Congratulations on the birth of your child! As a new parent, you probably feel excited to go home, but also uncertain and anxious about what to expect in the months ahead. Because we are parents as well as pediatricians, we understand how you feel.
Luckily, babies only have a few needs – to be clothed, fed, have a clean diaper and to be cuddled! Parenting will feel stressful and tiring sometimes, but it’s the greatest labor of love. Babies have one method of communication – crying – and with your instincts and common sense, you can determine what your baby needs. You’ll receive instant feedback when you address the need!
If you have any questions or concerns, please know that we are always a phone call away.
Resources to Help You Care for Your Newborn
Listed below are common topics that are important during your baby’s the first year of life.
Prevent Burnout – Take Time for Yourself
It is a lot of work to care for a baby, especially during the first few months. It can feel stressful and tiring, and you’ll always feel ‘on duty.’ Many new mothers who previously worked can feel alone and isolated during the first 1-2 months when staying home with the baby. It’s important to share the caretaker responsibilities with your spouse – you don’t have to do it all! You can also let family members and friends help.
Likewise, it’s important to take care of your mental health and wellness. Take time for yourself to recharge and do something you enjoy, such as taking a walk, reading a book, spending time with a friend, etc. Although we advise not taking your baby near crowds for the first 4 weeks, you can take the baby out of the house. Make sure to pick a time and location that isn’t overly crowded with people.
Please understand that it’s normal to feel stressed and overwhelmed sometimes. However, if you’re feeling extremely sad, down or depressed, please give us a call at (480) 860-8488. We can help.
Bathing Basics
Babies should have a sponge bath 2-3 times per week during their first year of life. More frequent baths may dry their skin. Be sure to use a gentle soap and shampoo made specifically for babies, such as Baby Magic, Johnson’s, etc.
Sponge baths should be done in a warm room on a flat surface, like a counter or changing table. Most importantly, when bathing the baby, never leave him or her alone.
Breastfeeding Your Baby
Nurse your baby on demand usually at least every 2-3 hours, but not less than every 5 hours. Wake your baby at 4-5 hours during the first week if he or she is not awake by then to nurse. Nurse your baby for 5-20 minutes per breast on the first day, and increase the amount of time gradually up to 20 minutes per breast by the fourth day. If your baby is still latched and sucking after 20 minutes, you can continue to nurse. Some babies require only 5 minutes to empty each breast while others require 20 minutes or more. Try to empty each breast at each feeding. Milk “comes in” around the third to fifth day, with the breasts becoming hard, sore and full. You may start to hear the baby swallowing more during feedings, and may notice the frequency of wet and dirty diapers increase. Burp the baby between feeding on each breast unless he or she is falling asleep, in which case move to the second breast and burp afterward. If the baby is sucking well at the above intervals, acting satisfied after feeding, wetting the diaper over 3 times a day and having several daily stools, then rest assured that he/she is getting enough. Breastfed babies normally lose up to 10% of their body weight during the first week of life, and then should be back to their birth weight by 2 weeks old.
We do not recommend routine formula supplements for breastfed infants unless the baby is sucking poorly or acts unsatisfied after nursing (crying and showing other feeding cues). If the baby wants to suck more after nursing and you are not having latch issues, you may choose to introduce a pacifier. While nursing, continue to take your calcium supplements and prenatal vitamins, drink plenty of fluids, and make sure you’re taking time to eat well.
The American Academy of Pediatrics recommends vitamin D supplementation (400 units a day) for all babies who are exclusively breastfed. These supplements can be purchased over the counter at any grocery store or pharmacy. Check with the office before taking any medicines (except Tylenol) while breastfeeding. Alcohol in moderation is okay after your baby is 1 month old. Try to limit your intake to 1 drink at a time, and wait about an hour to nurse or pump. For nursing babies, it can be helpful to introduce a bottle at 2-3 weeks of age and continue a bottle feeding 2-3 times a week so the baby knows how to take a bottle in the future. It also allows dads to be involved and not feel left out!
Some babies learn to nurse with ease. For others it is more difficult, and in about 15%, breastfeeding won’t be successful. Use the nurses at the hospital to coach you in the many “tricks” to help babies learn to nurse. For support after you go home, please ask us! We can arrange a lactation consultation in our office. Other great resources include KellyMom.com, La Leche League, and ilca.org. If nursing doesn’t work for you and your baby, try not to take it personally as a failure; instead, acknowledge the disappointment and move on. It is more important for the baby’s health and wellbeing for you to have a good mothering experience, and if that means bottle-feeding, so be it. Because your hormones are wreaking havoc with your emotions, such disappointments may seem devastating. If you are feeling very blue and “stuck” – please call us at (480) 860-8488.
Bottle-Feeding Your Baby
Formulas come in three different formulations: Ready-To-Feed mixture (open the can and pour into 2-4 ounce portions); concentrated formula requires you to dilute half-and-half with water, and powdered formula requires mixing one scoop of powder per two ounces of water. Find the formula that works best for you; make a day’s supply of bottles at one time and be consistent so that at 2 o’clock in the morning when you are half asleep, you won’t make a mistake. It is no longer necessary to sterilize water or bottles in most middle-class communities, but it’s a good idea to boil bottles and nipples once a week, using the dishwasher or hot water to clean them after each use. After a feeding, any remaining formula in the bottle should be discarded. Formula should be offered at room temperature. Microwaves are generally not recommended to warm formula because they heat unevenly, and if the bottle is not well shaken or the milk temperature isn’t checked, the infant can burn his/her mouth.
Find the nipple that works best for your baby. If your baby sucks hard and chokes, he may need a lower-flow nipple. If your baby takes over 30 minutes to feed, he may do better with a higher flow. If your baby is very gassy, try a collapsible plastic inner-type bottle (Playtex or Dr. Brown’s bottles). Periodically check to be sure the nipple hole is open, especially if the baby is fussy with feeding.
On average, infants should take 2 ounces per pound of body weight per day. The average amount per feeding is approximately 1 ounce per each week of age (for example, a 1 week old may take 1-2 oz. per feed and a 2 week old 2-3 oz. per feed) until about 4 weeks of age. Most babies should eat approximately every 2-4 hours. As a general rule, after 2 months of age, a baby should take 24-36 oz. of formula per day until they are 12 months old.
Infants usually set their own schedule by 1-2 months of age. If your baby is fussy and it has been more than 2 hours since his/her last feeding, feed them. By 3-4 months of age, most formula-fed infants will stop middle-of-the-night feedings. We generally don’t recommend starting solid foods until 4-6 months of age. Adding rice cereal to the bottle does not make babies sleep through the night and is not recommended as it may make the baby more gassy. Most babies may begin to sleep through the night by around 4 months of age on their own.
Burp your baby about halfway through a feeding, holding the baby up to the shoulder or sitting propped up on your knee. Pat the back gently for approximately 1-3 minutes. Hold your baby close during feedings and peer into his/her eyes – they can see you! Some wet burps or spitting after feeding is common. Hiccups are also common and even occasional mild choking occurs normally. Repetitive forceful vomiting, green vomitus or blood in the vomit or stools or choking and turning blue could be signs of serious problems – call us at (480) 860-8488 right away.
Caring for the Umbilical Cord
Now that the umbilical cord has served its purpose, it normally falls off at approximately 2-3 weeks of age. We usually advise folding the diaper down to let the cord dry out. There is no need to use Vaseline or rubbing alcohol on the cord or the stump. Umbilical cord infections are very serious — early signs include foul odor and redness. A small amount of bleeding or yellowy discharge is normal when the cord is ready to fall off. When the cord is off and dry, the baby can have a tub bath; until then, sponge baths only, please.
Cleaning the Genitals
Boys: If circumcised, gently sponge the circumcised area with a wet washcloth and apply Vaseline on a gauze pad with each diaper change for 4-5 days. Normally the circumcision site looks sore and red for 1-2 days, then yellow and sticky for 1-2 days, and then a dry yellow scab forms. Bleeding should be minimal, and the circumcision site should not hurt (even though it looks sore). Healing should be complete by the end of a week. If uncircumcised, there is nothing special to do until age 4-5 years old when boys should be taught to retract the foreskin when bathing.
Girls: Part the labia with each change and sponge off debris using a wet washcloth or baby wipe. Newborn girls normally have a white discharge for several days and sometimes a small amount of blood for a day or two during the first week.
Clothing
It is a natural tendency for parents to dress their baby too warmly. As a rule of thumb, dress the baby as you would yourself. If you are comfortable in short sleeves, do the same with your baby. At night or when sleeping, use a thin cotton receiving blanket and be sure that the baby is not in direct line with cooling or heating vents.
Diapers and Wipes
Cloth diapers or disposable diapers? From a health perspective, there is little difference. Cloth diapers are much more favorable to the environment, while disposable diapers are more convenient. The costs are similar. Baby wipes are acceptable to use on boys after the circumcision has healed. We recommend the unscented types.
Emergencies
Despite your best efforts as a parent, emergencies will happen. We recommend that all parents and caregivers take a CPR course through their local hospital, fire department or Red Cross. Know the location of the nearest emergency room, and keep these phone numbers ready by the phone:
- North Scottsdale Pediatrics – (480) 860-8488
- Poison Control Center – (602) 253-3334
- 911
Also instruct your babysitters about these numbers, and leave them along with your phone number in an easy-to-locate place near your home phone.
Local hospitals that have Pediatric Emergency Rooms include: Scottsdale Healthcare Shea, John C. Lincoln Deer Valley, Banner Desert/Cardon Children’s Hospital and Phoenix Children’s Hospital.
Faces and Sounds Babies Make
Babies make a lot more noise than you would think! Besides crying, they also sneeze, cough, grunt, snort, squeak and have endless series of facial grimaces to match. Hiccups are very common for the first 2 months and bother us, but not them. In your many hours of baby-gazing, you will get to know your baby’s sounds and faces. Your baby will follow your face with his/her eyes and alert to the sound of your voice within the first week or two. He or she may “startle” with a noise or jolt and may move his/her arms with jittery movements.
Fussing and Colic
During the first week, babies fuss very little except when hungry, soiled or need cuddling. Mysteriously, at about 2 weeks, many babies begin to have fussy periods lasting 1-3 hours, usually around the same time each day. For most babies, extra holding or sucking is all they need. However, in some babies, the fussing period can be quite intense with the baby drawing up his legs as if in pain and passing large amounts of gas. This is “colic.” The fussy periods build until about 2 months of age and generally disappear by about 3-4 months.
The cause of “colic” remains a mystery for most babies. It may be related to the type of formula or may indicate an illness, such as ear infection, so if fussing is severe, make an appointment with the doctor. During fussy periods, some babies like to be carried more than usual; some respond to an infant swing or a bath; some find the sounds of a radio, television or fan soothing; some are comforted by a car ride or by a vibrating infant seat. Try the 5 S’s – swaddling, side/stomach holding, shushing, swinging and sucking. If fussing is intense, the doctor may recommend Mylicon drops for gas (0.3 cc before feedings, up to 4 times a day). In very severe cases (rare), an anti-spasmotic medicine may be prescribed to help the baby get some rest.
For most babies with fussing, you can quickly "diagnose" their fussy period and proceed through your checklist of remedies. If nothing seems to work and you have had the baby checked, the doctor may advise you to allow the baby to cry up to 30 minutes to release tension. Probably the most difficult thing for parents to see is their infant’s discomfort and not be able to do something. Sometimes we even incorrectly "interpret" that the baby is upset with us. If fussing has posed a problem for you or your spouse, discuss this with the doctor.
Hospital Procedures
In the hospital, routine procedures include applying non-irritating antibiotic eye ointment shortly after birth to prevent eye infection from the bacteria encountered during the birthing process and vitamin K injections to prevent bleeding. When you are admitted, you will be asked if you want your baby to receive the Hepatitis B vaccine at delivery, which is recommended. A blood test for blood sugar or blood count may be performed if the baby is very large, very small or "jittery." At 36 hours of age, blood is drawn from baby’s heel for two tests: a bilirubin test to look at the level of the protein that causes jaundice, which is the yellow tint to the skin that many babies have, and the first state newborn screen is performed to evaluate the baby for a variety of rare diseases whose signs may not be recognizable at birth that require special treatment – sickle cell disease, PKU, hypothyroidism and 25 other rare causes of mental retardation. This test is repeated in the office once the baby is 5 days old. Before discharge, your baby will also have a hearing test and a pulse oximetry test that screens for congenital heart disease. Both of these are not invasive.
When you and baby are discharged from the hospital, the pediatrician will let you know when they would like to see baby in the office, usually 1-4 days after you go home. Please call to make your appointment at that time.
Immunizations
We strongly recommend that your children receive all necessary vaccines in a timely manner, and we do not support delaying or splitting up vaccinations. These include recommended vaccines on the immunization schedule and vaccines required by the school district. We are happy to discuss any questions at your child’s well visit.
Immunization Schedule:
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Birth
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HepB
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1 Month
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HepB
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2 Month
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DTaP, IPV, HIB*, Prevnar, RotaTeq
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4 Month
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DTaP, IPV, HIB*, Prevnar, RotaTeq
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6 Month
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DTaP, Hep B, HIB*, Prevnar, RotaTeq
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9 Month*
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HGB
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12 Month
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Hep A, MMR, Varivax, Vision
(Must be at least 1 year old)
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15 Month
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HIB, Prevnar
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18 Month
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DTaP, HepA, Flouride
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12,18, and 24 Months
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Developmental Screening
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2 Year
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Check-up, Fluoride, Vision
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3 Year
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Check-up, Vision
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4 Year
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DTaP, IPV, MMR, Varivax, Vision (Must be at least 4 years old)
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5 Year
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Check-up, Vision, Hearing
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6-18 Years
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Check-up, Vision – annually
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11-12 Years
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Tdap, Menactra, Gardasil (series of 2)
Lipid screening – 9-11 years
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16-18 years
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Menactra
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13-18 Years
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Teen Screening Questionnaire
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>6 months
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Seasonal Influenza Vaccine
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DTaP = Diptheria, Tetanus, Pertussis acellular (Whooping Cough)
IPV = Inactivated Polio Virus
Pentacel = (DTap, IPV, HIB) combined vaccine
Hep A = Hepatitis A
Hep B = Hepatitis B
HIB = Hemophilus lnfluenzae B (Meningitis)
Hgb = blood count (anemia screen)
MMR = Measles, Mumps, Rubella
Prevnar = Pneumococcal
Varivax = Chicken Pox
Tdap = Tetanus, Diphtheria, Pertussis acellular (Whooping Cough)
Gardasil = Human Papillomavirus (HPV)
Menactra = Meningoccal
Rotateq = Live Oral Rotavirus vaccine
For more detailed information, please visit VaccineInformation.org. This is a great non-biased website with a parent section.
Rashes
During the first 2 weeks, a splotchy red rash with tiny pimples comes and goes, then disappears. This is called “erythema toxicum” and is normal. Peeling of the skin in the first 2 weeks is also normal. Baby lotion is not necessary but may be used if desired. If cracking around the wrists or ankles occurs, apply Vaseline, Aquaphor or Lansinoh once or twice daily. At approximately 1 month of age, most babies get small bumps on the face, scalp and neck which resemble acne, called “neonatal acne.” This rash is related to hormonal changes and excessive oiliness of the skin. Wash with a mild soap once or twice a day; this rash disappears by 6-8 weeks of age.
Almost all babies get diaper rash sooner or later. Desitin, Balmex or other diaper creams containing zinc oxide usually cures the rash within several days when applied with each diaper change. If not, see the doctor.
For cradle cap (scaling of the scalp), use a dandruff shampoo (Selsun) approximately once every 10 days, using baby shampoo in between about twice a week, massaging the baby’s scalp during shampooing. (Warning: Selsun is irritating to baby’s eyes. Be careful.)
Safety
Always practice safe baby care! Always use a car seat properly; never leave a baby on a table or near water unattended. Avoid direct sun exposure. Never shake a baby.
Safe Sleep Positions
A newborn spends most hours of the day sleeping, so it is important to create a safe sleeping environment. SIDS, or Sudden Infant Death Syndrome, is a frightening prospect for many parents. SIDS is the sudden and unexplained death of an infant under the age of 1 year. Infants are at highest risk for SIDS during sleep.
The American Academy of Pediatrics has made the following recommendations to help reduce a child’s risk for SIDS and sleep-related suffocation:
- Infants should be placed on their back to sleep, for every sleep.
- Infants should sleep on a firm mattress/sleep surface.
- Room sharing, but not bed sharing, is recommended. There is evidence that this arrangement can decrease the risk of SIDS by up to 50%. Devices that are marketed to make bed sharing safe should be avoided. Infants may be brought into the bed for feeding or comforting but should be returned back to their crib when you go back to sleep. There is a very high risk of SIDS associated with couches and armchairs, so feeding your infant on these surfaces should be avoided when there is a high risk that you may fall asleep.
- Soft objects, like pillows, stuffed animals and loose bedding (sheets and blankets), should be kept out of the crib. Because there is no evidence that crib bumpers prevent injury and because they pose potential risk for suffocation and entrapment, these items should be avoided.
- Avoid smoke exposure.
- Breastfeeding is recommended.
- Consider use of a pacifier for naptime and bedtime. Though the reasons remain unclear, there does seem to be a protective effect on the risk of SIDS. If the pacifier comes out, it doesn't need to be replaced.
- Avoid overheating. Overbundling and covering of the face and head should be avoided.
- Infants should be immunized in accordance with recommendations set by the AAP and the CDC.
An important thing to remember is that by placing your infant to sleep on their back for every sleep increases their risk for positional plagiocephaly, or flattening of the back of the head. Therefore, supervised, awake tummy time is recommended on a daily basis, beginning as early as possible, to promote development and decrease the risk of plagiocephaly.
Signs of Illness
If your baby feels hot to the touch, take his/her temperature under the arm with a digital thermometer. A rectal temperature of 100.4 degrees F or higher is considered a fever. Fever in newborns under 2 months old can be a sign of serious illness; call the doctor immediately. If there is any question, a rectal temperature is more accurate. Ear thermometers (Thermoscan) are not accurate in infancy and are discouraged.
Excessive sleeping: Sleeping through 2 consecutive feedings (7-8 hours apart during the first week) could be a sign of a serious illness. Call us immediately at (480) 860-8488.
Fussing for hours: If this occurs during the first week and feeding doesn’t soothe your baby, call us at (480) 860-8488.
Jaundice: Jaundice occurs when yellow pigment (bilirubin) normally released from red blood cells is inadequately cleared from the circulation by an immature liver. About one third of infants develop mild jaundice on the third to fifth day of life involving the eyes and face, which is no cause for concern. As the bilirubin rises, the yellow color deepens and moves downward to involve the trunk and legs. At high levels (over 25), bilirubin may cause damage to the brain.
Forty years ago, they discovered that babies near windows were less likely to be jaundiced because daylight aids the body in ridding itself of extra bilirubin. So if your baby’s face looks yellow but the color does not extend to the body, place your baby near a window (but not in direct sunlight). If the yellow color is striking and it extends onto the abdomen and legs, call the office. We will usually do a blood test to measure the level of bilirubin. In babies with high levels of bilirubin, treatment may include phototherapy (special lights) which can usually be done at home; sometimes brief interruptions of nursing for up to 72 hours may be necessary.
Stools
The very first stools a baby passes, called meconium, are green-black and thick. As milk starts to come in, the baby’s stools will transition to a yellow-green, loose consistency with ‘seeds’ in it. Formula-fed babies have stools as often as several times per day or as infrequently as every 3 days. Breast-fed babies tend to have frequent and loose yellow or yellow-green stools at first, becoming as infrequent as once a week by the end of a month, although some babies continue to stool after every feeding. Some babies grunt or even cry when they pass a stool. Constipation refers to infrequent and very hard stools that are sometimes blood-streaked. One ounce of apple juice mixed with one ounce of water is a safe natural stool softener for mild constipation. If you see any blood or mucus in the stool, please call (480) 860-8488 for an appointment.
Urine
In the first few days of life, if you are breastfeeding, your baby’s urine may not be very frequent until milk starts to come in. Once milk is in, most babies will urinate after each feeding. Before milk comes in, you may see pink or orange-red discoloration in the urine on the diaper. This is not blood, it is urate crystals, which should resolve as your baby eats more. It is normal to see what appears to be crystals or tiny balls of gelatin in the diaper when using disposable diapers due to a reaction of the urine and chemicals in the diaper. If, however, all of the urine itself is pink, or your baby has not urinated in 24 hours, please call us at (480) 860-8488.