Newborn Care

Preparing For your Hospital Stay:
Recommended Items to bring to Hospital:
Comfortable change of clothing for you and your baby, slippers, camera, cell phone and charger, personal music device, comfort foods and water you can not live without, your usual toiletries, a breast feeding pillow, nail file, extra virgin olive oil (best natural product for nipple soreness and can be used for diaper rashes, lanolin a sheep oil is provided in hospital but we believe olive oil is better).  Bring diaper rash ointment such as A&D ointment or use olive oil: Babies first stools are black, thick, and will stick like tar to the skin.  Using olive oil or A&D ointment allow you to easily clean their bottom and will decrease the irritation most babies get from trying to wipe off those thick tar like stools. 

Medications given to babies in hospital:  After all babies are born an antibiotic eye ointment (erythromycin) is applied which has dramatically decreased the rate of vision threatening infections in babies, a vitamin K shot will be administered which prevents babies from having life threatening internal bleeding, Hepatitis B vaccines are also offered to babies shortly after birth and is strongly recommended to prevent a very serious liver infection that if acquired prior to vaccination can cause liver failure, and cancer in children.  Some mothers have asked to delay the vaccine until we see them in the office we strongly discourage this practice because it delays the time period that your baby will achieve protection from this contagious and harmful infection.

Feeding: Your baby should be fed as soon as possible after birth.  Babies have the natural ability to breast feed at birth, but at times they are not very good at it.  Practice makes perfect so continue to breast feed your newborn every 2 to 3 hours for the first 2 days and more often as your babies demands.  Initially your body produces Colostrum, a thin watery precursor to breast milk.  Colostrum contains antibodies, hormones, and essential nutrients to keep your baby healthy in the first few days of life.  While your baby breast feeds, it stimulates you to secrete hormones which gradually increase your breast milk production.   Most mom’s will feel a let down and start producing significant amounts of breast milk by the 3rd or 4th day of their babies life.   
    While breast feeding avoid the same foods you were avoiding while pregnant:  No raw meats, unpasteurized cheeses, limit or avoid foods that may contain mercury (tuna, swordfish).  Whille breast feeding also avoid peanuts, broccoli, cabbage, and cauliflower.
    Try not to confuse your baby with bottle feeding or the use of pacifiers* in the first 4 weeks after birth.  However introducing a pacifier sooner may be necessary if you develop sore nipples or if your baby is continuously suckling in a non-nutritive manner (using your nipples as a pacifier).  When babies are truly breast feeding they open their mouth widely taking in the breast and nipple.  When babies are non-nutritively suckling for comfort they only suckle on the nipple which can cause significant soreness. Non-nutritive suckling should be limited to 20 to 30 minutes after feeding to prevent soreness.  Consult with a lactation nurse to help you distinguish the difference between true breast feeding which is never limited and non-nutritive suckling.   
    Formula may be necessary in certain situations: if your baby loses a significant amount of weight (greater than 10 percent of birthweight), develops a low sugar level, or cries inconsolably due to hunger for more than 30 minutes.
     The facts are that the best source of nutrition for your newborn is breast milk.   Formula is always an option after breast milk.  Ask your doctor to recommend one for you based on your family’s medical history such as Asthma, Food Allergies, Eczema, etc.  Most formulas available today contain adequate vitamins/minerals/sugars/proteins to provide the infant adequate calories to grow well. 

*The use of pacifiers in the first 6 months of life can prevent SIDS (Sudden Infant Death Syndrome) so introducing a pacifier when your baby is 4 weeks old is strongly encouraged. 

Feeding Solids: In the recent past we used to recommend feeding at 4 months of age.  However in order to decrease food allergies Allergists have recommended waiting until 6 month of age to introduce solids.  We have noticed that some babies fed after 6 months of age have difficulty learning how to spoon feed.  Therefore we recommend families with no history of food allergies, asthma, eczema, or inflammatory bowel conditions start rice cereal only at 5 months of age.  In families with allergy or inflammatory bowel conditions start rice cereal only at 6 months of age. 
    First month after starting solids: Rice cereal only for 1 month start with 1 tablespoon rice and mix with 4 tablespoons of breastmilk or formula. Each day increase by rice cereal by 1 tablespoon until max of 4 tablespoons of rice cereal are reached. Initially continue 1:4 ratio cereal to breast milk/formula concentration and then may thicken gradually as tolerated. 
2nd month:  Add Stage 1 foods  peas, green beans initially then add 1 new stage one food every 5 days.
3rd month: Add stage 2 foods.  At this point you should be serving breakfast (rice cereal), lunch (stage 1) and Dinner Stage 2. Serving sizes are 2 to 4 oz each serving.
9 months of age and tolerating stage 2 foods: introduce finger foods: cheerios (unflavored), Veggie puffs.
Formula/Breast milk intake should remain relatively the same as it was prior to starting solids.  If formula/breast milk intake changes significantly (less than 16oz per day) or less than 4 breast feedings a day call us.

FOODS TO AVOID: Allergy Risk: Peanuts until 2 years of age, Egg whites until 1 year of age.  Choking Hazard: wait till 3 years of age: Popcorn,  hotdogs, whole grapes.  Avoid Honey until 1 year of age due to botulism risk. 

Bowel movements (BM):  Newborns should have their first BM during the first 24 hours of life.  The first BM will look black and thick and is called Meconium.    As your baby  feeds more and more, the stool frequency increases and the color will change from black to green to yellow.  The color, consistency and frequency of BM depends on source of food (breast milk vs. Formula).  Some breast fed newborns will have a BM after each breast feeding  during the first few weeks of life while formula fed babies usually have less.  If your newborn goes more than 72 hours without a BM, develops hard BM (round pebbles), or if you see any blood in their BM, please notify your physician. 

Constipation:  If your newborn goes more than 72 hours without a BM, develops hard BM (round pebbles), or if you see any blood in their BM, please notify your physician. If your are breast feeding make sure you are drinking at least 2 liters of water a day. If you are bottle feeding you may give 1 to 2 oz of pedialyte directly to your baby.  {Babies under 6 months should not be given pure water because of the risk of seizures}.

Jaundice: About 50% of babies develop mild jaundice (yellowing of the skin) which is usually noticeable on the face only.  As jaundice gets more severe the jaundice will spread to the chest then abdomen and then the extremities.  All babies should be checked by a physician on the third or fourth day to make sure they do not have jaundice.  It usually starts on the second or third day and can last a week. Mild jaundice gradually resolves with sunlight therapy (indirect sunlight avoiding face 15 minutes a day) but if your baby appears extremely jaundiced (if the jaundice is notable on the abdomen or extremities or your baby appears bright yellow) call our office.  Also call if your baby is jaundiced after 14 days of age.

Fever and Low Temperatures:  Pediatricians are actually more concerned about low temperatures than high temperatures in newborn babies. The normal temperature range is 97.5 to 99.5 in the first two weeks of life. After two weeks of age the range is 97.5 to 100.4. Always check an axillary temperature first and if it falls out of range recheck with a rectal thermometer.  
Low Temperatures If your baby has had a bath or has just had a diaper change wait at least 30 minutes after swaddling before checking your babies temperature. Most babies that are cold will shiver or have blue hands and feet.  If your baby is acting normal and does not have blue cold hands and feet your child is unlikely to have a low temperature.  If your baby is less than 3 months old has cold blue hands and feet or is shivering or pale and lethargic and the temperature remains below 97.5 check a rectal temperature.  If the temperature remains below 97.5 call your Pediatrician. 
Fever if the temperature is high and the room temperature is above 80 or your baby has more than two layers, or your baby has been held in your arms for a long period of time consider repeating the temperature 15 minutes after reducing the room temperature to 75, with one layer of clothes, and in a bassinet.  If the temperature remains above 99.5 in the first two weeks of life or greater than 100.4 check a rectal temperature.  In a baby less than two weeks old if the rectal temperature is greater than 99.5 call your Pediatrician or seek medical care immediately.  In a baby over 2 weeks of age  and under 3 months old with a temperature greater than 100.4 call your Pediatrician or seek medical care immediately. Regardless of your babies temperature if your baby is acting sick (lethargic, blue hands feet or any part of body, refusing to eat,  limp, pale, labored breathing, or shallow breathing) seek medical attention immediately.

SIDS (crib death) Prevention:  (AAP Recommendations)
*Use a Firm sleep surface: A crib mattress, covered by a sheet, is the
  recommended sleeping surface.
*Keep soft objects and loose bedding out of the crib: Pillows, Quilts,   
comforters, sheepskins, stuffed toys, and other soft objects should be kept out  
of an infant’s sleeping environment.
*Do not smoke during pregnancy: Also avoiding an infant’s exposure to  
second-hand smoke is advisable for numerous reasons in addition to SIDS  
risk.
*A separate but proximate sleeping environment is recommended such as a 
separate crib in the parent’s bedroom.  Bed sharing during sleep is not 
recommended.
*Consider offering a pacifier at bedtime and naps.  The pacifier should be used 
when placing infant down for sleep and not be reinserted once the infant falls
asleep. (Breast fed Babies only: Lactation nurses recommend waiting till a baby is a month old to prevent nipple confusion and problems with breast feeding)
*Avoid overheating:  The infant should be lightly clothed for sleep, and the 
bedroom temperature should be kept comfortable for a lightly clothed adult.
*Avoid commercial devices marketed to reduce the risk of SIDS.  Although 
various devices have been developed to maintain sleep position or reduce the 
risk of rebreathing, none have been tested sufficiently to show efficacy or 
safety.
*Do not use home monitors as a strategy to reduce the risk of SIDS:  There is 
no evidence that use of such home monitors decreases the risk of SIDS.
*Avoid development of positional plagiocephaly (flat back head):  Encourage “tummy time.”  
*Avoid having the infant spend excessive time in a car-seat 
carriers and “bouncers”. Place the infant to sleep with the head to one side for 
a week and then changing to the other side.
*Assure that others caring for the infant (child care provider, relative, friend, 
babysitter) are aware of these recommendations.
*Fans or good air circulation have been found to decrease SIDS. The fan 
does not need to be directed at the baby.  Ideally a fan of air should be 
directed over the crib.

Skin care:  Some babies are born with a white coating called Vernix which protects their skin from constant contact with amniotic fluid.  Vernix is washed away with babies first bath.  Other babies have a soft fine hairy skin called Lanugo.  Lanugo comes off after a couple of weeks.  Rashes are common in babies.  Their skin is so sensitive that if you look at them the wrong way they may get a rash (joke!).  Most of these rashes clear spontaneously.  Your doctor will be checking the baby to make sure that these rashes are normal. 

Cradle Cap:  Scaly crusted yellow patches on scalp, babies equivalent of dandruff.  Best treatments is scalp massage using combination of baby shampoo max twice a week and olive oil or baby oil.  A fine toothed comb to gently remove large crusted areas of cradle cap is helpful. Babies with cradle cap can have dry crusted skin behind ears that if left untreated can cause severe pain and inflammation always place small amount of vaseline or aquaphor behind ears to prevent this potentially painful condition. Call us if cradle cap is severe, causing hair loss, or if skin becomes red and inflamed.  Always call us prior to using dandruff shampoos, or steroids which are usually unnecessary and have the potential for harmful side effects.

Vitamins: Remember to continue taking your prenatal vitamins and omega 3 supplements while breast feeding.  Breast milk is deficient in vitamin D so if you exclusively breast feed your baby should also take Tri-Vi-Sol (Vitamin A, Vitamin C, and Vitamin D) 1ml a day. We recommend starting this vitamin at 2 weeks of age because the strong taste can cause gagging and vomiting in some babies.  Most pharmacies carry poly-vi-sol which is a multi-vitamin with a less palatable taste than tri-vi-sol. We recommend Enfamil Tri-Vi-Sol based on our own taste tests.  The vitamin can be given over two doses and mixed with a tablespoon of breast milk to improve success. Vitamin D deficiency has been attributed to rickets, diabetes, heart problems, and increased risk of infection.
A new recommendation by the American Academy of Pediatrics states all infants between 1 and 3 years of age should have a multivitamin with iron.  Options are Poly-Vi-Sol plus iron or to crush 1/2 of a Flintstones complete hard candy chewable (do not use gummies the gummies stick to the vitamins and interfere with absorbtion).

Diaper Rashes:  Diaper rashes are common. To help prevent and control minor diaper rashes nothing beats air drying and a little sunlight (5-15 minutes a day).  Ointments are also helpful at preventing and controlling minor rashes. Severe rashes especially rashes causing pustules or raw denuded skin should be seen by a physician.

Colic:  Colic is the same feeling you have if you have ever tried staying up all night.  Babies simply do not understand that closing their eyes will make that tired grumpy feeling go away so they cry, and cry.  Your goal is to convince them to close their eyes and go to sleep. All babies are different some respond to gentle rocking, singing, or background noise.  Other babies require more intervention such as a gentle massage, bathing, a drive around the block (a stroller for those green babies). When all else fails try drinking a cup of chamomile tea prior to breast feeding.  Gripe Water 1/2 teaspoon every 4 hrs. can be given to colicky babies.  Call us for more tips.

Gas:  Gas is normal but painful gas is a pain in their cute behind. Gassy babies also fuss and cry.  Try burping for 10-15 minutes immediately after feeding. When breast feeding remember to avoid broccoli, cabbage, and cauliflower.  If bottle feeding try a bottle which vents out the bubbles as babies feed such as a Doctor Brown’s bottle or Ventaire bottles.  Simethicone (Mylicon, baby gasx, or little tummies) 0.3 ml every 4 hrs. can be used for more significant pain.  Call us for more tips.

Bathing:  Babies only need to be bathed once or twice a week.  Sponge bathing is recommended until the umbilical cord falls off. Only water is necessary but if you wish to use soap use mild baby cleansers or Dove soap. 

Umbilical Cord:  Umbilical cords slowly dry and eventually fall off after about two weeks.  It is best left to dry on its own.  In case the umbilical cord needs to be cleaned, we recommend using 70% rubbing alcohol with a Q-tip to dry and clean the base of the cord to help prevent infection. Call us if the cord does not fall off by three weeks of age, redness develops around the cord, or you notice bleeding or oozing.

Nails: Newborns have can have sharp nails they should be filed with a nail file. Remember to never use clippers to clip the nails.  Parents using clippers will often clip the end of the finger along with the nail which can lead to infections.