NEWBORN BABY
CARE
Pediatric Associates-Greer
Edward Hausladen, MD, FAAP
Susan Shelley, MD
Lynn Smith, MD, FAAP
318 Memorial Drive
Greer, SC 29650
Office: (864)879-3883
Fax: (864)848-3492
ghschildrens.org/pag
INTRODUCTION
Congratulations! Thank you for choosing us to help you care for your
new baby.This booklet contains instructions concerning the routine care
of a healthy newborn and what to do if your baby becomes
ill or has a problem. It also outlines our office procedures and the
recommended schedule for well check-ups.
We encourage you to keep this booklet handy to use as a guide in the
management of common problems you may encounter as you get to
know your baby.
Our pediatricians see newborns at Greer Memorial Hospital. One of
our doctors will examine your baby daily while you are in the hospital.
We will be happy to discuss any questions you have during your
hospital stay and once you and your baby are home.
All of our pediatricians are specialists in the care of infants, young
children and adolescents from birth through age 22. You can see
the same doctor every time you come to the office or, if you prefer,
you may schedule appointments with each of the doctors so you can
get to know all of them. We encourage you to do whatever is most
comfortable for you and your baby.
We have partnered with the Children's Hospital of Greenville Health
System University Medical Center. This allows us to be more closely
aligned with pediatric specialty services, including the highest level of
pediatric inpatient care in the Upstate.
Appointments -Appointments should be made in advance as often
as possible.If your baby is sick or you have particular concerns, you
may call the office to schedule a same-day appointment. If you are
unable to keep an appointment, please call in advance to reschedule.
This allows another child to be seen during that time.
Office Hours- Our office is open Monday through Friday from 8:30
am to 5:00pm. We provide extended hours as needed after 5:00pm
for sick patients. On Saturdays our office is open for sick visits from
8:30am to 11:30am.
Telephone Calls - We are always available by telephone during
regular office hours.Our doctors and nurses strive to return calls as
soon as possible;however, it may be before lunch or after our last
patient is seen. After office hours our phone is answered by highly
trained pediatric nurse triage specialists. There is always a doctor on
call if needed.
Office Fees- Any office fees you are responsible for are payable on
the day of your child's visit. For your convenience, we do accept
credit cards. If you have any questions concerning charges, please
contact our office, and we will make every effort to assist you.
Well Check-ups- At each well visit, your child will be thoroughly
examined. Height, weight and head circumference are measured
at every well baby visit. We will discuss your child's growth,
development, diet, safety, sleep patterns, behavior and immunizations.
We will also answer any questions you have about your child. You
may want to write down your questions prior to your visit. We
recommend annual well child visits for all children over the age of
2 years. Influenza (flu) vaccination is recommended each Fall to all
children 6 months-old to 18 years-old.
Schedule of Well Check-ups and Immunizations
Age at time of visit
1 week (1'1visit may be earlier)
I month
2 months
4 months
6 months
9 months
12 months
15 months
18 months
2 years to 3 years
4 years
5 years
6 years to 10 years
9 years to I 0 years
11 years
12 years to 22 years
Vaccines and/or Tests
DTaP-Hepatitis B-JPV combination
(Pediarix), PCV-13(Prevnar), HIB, Rotarix
Pediarix, Prevnar, HIB, Rotarix
Pediarix, Prevnar, HIB
Developmental screening
MMR, Prevnar, Hepatitis A, hemoglobin test
Chickenpox (Varivax), DTaP, HIB
Hepatitis A
annual examination
DTaP-IPV combination (Kinrix), MMR,
Varivax, hemoglobin test, urinalysis,
Prevnar if needed
hearing and vision tests
annual examination; urine, blood, hearing and
vision tests as needed
Cervarix for females
Tdap (Boostrix), MCV-4 (Menactra); HPV
(Gardasil) (may start HPV at age 10)
annual examination; urine, blood, hearing and
vision tests as needed
FEEDING YOUR NEWBORN BABY
Breast feeding- Breast feeding is the most natural and inexpensive
way to feed your new baby. Breast milk provides the right nutrient s
that babies need for proper growth and development. It also contains
antibodies to help protect your baby from certain illnesses and
allergies. Breast feeding enhances bonding with your baby. Nursing is
also very healthy for the mother, including helping your body recover
from pregnancy and delivery . Call our office if you have questions
about breast feeding.
First feedings - The sooner and more often you nurse your baby, the
sooner your mature milk supply will become available. If you and
your baby are healthy, nursing immediately or within the first hour
after birth is ideal. At first, 5 to 10 minutes of feeding on each side
will be enough to empty the breast. In the first one to four days, your
milk will gradually change from the thicker, yellowish colostrum to
more watery, blue-white breast milk.
Feeding frequency- During the first week, most babies feed
frequently, at least 8 times per day. Breast-fed infants tend to feed
more often than formula-fed infants (usually 8 to 12 times per day),
since breast milk is more easily and quickly digested than formula.
Some nursing babies "cluster feed" during the first week, which means
they nurse more often for a few hours, then sleep for a few hours. You
should awaken your baby to feed at least every 4 hours for the first 2
weeks, which will help prevent low blood sugar.
Nipple Soreness - Nipple soreness can be caused by improper positioning
of the baby or prolonged feeding duration. To help your baby latch on,
apply a warm moist compress and express some milk prior to nursing.
A cool compress between feedings will help relieve soreness. Nursing
longer than 20 minutes per breast may be non-nutritive.Your baby
may be using you as a pacifier! If you are getting sore, it's okay to
limit feeding time and to stop nursing for an hour or two.
Supplements - If you need to supplement your baby, your own
expressed breast milk is the best supplement. This is usually
accomplished with a breast pump. Try to avoid using formula
supplements until breast feeding and your milk supply are well­
established. While your baby is nursing, we recommend a daily over-
the-counter vitamin D supplement such as Tri-vi-sol without iron.
Supplemental iron and fluoride may be added after the first six months.
Pacifiers- A pacifier is used to satisfy your baby's non-nutritive
sucking needs. It should not be used to replace or delay meals. Some
studies have shown that pacifier use reduces the risk of sudden infant
death syndrome (SIDS). For this purpose, a pacifier may be given to
your baby at nap or bedtime, but do not re-insert it once your baby
falls asleep. A potential disadvantage of pacifier use is that it may
cause nipple confusion and interfere with nursing. For this reason,
the American Academy of Pediatrics recommends delaying pacifier
use in nursing infants until one month of age. One-piece pacifiers are
thought to be less of a choking hazard than two-piece models. Never
fasten a pacifier to a cord placed around your baby's neck. Clean the
pacifier often and replace it regularly.
Maternal diet and medicines - Certain foods in your diet, such as
caffeine, cabbage, onions, garlic, broccoli and turnips, may cause gas
or fussiness in nursing infants. This is not a food allergy. Keeping a
food diary may help you recognize which foods in your diet do not
agree with your baby. In rare cases, your baby may develop a true
allergy to cow milk protein. This may cause a rash on the face and/or
more severe fussiness. Many medications are compatible with breast
feeding. Call our office or your obstetrician if you have a question
about taking a medication while nursing. Whenever you see a new
health care provider, inform them that you are nursing.
Formula feeding - If you are unable to or decide not to breast feed,
commercial infant formulas are an acceptable alternative. Cowmilk based formulas are well-tolerated by most babies. The formula
should be iron-fortified and contain DHA and ARA. Some babies
may require a soy-based or other specialized formula. Call our office
if your baby is excessively fussy or not taking formula well. For the
first few days, babies take an average of 1 to 2 ounces every 2 to 4
hours. After the first week, 2 to 3 ounces every 3 to 4 hours is typical,
and most babies take at least 4 ounces per feeding at one month of age.
Bottled water is lower in chlorine and is less likely to cause fussiness
in your baby than tap water. Fluoridated water, "nursery water," is
not recommended for the first six months of life. It is not necessary to
sterilize formula if you use bottled water or municipal tap water.
Spitting and vomiting- Most babies will spit up after some feedings.
This is normal and does not cause harm or distress to your baby. The
amount and frequency of spitting varies. Frequent burping, every 3
to 5 minutes, and keeping your baby upright during and after feedings
may reduce spitting. Vomiting is more forceful, greater in volume, and
usually causes discomfort to your baby. Call our office if your baby
vomits two or more feedings in a row, or vomits frequently (several
times per week).
"Is my baby getting enough to eat?" - Most babies lose weight
in the first few days of life. Up to 10% weight loss is normal in the
first week.They then return to birth weight by the end of the second
week. If your baby feeds vigorously, seems satisfied after feeding,
sleeps between meals, and gains weight, he or she is probably getting
enough milk. Most babies have 6 to 8 wet diapers per day. In severe
cases, feeding problems can lead to dehydration. Signs of dehydration
can include dry mouth, loose skin, sunken eyes and "soft spot", or not
urinating for 6 hours or more. Call our office immediately if you think
your baby may be getting dehydrated.
ROUTINE CARE
Sleep- Always place your baby on his or her back to sleep. This helps
prevent sudden infant death syndrome (SIDS). Babies sleep 16 hours
per day on average for the first 3 months. Newborns typically sleep
1 to 4 hours at a time, then stay awake for 1 to 2 hours. Most babies
get into a nighttime sleep routine by 2 to 3 months of age.
Shaking and head support- Babies have large, heavy heads relative
to their body size. In the first 2 months of life they have particularly
weak neck muscles. For these reasons, they are much more prone to
brain injury than adults. Always support the head when you lift or sit
up your baby. Never shake a baby! This can lead to permanent and
severe brain damage or even death.
Bathing - Give your baby sponge baths until the umbilical cord falls
off and the skin is healed.Daily baths are usually not necessary.
Bathe every few days as needed. Never leave a baby unattended in
standing water, no matter how shallow.
Cord care - The umbilical cord stump slowly dries after birth and falls
off after 1 to 3 weeks. It may be purple due to antibiotic dye applied
after birth in some hospitals. Keep the cord stump outside of the
diaper to help it dry. Rubbing alcohol applied to the base of the cord
twice daily may help the drying process.A small amount of bleeding is
normal when the cord separates. Sometimes the cord may have an
odor or drain slightly. Call our office immediately if drainage of the
cord area is accompanied by redness of the surrounding skin. This
may indicate a serious infection called omphalitis.
Genitals - Apply Vaseline liberally to the circumcision site with each
diaper change. Call our office if swelling, discharge or excessive
redness of the penis develops. It is normal to be unable to retract the
foreskin of an uncircumcised penis for the first several years of life.
Newborn girls may have a white or blood-tinged mucous discharge
from the vagina due to estrogen exposure in the womb. This is normal
and will resolve without treatment.
Bowel habits - After passage of dark green meconium stools in the
first few days, stool color can vary from yellow to green to tan. Stool
frequency can differ significantly. Some nursing infants have a soft
stool after each feeding. Some babies go 2 to 4 days between bowel
movements. Your baby is probably not constipated unless the stool
is hard or pellet-like. Call our office if the stools are watery and
frequent, bloody, or hard.
Clothing and travel - Dress your baby appropriately for the house or
outdoor temperature. Babies can quickly become overheated so do not
overdress your baby. It is fine to take your baby outside for walks or
short trips. Babies sunburn easily. During the day, the skin should be
covered when outdoors.
Illness prevention - Infections are spread by hand contact and droplets
from coughing. Avoid large crowds and letting numerous people
handle your baby unnecessarily. Have everyone in your household
wash their hands or use a hand-cleaning gel before picking up or
handling your baby.
Car seat- Use an approved, rear-facing car safety seat with every
car ride. If possible,install in the middle rear seat. Your child’s
car safety needs will change with age. See www.nhtsa.gov or
www.seatcheck.org for further information.
Home safety - Check your smoke and carbon monoxide detectors
regularly. Keep your hot water heater set at 120 degrees Fahrenheit
(F) or lower. Never heat formula or breast milk in a microwave. It can
be very hot in the center even if the container is cool to touch. Do not
allow your baby in a room or vehicle where someone is smoking.
COMMON CONCERNS
Fever and illness -Signs of illness include vomiting, refusal to
feed, cough, irritability, excessive sleepiness or inactivity. A rectal
temperature is the most accurate site. A normal rectal temperature
in a young infant ranges from 97.5 to 100.3 degrees F (about 36.5
to 38 degrees Celsius). A temperature that is too high or too low
can indicate an infection. If your baby is less than three months old
and has a rectal temperature above 100.3 or below 97.5 F, this is
considered an emergency. Call our office number immediately or
proceed directly to the emergency room.Call immediately if your
baby is more irritable, vomiting, refusing to feed, abnormally inactive,
having difficulty breathing, or "looks sick," even if the temperature is
normal.
Jaundice -Jaundice is a yellow color to the skin caused by bilirubin,
a pigment found in blood. Mild jaundice is normal in newborns and
usually resolves within 2 weeks. Most babies have a skin test for
jaundice before leaving the hospital. This is followed by a blood test
if the bilirubin level is high. Sometimes jaundice does not develop
until after a baby goes home. Call our office if your baby develops a
yellow or orange color to the skin after discharge from the hospital, or
if jaundice is still present at 2 weeks of age.
Crying and colic - Crying is how your baby expresses discomfort.
You will eventually learn your baby's normal crying pattern for
hunger, wetness, fatigue or overstimulation. Baby temperaments vary
greatly. If your baby cries 3 or more hours per day and at least 3 days
per week, this may be colic. The cause of colic is unknown, but it
usually resolves on its own by 3 to 4 months of age. Some parents
find that gentle rocking, swaddling, swinging, singing or soft music are
helpful. In some cases, a formula change may help.Call our office if
the crying is severe, lasts beyond 4 months of age, or is accompanied
by fever, vomiting, diarrhea or poor feeding.
Postpartum blues - Also known as the "baby blues," this is a period
of sadness, crying, fatigue and/or trouble sleeping and affects 70 to 80
percent of all new mothers. Fortunately, the symptoms aren't usually
severe and resolve within 3 to 4 weeks after childbirth. Keep in touch
with your sources of support (spouse, family, and friends) as much as
possible. You can't do everything. Let others help you so that you may
take a break. If your symptoms are severe or last more than a month,
you may have postpartum depression. Call your doctor immediately if
you feel overwhelmed, depressed, or that you may harm your baby.
Nasal congestion- A newborn's nasal passages are small and often
become congested,particularly when exposed to dry air in the winter.
This can be treated with salt water, or saline, nose drops. These are
available over-the-counter as Ayr, Little Noses, or generic saline nose
drops. You can make your own saline solution by adding '14 teaspoon
of salt to 1 cup (8 ounces) of warm water. Discard homemade saline
after 24 hours. To use the drops, place your baby on his or her back
and drip 2 or 3 drops of saline into each nostril. Wait 2 to 5 minutes
between nostrils. Repeat as needed for congestion up to 4 or 5 times
per day. If you see mucus in the nose, suction gently with a bulb
aspirator as needed. Suctioning too often or too vigorously may
make nasal congestion worse.It is okay to leave the drops in the nose without
suctioning.
Skin rashes and birthmarks - Newborns can develop a number
of harmless rashes that usually go away without treatment. If you
are unsure about a rash, bring your baby to the office for evaluation.
Salmon patches are birthmarks commonly known as stork bites or
angel kisses. They are flat red or deep pink patches of skin on the
scalp, neck, forehead, eyelids or nose. They tend to fade after a few
months but may become more pronounced during crying. Mongolian
spots are large, flat dark green or blue areas of skin on the back,
buttocks or thighs. They look similar to bruises and are most common
in dark-skinned babies. They usually disappear by school age.
Cradle cap - Cradle cap is an infantile form of seborrhea (dandruff).
It appears as yellowish scales and sometimes red skin on the scalp,
eyebrows, face, diaper area or behind the ears. It usually resolves by
one year of age and can be treated by massaging the scales away with
a clean, damp washcloth. Scales may occasionally be loosened with
baby oil or mineral oil. Rinse the oil from the scalp after use. Overuse
of oils may make cradle cap worse. Call our office for other treatment
suggestions.
Diaper rash- Urine and stool can be irritating to your baby's skin and
lead to redness, small bumps and raw areas. This is diaper dermatitis
and is best treated with frequent diaper changes and a petroleum jelly
based ointment like Vaseline. If the rash is large, well-defined and
deeply red, it may be a yeast infection.If you think your baby has a
yeast infection or a diaper rash does not improve with treatment, call
our office.
Thrush -Thrush is a yeast infection in the mouth. It is common in
young infants and results in white spots on the cheeks, gums, lips or
roof of the mouth. These spots are difficult to rub off. It is normal
for a baby to have a white coating on the tongue. This is probably not
thrush. Often thrush will resolve without treatment. Call our office if
your baby has thrush that lasts more than one week.
FURTHER READING:
www.healthychildren.org (American
Academy of Pediatrics educational website)
www.llli.org (La Leche League International
homepage)
Caring for Your Baby and Young Child Birth
to Age 5 (5th Edition, October 2009, by the
American Academy of Pediatrics)-available
from www.healthychildren.org or
www.amazon.com
The Womanly Art of Breastfeeding
(Paperback, 8th Edition, July 2010, by
La Leche League International)-available
from www.llli.org or www.amazon.com
Baby's Firsts
Telephone Numbers