FEEDING
As does every provider of health care to a child, we
encourage breast feeding as the preferred way of nourishing a baby.
Please see our section on breast feeding and its many web links. Whether you are breast feeding or bottle feeding, you
should feel comfortable with the method of feeding. Try to make this time as
relaxed, unhurried and pleasurable as possible. These moments supply your
baby with nourishment and love. Select a chair or breast feeding position
that is comfortable for you and the baby.
Schedule
Feeding schedules are best if they are flexible or
"on demand." A full term baby will generally need a feeding
every two to four hours. The baby may feed more frequently at certain
times than others, i.e. the evening. If your baby requires a feeding in
less than two hours, you may offer boiled city tap water. If your baby is
premature or breast fed, he may need feedings every two to three hours.
Try to avoid feeding your baby solely because he is crying, and try to
imagine what other factor might have triggered his need to cry. If
nothing else comes to mind, feed him even if it's only been a short time.
Burping
Breast fed babies can be burped as you switch breasts
and after nursing is completed. Bottle fed babies should be burped in the
middle of and at the end of each feeding. After a large burp, the baby may
still be hungry and want to feed longer. If you cannot get the baby to
burp in one position, try another one. Recognize that some babies may spit
some with burping.
Vitamins and Fluoride
Breast fed babies can be started on vitamin drops at
two weeks of age to give them adequate supplies of A, D, C and iron.
Bottle fed babies do not need supplements beyond what they get in the
formula. If you use solely bottled water or live in an area with well
water, talk to the office about fluoride supplements.
Addition of Solid Food
Formula or breast milk contains all the carbohydrates,
proteins and other essential nutrients for the baby to grow and be
healthy. Either form of milk is the most important food the baby’s first
four to six months of life. Addition of solid food will depend on your
baby’s weight and sleep patterns, absence of "tongue thrust"
and age. Early addition of solid foods is linked to over feeding and
obesity, allergies and other health problems. It is never a good idea to
put cereal in a bottle. The doctors will help you develop a plan for your
baby that will fit your baby’s health needs and family patterns.
Weight Gain
A full term infant will lose approximately 10% of his
birth weight in the first few days of life. Premature infants may lose a
little more weight. By the time the baby is seen for his two-week check
up, he should have regained his birth weight. Newborn infants that are
breast fed will gain approximately ½ ounce per day and bottle fed infants
will gain nearly 1 ounce per day in the first few months of life.
Pacifier Use
Many babies need extra sucking time beyond their
eating/feeding times. Hands, thumbs, fingers or pacifiers may be used to
fulfill this normal developmental need. It is important that you allow
your baby some form or oral gratification, but it is an individual choice
as to preference of pacifiers versus thumbs, fingers or hands. The doctors
can discuss pros/cons of each and dental concerns with you. If you do use
a pacifier, make sure it is a single piece, and fits your baby’s mouth
appropriately. Never hang it on a string around your baby’s neck to
avoid choking injuries. Using pacifiers at night for sleep
transition is not recommended, as babies lose them in their crib and find
the need to alert you in the night.
Feeding
Problems in Infants and Children
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Breast Feeding
Just as each pregnancy is different, and each child is
different, there is no absolute right way to nurse. The only rule
here is Whatever Works. It may take a while for you and your
infant to get in the groove, and there is help available. How do you
know if it's working? Swallowing sounds, muscle tone relaxation,
breathing rhythm changes, wet diapers, and weight gain.
Women will usually nurse from both breasts at each feeding, alternating the breast used
first. Initially, the baby may nurse five to ten minutes on each side. We
encourage you to feed as soon as possible after birth and continue every
two to three hours during the day. If you brand new newborn falls asleep after one
breast, try to undress him and wake him so he can feed from the second
breast. Nurse until your baby seems content, especially as he gets older.
The initial milk, called colostrum, will be thin and
clear/blue/gray/golden. It is rich in protein, fat, soluble vitamins, minerals,
and antibodies. Your milk will usually "come in" between day two
and three. It will make a transition to mature milk in the first two weeks
post-partum.
The color of your breast milk has little to do with its
quality. An adequate diet with a generous fluid intake and carbohydrate
intake is what is most important to insure good quality and quantity of
your breast milk. If your baby is gaining weight and has many wet diapers
in a day, your baby is getting enough milk and does not need
supplementation. If you are considering the addition of formula, please
call so we can discuss it. In general, we recommend that you exclusively
breast feed for
two to three weeks post-partum to avoid nipple confusion. Doing this will help your milk supply
build up and help your infant learn and get established with breast
feeding. After this time you may give one bottle of pumped breast milk once a day or once every other day. This bottle feeding will allow
others feeding time with the baby and will help the baby adjust to bottle
feeding when you are at work or out.
Nipple soreness usually indicates a problem with the
placement of the nipple in the mouth. Cracked nipples can be cared for
with simple treatments. Tylenol may relieve some of the pain. No other medications
should be taken without first checking with our office. If your breasts
get very tender, red and/or swollen or if you have a fever or chills,
please call our office regarding infection.
If you feel frustrated or need help with breast feeding,
please call our office or La Leche League.
Hints
to Get You Off to a Good Start
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Bottle Feeding
Similacâ with Iron is a
recommended formula. Ready to use, concentrate or powder forms are
available. It is best to make formula fresh daily and keep it refrigerated
until ready for use. You do not need to warm the formula more than to room
temperature. If you do warm it, use a pan over the stove rather than a
microwave. Unfinished bottles may be stored in the refrigerator, but
should be used in the next feeding.
There are many different nipple and bottle types on the
market. Use the type with which you and your baby are comfortable and is
easy to sterilize. It is recommended to sterilize nipples and bottles for
the first three months. After this time nipples and bottles can be cleaned
with warm, soapy water, then rinsed well and air dried.
Most full term infants will take 1 to 3 ounces of
formula every three to four hours. They will work up to 4 or 5 ounces
around one month of age. You can put ½ ounce more formula in each bottle
than your infant has been taking, so that he never routinely empties the
bottle, but avoid over feeding.
Propping the bottle is discouraged. Propping leads to
more swallowed air, spitting up and possible choking. It also takes away
from feeding time as an opportunity for loving and bonding with your baby.
To prevent the baby from taking too much air, the bottle should be tilted
in such a way as to completely fill the nipple and bottle neck with
formula.
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SLEEP
Most babies will be awake more at night in the first few
days of life. You can help your baby change his sleep schedule by:
- Starting up a nighttime ritual, going from the most
stimulating to the most relaxing activity just before bed.
- Not letting your baby sleep more than four hours at a
time during the day.
- Not waking your baby at night.
- Keeping nighttime interaction at feeding times to a
bare minimum: no light, no sound, no fun.
The baby should sleep on his side or back. "Tummy
sleeping" and "overheating" during sleep has been
associated with higher risk of SIDS, or sudden infant death syndrome.
Never use a pillow. Sleeping on water beds is also discouraged.
Babies will typically wake up two times during the night
at first, and then once a night for up to four months of age. Sleeping through the night is determined by
how you interact with your baby at bedtime and in the middle of the night,
and by your infant’s weight, usually between 12.5 lbs. and 13.5 lbs., not by the
addition of solid food before bed time.
Sleep routines and places of sleep are important to
establish early in your baby’s life for his general health and both his
and your well-being. Try to schedule standard nap times and develop a "night
time" routine by reading books, singing lullabies, turning down
lights, etc. Sleep time in strollers, car seats and your arms may be
necessary at times. Remember, however, it is not quality sleep for your
baby and should be avoided on a routine basis.
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ELIMINATION
A newborn baby’s diapers should be wet eight to ten
times in 24 hours. A male infant should have a good urine stream, which
you may see during a bath or diaper change. If you have any questions or
concerns, let our office know promptly.
A baby’s stools, or bowel movements, will be dark,
black-green sticky substance called meconium for the first few days of
life. As he feeds the stools will become more "transitional" and
appear quite loose, yellow-green or mucousy. This type of stool will
continue for three to four days, followed by the baby’s more typical
stools. Breast fed babies have softer, less firm and usually more frequent
stools than bottle fed infants. The color may be brown, yellow or
yellow-green. Your baby may have stools after each feeding or as
infrequently as every two days. If you baby has not had a stool in three
days, if there is blood in the stool, or if the stools are hard and pebble
like, let the doctors know.
Female infants may have small streaks of blood or
white/pink vaginal discharge in the first few weeks of life. The discharge
may continue longer if you are breast feeding. It is related to maternal
hormones and will disappear in time. Remember to wipe female babies from
front to back.
Elimination
Problems in Infants and Children
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SKIN
A baby’s skin may look thin and smooth or cracked/dry
depending on whether he is premature, full term or post term. You do no
need to use anything on the baby’s skin. In general, soaps and oils are
not recommended since they can irritate the skin and block skin pores. If
your baby’s skin is very dry or peeling, a good moisturizer may be used.
Bathing
Sponge bathing is recommended until your baby’s
umbilical cord falls off in approximately seven to fourteen days. Water
temperature should be warm, not hot. Always check the temperature prior to
putting the baby in the bath. Water or a mild soap, such as Dove or Baby
Bath, can be used. Baby shampoo can be used on the scalp. Baths should be
brief and not near drafty areas.
Umbilical Cord Care
The umbilical area should be kept clean and dry. With a
cotton tipped applicator, apply alcohol to the base of the cord. Do this
after a bath and with each diaper change until healed. After the cord
falls off, let our office know if the area looks red or infected or bleeds
excessively. Minor bleeding is normal for a day.
Circumcision Care
If the baby is circumcised after birth, the area may
look red and raw for a day or two. The skin will look better each day,
especially towards the end of the first week. It is important that the
baby voids (or passes urine) within 8 to 12 hours after the circumcision
is done. If he does not, please call our office. Wash the area gently
after each bath. Apply vaseline to the head of the penis with each diaper
change until is healed.
If your baby is uncircumcised, clean the penis as you
would any other part of the body. Do not forcibly retract the foreskin.
Many children’s foreskin, around one year of age, can be easily
retracted. Once it can be retracted, you can gently clean under the
foreskin with each bathing.
Diaper Change
Regular cloth or disposable diapers can be used. After a
stool, a wet tissue, wet cloth, cotton balls or commercial wipe may be
used to clean the area. Avoid products with alcohol or fragrances.
Jaundice
Within the first week of life some babies develop
jaundice or have a yellow pigmentation to their skin from bilirubin
accumulation. It can appear for a variety of medical reasons and,
sometimes, is related to breast feeding. You would notice a yellow or
yellow-orange hue in the baby’s face or all the way to his knees. The
white part of his eyes may also appear yellow. The doctors will be
following the jaundiced baby before you and the baby are discharged home.
If you notice it after you are home, please call our office promptly. The
baby may need a blood test for bilirubin and treatment.
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Diaper
Rashes
Most diaper rashes are caused by chafing of the skin
from moisture, or irritation from prolonged contact with stool. These
rashes are readily cleared by changing diapers more frequently, and by
using a diaper rash ointment such as Balmex or A&D.
Occasionally you will experience a rash that continues
to worsen in spite of the above treatment measures. This may be due to a
"yeast" infection. Yeasts require moisture to grow.
Consequently, keeping the area dry will improve this type or rash. Leave
the diaper off if practical, or change it frequently. Stop applying
Desitin or other ointments that seal moisture in. You may try baby lotion
or baby cream, as these are more readily absorbed into the skin. If these
measures are unsuccessful, we encourage a call to the office during office
hours.
Diaper
Rash
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Crying
Crying is normal for newborns. Some babies cry more than
others. Many babies have spells of crying, especially in the evening.
The amount of crying is not always related to the
general health of the baby. He may have a wet diaper, be hungry, or be
over-tired. The baby may also be over stimulated or in pain. Crying can be
a breathing exercise or a release into sleep. The baby may also be ill.
If they baby seems well and you have done everything you
can to comfort him try leaving him alone. Crying along will not harm the
baby. NEVER shake the baby as this can cause brain injury, or even death.
If your patience is wearing thin with a crying baby, get someone else to
take the baby, and take a break. In general, do not let the newborn cry
more than ten minutes without picking him up. Try changing positions,
wrapping him or using a pacifier or a swing to help calm him. If you have
concerns about his crying, please contact the office.
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Temperature Regulation/Dress
A newborn’s body temperature will fluctuate easily
depending on air temperature. In general, he should be dressed in the same
number of layers as yourself. For example, if you are comfortable in a
short sleeve shirt, the baby will probably be comfortable in a short
sleeve outfit. If you add a sweater, add another layer on the baby. At
night the baby will be comfortable under blankets, like yourself. Do not
over wrap and avoid over heating at night. You do not need to take your
baby’s temperature, unless he seems feverish. He will be warm,
generally, if his hands and feet are warm. If you do need to take a
temperature on your newborn use a digital thermometer or regular
thermometer axillary, under the arm, for ten minutes. An ear thermometer
may also be used. Call the office if your baby has a temperature above 101
degrees, or if you are concerned.
Outings
Once your baby is a week old, you may take him out
dressed appropriately for the weather. Avoid get-togethers where someone
is ill. Also, do not take a young baby to crowded places (like malls,
church, grocery stores, schools) especially in the winter. Always use an
approved car seat when you are in the car. Infant car seats should be
placed facing the back of the rear seat until the baby can sit up well
with good head/neck control. This event occurs typically between six and
eight months.
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Spoiling
You are encouraged to rock, cuddle, play with, and talk
to your baby as frequently as possible in the initial months. Meeting his
needs promptly and regularly will help you both develop a strong
relationship. It will also help him feel a sense of security, trust and
love. When the baby gets close to six months of age he can get
"spoiled." We will discuss how to respond to his development at
check-ups and anytime you have concerns.
Checkups/Immunizations
The doctor and nurse practitioner will see you and the
baby in the hospital after birth. The first office visit, to check the
baby’s weight and health, is typically two weeks after birth. If you
have any questions or problems before then, please call the office so we
can help you. Check-ups, for the first two years will be at one month, two
months, six months, nine months, twelve months, fifteen months, eighteen
months and twenty four months of age.
Immunizations include diphtheria, pertussis, and tetanus
(DPT); Hepatitis B; measles, mumps and rubella (MMR); Hemophilus
influenzae type B vaccine (HIB); the PPD or Tine test and the varicella
vaccine. The schedule for these immunizations will be discussed at the
baby’s check ups. It seems to change too often to post on the
site. We will also let you know when blood pressure,
hemoglobin, lead and urine testing are needed.
For information on vaccines, their usefulness, and their
side effects, try these sites:
Vaccines:
General Information CDC vaccine site
Vaccines:
Individual Information Sheets CDC vaccine site
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Safety
Safety is a major concern for your baby as a newborn and
throughout his growing up. Some initial tips include:
· Always use a car seat when
traveling in a car.
· Never turn your back on
your baby when he is off the ground. Between 2 to 4 months he
will begin rolling and could fall.
· Make sure your crib has no
more than 2-3/8" between the slats and has railings 22"
high. Do not leave the railings down if the baby is in
the crib.
· Keep cribs away from
blinds, pulleys, etc., in which they could get tangled or choke.
· Do not use pillows in
cribs or bassinets.
· Always have important
phone numbers posted, including Poison Control.
1-800-222-1222 or 1-312-942-5969.
· We do not recommend the
use of walkers.
· Prepare to baby proof your
home when your baby is 6 to 9 months.
· Have a smoke detector on
each level of your home, and check it regularly.
· Always check water and
food temperature before giving the baby a bath or feeding.
· Keep plastic bags and
wraps away from the baby.
· When buying toys, make
sure they meet the safety requirements and are age
appropriate.
· Watch siblings and/or
young visitors near a young baby.
Child
Safety
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Teething
Teething can produce the following symptoms:
- Runny nose and slight "cold-like" symptoms
- Temperature elevations – usually low grade
- Fussiness and irritability
Treatment of the symptoms of teething:
- Put the teething ring in the refrigerator to get
cold, then let the child bite on it.
- Acetaminophen (Tylenol) if fussy, irritable or
elevated temperature. Chronic use is not recommended.
- Antihistamine/decongestant such as PediaCare® for
"cold-like" symptoms.
- Commercial teething preparations, like Numzit, or
Baby Orajel may sometimes help.
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Loose
Stools
Normal bowel movements in newborn babies are soft and
pasty in consistency. The number of stools passed per day is often equal
to the number of times the baby eats each day. Changes in the color of the
stool are common and usually of no consequence. If the infant acts and
appears well, then an increase in the number of stools per day may be a
tolerable variation that is best not treated, but allowed to return to
normal by itself. To prevent a diaper rash from occurring, change the
diapers more frequently, wash the bottom with soap and water, then protect
the baby’s bottom by using baby cream or Vaseline.
If you become convinced the loose stools are adversely
affecting the baby, you should temporarily switch from milk to Pedialyte®
(a liquid nutrient bought at the drugstore). This will allow the infant to
maintain electrolyte balance and hydration. If this is required for more
than a few days, check with your physician. If breastfeeding, continue. If
questioning dehydration, see DEHYDRATION.
Elimination
Problems in Infants and Children
Constipation
For bottle-fed infants, add 1 teaspoon of dark Karo
syrup to each 6 oz. formula.
Infant glycerin suppositories (purchased at the
pharmacy) are safe for use with newborns and always effective. If the baby
has not had a bowel movement within 3-4 days, you may stimulate a bowel
movement using a suppository. For newborns use ½ of an infant size
suppository. The suppositories are long and thin. Hold the suppository
like you would a thermometer, inserting the tip rectally until a response
occurs. You may cut the suppository in ½ and insert it
completely.
One half strength apple or prune juice may be used for
infants not taking solids yet.
Strained prunes can be given if the infant is on fruit.
Chronic constipation can be discussed with you doctor at routine visits.
Elimination
Problems in Infants and Children
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Early Childhood Medication
Dosages
When the package notes, "below this age consult
your physician for dose", refer to the following.
Acetaminophen (Tylenol,
or store brand)
Acetaminophen is a non-aspirin product suitable for
children and adults in treating fever, aches, and pain. The following
table gives dosages for younger children. Since products may vary in the
concentration of active ingredient, please check each product’s package
for directions.
The safest way to give a dose is by the number of
milligrams. If the package directions do not give dosages for young
children, then use the table.
