GENERAL INSTRUCTIONS FOR YOUR NEW BABY
General Introductory Philosophy
The most important thing to do with your newborn is to enjoy him. Having a new baby is one of life’s great experiences, but it also involves a lot of work and responsibility. Remember to have a certain degree of flexibility and optimism, which will help greatly on some of those difficult days that come to all parents.
There is no one right way to raise a baby. You will receive lots of conflicting and, at times, confusing advice from many sources. Trust yourself and what makes sense for you. You will know a good deal more than you think. If you are worried, call us.
Our aim as your pediatrician is twofold – a healthy baby and happy parents.
This booklet that we have prepared for you has suggestions and recommendations rather than rules. Remember that problems are best met by the common sense approach.
Each morning, while you are in the hospital, we will visit you. We want this to be an opportunity to answer questions in preparation for your baby’s home care. Later, your regular well baby visits will serve this purpose. Should any concerns arise at home, call us immediately.
YOUR NEW BABY
The skin undergoes many changes during the first days and weeks. During the first few weeks the skin may appear quite red. Over the first month, the skin may have some scaling or cracking. Whiteheads occur frequently, particularly on the forehead, nose and onto the cheeks. They are due to hormones affecting the infant’s sweat glands. None of these conditions require any special treatment. Many infants have reddened birth markings over the forehead, eyelids, or at the nape of the neck you may note at birth. They may persist beyond the first year but will eventually disappear.
Breast enlargement is normally seen in both boys and girls. There may even be a thin watery discharge from the nipple. This is secondary to hormones and no treatment is necessary.
A white mucous vaginal discharge (often accompanied by a small amount of blood) is often seen in female babies. The discharge is more common in breast-fed girls. The discharge is normal and does not require treatment.
The head may be quite lopsided or molded from its position in the womb and from passage through the birth canal. These effects are only temporary.
The legs and feet may be bowed or molded and appear quite misshapen at birth. These are usually selfcorrecting and should be reviewed with your physician.
Babies do many things naturally and normally. They burp or belch because of swallowed air. They also pass gas for the same reason. Sneezing is the only way a baby can clear his nose of lint, mucus, or milk curds. Babies have hiccups quite often; they are little spasms of the diaphragm. These may be stopped by burping or offering a few swallows of warm water, just as he occasionally sneezes to clear his nose, he may cough to clear his throat. All babies cry for many reasons. By the character of the cry, you may be able to recognize why. He may be hungry or thirsty, need changing, be too hot or cold, want a change in position or simply to have some attention (e.g., to be picked up). Even a well baby will probably cry for a little while each day. This will probably increase between two to four weeks as the baby becomes more responsive. If all of his needs have been met, he could cry for an hour or so occasionally without doing himself any harm.
It is important to keep the navel as dry as possible until the cord falls off. If the navel becomes dirty or contaminated by the diaper, clean with cotton moistened with alcohol. When the cord does fall off (7-14 days of age), there may be a few drops of blood and moist discharge for a day or so. When it remains dry, you may begin tub bathing. There should not be any redness of the skin surrounding the navel or any foul smelling discharge.
Infant nails grow quickly. You will need to maintain them 2-3 times per week to avoid scratching. Use a nail file (adult) or bite the edges of the nail and peel. If you use mitts, be sure to remove all strings inside to avoid wrapping around the fingers.
Following circumcision, Vaseline or Crisco lard should be liberally applied around the end of the penis with each diaper change until the wound is completely healed (usually 7-10 days). As the penis is healing, you will notice a thin yellow film over the head. This is normal.
Infants are born creatures of habit. They are creatures of the uterine habit. Our world is quite different than where they came from. They will do many things in response to their new environment.
They burp because of swallowed air. They pass gas for the same reason. For the first three months, they only breath through their nose. They sneeze a lot to clear their nasal passages of lint, mucous or milk curds. Babies will often hiccup. He may cough to clear his throat.
Babies cry for many reasons. With time you will begin to recognize his needs by the character of his cry. He may be hungry, need changing, be too hot or cold; he may want a change in position or to be picked up.
Most babies will cry for a little while each day. Infants are overwhelmed and bombarded by new stimulation (stress) from our environment. Crying is one way for babies to release some of that new stress. As babies develop more daytime alertness between two and four weeks of age, you may also find your baby to be more fussy and ‘opinionated’ at that time.
There is a wide variation in frequency and consistency of stools. There may be a stool after each feeding or only one or two a day. Babies may go up to 2-3 days without a stool and be normal. Please consult with your physician regarding your babies stooling patterns.
It is also quite normal for babies to fuss and strain for awhile before having a stool. Sometimes the stools may be quite loose or dry; they may occasionally contain some mucus or even be green in color without concern.
Do not use baby wipes, except for travel, in the first month for cleaning. You may use cotton balls or washcloths with water or wipes with soap rinsed out.
If you have concern that your baby has a temperature, it should be taken with a digital thermometer under the armpit. A degree should be added to the armpit temperature. If this temperature is greater than 100.5, it should be confirmed by taking a rectal temperature. You do not have to routinely check your infant’s temperature.
Try to keep an even comfortable temperature ideally (68 – 70 degrees) in the baby’s room. The baby should be clothed in loose garments. In the first couple of weeks, babies generally prefer the swaddle wrap. Be careful not to over wrap the baby. If the skin feels damp on the neck or abdomen, he is probably too hot. In general, the baby will need one more layer of clothing than adults need in a similar environment.
The infant in any cooled environment for the first few weeks should wear a hat. Babies lose a lot of body heat through the head because of its large surface area.
Your baby’s initial bond with you takes place during feeding. Therefore, this time should be as free from external distraction as possible. Both you and your baby should be as comfortable as possible.
There is no hard and fast rule. A modified demand-feeding schedule is preferable for either breast or bottle fed babies. Most infants will naturally fall into a 2 ½ to 4 hour feeding routine. Babies in the first few weeks of life often prefer to eat every two to three hours. Sucking is very calming to infants. You may easily mistake your baby’s need to suck for his need to feed. To avoid having a very demanding baby, don’t rush to feed him at his first whimper if he has eaten in the past one to two hours. It will not take you long to determine whether the baby is crying from hunger or for some other reason. To encourage the baby to take more of his feedings during the day and fewer at night, awaken him if he sleeps longer than three hours during the day and feed him. At night, let him sleep as long as he wants.
Whether the baby is breast or bottle fed, the semi-upright position is best for nursing. Never prop a bottle or leave the baby to feed himself. The bottle can easily slip into the wrong position. This helps to avoid bringing up large quantities of milk when the baby is burping. Generally allow thirty to forty minutes for each feeding to ensure the baby has enough sucking time. Burp the baby once or twice during breast-feeding or every two ounces during bottle-feeding and again after the feeding. All babies spit up small amounts of their feedings from time to time. This is not a reason for concern unless it is habitual, painful, or in large quantities. If this is the case, please call your physician.
For nursing mothers, most babies will be satisfied with 20-40 minutes of nursing. A few will need longer. Supplemental feedings are not needed in most situations. Watch your diet: go easy on caffeine, spicy foods, milk products, acidic foods like citrus and tomatoes, and gas-producing foods (beans and raw vegetables). Attempt to eat a balanced diet and drink plenty of water. Take your prenatal vitamins and get as much rest as possible.
Several commercial prepared infant formulas are available. Most are supplied in powder concentrated liquid and ready-to-use forms.
Babies do not need water in addition to feedings. Babies are satisfied by volume and water supplies volume to the baby without supplying calories. If babies are thirsty, they need calories. You may wish to offer plain water at various times if the baby is fussy, has the hiccups, or the weather is hot. Only small sips of water are appropriate. There is no need to sterilize bottles or nipples. The water does not need to be boiled. Bottles can be washed in the dishwasher or by hand with hot soapy water.
Due to nutritional advantages of breast milk or infant formula over cows’ milk, we recommend that your infant remain on breast milk or formula until 12 months of age. Both breast milk and infant formula are more nutritionally complete, more easily digested, and minimize the potential for iron deficiency, kidney overload and early development of allergy.
Since the minimum requirements for vitamins are met by breast milk and all currently commercially available formulas, we do not recommend any vitamin supplements for the newborn. Mothers who are breast feeding should remain on prenatal vitamins for the duration of time they are nursing.
We will discuss with you at the routine well baby visits when to begin vitamins and fluoride supplements. We will also discuss when to begin solid foods in your infant’s diet (usually 6 months).
CARE OF BABY
Until the navel and/or circumcision have healed, you will only be sponge bathing your baby. Once every two to four days is adequate. After healing, your baby will enjoy a bathtub. Be sure to wash, rinse and dry all creases well. It is not necessary to clean the mouth at all. Nothing small should ever be introduced into the nose or ears. Never use a Q-tip in baby’s ears. Only those visible areas need to be cleaned, and this can be adequately accomplished by wrapping your little finger with the washcloth. Working from the front to the back you should lather your baby’s head gently in order to keep the soap from his eyes. For the first month water alone is adequate for cleaning; occasionally you may use mild baby soap.
Babies should sleep on their backs. Babies should not sleep on their stomachs. As a newborn, your baby may sleep 18-21 hours a day. Babies should be allowed to sleep in a well-ventilated room. The crib should have a firm mattress and be free of pillows and loose bedding. You may swaddle your newborn initially until the baby starts to loosen from the blankets. At that point, the blankets should also be removed from the crib or bassinet.
Once you take your baby home from the hospital, you may safely take him outdoors when going from place to place. Avoid long outdoor exposures initially and be very careful to protect your baby’s eyes and skin from direct sunlight (particularly in fair skinned babies).
Your other children should be encouraged, whenever they are interested, to show their affection toward and help in the care of their new brother or sister. You should also be careful to continue to show your interest and affection toward your other children. Allowing other children to hold the baby in your presence may discourage them from wanting to do so in your absence.
Infants should always be placed in a good car seat whenever riding in a car. (This includes the trip home from the hospital). The seat will be rear facing.
A SAFETY CHECKLIST
- Do you always keep a hand on him when bathing or when he is resting on any place without sides?
- Do you check the water temperature before immersing him?
- Do you keep pins closed, and small objects away?
- Are all baby toys free from splinters, sharp edges, paint, removable parts and are they too big to be swallowed?
- Are electrical sockets all closed and/or covered? Cords in good condition? Are furniture and lamps heavy enough so they cannot be pulled over easily?
- Do you keep the baby away from the stove, open fires, hot drinks, water pipes, spa and Jacuzzis?
As your pediatricians, we are greatly interested in the preventative aspects of medicine. The goal of well baby care is to support the total emotional and physical development of your child. The first year of life marks incredibly rapid changes in all aspects of development. During this marvelous period, we recommend regular well baby checks. Well baby visits include immunizations to protect your child against preventative childhood illness. These visits may also involve urine or blood tests in order to detect a number of problems as early as possible. We hope these visits are of continuing dynamic educational benefit to you and your baby.
The baby’s first office visit should be at one week of age. Call the office the first day after your discharge from the hospital for an appointment. All visits, sick and well, are by appointment only. Many emergencies can be handled in our office. Never rush directly to the emergency room. A quick call to the office means the best course of action can be taken without delay. We are available to help you; please don’t hesitate to call us! You should call at any time, day or night, if your newborn infant shows any of the following signs of illness:
- Fever 100.5 degrees or more, rectally
- Excessive crying or irritability
- Vomiting (not just spitting up) or refusing feedings several times in a row
- Any unusual rash