ABOUT THE OFFICE
The office where you will seek both information and health care. We will serve you most
effectively if you understand our policies. Your cooperation will help us deliver care to you
efficiently.
ADDRESS CHANGE: Should your address or phone number change, please inform us
immediately. In an emergency, the only record we have of your address and phone number is in
your child's medical chart. If this is incorrect, we have no way to contact you. Again, please do
not wait for your next visit to inform us of a change, but rather do so immediately.
APPOINTMENTS: Please be on time for appointments. We will make every effort to be on
time as well. Please schedule well child exams at least one month in advance. We will make
every effort to see your child for same day acute visits. if an appointment is not available our
nursing staff can triage your child and make a recommendation for managing your child's needs.
24 hour notice is required for cancellation of appointments. Appointments not cancelled with at
least 24 hours notice will result in a missed appointment. 3 missed appointments will result in
asking to find a new doctor.
FEES: We try to keep our fees reasonable. In order to do this we need your help. Co-payments
are requested at time of visit. We will assist you with insurance billings. Our collection policy
states that accounts 90 days past due will be processed for collections. Please contact our billing
office for questions on your account.
PHONE CALLS: We are available to our patients 24 hours a day, 7 days a week, 365 days a
year! We do ask, however, that you appreciate that there is an appropriate time for most phone
calls. Routine questions (medication refills, billing questions, etc.) should be made between 7:30
am-5:00 pm Monday - Friday. The phones are busiest between 9:00-11:00 am and 3:00-5:00 pm.
Please be patient; Calling during non-busy times will result in faster response times. We do have
evening (both offices) and Saturday morning (Silverdale only) office hours to handle medical
emergencies. After the clinic closes a recorded message will provide you with contact
information to reach the on-call provider for urgent medical questions.
TRANSFER OF MEDICAL RECORDS: Hopefully, we will care for your children until they
graduate from college. However, because of relocation and various other reasons, people change
physicians. Should you do so, request a Transfer of Record release from your new physician.
Please allow 2 weeks for records to be transmitted.
GENERAL COMMENTS ABOUT BABY CARE
Your child is an individual from the day he/she is born. Use your parental instincts and our
advice to guide you as you raise your child and do not depend overly upon advice of friends and
relatives.
Crying
New babies cry frequently; it is their way to communicate their needs and does not harm them
physically or psychologically. Relax and be as calm as possible as you gradually get to know
what your baby is trying to say when he/she cries.
Bathing
Your baby should have sponge baths only until the umbilical cord has separated. Once tub baths
are started any mild soap may be used except on the face, where plain water will suffice. Cleanse
the outer ear only; do not use cotton applicators inside the ear canal. Baby lotion may be used
after bathing, but avoid baby oil or dusted baby powder (talc particles can be inhaled). NEVER
LEAVE INFANT OR TODDLER UNATTENDED, even for a few seconds. Your water heaters
should be adjusted so that the maximum water temp is 120º.
Skin Care
Full term newborns frequently have peeling skin particularly around wrists and ankles. Most
infants will also have small red pimple-like lesions (infant acne) appearing periodically on the
face, scalp, and chest. These conditions are both normal and require no treatment.
Cord Care
The umbilical cord stump usually falls off in 10-14 days. Until that time you may use rubbing
alcohol on the cord several times per day, apply with a cotton swab.
Circumcision Care
Gently clean the area with water every day and whenever the diaper area becomes soiled. Some
swelling of the penis is normal after circumcision. A clear crust will probably form over the area.
It normally takes 7 to 10 days for the penis to heal after circumcision.
After the circumcision, you may notice a small amount of blood on the baby's diaper. If the
bloodstain is larger than the size of a quarter, call your doctor right away. In addition, you should
call your doctor if a Plastibell device was used during the circumcision and the device doesn't
fall off within 10-12 days. If there is a bandage on the penis instead of a Plastibell, the bandage
should be changed each time you change your son's diaper. This will help prevent infection.
Signs of infection also signal the need to call your doctor. These signs include a temperature of
110.4º or higher, redness, swelling and/or a yellowish drainage.
Bowel Movements
Normal bowel patterns vary from baby to bay and depending upon whether the baby is breast or
bottle fed. Breast fed infants usually have a decrease in the frequency of the bowel movements at
about 1-4 months of age. Bottle fed infants generally have less frequent and slightly firmer
stools. Most babies strain, draw up their legs and even cry when they pass stool. As long as the
stools are not hard pellets this is perfectly normal. Diluted prune or apple juice will usually
soften hard stools. After all the meconium is expelled, the stools are usually mustard yellow,
light brown, or even green in color with small curd or seed like particles.
Care of the diaper area
Change your baby's diaper as soon as possible after each bowel movement or wetting. Wash the
diaper area clean with plain water or a mild soap and air or pat dry. We do not recommend
routine use of baby wipes. Vaseline, Desitin, or A & D can be used to prevent and treat minor
diaper irritations. Both cloth and disposable diapers are acceptable. A diaper service may be a
convenient option.
Babies are Babies
All babies sneeze, hiccup, pass gas, burp, occasionally cough and sometimes look cross-eyed.
Trembling of the chin, arms and legs is very common in babies and usually diminishes with
advancing age. Babies may be taken outdoors, if properly dressed, anytime after coming home
from the nursery. Many parents tend to overdress their babies. During the day your baby requires
no more clothing than an adult to be comfortable. At night we recommend adding one additional
layer to the baby over that which would be necessary for adult comfort. People may visit with
your baby, but an obviously ill individual should be avoided.
We recommend avoiding exposing your baby to large crowds for the first month of life.
Remember that the hands and feet of babies are always cool to touch even if the baby is warm
enough. Ideal room temperature is roughly 68-70 degrees. New babies spend a lot of time
sleeping. We recommend placing babies on their back for sleeping; stomach sleeping has been
shown to slightly increase the risk of crib death. A baby's mattress should be firm and flat and no
pillow should be used. It is usually best to have your baby sleep in a room separate from yours.
Feeding
Feeding is one of the baby's first pleasant experiences and should be a relaxed time. Feed your
baby according to his/her needs and hunger, realizing that most babies require feeding every 3-4
hours.
Breast Feeding
Breast Feeding is the most natural and simple means of feeding your baby in the early months. It
also gives the baby some protection from disease and aid's in the mother's recovery from
childbirth (the uterus often contracts with nursing). Before nursing you want to rinse the nipples
with plain water, avoiding soap or alcohol. Sometimes you may need to encourage your baby to
nurse by gently stroking his cheek with the nipple; he/she will turn their head to hunt for it.
Colostrum is present right after birth and is sufficient nourishment for the newborn until the milk
comes in, usually the third day after birth. Many Newborns nurse frequently the first several days
after birth, but once the breast milk is established, most babies will nurse on a 2-4 hours
schedule. Babies should be allowed to nurse as long as they want to up to 40 minutes per
feeding.
If the nipples are painful, sometimes air exposure or an application of breast cream such as
hydrous lanolin may be helpful. if this doesn't help, please contact our office or your
obstetrician's office since the baby's nursing technique may be leading to sore nipples. Breast fed
infants may occasionally be given a bottle containing breast milk, formula, or water so that they
will learn early to accept a bottle should it ever become necessary. it is a good idea to wait as
least 2 weeks before giving a bottle; sometimes early use of the bottle interferes with establishing
breast feeding. Breast milk can be expressed and refrigerated in clean bottle for up to 3 days and
frozen for up to 6 months. Breast feeding mothers should eat a well balanced diet and drink lots
of water. Avoid alcohol or excessive caffeine, chocolate, and for some mothers, spicy food. Any
medication taken while breast feeding should be okayed by a doctor. When to wean off the
breast is an individual matter. If weaning occurs before 12 months we recommend offering an
infant formula. Beyond 12 months of age, we suggest the baby be weaned to whole milk. Some
parents may wish to avoid the bottle entirely and wean the baby to a cup at 9-12 months of age.
Bottle Feeding
The best alternatives to human milk are commercial infant formulas, which are designed to
closely approximate human milk. Formulas are available in Ready-To-Use, concentrate, or
powder forms. Instructions on the formula can should be followed carefully. It is not important
to sterilize the water (the exception would be with well water) or bottle prior to preparing
formula. If you have a dishwasher, put nipples, caps, & tops in a nylon bag and the bottles in the
rack and allow the entire cycle to run. If you don't have a dishwasher, wash bottles and nipples
well; pour boiling water over both and they will be clean enough. When bottle feeding seat
yourself comfortably and hold your baby; never prop the bottle. As you hold the bottle the neck
and nipple should always be filled with formula to prevent the baby from sucking and
swallowing air. You will need to occasionally take the nipple out of the baby's mouth to keep it
from collapsing. Check the hole size occasionally to see that milk drips steadily but does not
stream from the hole. If your baby shows any signs of milk allergy or lactose intolerance your
pediatrician may recommend a soy based formula. Please ask your doctor before making any
changes in your baby's diet. The amount of formula your baby takes will vary. Most infants are
consuming about 1½ to 2 ounces as they leave the nursery and by one month of age are requiring
4-5 ounces per feed. Most babies need to feed every 3-4 hours, but no rigid schedule should be
adhered to. The best way to judge if your baby is getting enough milk is to document a steady
weight gain of approximately 2 pounds a month for the first 6 months of life.
Burping
Even if fed properly, both bottle fed and breast fed babies usually swallow some air. Holding the
baby upright over your shoulder and then patting or rubbing his back usually helps bring up the
air. The baby may also be burped by holding him in a sitting position or placing him face down
over your lap and gently rubbing his back. It is not always necessary to interrupt a feeding to
burp the baby but should be attempted after each feed. Of course babies do not always burp and
you should not try to force it, but you may try again 15-20 minutes after the feed.
Vitamins and Solids
Vitamins are already incorporated into commercially prepared formula; however, if your water is
not fluoridated we will be prescribing fluoride drops for your infant when he/she is 6 months old.
There is considerable variation among pediatricians concerning when and what kids of solids to
start with. There is no one right way to feed all babies. The current trend is to wait several
months before introducing solids. Your pediatrician will advise you about this at your baby's
well visit.
SAFETY AND YOUR CHILD
Accidents are the number one cause of death in children 1-15 years of age. Seventy-5five percent
of these accidents occur in the home. The principle cause of accidental deaths are auto accidents,
drowning, burns, poisoning, and falls. Even small infants must never be left unattended on a
dressing table or adult bed. Be extremely cautious around hot liquids including baby's bath. We
suggest turning down your water heater to 120º to help prevent accidental burning from the tap.
If your child ever gets burned, immediately apply cold water or ice. Toys should be too large to
swallow, have no sharp corners, and be too tough to break. Safety plugs should be put on all
unused electrical sockets. Fence off stairways and deck areas and poison proof your home.
Destroy old medications, put cleaning agents out of reach, don't use food containers or pop
bottles to store poison. Lock cabinets with potentially dangerous substances (Kinderlocks are
available at hardware stores). For protection of your home and family, install smoke detectors on
each floor of your home. Remember to wear a helmet when riding bikes, skateboards, scooters,
etc. Keep matches and lighters out of reach of children.
For accidental poisoning, call the Poison Control Center at 1-800-222-1222.
Automobile accidents are a leading cause of accidents and death in children. The use of a safe
car seat is essential for the safety of your infant or child, even on the very first care ride.
Washington state law also requires you infants, toddlers, and older children use approved are or
booster seats and restraints for protection.
IMMUNIZATIONS
Vaccines are among the safest and most reliable preventative medicine measures. Every year
they prevent countless serious illnesses and thousands of deaths from meningitis, pneumonia,
hepatitis, measles, polio, diphtheria, tetanus, mumps, rubella, and whooping cough.
Immunizations should begin in infancy and continue through childhood and extend into adult
life. At your baby's well visits these will be discussed and given. Ask your doctor for the current
immunizations schedule at your first visit.
EARLY DISCHARGE CHECKLIST
Care of Baby:
1. Observations: Check the following every four hours for the first 24 hours after baby
comes home from the hospital. After that, check daily for the next 3 days. Records baby's
temperature and breathing rate on a chart.
a) Temperature: Insert rectal thermometer into the baby's rectum about ½ inch and hold
there for 3 minutes or until thermometer indicates complete. Normal temperature range
is 97.6º - 100º F (36.5º - 37.5º C). Readings outside of the normal range should be
called to your baby's doctor.
b) Breathing: Count your baby's breaths over 60 seconds by watching the baby's chest
while quiet. Breathing can be irregular but count should range 40-60 over the first 2
days and 30-40 thereafter. Breathing should not seem labored. If baby has difficulty
breathing or count seems abnormal, call your baby's doctor.
2. Bottle Feeding/Breast Feeding: Feed baby on a demand schedule. It is normal to have
irregular and infrequent feeds over the first 2 days. However, if no feeds in an 8 hour
period, contact baby's doctor.
3. Urine and Stools: Anticipate one wet and one soiled diaper within the first 24 hours. If
this does not occur, call baby's doctor.
4. Jaundice: During the first few days home, jaundice can appear. If skin or eyes appear
yellow or orange, call baby's doctor.
5. Activity Level: Wake and sleep patterns vary with each baby. Expect baby to sleep much
of the time during the first 24 hours after birth. However, baby should not go more than 6
hours without eating during this period. After the first 24 hours, too much sleepiness
(especially with poor appetite) should be reported to your baby's doctor.
6. Because certain problems may arise that cannot be detected on any exam in the first 24
hours, it is recommended that the baby be re-examined by your doctor 3-4 days after
going home.
RECOMMENDED READING
1. Your Child's Self Esteem, by Dr. Dorothy Briggs
2. The New First Three Years of Life, by Dr. Burton White
3. How to Parent, by Dr. Fitzhugh Dodson
4. Infants and Mothers, by Dr.
5. Toddlers and Parents, by Dr. T Brazelton
6. The Difficult Child, by Stanley Tureck
7. New Mother's Guide to Breastfeeding, by Joan Younger Meek, MD
8. Your Baby's First Year, by Steven P. Shelov and Joan Younger Meek, MD
9. Guide to Toilet Training, by Mark L. Wolraich, MD and Sherill Tippins
10. Growing Up Again, by Jean Illsley Clarke
11. Self Esteem, A Family Affair, by Jean Illsley Clarke
12. Guide to Your Child's Symptoms, by Donald Schiff, MD
13. Your Child's Health; The Parent's Guide to Symptoms, Emergencies, Common Illnesses, Behavior, and School Problems,Revised
Edition, by Barton D. Schmidtt M.D., F.A.A.A.P.
14. Caring for Your Adolescent, Ages 12 to 21; The Complete and Authoritative Guide, by Donald E. Greydanus M.D., F.A.A.A.P., EditorIn-Chief
13. Caring for Your Baby and Young Child, Birth to Age 5; The Complete and Authoritative Guide,by Steven P. Shelov M.D., F.A.A.A.P.,
Editor-In-Chief