New Parents: BABY BASICS 101

• Nurses, or even a whole team, will be there at birth to make sure your baby is healthy
• A pediatric “hospitalist” will see your baby daily
• They may check for: low blood sugar, jaundice, signs of infection
• Vitamin K (to avoid bleeding)
• Prophylaxis: eye drops (to avoid eye infection)
• Hearing Screen to check for congenital hearing loss
• “Newborn Screening” = blood sample sent to the State (results will come to us about 10 days later)
• Oxygen Level to check for Congenital Heart Disease
• Immunizations begin: the first dose of hepatitis B vaccine
• Lactation Consultation and/or classes to help with Breastfeeding

• Within 1-2 days of going home from the hospital
• Call to schedule an appointment when you know what day you are going home
• We want to support you from the beginning, and we know the first week is tough
• The first 1-2 weeks we will continue to monitor feeding, weight, and jaundice

Typical well-child visits (“check-ups”) in the first year occur at:

• 3-5 days
• 2 weeks
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 1 year

APPEARANCE:

• They were in a tight space until delivery.
  “Molding” (weird head) or positional abnormalities (crooked feet) can be normal
• Hands and feet may look blue or purple.
  Check to see if they are cold and how you have been holding him/her
  Call your doctor if you think your baby’s lips and tongue look blue
• Jaundice (yellow color of eyes and skin) is usually normal and may last 2-4 weeks.
  Check with your doctor if it is increasing, or not going away by 1 month
• Rashes are common, peeling skin is normal.
  Be a minimalist with products the first few weeks
  Then choose fragrance-free products (lotions, soaps, detergent, etc.)
• Birthmarks are common. They may be brown, pink, red, blue…
  Ask your doctor about it. Some stay, some go away.
• Crusty or watery eyes are usually normal.
  Some babies have a blocked tear duct that will go away on it’s own                                            Check with your doctor if eyes are red, or lots of eye drainage is present
• Crossed eyes, or wandering eyes are normal until 3 months of age
• Speaking of eyes… all babies have deep blue/grey eyes at birth
  You will see them start to change color between 2-6 months of age
• Breast lumps are normal and will go away with time (this goes for girls AND boys)
• Umbilical Cord: slimy at first, and then dries up and falls off (1-2 weeks)
  Keep it clean and dry (alcohol is not necessary)
  Call your doctor if it is draining pus, won’t stop bleeding, or looks infected
• Vaginal Discharge is common and normal
• Baby fingernails are soft, but they can scratch and grow fast!
  Try keeping them covered with mittens or capped sleeves
  Avoid cutting them until after 1 month of age
• Think your baby is developing a “flat head”?
  Do more tummy time, change positions for play and feeding more often

BEHAVIOR:

• Temperament:
  There is no “good” or “bad” baby!
  The first week or so they are usually either the “sleepy baby,” or the “feisty, hungry baby”
  Once they get into a rhythm after 2-4 weeks, you will see their true colors.
• Feeding Schedule:
  First 1-2 weeks: most babies do best eating “ad-lib” (on demand).
  Your doctor will let you know if there is a max interval at which you need to wake your baby to feed.
  Cluster-feeding happens. They may want to eat every hour! Go with it.
• Peeing: at least once in the first 24 hours
  Sometimes it looks orange in the diaper after your newborn pees.
  (This is not blood, but is a sign your baby may be dehydrated and needs more to eat)
  Eventually your infant should have 6-8 full “pee” diapers per day.
• Pooping: at least once in the first 24 hours
  First poops are “meconium” = dark green to black, sticky like tar.
  “Transitional” poops are lighter green, slimy and sometimes lumpy.
  “Normal” baby poop is yellow like mustard and seedy like cottage cheese (yum.)
  Call your doctor if the poop looks white like clay or has blood in it.
  Once your baby is feeding well, he/she may poop with every feeding                                   Eventually after 1 month of age the pooping slows down and anything between 5 to 10x per day to once every 5-10 DAYS can be normal
• Days and Nights: you may think your baby is “confused” but he / she is not.
  Babies are just not developmentally ready to participate in this loud, bright, chaotic world.
  Give it 2-3 weeks, he/she will adjust.
• Congestion and noisy breathing are common. Noisy does NOT always equal sick.
  If you see boogers, try some nasal saline and then suction his/her nose
  Look at your baby while plugging your ears. If they LOOK comfortable, they probably are
  If your baby can eat, or suck on the pacifier, he/she is probably fine
  If you are still worried, take a video and bring it to your doctor’s appointment
• Sneezing is common, and not a sign of illness or allergies in your newborn
• Squeaks, gasps, wheezes, and coughs are common
• Hiccups happen
• Spit-ups happen
  Try burping more, feeding less at a time, and/or holding upright after feeds
  If your baby is happy and gaining weight, he/she is healthy
  Spitting up usually gets better after 3-4 months of age
  Call your doctor if the spitting up is projectile, or is green, or has blood in it
• Babies startle easily. It is a reflex and is normal up to 6 months of age

Babies cry!  On average, 2-4 hours per day!

Be patient. Never shake your baby.
You will learn what things soothe him/her and eventually what different cries mean.
You cannot “spoil” a newborn. Snuggling and skin-to-skin contact is good. The more, the better!
Babies have a hard time self-soothing until 3-4 months of age. “Crying it out” will not work.

ALL PARENTS:

• Sleep deprivation
  Rest and sleep when your baby is sleeping.
• Lots of friends and family calling and texting
  Don’t be afraid to ask them for help. Give them chores or shopping lists.
• Unsolicited advice (just smile and say “thanks”)
  Try to stick to your instincts, pediatrician, and these “baby basics”.
• Lots of people that want to come over and hold your baby
  Beware of toddlers and germs and try to avoid a lot of visitors
  Nobody comes over sick
  Everybody should be up-to-date on vaccines
• FEAR. There are a lot of “what-ifs,” but being prepared can’t hurt
  Find an Infant First Aid and CPR class
  • Search your local American Heart Association or American Red Cross for classes
  • Infant CPR Anytime home training kit
  • Your local hospital often offers classes
  • DVD from CPR Associates of America:  Big Steps for Saving Small Lives

MOMS:

• The “BABY BLUES” are real.
• There are a lot of changes in your body and your hormones after birth
• Most moms describe their mood as chaotic and unpredictable
• Some moms are flat-out sad.
• If you feel sad, blue, panicky or overwhelmed for more than a few days, call someone to help, AND Call your doctor

PARENTS OF BOYS: To circumcise or not to circumcise?

• • There is medical evidence to suggest benefits outweigh the risks
  • This is truly a personal decision for you and your family to make
  • DO: decide before birth
  • May be done in most hospitals, or in our office
  • Tell someone if there is any family history of a bleeding disorder
    • He may need labs checked before the procedure can proceed
  • The procedure should be done before 1 month of age (if you want it done during infancy)
    • I prefer to do them before 1-2 weeks of age
  • After the circumcision, the penis will look red and raw (like road rash) and then develop a yellowish layer over this fresh skin before it heals
    • Apply Vaseline every diaper change
    • The area usually heals within 7-10 days
    • Call your doctor about bleeding, or a decrease in wet diapers

NUTRITION BY THE WEEK

• Feeding during the first 1-7 days:
  • Feed your baby EVERY 2-4 hours
  • try to pick up on early hunger cues, before he/she starts wailing
  • If breastfeeding, encourage your baby to latch and feed for 15-30 minutes.
  • If bottle-feeding, start with about 15ml per feed and slowly increase to about 60ml (for most babies)
• Feeding during the second week:
  • Most babies are gaining weight at this point.
  • His/her “cues” for feeding become more consistent.
    • Hunger cues: sucking, rooting, putting hand to mouth, fussing
    • Satiety cues: turning away from breast or bottle, closing mouth, relaxing hands
  • He/she may start to “cluster feed”:
    • Feeding small amounts frequently (every 20-45 minutes) for 2-5 hours at a time
    • And yes, this will definitely occur in the middle of the night
• Feeding during the third week and beyond:
  • Most babies are back to or beyond their birth weight
  • Babies usually fall into a more predictable pattern of feeding (usually every 2 to 4 hours)

TIPS FOR EVERYONE

• Do not give your baby WATER (unless instructed by your doctor)
• If feeding formula, check the instructions on the amount of water to add (if any)
• Your baby does not need any “solids” until at least 4-6 months of age
• Cereal is for spoons, not bottles (unless recommended by your doctor)
• DO NOT give your baby HONEY during the first year of life

BOTTLE-FEEDING

If you choose to bottle-feed, supplement, or pump:

• Standard cow’s-milk based infant formula with iron is appropriate for most babies
• After the first few weeks of life until a few month, some general “rules of thumb”:

1. Babies will probably not take more than 1/2 their weight in ounces PER FEEDING                            (ie: if they are 8 lbs, then 4 ounces is likely the MAX amount to give at once)
2. Babies will usually take about 2 1/2 ounces per pound of body weight total PER DAY                      (ie: if they weigh 8 lbs, they will likely take about 20 ounces total per day)

BREASTFEEDING

• Start Breastfeeding in the delivery room (if possible)
• Even if you do not plant to breastfeed long term, give it a try for a few days.  Your baby will get the COLOSTRUM that is rich in nutrients and IMMUNE PROTECTION
• Your milk may not “come in” until 2-5 days after birth.  Don’t worry!   Babies do not need that much in those first few days.  Your goal is for your baby to establish a good latch, and for your body to increase milk production.
• There are a few instances in the first few days or weeks of life where formula may be recommended temporarily, or to supplement breastfeeding.  This may include: jaundice, low blood sugars, trouble breastfeeding, a lack of peeing/pooping, or a high % of weight loss.  Don’t worry!  Your baby can still learn to latch to your breast.
• Try to establish a good latch before becoming too dependent on a bottle or pacifier
• Take care of yourself: eat plenty, and drink plenty of water!
• Keep taking your prenatal vitamin daily
• Your baby will need daily Vitamin D (400IU)

BENEFITS OF BREASTFEEDING

• Breastmilk is FREE, and your breasts are portable!
• Your baby will have less risk of infection, and a decreased risk of SUID
• Long-term, children will have decreased risk of food allergies and obesity
• Mom’s also get benefits from breastfeeding

RESOURCES FOR BREASTFEEDING

• Your pediatrician
• Lactation Consultants both in and outside the hospital
• Many hospitals offer breastfeeding classes for moms after they leave the hospital
• WIC has nursing supplies and nutritional support
• Breast pumps should be available through your insurance
•  HealthyChildren.org answers several common questions
•  “New Mother’s Guide to Breastfeeding”  is a great book from the AAP

SAFE-SLEEP PRACTICES

• Firm mattress with sheet only
• No bumpers or pillows or stuffed animals
• Swaddle with baby positioned on his/her back only
• Baby’s bed located in your room (not in your bed) for the first 6-12 months
• Crib with closely placed slats (less than or equal to 2 3/8 inches apart)
• Keep room temperature comfortable and baby dressed appropriately
• Car seats are NOT crib alternatives

PREVENTING SUID (Sudden Unexplained Infant Death)

• Back-to-Sleep.  ALWAYS.
• No co-sleeping
• No smoke exposure
• Try a pacifier for sleep, ages 1-12 months
• Read about SAFE SLEEP GUIDELINES from the AAP

CAR SAFETY / CAR SEATS

• Position REAR-FACING in the back seat in the middle (driver’s side if middle is not possible)
• Never position in a seat with a passenger air-bag
• There is no one “best” or “safest” car seat
• Take into account the size of your child and the size of your car

Information on installation, positioning, and which seat is right for your child:

• CAR SAFETY SEATS GUIDE from the AAP
• Car seat safety, recommendations and guidelines  from NHTSA.GOV
• Altamonte Mall police station: Monday – Friday by appointment
• Check your local fire station for available safety checks

WATER SAFETY

• Set your water heater so that it is less than 110 – 120′ F
• Always check bath water with the inside of your wrist before putting your baby in
• Have all supplies needed for bath-time available and within reach
• While bathing, do not multi-task and do not turn your focus away from your baby
• Plan ahead.  Get a fence and other safety measures installed if you have a pool

AVOIDING FALLS

• Do not leave your baby unattended on ANY elevated surface (beds, changing tables, couches)
• Do not set any baby chairs, car seats or carriers on any elevated surface while your baby is in it

BABY-PROOFING

• Try to stay one step ahead of what you think your could do or get in to
• Don’t forget strangle hazards

SUN EXPOSURE

• Try to avoid sun exposure for any prolonged period of time (especially 10am to 4pm)
• Sunscreen use is not recommended until 6 months of age
• Use shade, hats and UPF clothing
• If sun will be unavoidable, go for a “mineral” or “organic” sunscreen

If babies get a fever in the first 3 months of life, it can be a sign of something serious.  Babies often do not show classic signs of illness and cannot tell us when they feel ill.  Their immune system is immature and cannot localize nor fight off some types of bacteria.  They also cannot mount a very strong immune response when exposed to germs.  And until they receive their first set of immunizations at 2 months of age, they are susceptible to things like whooping cough and meningitis.

If at any time your baby has a fever in the first 3 months of life, call your doctor immediately

IDENTIFYING A FEVER

• 100.4′ F (38′ C) and above
• Temperature should be taken rectally (other methods are not as accurate)

RECOGNIZE SIGNS THAT YOUR BABY MAY BE SICK

Take a rectal temperature and call your doctor if your baby:

• Feels warmer than usual (and is 100.4F or more)
• Is not wanting to / will not feed for more than 1 feeding in a row
• Is irritable and crying more than usual and is very difficult to console
• Is acting more sleepy than usual (or more limp) and does not respond to your normal ways of waking or interacting with him / her

HOW TO DECREASE THE CHANCES OF YOUR BABY GETTING SICK

• Wash your hands frequently
• Anyone that is going to touch or hold your baby washes their hands first
• Avoid crowded (especially indoor) areas
• Have anyone that is ill, no matter how mild, stay away from your baby
• Unless they are siblings, avoid toddlers and school-age children
• For siblings: change the shirt and wash up to the elbows when they get home from school
• No kisses on the face

VACCINES ARE THE BEST DEFENSE AGAINST MANY LIFE-THREATENING ILLNESSES

• Caregivers and close contacts should be up-to-date on both TdaP and yearly Influenza vaccines.
• Mothers should get a TdaP booster in their 3rd trimester (or at birth if she did not get one during pregnancy)
• Mothers are able to receive a vaccine for RSV during their 3rd trimester, or babies may be eligible for an RSV monoclonal antibody injection after birth
• Your baby will get his / her first set of vaccines at 2 months of age
• Schedule your baby’s shots as early as 6 weeks of age if he / she will be going to daycare soon or will be exposed to other children on a regular basis (including siblings)

For vaccine information, our immunization schedule, and resources for reading about vaccines, go to our “Vaccine Information” tab

• Ask your doctor about ANY over-the-counter medication you want to give your baby in the first 3 months of life
• Tylenol (acetaminophen) may be given AFTER 3 months of life for fever or pain
• It is important to know a recent weight estimate of your baby in order to dose correctly
• Ibuprofen (Motrin) should not be given until AFTER 6 months of age
• Beware medicines that say “all natural” and/or “homeopathic.” This does not mean they are benign.  Some can cause harm.
• Remedies that are not proven to work, but have been studied, and do no harm:  GAS DROPS (simethicone).  Some parents report anecdotally that they are helpful.
• Remedies that may be helpful in studies and are determined safe: GRIPE WATER (ginger is the helpful ingredient, do not buy if it says “bicarbonate” in the ingredient list) and PROBIOTICS (specifically L. Reuteri)
• It is usually better to just check with your pediatrician first

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