Weight _________ ____%
SAPPHIRE PEDIATRICS
Height_______ ____%
Tylenol ______ every 4 hrs
Head circ ________ ____%
Ibuprofen ______ every 6 hrs
Well Child Care at 2 Weeks
Feeding



Your baby is growing! At this age, a baby only needs breast milk or infant formula. Most babies take
2 to 3 ounces of formula every 2 to 3 hours now. Breast-fed babies should usually feed about 10
minutes at each breast during each feeding. Breast-fed babies may want to nurse as often as every 2
hours. Babies usually wake up at night to feed. This is normal. Cereal or baby food is not needed yet.
Babies can have food allergies if solids are started too early. If your baby wants to feed more often,
try a pacifier. Your baby may need to suck but not feed.
It is important to hold your baby during feeding. This is a good time to talk and play. Hold the bottle
and do not prop it up.
Mixing formula: If you use concentrated liquid formula, always mix 1 can of formula with 1 can of
tap water. Keep the mixture in the refrigerator. If you get powdered formula, mix 2 ounces of water
per 1 scoop of formula.
Development


Babies are learning to use their eyes and ears. Smiling faces and gentle, pleasant voices are interesting
for babies at this age.
Many mothers find that the baby brings a lot of new work. Help from fathers, friends, and relatives is
often very important at this time.
Sleep
Babies usually sleep 16 or more hours a day. Healthy babies should be placed in bed on their backs.
Sleeping on the back reduces the risk of sudden infant death syndrome (SIDS).
Bowel and Bladder
Most babies will strain to pass bowel movements. As long as the bowel movement is soft, there is no need
to worry. Ask your doctor about bowel movements that are hard (constipation). Babies usually wet the
diaper at least 6 times each day.
Safety Tips
Carbon Monoxide Poisoning Furnaces, water heaters, and cars are daily sources of fatal carbon
monoxide. Detectors (and routine service to your appliances) will prevent death from CO.
 Install at least one detector near your sleeping areas. Don’t rely on your landlord.





Never use your stove to heat your house
Never leave a car running in the garage
Always have your furnace checked before turning it on in the fall
Never leave children in a running car while clearing off snow. Tailpipes blocked with snow will
cause fatal levels of CO inside the car.
Never use a generator inside the house-- even in a power outage.

Other safety

Car seats are the safest way for babies to travel in cars and are required by law. Infant car seats should
be placed in a back seat with the infant facing backwards. Never leave your baby alone in a car or
unsupervised with young brothers, sisters, or pets.
If you use a crib for your baby, be sure to pick a safe location. It should not be too near a heater.
Make sure the sides are always completely up. Crib slats more than 2 and 3/8 inches apart can lead to
injury.
Mesh netting of playpens should always be in the upright position.


Call Us If:


Your baby develops a fever. (over 100.4 rectal)
Your child is very irritable and you cannot calm him
4500 E. Ninth Avenue Suite 740 Denver, CO 80220 ph 720-941-1778 fax 720-941-1783 www.SapphirePediatrics.com
Sapphire Pediatrics
www.SapphirePediatrics.com
Normal Development: 2 Weeks Old
Here's what you might see your baby doing between the ages of 2 weeks and 2 months.
Movement
Movements gradually become smoother and more controlled.
Lifts chin for a few seconds when lying on tummy.
Cannot support head without assistance.
Grasps whatever is placed in hand.
Vision and Hearing
May follow some moving objects with eyes.
Explores surroundings with eyes.
Turns in direction of some sounds.
Interactive Behaviors
Gives more precise meaning to crying (hunger, discomfort, and excitement).
Cries when left alone; usually stops when picked up.
Makes variety of gurgling and cooing sounds when happy and content.
Makes eye contact.
May quiet down in response to human face.
Responds positively to being held and comforted.
May smile socially at familiar faces and voices, especially mother's voice.
Each child is unique. It is therefore difficult to describe exactly what should be expected at each
stage of a child's development. While certain behaviors and physical milestones tend to occur at
certain ages, a wide spectrum of growth and behavior for each age is normal. These guidelines are
offered as a way of showing a general progression through the developmental stages rather than as
fixed requirements for normal development at specific ages. It is perfectly natural for a child to
attain some milestones earlier and other milestones later than the general trend.
? ? ? 
Have Questions about your Child?
Medication doses… Symptoms and signs…
When to worry…
When to call us…
Pay a bill online….
Print Packets and forms…
Our website is always available
 Lunch time
 Night time
 Fussy time
 Any time!!
www.SapphirePediatrics.com
Try our NEW Patient Portal
Please call the office during business hours to register (its free )












Secure access your child’s medical records
Download shot records at home!
Schedule routine appointments
Request a refill or referral
Ask a non-urgent question
SAPPHIRE PEDIATRICS
Schedule of Well Child Visits
AGE
2-3 days
development
IMMUNIZATIONS/TESTS
none
VISIT DETAILS
2 weeks
state newborn screen
exam, growth, newborn screen
2 months
DTaP/IPV/HIB, HepB, Prevnar, RotaTeq
exam, growth, development
4 months
development
DTaP/IPV/HIB,( HepB*), Prevnar, RotaTeq
6 months
DTaP/IPV/HIB, HepB, Prevnar, RotaTeq
9 months
Blood Count, Lead and TB screen
12 months
Prevnar, HepA
exam, growth, development
15 months
MMR, Varivax
exam, growth, development
18 months
Pentacel, Hep A
exam, growth, devel., autism screening
2 years
Blood Count, Lead screen
exam, growth, devel, hearing
3 years
 None 
exam, growth, devel, hearing
4 years
MMR, Varicella
exam, growth, devel, vision, hearing
5 years
DTaP, IPV, Urinalysis
exam, growth, devel, vision, hearing
6 years
7 years
8 years
none
none
none
exam, growth, devel, vision, hearing
exam, growth, devel, vision, hearing
exam, growth, devel, vision, hearing
9 years
10 years
hearing
Cholesterol screen
none
exam, growth, devel, vision, hearing
exam, growth, devel, vision,
11 years
TdaP, Menactra, UA
Gardasil (series of 3 shots)
exam, growth,
exam, growth,
(*no HepB if received birth dose)
12 years
issues*
13 years
issues*
14 years
issues*
15 years
exam, growth, development
exam, growth, development
exam, growth, devel, vision, hearing, puberty issues*
none
exam, growth devel, vision, hearing, puberty
none
exam, growth, devel, vision, hearing, puberty
none
exam, growth devel, vision, hearing, puberty
none
exam, growth, devel, vision, hearing puberty
Menactra
exam, growth devel, vision, hearing, puberty
none
exam, growth, devel, vision, hearing, puberty
issues*
16 years
issues*
17 years
issues*
Sapphire Pediatrics 4500 E. Ninth Avenue, #740 Denver, CO 80220
Phone 720-941-1778
Fax 720-941-1783
www.SapphirePediatrics.com
SAPPHIRE PEDIATRICS
* Puberty issues: adolescent issues including sexuality will be discussed at these visits. These visits may
include one-on-one time for the Teen and the physician. Please prepare your child appropriately.
DtaP = Diptheria/Tetanus/Acellular Pertussis
HIB= Hemophilus influenza type B
HepB = Hepatitis B vaccine
IPV = Inactivated Polio Virus
Prevnar = Pneumococcal 7- conjugate
Varivax = Varicella (chickenpox)
MMR = Measles/Mumps/Rubella
RotaTeq= oral Rotavirus vaccine
TdaP = Tetanus/Diptheria/acellular Pertussis booster
Gardasil= HPV (cervical cancer) vaccine
Menactra = meningococcal vaccine
UA= urninalysis
Hgb= hemoglobin (blood count)
HepA = Hepatitis A
Sapphire Pediatrics 4500 E. Ninth Avenue, #740 Denver, CO 80220
Phone 720-941-1778
Fax 720-941-1783
www.SapphirePediatrics.com
SAPPHIRE PEDIATRICS
How to Use a Bulb Syringe
A baby needs a bulb syringe when the nose is too congested to allow nursing or taking
the bottle, or if milk or mucus in the baby's mouth causes gagging or choking. Follow
these easy steps to ensure you use the bulb syringe properly.
Clear Baby's Mouth
Steps:
1. Hold baby on your lap or in the crook of your arm.
2. Squeeze the bulb of the syringe, caving in the sides completely.
3. Place the tip of the syringe gently in the baby's mouth, sliding it between the cheek
and gums.
4. Release the bulb while slowly pulling it from the baby's mouth.
5. Squeeze the bulb again into a sink to remove the milk or mucus.
6. Wipe off the tip of the syringe and repeat if needed.
Tips: Clean the bulb syringe thoroughly with warm water after each use.
Clear Baby's Nose
Steps:
1. Lay the baby tummy-side up on your lap. Baby's head should be at your knees
and slightly tipped back.
2. Drop or squeeze one or two saline drops in baby's nostril if necessary. Keep the
baby's head still for about 10 seconds after inserting saline.
3. Squeeze the bulb of the syringe, caving in the sides completely.
4. Gently place the tip of the syringe into one nostril and release pressure on the bulb.
Don’t forget to push the other nostril closed with your finger to ensure good
suction.
5. Remove the tip and squeeze the bulb into a sink or tissue to remove the
mucus.
6. Repeat the steps for the second nostril if needed.
7. Repeat suctioning after ten minutes if the baby is still congested.
Tips: Clean the bulb syringe thoroughly with warm water after each use. If the mucus
is dried or crusty, you may need to use saline drops to moisten it enough to suck out.
You can buy saline drops at pharmacies, or make them at home by dissolving 1/4
teaspoon of salt in 8 ounces of warm water. Make a fresh batch each time you need to
use it.
4500 E. Ninth Avenue Suite 740 Denver, CO 80220
Ph 720-941-1778 fx 720-941-1783 www.SapphirePediatrics.com
IMPORTANT
For patients who are going to be applying
for Colorado State Medicaid:
 We ask that you contact your Medicaid technician
immediately to start the application process for your
new baby.
 Also it is very important to let Medicaid know you
Do Not want to be enrolled into Denver Health and
list Sapphire Pediatrics as your health provider.
 Below is a list of contact numbers to get you started.
If you started this process while in the hospital it is
important to know that you must still contact
Medicaid directly.
Adams County- (303)-287-8831
Arapahoe County- (303)-636-1130
Denver County- (720)-944-3666
Jefferson County-(303)-271-1388
For other counties you may call: 1-800-221-3943
A Note about Commercial Insurance
PLEASE KNOW YOUR INSURANCE: As you bring your child for routine health care, you
will get to know the ins and outs of your insurance policy. Each policy is different—we accept
hundreds of plans and each has its own challenges. In general, even a well child will incur
significant out-of-pocket charges. This letter is an attempt to make you aware of some common
pitfalls and misunderstandings about commercial insurance.
We bill your insurance as a courtesy to you. We provide care to your child as medically
indicated, without regard to your insurance. We cannot and do not know the details of your
particular plan. Payment for your child’s care ultimately rests with you, not with the insurer. If
this sounds harsh, please understand that as health-care professionals, our priority is providing the
best medical care for your child. We do keep common insurance issues in mind, but please keep
us up to date, as coverage plans change over time.
In order to assist us in keeping your out-of-pocket costs to a minimum, it is essential that you tell
us (at each visit), if:
1.
2.
3.
4.
5.
6.
your insurance does not cover well visits
your insurance does not cover vaccines
you have a high-deductible health care plan (payment is required at the time of service)
your insurer requires you to use a specific laboratory company
your insurer requires you to use a certain hospital for x-rays or hospital services
Your insurance has changed from what we have on file
Newborns: your insurer requires you to enroll your infant within 30 days of birth. After this
date, enrollment may be refused and all medical bills the infant has accrued will revert directly to
you. PLEASE DON’T FORGET TO ENROLL YOUR BABY!
For children over age 2, most insurers will require 365 days between well visits, while sick visits,
of course, are allowed at any time. We attempt to keep you on schedule with annual well visits,
but, again, final responsibility for timing and payment rests with you. If you are unsure of the
date of your child’s last visit, please ask us to verify that date before scheduling another wellcheck.
Regarding Co-Pays: A co-pay is the portion of the visit charge that the insurer applies to you. It
is not an additional fee charged by the office. For instance, if your child has a visit that costs
$100, and your co-pay is $25, the insurer will reimburse the office $75 and apply the rest to you.
It is a violation of our contract with your insurer to waive copays for any reason. Most plans will
have a co-pay for every visit, regardless of the visit type or visit frequency.
The above issues are complicated and we all wish insurers provided simpler, more complete
coverage. We thank you for your attention to these details and for your understanding when we
are not able to troubleshoot complaints related to insurance and coverage. While no one can
guarantee a hassle-free insurance experience, at Sapphire Pediatrics, we do guarantee superb
pediatric healthcare for your child! 
SAPPHIRE PEDIATRICS
Vitamin D Supplementation for your Breast-Fed Infant
Here are some commonly asked questions and answers on the recommendations in the AAP Clinical
Report, "Prevention of Rickets and Vitamin D Deficiency: New Guidelines for Vitamin D Intake", that may
be helpful for families.
1. Q. Why do babies and older children need vitamin D?
A. Vitamin D is needed to help your body develop strong bones.
2. Q: Why is it necessary to give vitamin D supplements to my breastfeeding baby? Doesn’t human milk have all the
essential nutrients for babies?
A. The AAP recommends breastfeeding of infants for at least 12 months and for as long thereafter as the mother and
infant desire. However, human milk does not contain enough vitamin D to prevent rickets. Sunlight is the usual source
of vitamin D production in the skin.
3. Q: If my baby goes out in the sunlight every day or every other day for an hour or so, isn’t that enough?
A: It may be enough sunlight exposure in some parts of the country throughout the year, but sunlight exposure is
difficult to measure. Factors such as the amount of pigment in your baby’s skin and skin exposure affect how much
vitamin D is produced by your body from sunlight. In the more northern parts of the country during the winter, the
amount of sunlight is not enough for any baby. Exposing infants and children’s skin to sunlight has been shown to
increase the risk for skin cancer later in life. We now recommend that infants and young children not be in direct
sunlight when they are outside, particularly infants younger than 6 months of age. Sunscreens should be used on all
children when in sunlight but it prevents vitamin D formation in the skin.
4. Q: Do I need to give vitamin D supplements to infants who are fed infant formula?
A. No. All formulas sold in the United States have a sufficient amount of vitamin D that infants need as long as they
are given about 16.9 ounces (pint) of infant formula per day.
5. Q: When I take my baby outside, I always cover all of his skin with sunscreen, just as the AAP recommends. Isn’t
that enough to protect him from cancer and yet give him vitamin D?
A: No, the sunscreen prevents the skin from making vitamin D.
6. Q: How do I give vitamin D to my infant?
A: Liquid multivitamin drops with vitamin D are available. If you give your baby the recommended amount from the
dropper in the vitamin drops bottle, the baby will get all the vitamin D needed to prevent rickets.
7. Q: When should I start giving the vitamin D drops?
A: You should start some time during the first 2 months of life.
8. Q: How often do I give the vitamin D drops?
A: You should give the drops once a day, every day. But, if you forget one day, it is all right. The vitamin D is stored
in the baby and there will be enough in the baby’s body to prevent rickets.
9. Q: If I give the vitamin drops to the baby, will the baby not want to breastfeed?
A: No, the drops will not interfere with breastfeeding. The amount is very small and giving a few drops from the
dropper in to the corner of the baby’s mouth toward the cheek will not give the baby any problem with breastfeeding.
10. Q: Don’t the vitamin drops taste bad?
A: Some vitamin drops do have a strong taste, especially the ones that contain vitamin B, but the triple vitamin drops
that contain only vitamins A, C, and D taste all right.
11. Q: Do babies need vitamins A and C also?
A: Breastfed babies do not need vitamins A and C, but giving them these additional vitamins in this dosage is not
harmful. At the present time there is no vitamin drop available with only vitamin D. In the near future, there may be
vitamin D-only drops manufactured. When that is available, it would be the perfect vitamin to give to the breastfeeding
baby. In some parts of Africa, there is deficiency in vitamin A and those babies may also need the vitamin A.
12. Q: How long do I keep giving the vitamin D drops?
A: You should keep giving it until your child has weaned from breastfeeding and is receiving at least a pint (16.9
ounces or 500 ml) of infant formula every day. The AAP recommends that "infants weaned before 12 months of age
should not receive cow’s milk feedings but should receive iron-fortified infant formula". Once your child begins
drinking at least a full pint of vitamin D-fortified milk after 12 months of age, he/she does not need additional vitamin D
drops or a tablet. If, however, your child drinks less than 17 ounces of regular milk, you should give him/her vitamin D
drops or a tablet. This recommendation applies to children of all ages and even to adults.
Infant and Child Stooling Patterns
FEEDING
TYPE
Breast milk
Formula
AGE
STOOL TYPE
1-3 days
3-6 days
Meconium
Transitional
1 week-2
weeks
Breast milk stools
2-3
weeks
and older
Breast milk stools
as above
(less frequent)
1-3 days
3-6 days
Meconium
Transitional
1 week-2
weeks
2-3
weeks
and older
Formula stools
DESCRIPTION
green-black, sticky
between meconium
and yellow mustard or cottage cheese -like
yellow liquid mustard, but may be brown, green,
orange. Often runs out of the diaper and down the
legs or back; also cottage cheese with clumps or
curds; also seedy.
STOOL FREQUENCY
1-4x/day
Each feeding or so
Formula stools as
above (less
frequent)
Frequent stools at this age are a sign of good
milk intake
Each feeding to every
Other feeding
Variable: each feeding
or as little as once per
week
green-black, sticky
between meconium
and yellow-green soft stools
Soft, seedy, or pasty stools; color varies between
brown, green, grey, and yellow
TIPS
Baby’s intestines are more mature; there is little
waste in breast milk so stools may be
infrequent. Babies naturally grunt and strain,
even when stools are soft.
1-4x/day
Several times a day
A few times a day
Once or twice a day; as
little as once every 3-4
days
Babies grunt and strain just because. If the
stools are not small pellets, straining is not a
sign of constipation or a medical problem.
What is Constipation?
Normal stooling efforts for babies include:
-straining with stools
-grunting with stools
-turning red in the face with stools
-play-dough consistency stools
Constipation is:
-in a breast fed baby:
-more than 7 days between stools (assuming good feeding and weight gain)
-stool is hard, dry pellets
-in a formula fed baby:
-more than 4 days between stools
-stool is hard, dry pellets
At-Home Constipation treatment:
-for immediate relief:
-glyerine liquid suppositories (baby-lax®, available over the counter); solid suppositories ok if liquid not available
-squeeze contents into baby’s rectum; baby will have a stool within 15 minutes
-for more consistent relief:
-1 oz of prune juice mixed with 1 oz of water
-give to baby in a bottle 1-2x daily until stools are soft (7 days max); then stop
DO NOT USE HONEY OR KARO® SYRUP IN INFANTS UNDER AGE 1. THESE ITEMS CAN CAUSE SERIOUS HEALTH PROBLEMS FOR YOUR BABY.
If your child has true constipation that doesn’t improve with the above treatments, call the office for an appointment. Your child may need additional treatment.
United States
Environmental Protection
Agency
Indoor Environments Division (6609J)
Office of Air and Radiation
EPA-402-F-96-005
October 1996
Protect Your Family and
Yourself from Carbon
Monoxide Poisoning
Carbon Monoxide Can Be Deadly
Play it Safe
You can’t see or smell carbon monoxide, but at
high levels it can kill a person in minutes. Carbon
monoxide (CO) is produced whenever any fuel
such as gas, oil, kerosene, wood, or charcoal is
burned. If appliances that burn fuel are maintained
and used properly, the amount of CO produced is
usually not hazardous. However, if appliances are
not working properly or are used incorrectly,
dangerous levels of CO can result. Hundreds of
people die accidentally every year from CO
poisoning caused by malfunctioning or improperly
used fuel-burning appliances. Even more die from
CO produced by idling cars. Fetuses, infants,
elderly people, and people with anemia or with a
history of heart or respiratory disease can be
especially susceptible. Be safe. Practice the DO’s
and DON’Ts of carbon monoxide.
If you experience symptoms that you think could be
from CO poisoning:
CO Poisoning Symptoms
Know the symptoms of CO poisoning. At moderate
levels, you or your family can get severe
headaches, become dizzy, mentally confused,
nauseated, or faint. You can even die if these levels
persist for a long time. Low levels can cause
shortness of breath, mild nausea, and mild
headaches, and may have longer-term effects on
your health. Since many of these symptoms are
similar to those of the flu, food poisoning, or other
illnesses, you may not think that CO poisoning
could be the cause.
DO GET FRESH AIR IMMEDIATELY. Open
doors and windows, turn off combustion
appliances and leave the house.
DO GO TO AN EMERGENCY ROOM and tell
the physician you suspect CO poisoning. If CO
poisoning has occurred, it can often be
diagnosed by a blood test done soon after
exposure.
DO Be prepared to answer the following
questions for the doctor:
Do your symptoms occur only in the house?
Do they disappear or decrease when you
leave home and reappear when you return?
Is anyone else in your household
complaining of similar symptoms? Did
everyone’s symptoms appear about the
same time?
Are you using any fuel-burning appliances
in the home?
Has anyone inspected your appliances
lately? Are you certain they are working
properly?
Prevention is the Key to Avoiding Carbon
Monoxide Poisoning
DO have your fuel-burning appliances -including oil and gas furnaces, gas water
heaters, gas ranges and ovens, gas dryers, gas
or kerosene space heaters, fireplaces, and
wood stoves -- inspected by a trained
professional at the beginning of every heating
season. Make certain that the flues and
chimneys are connected, in good condition, and
not blocked.
DO choose appliances that vent their fumes to
the outside whenever possible, have them
properly installed, and maintain them according
to manufacturers’ instructions.
DO read and follow all of the instructions that
accompany any fuel-burning device. If you
cannot avoid using an unvented gas or
kerosene space heater, carefully follow the
cautions that come with the device. Use the
proper fuel and keep doors to the rest of the
house open. Crack a window to ensure enough
air for ventilation and proper fuel-burning.
DO call EPA’s IAQ INFO Clearinghouse (1-800438-4318) or the Consumer Product Safety
Commission (1-800-638-2772) for more
information on how to reduce your risks from
CO and other combustion gases and particles.
DON’T idle the car in a garage -- even if the
garage door to the outside is open. Fumes can
build up very quickly in the garage and living
area of your home.
DON’T use a gas oven to heat your home, even
for a short time.
DON’T ever use a charcoal grill indoors -- even
in a fireplace.
DON'T sleep in any room with an unvented gas
or kerosene space heater.
DON’T use any gasoline-powered engines
(mowers, weed trimmers, snow blowers, chain
saws, small engines or generators) in enclosed
spaces.
DON’T ignore symptoms, particularly if more
than one person is feeling them. You could lose
consciousness and die if you do nothing.
A Few Words About CO Detectors
Carbon Monoxide Detectors are widely available in
stores and you may want to consider buying one as a
back up -- BUT NOT AS A REPLACEMENT for proper
use and maintenance of your fuel-burning appliances.
However, it is important for you to know that the
technology of CO detectors is still developing, that there
are several types on the market, and that they are not
generally considered to be as reliable as the smoke
detectors found in homes today. Some CO detectors
have been laboratory-tested, and their performance
varied. Some performed well, others failed to alarm even
at very high CO levels, and still others alarmed even at
very low levels that don’t pose any immediate health
risk. And unlike a smoke detector, where you can easily
confirm the cause of the alarm, CO is invisible and
odorless, so it’s harder to tell if an alarm is false or a real
emergency.
So What’s a Consumer to Do?
First, don’t let buying a CO detector lull you into a false
sense of security. Preventing CO from becoming a
problem in your home is better than relying on an alarm.
Follow the checklist of DOs and DON’Ts above.
Second, if you shop for a CO detector, do some
research on features and don’t select solely on the basis
of cost. Non-governmental organizations such as
Consumers Union (publisher of Consumer Reports), the
American Gas Association, and Underwriters
Laboratories (UL) can help you make an informed
decision. Look for UL certification on any detector you
purchase.
Carefully follow manufacturers’ instructions for its
placement, use, and maintenance.
If the CO detector alarm goes off:
Make sure it is your CO detector and not your smoke
detector.
Check to see if any member of the household is
experiencing symptoms of poisoning.
If they are, get them out of the house immediately
and seek medical attention. Tell the doctor that you
suspect CO poisoning.
If no one is feeling symptoms, ventilate the home
with fresh air, turn off all potential sources of CO -your oil or gas furnace, gas water heater, gas range
and oven, gas dryer, gas or kerosene space heater
and any vehicle or small engine.
Have a qualified technician inspect your fuel-burning
appliances and chimneys to make sure they are
operating correctly and that there is nothing blocking
the fumes from being vented out of the house.
Sapphire Pediatrics
www.SapphirePediatrics.com
Prevention of Sleep Problems: Birth to 6 Months
Parents want their children to sleep through the night, giving the parent 7 or 8 hours of uninterrupted sleep.
Newborns, however, are not able to sleep through the night. They usually cannot go without a nighttime
feeding for more than 4 or 5 hours. By 2 months of age, about 50% of bottle-fed infants can sleep through
the night. By 4 months, most bottle-fed infants have this ability. Most breast-fed babies can sleep through
the night by 5 or 6 months of age. Good sleep habits may not develop, however, unless you have a plan.
It is far easier to prevent sleep problems before 6 months of age than it is to treat them later. These
guidelines will help you teach your baby that:
Nighttime is a special time for sleeping.
Her crib is where she stays at night.
She can put herself back to sleep after normal awakenings that don't relate to hunger.
Newborns
Help your baby fall asleep using any technique that works. Some babies fall asleep at the breast or
bottle. They may need skin-to-skin contact to fall asleep. This is okay at this age, but if your baby is on the
brink of falling asleep and calm, try to put him in his crib. This helps the baby learn how to fall asleep by
himself. (Note: The safe sleep position for healthy babies is on the back.)
Swaddle your baby in a blanket. Snug swaddling reduces awakenings caused by the startle reflex and
increases the length of sleep. Swaddling also helps babies fall asleep. Swaddling should be done before your
baby is put down in the crib. To swaddle your baby use the 3-step "burrito-wrap" technique. Start with your
baby lying on the blanket with the arms at the sides. Then (1) pull the left side of the blanket over the body
and tuck it in, (2) pull the bottom up, and (3) pull the right side over and tuck. It is a useful technique from
birth to 4 or 6 months of age. For more details, see Dr. Harvey Karp's book: The Happiest Baby on the
Block.
Try different techniques to calm your baby. If your baby is tired but irritable, try holding and gentle
rocking to calm her. If that does not work, try swaddling her. For babies, swaddling is the next best thing to
being hugged. Try humming, singing lullabies, or using white noise. Try massage or patting. Different
babies respond to different calming techniques.
Do not use a pacifier to help your baby fall asleep. While it is OK to use a pacifier to calm a crying
infant if holding does not work, do not use a pacifier when your child is drowsy. Your infant will not be able
to find and reinsert the pacifier until at least 10 months of age. If the baby cannot find the pacifier, he will
cry and you will need to be there to help him find the pacifier again.
Do not feed newborns more often than every 2 hours during the day. More frequent daytime
feedings (such as hourly) lead to frequent awakenings for small feedings at night (exception: the first week
when breast milk is still coming in). Feeding when your baby cries is okay, but only if your baby is hungry.
Crying is the only way that newborns have to communicate. Crying does not always mean your baby is
hungry. He may be tired, bored, lonely, or too hot. Hold your baby at these times or put him down to sleep.
Don't let feeding become comfort nursing. For every time you nurse your baby, there should be 4 or 5 times
that you snuggle your baby without nursing. Don't let him get into the bad habit of nursing every time you
hold him (called grazing).
Give the last feeding at your bedtime (10 or 11 PM). Try to keep your baby awake for the 2 hours
before this last feeding. Going to bed at the same time every night helps your baby develop good sleeping
habits. Look after your sleep needs by sleeping when your baby sleeps.
Do not let your baby sleep for more than 3 hours in a row during the day. Try to awaken her gently
and entertain her during the day. Doing this helps your infant sleep longer during the night. (Note: Many
newborns can sleep 5 hours in a row every 24 hours. You can teach your newborn to sleep for this longer
period at night.)
Don't let your baby sleep in your bed. Once your baby is used to sleeping in your bed, a move to her
own bed will be very difficult. Teach your child to prefer her crib. The risk of sudden infant death during the
first 8 months is higher for babies who sleep in an adult bed than for babies who sleep in a crib. For the first
2 or 3 months, you can keep your baby in a crib or bassinet next to your bed.
1 Month-Old Babies
Learn to recognize the signs of drowsiness. These include droopy eyelids, tired eyes not interested in
the surroundings, yawning, decreased body movement, decreased facial expression, and quietness. When
you see these signs, put your baby in the crib. If you miss these signs and your baby gets overtired, he may
become irritable and harder to put down. If your child has been awake longer than 2 hours, assume he needs
some sleep.
Place your baby in the crib when he is drowsy but partially awake. This step is very important. Your
baby's last waking memory should be of the crib, not of being held or of being fed. He must learn to go to
sleep without you. Don't expect him to go to sleep as soon as you lay him down. It often takes 10 to 20
minutes of restlessness and fussiness for a baby to go to sleep. If he is crying, hold him and try to calm him.
But when he settles down, try to place him in the crib before he falls asleep. Handle naps in the same way.
This is how your child will learn to put himself back to sleep after normal awakenings during the night.
Comfort your baby for all crying, but not for normal fussiness. All new babies cry some during the
day and night. Always respond to a crying baby. Babies can't be spoiled during the first 6 months of life.
But by 1 month of age, hold your baby just for crying, not for normal fussiness. Soothe him until he's calm,
not until he's asleep. (Note: Even colicky babies have a few times each day when they are drowsy and not
crying. On these occasions, place your child in the crib and let him learn to comfort himself and put himself
to sleep).
Make middle-of-the-night feedings brief and boring. You want your baby to think of nighttime as a
special time for sleeping. When he wakes up at night for feedings, don't turn on the lights, talk to him, or
rock him. Feed him quickly and quietly in the dark. Provide extra rocking and playtime during the day. This
approach will lead to longer periods of sleep at night. Normal levels of background noise may keep him
from oversleeping during the day. During the day don't make the baby's bedroom too quiet or dark.
2-Month-Old Babies
Move your baby's crib to a separate room. Between 2 and 3 months of age, your baby should be
sleeping in a separate room. This will help parents who are light sleepers sleep better. Also, your baby may
forget that her parents are available if she can't see them when she awakens. Also close the bedroom door so
your child gets used to sleeping that way. If separate rooms are impractical, at least put up a screen or cover
the crib railing with a blanket so that your baby cannot see your bed.
Try to stretch daytime feedings to 3 hours apart. Over the next 2 months gradually lengthen the time
between daytime feedings. Going without feeding for 3 hours at a time during the day increases the chances
that your infant will sleep through the night. Going more than 3 hours between feedings during the day may
leave your child more hungry during the night. During the day offer a feeding if 4 hours pass and your
infant has not given any signals of being hungry.
Try to delay middle-of-the-night feedings. By now, your baby should be down to 1 feeding during the
night (2 for some breast-fed babies). Before preparing a bottle, try holding your baby briefly to see if that
will satisfy her. Never awaken your baby at night for a feeding except at your bedtime.
4- to 6-Month-Old Babies
Try to discontinue the last middle-of-the-night feeding before it becomes a habit. By 4 months of
age, your bottle-fed baby does not need to be fed formula more than 4 times a day. Breast-fed babies do not
need more than 5 or 6 nursing sessions a day. If you do not eliminate the night feedings by 6 months of age,
they will become more difficult to stop as your child gets older. Remember to give the last feeding at 10 or
11 PM. If your child cries during the night, try to comfort him with a back rub and some soothing words
instead of with a feeding.
Do not let your baby hold his bottle or take it to bed with him. Babies should think that the bottle
belongs to the parents. A bottle in bed leads to middle-of-the-night crying for refills when your baby reaches
for the bottle and finds it empty or on the floor.
Make any middle-of-the-night contacts brief and boring. All children wake up 4 or 5 times each
night. They need to learn how to go back to sleep on their own at these times. If your baby cries for more
than a few minutes, visit her but don't turn on the light, play with her, or take her out of his crib. Comfort
her with a few soothing words and stay for less than 1 minute. If the crying continues for more than 10
minutes, calm her and stay in the room until she goes to sleep. (Exceptions: You feel your baby is sick,
hungry, or afraid.)
Sapphire Pediatrics
www.SapphirePediatrics.com
Breastfeeding mothers - self-care
Definition
Breastfeeding is often an enjoyable and rewarding experience for mothers. A breastfeeding mother
must continue to take care of her baby and herself, as she did during her pregnancy.
Recommendations
In general, lactating women should get nutrients from a well-balanced, varied diet, rather than from
vitamin and mineral supplements. Eat generous amounts of fruits and vegetables, whole and grain
breads and cereals, calcium-rich dairy products, and protein-rich foods (meats, fish, and legumes).
Make sure you are getting enough calories.
BREASTFEEDING DAILY FOOD GUIDE
Milk, yogurt, and cheese -- eat at least 4 servings
Meat, poultry, fish, dry beans, eggs, and nuts -- at least 3 servings
Vegetables -- at least 3 to 5 servings
Fruits -- eat 2 to 4 servings (choose two foods high in vitamin C and folic acid, and one food
high in vitamin A)
Bread, cereal, rice, and pasta -- at about 6 to 11 servings
Fats, oils, and sweets -- go easy!
This is just a guide. You may need to eat more than this based on your size and activity level.
DRINK FLUIDS
Nursing mothers need enough fluids to stay hydrated -- most experts recommend drinking enough
fluids to satisfy thirst. Eight 8-ounce servings (64 ounces) of fluid such as water, milk, juice, or
soup is a good goal.
FOODS
Breastfeeding mothers can safely eat any foods they like. Some foods may flavor the breast milk,
but babies rarely react to this. If your baby is fussy after you eat a certain food, try avoiding that
food for a while, then try it again later to see if it is a problem.
Don't limit your diet excessively. Make sure you are getting enough nutrition for yourself and your
baby. If you become overly concerned about foods or spices causing problems, try to remember
that entire countries and cultures have diets that contain foods that are extremely spicy. In these
cultures, the mothers nurse their infants without problems.
It is possible that some highly allergenic foods (strawberries, peanuts) may be passed into breast
milk, increasing the risk of a later food allergy in the baby. If this is a concern, discuss food
allergies with your pediatrician.
CAFFEINE, ALCOHOL, AND SMOKING
A nursing mother can safely consume moderate amounts of caffeine (equal to 1 to 2 cups of coffee
per day) without causing harm to her baby. But any more caffeine than that may cause agitation and
difficulty sleeping for your baby.
Since alcohol has been found in human milk and can interfere with the milk ejection reflex, avoid
alcohol while breastfeeding. An occasional drink, not exceeding two ounces of alcohol, may be
safe, but you should consult your health care provider about the associated risks.
If you are a smoker, this is a great time to quit for yourself and for your baby. Nicotine and other
chemicals from cigarettes are found in breast milk. If you are unable to quit, try to limit the number
of cigarettes as much as possible, change to a brand with low nicotine, and visit your doctor
regularly.
DRUGS IN HUMAN MILK
Many medications (prescription and over-the-counter medications) will pass into the mother's milk.
Check with your physician before taking any medications. Do NOT stop taking any prescribed
medication without speaking first to your doctor.
The American Academy of Pediatrics' Committee on Drugs releases a periodic statement with a list
of drugs and their compatibility with breastfeeding. Your obstetrician and pediatrician are both
likely to be familiar with this publication and can answer your concerns about breastfeeding while
taking medications.
LACTATION AMENORRHEA
Most breastfeeding women do not have normal menstrual
periods (lactation amenorrhea). Although the risk of pregnancy is less for a woman experiencing
lactation amenorrhea, pregnancy CAN occur during this time. Breastfeeding should not be used for
contraception, since failure is likely.
BIRTH CONTROL
Birth control choice should be discussed with your health care provider.
Barrier methods (condom, diaphragm), progesterone contraceptives (oral or injectable), and IUDs
have all been shown to be safe and effective. Progesterone contraception is generally not started
until the milk supply is established, usually at 4 weeks postpartum.Estrogen-containing birth
control pills are not recommended for breastfeeding women, because they may affect milk supply.
WORKING OUTSIDE THE HOME
Mothers face unique obstacles in maintaining adequate milk supply once they return to work. With
planning, commitment, and skilled use of a breast pump, breastfeeding mothers can maintain their
milk supply and continue breastfeeding even after returning to work outside the home.
A maternity leave is helpful for establishing your milk supply and breastfeeding skills before
returning to work. An ideal work place would provide a private room for breastfeeding moms, with
a comfortable chair and an electric breast pump for use by all nursing mothers.
However, many moms have had success using a hand breast pump and a bathroom stall for privacy.
Many women prefer the speed of the electric breast pump. Hospital-quality pumps are available for
rent through medical supply stores. Personal, portable models are available for purchase.
MAINTAINING YOUR MILK SUPPLY
Here are some tips that have worked well for many breastfeeding mothers who work fulltime
outside the home:
1.
If you plan to return to work, introduce your baby to bottle-feeding at 3 to 4 weeks of age.
This allows plenty of time to establish good feeding habits. Starting bottle-feeds before 2 weeks
of age often results in nipple confusion -- the baby has difficulty changing between the different
sucking patterns required for the different types of feeding.
2.
Two weeks before you return to work, buy or rent an efficient and comfortable breast pump
and start building up a supply of frozen milk. If the day you return to work arrives and you
don't have a freezer full of breast milk, one bottle of formula fed to your baby will be an
adequate supplement. After returning to work, express milk 2 or 3 times a day, every 2 to 3
hours to continue exclusively breastfeeding. If you can only get one break a day and you are
unable to pump a full day's allotment in one pumping, a supplemental bottle of formula may be
needed. Be aware, however, that feeding formula decreases the need for breast milk, and your
milk supply will decrease accordingly.
3.
Nurse your baby immediately before leaving in the morning and immediately upon return
from work in late afternoon. Many mothers find that their babies nurse more frequently in the
evenings on days they work. Feed on-demand when you are with your baby.
4.
If possible, arrange to nurse your baby at lunch time.
5.
Try to breastfeed exclusively when you are with your baby (evenings, nighttime, weekends).
6.
Delegate and share household responsibilities with other members of the family.
BREAST PUMPS
There are a number of breast pumps on the market, with varying degrees of comfort, efficiency,
and cost. Most require time to develop the skills to use them. Pumps may be hand-operated
(manual) or work by battery or electricity.
The most dependable, efficient, and comfortable pumps are electric, have intermittent action
(creates and releases suction automatically), and require minimal training.
Adhering to vaccine schedule is best way to protect children from disease
Margaret C. Fisher and Joseph A. Bocchini, Jr.
AAP News 2009;30;4
DOI: 10.1542/aapnews.2009301-4
The online version of this article, along with updated information and services, is located on
the World Wide Web at:
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AAP News is the official journal of the American Academy of Pediatrics. A monthly publication, it has
been published continuously since 1985. AAP News is owned, published, and trademarked by the
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Copyright © 2009 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.
Downloaded from http://aapnews.aappublications.org by Robin Larabee on September 14, 2010
Downloaded from http://aapnews.aappublications.org by Robin Larabee on September 14, 2010
Downloaded from http://aapnews.aappublications.org by Robin Larabee on September 14, 2010
Adhering to vaccine schedule is best way to protect children from disease
Margaret C. Fisher and Joseph A. Bocchini, Jr.
AAP News 2009;30;4
DOI: 10.1542/aapnews.2009301-4
Updated Information
& Services
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Your Baby’s First Vaccines
What You Need to Know
Your baby will get these vaccines today:
DTaP
Polio
Hib
Rotavirus
Hepatitis B
PCV13
(Provider: Check appropriate boxes.)
Ask your doctor about “combination vaccines,”
which can reduce the number of shots
your baby needs.
Combination vaccines are as safe and effective
as these vaccines when given separately.
Many Vaccine Information Statements
are available in Spanish and other languages.
See www.immunize.org/vis.
Hojas de Informacián Sobre Vacunas están
disponibles en español y en muchos otros idiomas.
Visite http://www.immunize.org/vis
These vaccines protect your
baby from 8 serious diseases:
- diphtheria
- tetanus
- pertussis (whooping cough)
type b
(Hib)
- hepatitis B
- polio
- rotavirus
- pneumococcal disease
ABOUT THIS VACCINE INFORMATION STATEMENT
Please read this Vaccine Information Statement (VIS) before your baby gets his or her immunizations, and take
it home with you afterward. Ask your doctor if you have any questions.
about reporting an adverse reaction and about the National Vaccine Injury Compensation Program, and how to
get more information about vaccines and vaccine-preventable diseases. (Individual VISs are also available for
these vaccines.)
HOW VACCINES WORK
Immunity from Disease: When children get sick with an infectious disease, their immune system usually
produces protective “antibodies,” which keep them from getting the same disease again. But getting sick is no
fun, and it can be dangerous or even fatal.
Immunity from Vaccines: Vaccines are made with the same bacteria or viruses that cause disease, but they
have been weakened or killed – or only parts of them are used – to make them safe. A child’s immune system
VACCINE BENEFITS: WHY GET VACCINATED?
Diseases have injured and killed many children over the years in the United States. Polio paralyzed about
37,000 and killed about 1,700 every year in the 1950s. Hib disease was once the leading cause of bacterial
meningitis in children under 5 years of age. About 15,000 people died each year from diphtheria before there
was a vaccine. Up to 70,000 children a year were hospitalized because of rotavirus disease. Hepatitis B can
cause liver damage and cancer in 1 child out of 4 who are infected, and tetanus kills 1 out of every 5 who get it.
Thanks mostly to vaccines, these diseases are not nearly as common as they used to be. But they have not
disappeared, either. Some are common in other countries, and if we stop vaccinating they will come back here.
This has already happened in some parts of the world. When vaccination rates go down, disease rates go up.
Vaccine Information
Statement (Interim)
42 U.S.C. § 300aa-26
11/16/2012
Only
Childhood vaccines can prevent these 8
Diseases
1. DIPHTHERIA
Signs and symptoms include a thick covering in the back of the throat that can make it hard to breathe.
Diphtheria can lead to breathing problems, and heart failure.
2. TETANUS (Lockjaw)
Signs and symptoms include painful tightening of the muscles, usually all over the body.
Tetanus can lead to stiffness of the jaw so victims can’t open their mouth or swallow.
3. PERTUSSIS (Whooping Cough)
Signs and symptoms include violent coughing spells that can make it hard for a baby to eat, drink, or breathe.
These spells can last for weeks.
Pertussis can lead to pneumonia, seizures, and brain damage.
4. HIB (
type b)
Signs and symptoms can include trouble breathing. There may not be any signs or symptoms in mild cases.
Hib can lead to meningitis (infection of the brain and spinal cord coverings); pneumonia; infections of the
blood, joints, bones, and covering of the heart; brain damage; and deafness.
5. HEPATITIS B
Signs and symptoms can include tiredness, diarrhea and vomiting, jaundice (yellow skin or eyes), and pain in
muscles, joints and stomach. But usually there are no signs or symptoms at all.
Hepatitis B can lead to liver damage, and liver cancer.
6. POLIO
Signs and symptoms
Polio can lead to paralysis (can’t move an arm or leg).
7. PNEUMOCOCCAL DISEASE
Signs and symptoms include fever, chills, cough, and chest pain.
Pneumococcal disease can lead to meningitis (infection of the brain and spinal cord coverings), blood
infections, ear infections, pneumonia, deafness, and brain damage.
8. ROTAVIRUS
Signs and symptoms include watery diarrhea (sometimes severe), vomiting, fever, and stomach pain.
Rotavirus can lead to dehydration and hospitalization.
Any of these diseases can lead to death.
How do babies catch these diseases?
Usually from contact with other children or adults who are already infected, sometimes without even knowing
they are infected. A mother with Hepatitis B infection can also infect her baby at birth. Tetanus enters the
body through a cut or wound; it is not spread from person to person.
Routine Baby Vaccines
Number of
Doses
Vaccine
DTaP (diphtheria,
tetanus, pertussis)
5
Hepatitis B
3
Polio
4
Hib (Haemophilus
type b)
PCV13
(pneumococcal)
Rotavirus
3 or 4
4
2 or 3
Annual
Recommended Ages
Other Information
2 months, 4 months, 6 months, Some children should not get pertussis vaccine. These
children can get a vaccine called DT.
15-18 months, 4-6 years
Birth, 1-2 months,
6-18 months
2 months, 4 months,
6-18 months, 4-6 years
2 months, 4 months,
(6 months), 12-15 months
2 months, 4 months,
6 months, 12-15 months
2 months, 4 months,
(6 months)
Children may get an additional dose at 4 months with
some “combination” vaccines.
There are 2 types of Hib vaccine. With one type the
6-month dose is not needed.
Older children with certain chronic diseases may also
need this vaccine.
Not a shot, but drops that are swallowed.
There are 2 types of rotavirus vaccine. With one type the
6-month dose is not needed.
is also recommended for children 6 months of age and older.
Precautions
Most babies can safely get all of these vaccines. But some babies should not get certain vaccines. Your doctor
will help you decide.
A child who has ever had a serious reaction, such as a life-threatening allergic reaction, after a vaccine
dose should not get another dose of that vaccine. Tell your doctor if your child has any severe allergies,
or has had a severe reaction after a prior vaccination. (Serious reactions to vaccines and severe allergies
are rare.)
A child who is sick on the day vaccinations are scheduled might be asked to come back for them.
Talk to your doctor . . .
. . . before getting DTaP vaccine, if your child ever had any of these reactions after a dose of DTaP:
- A brain or nervous system disease within 7 days,
- Non-stop crying for 3 hours or more,
- A seizure or collapse,
- A fever of over 105°F.
. . . before getting Polio vaccine, if your child has a life-threatening allergy to the antibiotics neomycin,
. . . before getting Hepatitis B vaccine, if your child has a life-threatening allergy to yeast.
. . . before getting Rotavirus Vaccine, if your child has:
- A weakened immune system for any other reason,
- Digestive problems,
- Recently gotten a blood transfusion or other blood product,
- Ever had intussusception (bowel obstruction that is treated in a hospital).
. . . before getting PCV13 or DTaP vaccine, if your child ever had a severe reaction after any vaccine
Risks
Vaccines can cause side effects, like any medicine.
Most vaccine reactions are mild: tenderness, redness, or swelling where the shot was given; or a mild fever. These
happen to about 1 child in 4. They appear soon after the shot is given and go away within a day or two.
Other Reactions: Individual childhood vaccines have been associated with other mild problems, or with
moderate or serious problems:
DTaP Vaccine
Mild Problems: Fussiness (up to 1 child in 3); tiredness or poor appetite (up to 1 child in 10); vomiting (up to 1
child in 50); swelling of the entire arm or leg for 1-7 days (up to 1 child in 30) – usually after the 4th or 5th dose.
Moderate Problems: Seizure (1 child in 14,000); non-stop crying for 3 hours or longer (up to 1 child in 1,000);
fever over 105°F (1 child in 16,000).
Serious problems: Long term seizures, coma, lowered consciousness, and permanent brain damage have been
reported. These problems happen so rarely that it is hard to tell whether they were actually caused by the vaccination
or just happened afterward by chance.
Polio Vaccine / Hepatitis B Vaccine / Hib Vaccine
These vaccines have not been associated with other mild problems, or with moderate or serious problems.
Pneumococcal Vaccine
Mild Problems: During studies of the vaccine, some children became fussy or drowsy or lost their appetite.
Rotavirus Vaccine
Mild Problems: Children who get rotavirus vaccine are slightly more likely than other children to be irritable or to
Serious Problems:
What if my child has a serious problem? The National Vaccine Injury
Compensation Program
What should I look for?
Look for anything that concerns you, such as signs of a
severe allergic reaction, very high fever, or behavior changes.
The National Vaccine Injury Compensation Program
(VICP) was created in 1986.
Signs of a severe allergic reaction can include hives,
People who believe they may have been injured by a
heartbeat, dizziness, and weakness. These would start a few
minutes to a few hours after the vaccination.
claim by calling 1-800-338-2382, or visiting the VICP
website at www.hrsa.gov/vaccinecompensation.
What should I do?
If you think it is a severe allergic reaction or other
emergency that can’t wait, call 9-1-1 or get the person to
the nearest hospital. Otherwise, call your doctor.
Afterward, the reaction should be reported to the “Vaccine
Adverse Event Reporting System” (VAERS). Your doctor
the VAERS web site at www.vaers.hhs.gov, or by calling
1-800-822-7967.
VAERS is only for reporting reactions. They do not give
medical advice.
For More Information
Contact the Centers for Disease Control and
Prevention (CDC):
- Call 1-800-232-4636 (1-800-CDC-INFO) or
- Visit CDC’s website at www.cdc.gov/vaccines