, rarely lasts beyond three months of age. Several strategies to limit crying include:
- Do not worry about spoiling your newborn. He or she is dependent on you for almost everything – be available.
- Hold your baby frequently (a Snugli or a sling often helps) and for at least three hours each day when he or she is not fussy.
- Respond quickly to your baby’s cry.
- Help your baby learn how to sooth himself/herself.
- Develop a routine to soothe your crying baby; suggestions include:
- Hold / rock / cuddle
- Change diaper
- Offer food if not fed more than two hours prior
- Burp your baby
- Offer a pacifier or clean finger for sucking
- Check for a hair wrapped around a finger/penis, an eyelash in the baby’s eye, clothes that are too tight.
- Offer visual or auditory stimulation (e.g. singing) that is likely to soothe or distract.
As new parents, two important strategies to remember are: one, get rest whenever possible, as being tired only serves to heighten the anxiety created by a crying baby, and second, never turn down help from friends and family. Call your spouse, a friend, a relative and ask for support. They will help ease the workload associated with a new baby and allow you to better enjoy the excitement of a very busy time in your life. When friends or family ask how they can help, invite them to bring you dinner!
Spitting / Vomiting
Many infants spit up a little milk from time to time and some normal, healthy infants spit up after every feeding. This spitting can be related to overeating and / or frequent, normal opening and closing of the muscle between the esophagus and the stomach. By nine months of age, the vast majority of normal “spittiness” has resolved. Patience, bibs, and laundry detergent are the key. However, if your baby spits up large amounts on a regular basis or has forceful vomiting that shoots across the room, you should call the office for your baby to be seen. Additionally, green or dark yellow vomit can be a medical emergency in infants and you should call without hesitation if your baby’s vomit is dark yellow or green.
To help you succeed with breast feeding, I offer the following guidelines, early office follow-up after hospital discharge, and referral if necessary for lactation consultation.
- Good technique is necessary for successful breast feeding. For most mothers, breast feeding is a skill that must be learned; it does not just happen. Remember that the nurses in the hospital are available to help. Take advantage of their expertise while in the hospital.
- Breast milk is produced based on “supply and demand.” Most breast fed infants do not need supplemental water or formula as this will interfere with the desire to suck and reduce the stimulation from sucking that is necessary for the production of milk. Babies are born with enough extra “water” to keep them safe until maternal milk is produced. Healthy babies can lose up to 10% of their birth weight and then slowly gain it back over a couple of weeks.
- The mother’s comfort is important for successful breastfeeding. Avoid leaning into the baby. Position the baby on a pillow on your lap with his/her face and body facing your breast using either the football hold or the cradle position. Remember that you are in charge of his/her head. Use on hand to guide your baby’s mouth the the area of the nipple. Use your other hand to lift or position the breast so that the areola and nipple are available to the baby to latch on. Avoid squeezing the breast if it flattens the nipple. Remember to bring the baby to the breast, not vice versa.
- Latching on properly occurs when the baby has all or most of the areola (brown skin surrounding the nipple) in his/her mouth while sucking. The baby’s nose and chin touch the breast and there is no sustained pain. Although the skin may be sore, if the nipple hurts persistently while the baby sucks, then he or she is not latched on properly. Gently release the nipple by putting your finger in the baby’s mouth and reposition the breast and the baby’s mouth. With appropriate latching on, a consistent pattern of suck, suck, suck, pause…. swallow can be heard. Avoid jostling your baby during the periods of pause, as this can interfere with the seal.
- With proper stimulation (sucking), milk production will be apparent 48 to 96 hours after delivery. It is the frequency (how often) of proper latching and sucking and not the duration (how long) that stimulates the mother’s body to produce milk. The baby should be put to the breast as soon after delivery as possible and allowed to suckle 5-10 minutes on each breast. The baby should be returned to the breast every 2-3 hours or 8-10 times per 24 hours until the mother’s milk comes in. It may be necessary to wake the baby. Helpful hints include unwrapping any swaddling blankets, changing a diaper, using a cool washcloth to wipe the face, etc. Should you have a cesarean section or complication that prevents you from nursing the first day or two, be assured that your milk will still come in, perhaps a bit slower than with an uncomplicated delivery. The nurses at the hospital can help you with the necessary equipment and instruction to pump your breasts until you and your baby can get together for nursing.
- Breast engorgement (fullness, pressure, leakage), obvious swallowing followed by a content, sleepy baby, and yellow stools are signs of successful milk production and adequate milk intake. Once the milk is in and the baby has yellow stools, he or she does not need to be awakened every 2-3 hours. Most breast fed infants will gain between ½ and one ounce per day when the milk is in.
- Nipple preparation/toughening does not promote good nursing. This is a myth.
- While breastfeeding, the mother needs healthy fluids (orange juice with calcium, water, milk, etc.) to satisfy thirst; you will also require a slight increase in protein rich foods, a vitamin supplement, and 300-500 calories above your normal daily caloric intake.
- Breast milk alone is adequate for normal growth and development in the first 4-6 months of life. Expressing milk for a bottle feed should be delayed for several weeks. Vitamin supplementation to the baby is not necessary.
Formula and Feeding
While there are several advantages to breastfeeding, please feel comfortable with the fact that your baby will still grow normally if you choose to formula feed him/her. it is important that you know I recognize that there is much more to parenting than the method of feeding you choose. There are several good formulas available; be sure to choose a formula with full iron content. The vast majority of babies will grow well on cow’s milk formula, and for most babies, interchanging specific brand names is just fine. Formula left in the bottle should be discarded. As your infant grows, the volume consumed will increase and the time between feedings will lengthen. In general, your baby should be fed as much as he or she wants in 20-30 minutes and be fed every two and a half to four hours in the daytime and with no limit on the minimum time between feedings at nighttime (i.e. don't wake up your baby in the middle of the night for a bottle). Formula comes in powder, concentrate, and ready-to-feed forms. The powder is usually the most economical of the three and helpful when you are traveling, since water can be added just before feeding, avoiding the need for refrigeration. Premixed formula can last several days in the refrigerator. Remember that if you heat formula in the microwave, be sure to mix well because uneven heating can cause hotspots which may result in a burn to the baby.
Water source for feeding and cleaning
Municipal water supplies are considered safe for drinking and mixing formula without boiling. You can wash bottle, caps, nipples, etc. in hot soapy water, rinse well, and air dry with no need for sterilization. The dishwasher is just fine but sometimes can make plastic nipples break down and become sticky. If you have a well, the water can be checked for bacteria by a commercial testing company. If your water is safe for you to drink, then you may consider it safe for your baby with the guidelines above. Regardless of the water source, remember to refrigerate the milk once a can has been opened or it has been mixed with water.
Vitamins, Iron, and Fluoride
Iron need not be supplemented in breastfed babies for the first 4-6 months. Dr. Simon will discuss during routine well baby visits whether supplemental vitamins, iron, or fluoride are needed, depending on your particular situation.
There is no advantage to introducing solid foods before 4 to 6 months, and solid foods given too early may inhibit your baby’s ability to absorb iron from his or her milk. When you do decide to introduce solids, it is important to feed your baby with a spoon and not offer solids through the bottle.
One of the earliest ways an infant expresses his/her own individuality is in the frequency of eating. Some infants wake like clockwork every four hours; others eat erratically – going variable periods of 2 to 4 hours between feedings. Frequency of feeding is dynamic – especially for breastfed infants, and there may be rapid changes for the first few weeks. What is important is that both the baby and parents are content with what is happening. If not, please make an appointment so we can talk it over.
Other Common Concerns
Tears are usually absorbed in the tear ducts, which drain from the inner part of the lower eyelid into the nose. If the tear duct is blocked (6-10% of newborns), tears well up in the eye and discharge may be present. Most blocked tear ducts open spontaneously by 6-8 months. Cleaning the discharge with a moist tissue or cotton ball and gentle massage of the tear duct (along the side of the bridge of the nose) may facilitate drainage.
If your baby feels warm, you can use a thermometer to record his/her temperature. Forehead strips are not accurate, and I do not recommend using an ear thermos can in infants less than four months. Temperatures measured rectally are the most accurate. A clean blunt-tipped thermometer is safe. Lubricate the tip of the thermometer with petroleum jelly, position your baby belly-down on your lap, insert the tip into the rectum, hold the buttock cheeks together and allow three minutes for accurate measurement (digital thermometers may not take as long). If your baby is less than three months of age and the temperature is above 100.4 degrees rectally, it is recommended that you call the doctor or the on-call service. No anti-fever medication should be given to a baby less than three months of age until you have spoken with the doctor.
During the first few days of life, some babies get a yellow color to their skin and the whites of the eyes that is referred to as “jaundice.” Bilirubin, which is breakdown product of blood cells, causes this yellow tinge. Babies are at risk for jaundice because they have more red blood cells at birth that they need, they are sometimes bruised during birth, and sometimes the baby and the mother’s blood-types are in conflict, causing the red blood cells to spill extra bilirubin. Since the young baby has a slower liver metabolism and is getting fewer calories, the bilirubin is getting removed from the body more slowly. Hence there is a buildup of the pigment in the skin. The best way to prevent jaundice is to feed your baby early and often. Although the majority of babies with jaundice will have no bad effects, we know that extremely high levels of bilirubin may affect hearing and possibly development, so we will be careful to evaluate jaundice and follow any baby for whom the jaundice may pose a problem.
Most newborn rashes are normal events requiring no treatment. Erythema toxicum is a characterized by small flat, red areas surrounding a tiny central yellow/white bump. There are no bad consequences and by two weeks, most spots have disappeared. Milia are tiny white bumps at the surface of sweat glands (often most obvious over the bridge of the nose). These disappear during the first few weeks/months. Mongolian spots are blue-gray areas of skin over the buttocks, lower back and extremities that are most often seen in dark-skinned children. These patches generally fade over the first few years of life. Neonatal acne may develop (and clear) over the face and upper trunk during the first three months of life. These are small superficial cysts with red skin that are thought to result from maternal and infant hormones. Salmon patches (flat red birthmarks or “stork-bites”) occur in more than 30% of newborns, usually on the forehead, upper eyelids, or nape of the neck. All generally fade with age.