Caring for Your New Baby
Frank A. Sinatra, MD, FAAP
John J. Visci, MD, FAAP
Patricia E. Peng, DO, FAAP
Jaclyn F. Brittman, DO
Marisa A. Farinella, DO, FAAP
169 Minebrook Road
Bernardsville, NJ 07924
908-766-0034
advocaresinatrapengpediatrics.com
Advocare Sinatra & Peng Pediatrics
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Caring for Your New Baby
Getting to Know Your Baby
Sometimes new mothers are a little unsure of themselves at first. As long as
your baby is well fed, well loved, warm and comfortable, she doesn’t mind a
bit that you are not an expert. The few basic infant-care instructions that follow
should help you to relax and enjoy your baby. The most valuable thing parents
can do for their children is to enjoy them.
Your baby is an individual from the day she is born. As the baby’s mother, the
person most intimately involved in her care, you will come to know her best.
Trust yourself and do not take all of the advice of well-meaning friends and
relatives too seriously. If you have questions or need advice, call our office.
Your baby will do some things all babies do. For example, all babies sneeze,
yawn, belch, have hiccups, pass gas, cough, and cry. They may occasionally
look cross-eyed. Sneezing is the only way in which a baby can clean his or her
nose. Hiccups are little spasms of the baby’s abdominal muscles. Hiccups often
may be stopped by giving a few swallows of warm water. Coughing is your
baby’s way of clearing her throat. Crying is the baby’s way of saying, “I’m wet,
I’m thirsty, I want to turn over, I’m too hot, I’m too cold, I have a stomachache,
I’m bored, or I’m hungry.” You will gradually learn what your baby means.
Almost all infants have a fussy period. This may occur regularly, perhaps in
the late afternoon or evening but hopefully not at night. This is not colic, but
a normal response for which there is no explanation. Even well babies cry!
Your Baby’s Safety
The types of injuries a baby may sustain change with age, thus, you will continually need to consider and adjust your safety efforts. No one can protect a
baby from all hazards, but you can take some specific actions, starting the day
your baby comes home from the hospital.
The crib for your baby must have slats no more than 2 3/8 inches apart, no
unsafe design features, and a snug–fitting mattress. To avoid blocking your
baby’s breathing, do not place pillows, large and floppy toys, or loose plastic
sheeting in the crib. Stay close by when your baby is on a flat surface above
the floor to avoid injury from falls.
Car Seats – A car seat will be necessary to transport the baby home from the
hospital and should be used with utmost concern and diligence. Closely follow
product and safety guidelines and be sure to use equipment meeting federal
safety standards. Car seats are a must!
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Pacifier and Jewelry – Pacifiers should never be worn around the infant’s neck. Suitable pacifier attachments are available which can be clipped
onto the infant’s clothing. Equally important in preventing strangulation, is not
placing jewelry of any kind around the child’s neck. Wrist and ankle bracelets
are acceptable if properly fitted and refitted (i.e. not too loose so that they
won’t accidently come off and not too snug to allow good circulation).
Infants Seats – Never place an infant in an infant seat and leave it on an
elevated surface, like a table. An active infant can easily maneuver the infant
seat to the table edge and fall. Also, curious toddlers have been known to pull
infant seats on top of themselves in an effort to obtain a closer look.
Walkers – Walkers will not misalign healthy normal legs, but can be the cause
of serious accidents, as they allow the infant to move faster than she should.
Therefore, we do not recommend the use of walkers. Use a stationary exersaucer instead.
Toys – Early in life, babies prefer simple black-and-white shapes but soon
become attracted to colorful and shiny objects. Keep small objects such as
buttons and pins out of the baby’s reach so she cannot pick them up and
swallow them.
Skin – A baby’s delicate skin can be burned easily. When you take the baby
outside, shade your baby from the hot rays of the sun. Always use a hat when
outside to protect baby’s head and eyes. Set your water heater to lower than
130°F (54.4C). Always test the temperature of the water before your baby’s
bath to be sure it’s not too hot. Smoking cigarettes while feeding or playing
with the baby is harmful to the baby’s lungs and dangerous because hot ashes
could fall on the baby. Also, don’t hold the baby while cooking. Hot food could
splatter on the baby, or she could touch hot pans or their contents.
For Your Baby’s Comfort
Room Temperature – Try to keep an even, comfortable temperature (68◦-70°)
in your baby’s room. Windows may be opened in warm weather, provided
the baby is not in a draft and the room temperature does not fall below 68°F.
Crib – Cover the mattress with a waterproof cover, quilted pad, and soft
baby sheet.
Clothing – A baby does not require any more clothing than an adult. Dress your
baby according to the temperature. Some babies are allergic to certain materials,
so keep an eye out for rashes in areas where clothing touches the skin.
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Caring for Your New Baby
Outdoors – You can take your baby outside whenever the weather is pleasant.
Babies born during warm weather may be taken outside after they are about
two weeks old. If you use a carriage or stroller, be sure the wind blows over
the top and not into it, or directly on your baby. Avoid taking your baby to
crowded places in the first two months of life due to the increased potential
for infection.
Jaundice
Jaundice frequently occurs in newborns. The baby’s red blood cells break down
to form a pigment called bilirubin. The bilirubin undergoes further changes
in the liver until it is excreted in the stools. Most newborns have an immature
liver; hence bilirubin tends to accumulate in the skin, giving the baby a yellow
color. As the baby’s liver matures and as the baby feeds more, the bilirubin
is handled more efficiently and excreted. In a full term baby this maturation
occurs about the third or fifth day of life. This normal process may be exaggerated if there is an incompatibility between the mother and baby’s blood type.
Breastfed babies also tend to have more jaundice than bottle fed babies. If your
baby is jaundiced a blood test will be done to check the bilirubin level.
Newborn Supplies
Shampoo
Rectal thermometer
Ointment (A&D, Triple Paste, Desitin, etc.)Bottles
Baby Oil (for dry scalp)Nipples
Pacifier (one piece)
Cotton balls
Diapers (disposable or cloth)
Mattress pads
Detergent (Dreft, Ivory, All clear)
Crib sheets
Nasal aspirator
Wipes (unscented)
Salt water nose drops (Nasal, Ocean, Ayr)
Measuring spoons, syringe
Baby bath and lotion (unscented)
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Breast Feeding
Nursing is the most convenient and natural way to feed your baby and has
numerous benefits such as the transfer of protective antibodies and a significantly decreased risk of developing food allergies. Additionally, breast milk is at
the perfect drinking temperature and over time adapts to the baby’s changing
energy needs. Once established, a mother’s supply of breast milk will usually
meet her baby’s needs and the quality of her milk will remain fairly constant.
At first, breast feeding requires patience as the milk does not really begin to
flow until about three to four days after delivery. During this period the baby
receives small amounts of a very nutritious substance called colostrum. Because
of the limited amounts, babies will feed more frequently in the first few days
of life until the breast milk begins to flow. You may be tempted to offer your
baby formula for fear that she is not receiving enough. We encourage you to
be patient as frequent nursing in the initial days will stimulate your body to
produce more milk. Occasionally, a baby may lose significant weight in the
first few days of life and we may recommend supplementation with formula.
Should this become necessary, it is important to still continue nursing and offer
your baby formula after each nursing session so that the supplementation can
be discontinued once your milk starts flowing.
Before nursing, wash your hands with soap and water, and then wash your
breast with clear water. When you nurse you should be relaxed and comfortable. Numerous nursing positions work well, i.e. lying on your side, or sitting in
a rocking or low arm chair. Commercially available “u”-shaped nursing pillows
work well and are highly recommended. Cradle your baby’s head in your arm
so that the infant’s head is higher than his or her stomach. Gently stroke his
or her cheek nearest the breast—she will then turn his or her head and open
his or her mouth searching for the nipple. Use one of your hands to hold your
breast and the other to gently push your baby’s head towards your nipple. Be
certain that the whole nipple and as much of the surrounding areola (the flat
brown part of your nipple) as possible enter the baby’s mouth. It is important
your baby grasps as much of the areola as possible to prevent nipple soreness.
When latched on correctly, the baby’s jaws should clamp down on the areola
with his or her chin resting against the breast and his or her nose unobstructed.
Sometimes it may be necessary to hold part of the breast to keep it from pressing against the baby’s nose and interfering with her breathing.
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Caring for Your New Baby
If your breast is engorged, it may be difficult for your baby to latch on correctly. In this case, hand express a little milk before nursing. Hand expression is
performed by surrounding the nipple with your thumb and index finger, then
pressing back until you can feel your ribs under the breast and then squeezing gently down towards the nipple. At first you will only get a few drops of
milk but later on the milk will come out in a stream. Alternatively, you may use
a breast pump (either hand or electric) for this purpose. Once the breast has
softened, it should then be possible for your baby to latch on.
Allow your baby to feed for 15-20 minutes at each breast. Avoid having your
baby feed for prolonged periods (e.g. over 50 minutes) as you and your body
will not have a chance to rest prior to the next feeding. Each baby’s feeding
needs will vary. Some babies are very efficient feeders and will be done after
5-10 minutes, other babies will take longer. For the first five minutes the baby
should be sucking vigorously; after that, the baby may take short breaks between periods of sucking. After 15-20 minutes sucking usually does no longer
serve to satisfy nutritional needs but simply sucking needs. After the milk supply
is established, nursing from one breast may be sufficient. If both breasts are
used, alternate the breast you start with and if one breast is adequate give the
other breast a rest period and use it for the next feeding.
After nursing, let nipples dry in the air before putting your bra flaps up. If you
encounter difficulty or pain with breastfeeding please call your physician. To establish a sufficient milk supply, it is important to feed regularly and drink plenty
of fluids. Your baby will usually dictate the feeding interval, but in general, you
can expect to be feeding your baby approximately every two to three hours.
It is important to get plenty of rest and try to take a nap yourself while your
baby is sleeping. If you are very tired or need a rest, a formula feeding may be
substituted. Any commercially available infant formula may be used. However,
until breastfeeding is well-established, try to feed frequently and not replace
too many feedings with formula as your milk supply may otherwise decrease.
Remember to drink plenty of fluids and call our office before taking any medications other than medication prescribed by your obstetrician. Breast feeding
mothers should avoid alcohol, smoking and drugs. It is advisable to avoid gassy
foods as anything you eat is passed to the baby.
If you are breast feeding exclusively, we recommend starting your baby on
Tri-Vi-Sol infant drops as breast milk can be deficient in Vitamin D. These can
be purchased over the counter at most pharmacies and supermarkets.
If you choose not to breastfeed we will advise you on what formula to use.
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Burping
Infants swallow some air during both breast and bottle feedings and it is usually necessary to burp your baby during and after each feeding. This is done by
holding her upright with his head over your shoulder and patting her lightly on
the back. Alternatively, you can hold her in a sitting position on your lap and
pat her back. Some babies do not require burping.
Schedule
Rather than adhere to a rigid schedule of feeding, it is better to feed your baby
when she becomes hungry. This may vary from 2 ½ to 4 hours. Smaller infants
will eat more often than larger babies because of their smaller stomachs. As
your baby grows, she will take larger quantities and eat less often. Babies who
are breast feeding will eat more often than babies who are formula feeding,
usually every 2 ½ to 3 hours. It is usually advisable not to wake a sleeping baby
to feed as sleepy babies are often fussy and not interested in feeding. Infants
will eat better if they become fully awake for 10 to 15 minutes before feeding.
If your baby sleeps longer than five hours, however, she should be awakened
and fed as she needs the nutrition. Changing the diaper usually works very well
in waking up a sleeping baby. If your baby seems excessively sleepy or not interested in feeding please call us immediately as this can be a sign of a serious
problem.
Vomiting
Many infants regurgitate or “spit up” part of their feedings during the first few
months. To a certain degree this may be normal. Excessive regurgitation may be
due to:
• Inadequate “burping”
• Taking excessive amounts of milk
• The milk flow is too rapid
• Lying on back after feeding.
Jostling or rough handling after feeding.
Most infants will continue to gain weight even though spitting up some of
their feeding. However, if you believe your baby is regurgitating more than
normal please call the office.
Bowel Movements
The stools vary considerably from one day to another in appearance and consistency. Some infants will have a stool after every feeding and some will have one
every few days. Normal stools may be yellow, brown, or green and may vary in
consistency from soft to mushy to well formed. Straining with bowel movements is normal in infants.
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Caring for Your New Baby
Bathing and Skin Care
In order to maintain healthy, clear skin, it’s essential to keep your baby as dry as
possible and free of irritating substances. Sponge baths should be given until
the umbilicus is well healed. Thereafter, you may partially immerse your baby in
warm water for her bath. A daily bath is not a necessity.
Using a soft wash cloth and a mild soap, bathe the entire body including the
scalp and face. Do not be afraid to wash over the “soft spot”. Your baby’s skin
is naturally supplied with the necessary ingredients and for the most part oils,
creams, lotions, and ointment are unnecessary.
If the skin becomes red or is very dry use a moisturizing cream made for infants
or sensitive skin. Baby powders are not to be used. Many skin rashes are due to
overdressing, one layer of soft loose clothing is usually sufficient during the day.
It is best to avoid wool garments which may come in contact with the skin.
Scalp – The scalp should be cleaned 1-2 times a week with a mild soap. No
special shampoo is needed. Rinse soap out thoroughly, dry the scalp with a
towel, and brush hair with a baby brush or use a fine comb. If the scalp is dry,
put a few drops of lotion on and massage generously. Do not be afraid of the
“soft spot”. The following morning, remove the crusts with a fine comb, and
shampoo the hair. Follow this procedure two or three times, and if not successful, call our office.
Eyes – The baby has no tears until she is about one to two months old. For the
first two months, was your baby’s eyes with sterile cotton and warm water to
remove the mucus that accumulates.
Nose – The baby’s nose does not ordinarily require attention. All babies breathe
noisily for the first month due to the large amount of adenoid tissue. Only salt
water nose drops may be used. Prepare nose drops by adding ½ teaspoon of
salt to 8 ounces of water. Boil and place in a dropper bottle. Discard the excess.
Use as directed by physician. Saline nose drops are also available at your drug
store. Do not use any non-saline nose drops unless prescribed by your physician.
Sun
Newborns should not be exposed to direct sunlight. Sunscreens are not recommended for babies under 6 months of age. Always protect your baby’s head
with a hat when outside in the sun.
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Diaper Rash and Diaper Care
The most common cause of diaper rash is wet diapers in contact with the skin
for a long period of time. There is no substitute for frequent diaper changes.
The diaper area should be cleaned with each diaper change. If a diaper rash
appears, ointments, such as, Destin, Balmex, Triplepaste, etc., may be effective
in clearing the rash. If there is no response after 72 hours, call us. Exposure of
the diaper area to the air is also helpful in clearing a diaper rash. If the rash is
severe or unresponsive to treatment, your baby should be examined for other
possible causes. Baby’s clothes should be washed separately from the families
clothes for the first 6 months. Bounce should be avoided. Ivory, Dreft, and Tide
are least irritating to the skin.
Umbilicus
After discharge from the nursery, the cord is usually still attached to the navel.
A small amount of bleeding from the area is common and clears as the navel
heals. If inflammation occurs, call our office. Do not immerse your baby in the
tub until the cord falls off.
Visitors and Relatives
Newborn infants are susceptible to colds and other infections. You should
discourage handling or intimate contact with friends or relatives even though
they may mean well. Anyone who is ill should not handle your baby. Always
stress good hand washing habits to anyone who handles your infant.
Crying
You cannot spoil a very young infant. Paying close attention to your baby’s cries
will help you decipher and respond to her needs. Crying is her sole form of
communication. Soon you will become an expert at interpreting the different
cries. One will mean hunger, another restlessness, and another pain. Even if
your infant cries to be held, this should not be viewed as a premeditated form
of manipulation. Rather her cry to be held stems from her basic needs for security, love, and warmth.
Almost all babies have “fussy periods”, which usually occur in the late afternoon or evening. Dinner hour, bath times for siblings or people coming home
from work, are times of the day which can be mildly stressful relative to other
parts of the day. Perhaps your infant picks up on the tension and wants extra
nurturing or reassurance. Fortunately, these “fussy periods” will be less frequent
after the first few months of life.
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Caring for Your New Baby
Colic can be defined as excessive crying as a result of spasms of abdominal
pain. This abdominal pain or cramping is thought to be related to an immature
gastrointestinal system and the presence of gas. Breastfed, as well as bottle
fed infants, can have colic. Usually comforting is all that is required. If your
baby has long crying periods when nothing seems to calm her down, call our
office to discuss whether your infant has colic and what can be done to provide
relief. There are many old-time remedies that may prove helpful. Try some
of these suggested methods: swinging, rocking, use of a pacifier, rhythmic
patting on the back, “infant massage”, music, a ride in the car, gentle rubbing
of the stomach, use of a “snuggly” or infant carrier, or swaddling the baby in
a blanket.
If you are using formula, we may consider the possibility of an allergy to the proteins in cow’s milk. A formula change may be indicated. A protein hydrolysate,
such as Alimentum or Nutramigen, may also be considered. Always check with
our office prior to changing formula. If you’re breastfeeding, we may suggest
eliminating or cutting back on the amount of milk, dairy products, chocolate,
fruit, certain vegetables, eggs, caffeine, onions or supplements you consume.
These diet modifications are done gradually and incorporate a trial-and-error
approach. Getting through colic is not easy and requires patience on your part,
as well as ours. Happily, this is a self-timed condition and is usually resolved by
three months of age. Some parents report relief of symptoms magically at ninety
days while others feel the problem vanishes gradually until it is nonexistent.
Don’t be afraid to ask for advice or look to us for support. Medication can be
helpful in extreme instances but mostly we are interested in providing “care for
the care-giver.” Try to arrange for some time away from the baby, especially if
you are distressed about the crying. Ask a trusted friend or relative to care for
the baby for a short while so you can get some rest.
Pacifiers
Newborns have a tremendous sucking need which cannot be met by feeding
alone. This additional time spent sucking is called “non-nutritive sucking” and
will occur with or without the use of a pacifier. For example, some infants will
suck on fingers, hands, or demand to breastfeed or bottle-feed even when they
aren’t hungry For this reason, we recommend using a one-piece pacifier until
the age of four or five months, when the sucking need diminishes. Removing it
at this age prevents a pacifier habit.
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Thermometer
Buy a rectal thermometer and learn how to use it. Call our office with any
temperature over 100.4°F in an infant less than 8 weeks of age.
“Normalcy” In Infancy
1.All newborn babies have an immature nervous system which is responsible
for the so-called startle reflex. Sudden jarring, even loud noise will result in
a sudden outward jerking of the arms.
2.Because of an immature circulatory system, many babies are apt to
develop a mottled or blotchy appearance when undressed or have “blue
hands or feet”.
3.It is normal for many newborn babies to have irregular respiration.
4.Crossing of the eyes are common, especially after a few weeks, when
baby is gazing at any object a few inches away.
5.Due to the presence of various hormones passed into the baby from
the mother, many full-term babies show transient swelling of breast
tissues. Female newborns often show a whitish vaginal discharge, and
may even bleed.
6.Other normal manifestations may include frequent sneezing, coughing,
hiccups, and quivering of the chin when crying.
Sleep
Typically, newborns alternate between sleeping and feeding with greater alert
periods as they get older. Time spent sleeping is also very individual and will
range from fourteen to twenty hours per day. On average, babies do not usually sleep through the night until 4-6 months of ages. While newborn babies
often drift randomly in and out of sleep, babies around six weeks of age are
more definite about the difference between an awake state and a sleep state.
Three- to four-week-olds wake up because they are hungry and go to sleep
because they are full. By the second month, the relationship between feeding
and sleeping begins to slacken a little. By the time the baby reaches three to
four months, she is likely to have two or even three wakeful periods in the day
with usually one morning and one afternoon nap. Most babies have “set” times
during which they will appear sleepy and will be ready to nap. To establish
good sleep patterns, it is often helpful to plan your day (e.g. running errands)
around your baby’s routine sleep periods. Babies who are used to a routine
usually sleep better and find it easier to self-soothe. This is not to say that you
cannot occasionally change your routine. However, for the most part it is advisable for the first year of life to stick to your baby’s schedule. Babies are to sleep
on their back.
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Caring for Your New Baby
Child Proofing
During your well-child visits we will discuss your child’s level of development
and offer anticipatory guidance in eliminating hazards and providing a safe,
child-proof environment. Written and illustrated information sheets are available through our practice. Keep in mind, however, that a home that is thought
to be child-proof does not always prove to be “fool-proof”. For this reason you
should have emergency numbers (including Poison Control 1-800-222-1222)
near the phone. We will be happy to provide written instructions on handling
other emergencies (i.e. choking, etc.) and answer any questions you may have.
Guidelines for Obtaining Assistance
Learn to trust your instincts. You are the best judge of your baby’s state of
health and you will sense when your child does not seem right or is having difficulty. If you are concerned, call our office.
Signs of Illness
During the first few weeks of life you should be alert for changes in your baby’s
daily routine and/or physical findings. The following are reasons for potential
concern during the first few weeks. Call the office if your baby develops:
1.Fever over 100.4° rectal
2.Projectile vomiting (not just spit up)
3.Any unusual rash
4.Listlessness
5.Yellow skin
6.Green or yellow eye drainage
7.Rapid or labored breathing
8.Marked jitteriness
9.No urine in 12 hours
10. Baby’s very irritable and inconsolable
11. Any other notable change or concerns you may have
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Telephone and Emergencies
Our nurses have been thoroughly trained with our plans to handle most of the
routine problems of child care. All telephone messages are written down and
transmitted to a physician. If you feel the need to talk with a physician, tell the
nurse. In cases of emergency, a doctor can be reached within minutes. In case
of life-threatening emergencies, please go to the nearest emergency room or
call 911.
Suggested Reading
1.Caring for Your Baby and Young Child Birth to Age 1, American Academy
of Pediatrics
2.Baby and Child Care, Benjamin Spock, M.D.
3.Toddlers and Parents, T. Brazelton, M.D.
4.Infants and Mothers, T. Brazelton, M.D.
5.Dr. Mom, a Guide to Baby and Child Care, M. Neifert, M.D.
6.The First Twelve Months of Life, F. and T. Caplan
7.Crying Baby, Sleepless Nights, Sandy Jones
8.The Womanly Act of Breastfeeding, LaLeche League International
9.Nursing Your Baby, Karen Pryor
10. Caring for Your Baby and Young Child, Steven P. Shelov, M.D.
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Caring for Your New Baby
Notes
15
169 Minebrook Road
Bernardsville, NJ 07924
908-766-0034
advocaresinatrapengpediatrics.com