Information for the Care of Your New Baby

Congratulations! Pregnancy is a time of anticipation, excitement, preparation and uncertainty. Birth is one of the most extraordinary times and experiences in the parents’ life. With the joys of birth come feelings of fatigue and an overwhelming sense of responsibility. This handout, and the ones you will receive during Well Child Care appointments, are written to help you be more informed about child reaing and to provide better health care and nurturing for you child.
Enjoy this exciting time and remember that we are here to here to help all times!

Feeding: The most important responsibilities during the early months of life are to provide love and nourishment to your baby. All babies lose a few ounces during the first few days after birth. However, they should never lose more than 10% of the birth weight. Most bottle-fed babies are back to birth weight by 10 days of age, and breast-fed babies by 14 days of age. Then infants gain approximately an ounce per day during the early months. If milk is provided liberally, the normal newborn’s hunger drive ensures appropriate weight gain. Whenever you are worried about your baby’s weight gain, bring your baby to our office for a weight check. Feeding problems detected early are much easier to remedy than those of long standing.

Breast: It’s a great idea to breast-feed. Babies who are breast-fed have fewer infections and allergies during the first year of life than babies given formula. Breast milk doesn’t cost anything, is ready anytime, and best of all, it is made especially for babies. A breast-feeding mother often wonders if her baby is getting enough calories, since she can’t see how many ounces the baby takes. Your baby is doing fine if he or she demands to nurse every 1 1/2 to 2 1/2 hours, appears satisfied after feedings, takes both breasts at each nursing, wets 6 or more diapers each day, and passes 3 or more soft stools per day. A special weight check 1 week after birth is a good idea for infants of a first-time breast-feeding mother or a mother concerned about her milk supply.
If you have questions or worries, call. Please take advantage of the hospital nurses’ experience. We may also want to get the help of a lactation consultant.
Formula: If you choose to bottle-feed, be sure to use only formula until your baby is 1 year old. Formulas are made especially for babies. Most are made with cow’s milk. Others are made from soybeans for babies who are allergic to or have a hard time digesting a milk based formula. Start with a milk based formula with iron (i.e. Similacâ or Enfamilâ) unless instructed to use another. Initially your baby may want to feed every 2-4 hours. Formula is available in three forms: Powder, Concentrated liquid, and Ready-to-serve liquid. Always closely follow the directions for preparation.

Normal Activities: Your newborn may display behaviors that appear concerning. Hiccups, sneezing, snorting, shivering with urination, straining, grunting and crying with the passage of gas and bowel movements are all normal behaviors. Temporary crossed eyes, occasional spitting up, startling to loud noises and changes in position, spots of blood when the cord comes off, vaginal blood spotting in 1-2 week old females, and a fussy period of time at least once daily are also normal and commonly seen behaviors in newborns.

Bathing: Sponge bathe with a soft washcloth until the navel is healed for two days (and for five days following circumcision). Then, tub bathe with any mild soap. The water and room temperature should be comfortable. A baby lotion may be used after the bath. We prefer no oil unless specified.
Diaper Area: After bowel movements and urination cleanse the diaper area. In girls, separate the labia and gently remove debris with cotton and water. In circumcised boys, place Vasoline and gauze on the raw area of the circumcision for at least 5 days and change this with each diaper change.
Cleansing The Umbilicus: You may clean the area with rubbing alcohol for several minutes up to six times each day. Use a cotton swab and remove all dried pus or debris. The umbilical area does not have any sensation, so the alcohol won’t sting. If the cord is still present, clean underneath it by lifting it up. If the cord has fallen off, pour some alcohol into the depression and remove it after 2 or 3 minutes. It takes that long to kill bacteria. Air exposure and dryness help healing, so be sure to keep the diaper folded down below the cord area.
Cradle Cap: Cradle cap consists of oily, yellow scales on the scalp and begins in the first weeks of life. Without treatment it can last for months; with treatment it usually is cleared up in a few weeks. Rub mineral oil on scalp before bed. Comb out with fine comb or tooth brush in morning. Baby oil may be applied during the daytime until scaling is at a minimum.
Eye Discharge: Bathe with saline applied with cotton ball three times daily. If persists call us.

Sleep Position: On the Back (Supine)
In 1992 the American Academy of Pediatrics (AAP) recommended that all healthy infants be positioned for sleep on their backs (supine) or on their sides for the first 6 months of life.
The back position is recommended for bedtime and naps. It is not necessary if your infant is awake. Yet many parents keep the infant lying on his back throughout the day. This can cause some flattening of the back of the head and also some decreased strength in the shoulder muscles. Avoid these side effects by keeping your infant prone for some of his playtime and waking hours.

Car Seat: Whenever riding in a car, the infant needs to be in an approved car seat facing backwards. Position the car seat in a seat without an airbag, preferably the rear middle seat.

Visitors: Keep visitors to a minimum. Do not allow anyone with a cold or other infections near the infant. Never kiss an infant on the mouth.

Excursions: The infant may go outdoors at two weeks old in warm weather and three weeks in the cold. Start with a short period (30 minutes) the first day and increase gradually each day. Beware of wind and excess sun.

What is a circumcision?
Circumcision means cutting off the foreskin or ring of tissue that covers the head of the penis. If you decide to have your newborn son circumcised, it is usually done the day he goes home from the hospital. Fewer children in the U.S. are being circumcised now than several years ago. In 1979, 90% of American males were circumcised compared to 60% now.
Recommendations
Circumcision of boys for religious purposes will continue. The need to circumcise other boys is open to question. Just because a father was circumcised doesn’t mean that the son needs to be circumcised. The risks and benefits are both too small to swing the vote either way. This is a parental decision, not a medical decision.

First Weeks at Home with a Newborn

PREVENTING FATIGUE AND EXHAUSTION: For most mothers the first weeks at home with a new baby are often the hardest in their lives. You will probably feel overworked, even overwhelmed. Inadequate sleep will leave you fatigued. Caring for a baby can be a lonely and stressful responsibility. You may wonder if you will ever catch up on your rest or work. The solution is asking for help. No one should be expected to care for a young baby alone. As already emphasized, everyone needs extra help during the first few weeks alone with a new baby. Ideally, you were able to make arrangements for help before your baby was born. Your helper’s role is to shop, cook, houseclean, and wash clothes and dishes.

THE POSTPARTUM BLUES: More than 50% of women experience postpartum blues on the third or fourth day after delivery. The symptoms include tearfulness, tiredness, sadness, and difficulty in thinking clearly. The main cause of this temporary reaction is probably the sudden decrease of maternal hormones. Since the symptoms commonly begin on the day the mother comes home from the hospital, the full impact of being totally responsible for a dependent newborn may also be a contributing factor.

THE ONE-TWO WEEK MEDICAL CHECKUP: This checkup is probably the most important medical visit for your baby during the first year of life. By two weeks of age your baby will usually have developed symptoms of any physical condition that was not detectable during the hospital stay. Your child’s physician will be able to judge how well your baby is growing from his or her height, weight, and head circumference. This is also the time your family is under the most stress of adapting to a new baby. Try to develop a habit of jotting down questions about your child’s health or behavior at home. Bring this list with you to office visits to discuss with the physician. We welcome the opportunity to address your agenda, especially if your questions are not easily answered by reading or talking with other mothers. If at all possible, both the mother and father should go to these visits. We prefer to get to know both parents during a checkup rather than during the crisis of an acute illness.
We recommend the following books to help with newborn and young children:
1.​CARING FOR YOUR BABY AND YOUNG CHILD, by the American Academy of Pediatrics, Bantam Books, 1994
2.​YOUR CHILD’S HEALTH, by Barton Schmitt, MD, Bantam Books, 1991
3.​TOUCHPOINTS, by T. Berry Brazelton, MD, Addison-Wesley, 1992
4.​SOLVE YOUR CHILD’S SLEEP PROBLEMS, by Richard Ferber, MD, Simon & Schuster, 1985
Our well care handouts are available on-line at www.phapc.com