Thank you for entrusting the care of your newborn to us. We hope the following information will be helpful to you.
First Office Visit
If your infant will be continuing care in our office, please call the office to arrange a visit within the first week. If you will be seeing another doctor, please call that office to arrange follow-up. Notify your insurance company of your infant’s birth.
Commercially available iron fortified cow’s milk formulas, such as Enfamil and Similac, provide adequate nutrition for those infants who are formula fed. Evaporated milk formulas are not recommended. Soybean formulas, such as Prosobee and Isomil, are recommended for those infants intolerant to cow’s milk formulas. Formula can be purchased in powder, concentrated liquid or ready to feed form. Cost and convenience are the two factors for consideration. All formulas must be prepared according to the instructions on the container. In general, infants will consume 2-4 ounces every 2-5 hours. It is rarely necessary to give more than 32 ounces of formula in a 24-hour period. Overfeeding may lead to excessive weight gain, vomiting, or fussiness. You should never prop the bottle, leave your infant unattended during feeding or put your infant to bed with a bottle. Burp well after each feeding. We recommend sterilizing bottles and nipples for the first few weeks; this can be done in the top rack of a dishwasher.
Since infants have little opportunity to get dirty, it is not necessary to bath them more frequently than every other day. Any mild non-deodorant soap may be used. Tub baths should not be given until the umbilical cord falls off and the navel has stopped draining. Never leave your infant unattended in the tub. Dry skin is common, is usually self-limited and may be treated with moisturizing lotion. Baby powders are not recommended. Talcum powder should not be used because of the danger of causing pneumonia if inhaled. Finger and toenails should be trimmed carefully to avoid cutting the skin. Red pimply rashes, especially on the face and neck, are quite common, are usually self-limited and require no treatment.
Diaper rash refers to any rash in the diaper area and is caused by excessive moisture resulting in skin irritation that can then become secondarily infected. The most critical factor in treating diaper rash is keeping the skin dry. Change your infant frequently. Keep the diaper area open to the air as much as possible. Cleanse the skin with water and dry well. We do not recommend the routine use of diaper wipes and definitely not if the infant has a diaper rash. Apply a protective thin coating of petroleum jelly (Vaseline). If the rash persists despite these measures, call the office for further advice.
Care of Genitalia
Medical opinion regarding circumcision is controversial and we believe the decision should be based on personal or religious preferences. If your infant has been circumcised, apply Vaseline to the penis at each diaper change and gently pull back the foreskin to keep it from sticking to the tip of the penis. If your infant is uncircumcised, gently pull back the foreskin as far as it comfortably goes for cleaning. Vaseline may be applied if desired. Do not forcefully retract the foreskin and always push it back over the tip of the penis after cleaning. Female infants may normally have a mucousy or blood-tinged vaginal discharge for the first month. Gently clean the area with warm water at each diaper change, making sure to clean carefully between the folds of skin.
The single most important precaution you can take is to purchase an approved car seat, use it every time you take your infant for a ride in a car, and always fasten seat safety restraints when your baby is in the car seat (in or out of car). Never hold your infant in your lap; you will not be able to hold the baby in the event of a collision or sudden stop. Never leave your baby (or any child) unattended in the car.
Safety procedures should begin right after birth. Never leave your infant unattended on a bed or changing table. Do not leave containers of powder on the changing table where they may be spilled, and the powder aspirated into the lungs. Make sure the crib mattress extends all the way out to the side rails and the head and footboards and always put up the side rail when leaving the infant in the crib. Do not leave an infant in an infant seat on a table, bed, or couch.
Jaundice is the yellow color of the skin and white of the eyes. Slight jaundice is normal, but significant jaundice can be dangerous. If your infant becomes more yellow after leaving the hospital, please call the office.
The American Academy of Pediatrics recommends that infants be placed on their back when sleeping. We support that position.
Feeding time should be a quiet, relaxing experience for both parent and infant. Usually, infants will be fed on demand every 2-5 hours. Feeding should not take longer than 30 minutes. Water is not necessary. It is not necessary to awaken an infant at night for feeding. Do not expect your infant to sleep through the night at this age. Many infants spit up after feeding. Make sure that the infant is burped during and after feeding. Call the office if the spitting becomes persistent or forceful.
The umbilical cord usually falls off sometime during the first 2 weeks. Prior to this time the infant should be given sponge rather than tub baths to avoid soaking the cord. Rubbing alcohol should be applied to the base of the cord by cotton applicator 3 or 4 times a day to keep it dry. Do not cover the navel. Roll the top of the diaper down below the cord and keep the undershirt rolled up above the cord leaving the navel completely open to the air. Small amounts of blood or yellow drainage from the navel are normal. Please call the office if large amounts of drainage or significant redness occur around the navel or if the cord has not fallen off by 4 weeks of age. Tub bathing may begin once the navel has stopped draining.
All infants cry: it is their most effective means of communication. Infants may cry as much as 2-5 hours a day. Although crying is distressful to parents, it is not harmful to infants; however, there is no need to let your infant “cry it out.” Feed your infant only if it is feeding time. Most infants can be comforted by picking them up and holding them. Some infants over stimulate themselves with their own movements and cry less when swaddled. Gentle rocking or swaying is often more effective than bouncing.
Breast-feeding is the natural method of infant feeding. Most women who desire to breast-feed can successfully nurse regardless of breast or nipple size or shape. A strong commitment to nursing is the most important factor in achieving a successful nursing experience. A mother’s milk supply is regulated by the infant’s demand; the more an infant sucks, the more milk the mother produces. During the first few days after birth, the infant may not suck well; consequently, the infant may initially lose weight. When the mother’s milk comes in, usually on the third or fourth day, the infant will nurse vigorously, and the lost weight will be rapidly regained. During the first 24 hours, try nursing your infant for 3-5 minutes on each breast. Over the next several days gradually increase to about 10 minutes on each breast. Start each nursing on the breast on which the infant finished the previous nursing. Always empty at least one breast at each feeding. Nursing frequency will be approximately every 2-5 hours. We recommend nursing infants be given Tri-vi-sol vitamins, available over the counter in your pharmacy.
Care of the breast is important. A good nursing bra is recommended. Before nursing, the nipples may be cleansed with clear water. After nursing, the nipples should be allowed to dry thoroughly. Nursing too frequently can lead to sore or cracked nipples. Nursing should be used for feeding, not for pacification. Red-tinged breast milk is due to maternal bleeding into the milk ducts, will not harm the infant and does not require that nursing be stopped.
Breast milk can be expressed from the breast by hand or by a manual or electric pump. It should be collected in clean plastic containers and immediately refrigerated for use within 24-48 hours or frozen for use within two months.
Good maternal nutrition is essential since a nursing mother will be providing her infant with 400-600 calories and approximately one quart of fluid per day. A nursing mother needs lots of fluids and lots of rest; drink an 8-oz. glass of water or juice whenever you are nursing your baby and sleep when the baby sleeps. You need not drink milk if adequate calcium intake is available from other sources. Most nursing mothers do not have to restrict their diets. Some foods you eat may upset your infant and you will learn through experience which foods to avoid. The upset, if it occurs, is 4-6 hours after eating the offending food. Continue your prenatal vitamins while nursing. Almost all drugs and medications (including nicotine from cigarette smoking) are excreted in breast milk; for this reason, nursing mothers should take as few medications as possible. If you have any nursing issues, please call the office for advice.
Stool consistency and frequency vary widely from infant to infant and even in the same infant from time to time. Breast fed infant’s stools are loose, frequent (as many as 10-15 per day) and vary in color from yellow to green to brown. As the infant becomes older, stool frequency may decrease to as few as one per week. Formula fed infants’ stools are formed and less frequent. Constipation is defined as hard stools and does not occur in breast fed infants. Many infants strain, grunt, cry and get red in the face before or during a bowel movement or during or after feeding; this is normal if the stools are not hard.
A rectal temperature greater than 100.5 degrees is considered a fever. Any fever in an infant less than three months of age should be reported to the office. Rectal temperatures, using a rectal thermometer, are preferred under 1 year of age.