CARE OF THE NEWBORN

HOMECOMING - Prior to leaving the hospital you should purchase a car seat for the baby. There should be few visitors the first few days you and the baby are home. Every new baby must adapt to new surroundings and the baby will need time to adjust to his new environment and to you. Do the best you can to limit visitors during the early weeks because your newborn is susceptible to respiratory as well as other types of infections.

COMFORT - The house should be kept the same temperature you would normally have it. Windows may be opened in cool weather, provided the baby is not in a draft. A baby does not require any more clothing than an adult. Dress your baby according to the temperature and how you yourself are dressed. Over dressing and over-heating have been associated with Sudden Infant Death Syndrome also known as Crib Death (see below).

SLEEP - Make sure your crib is approved by the US Consumer Product Safety Commission. The legal space between the vertical bars around the crib must not exceed 2 3/8 inches. Make sure the bedding is not too soft. Never let your baby sleep on sheepskins, comforters, or soft pillows. Remove all toys and decorative items from the sleeping are of the crib, items that may pose a risk. Make sure no loose objects or curtain strings are hanging inside or near the crib.  Avoid smoking around the baby. It has been implicated in many childhood illnesses, including asthma, ear infections, crib death and other lung ailments.  The American Academy of Pediatrics recommends that healthy infants sleep on their backs or sides. For safety, parents commonly use a rolled towel or positioning wedges to prop their babies to sleep on their sides or backs. These recommendations are for sleeping infants. A certain amount of "tummy time," while the baby is awake and observed, is recommended.

BATH - Until the navel and circumcised penis are healed the baby is not to have a tub bath, but can be sponge- bathed with soap and water. Make sure the water is warm but not too hot. The bath should be short and the baby dried quickly without too vigorous rubbing. Be certain that all folds and creases are patted dry.

SKIN - Many infants have skin that scales and peels. This is common and is nothing to be concerned about. Daily application of a baby skin lotion after the bath will usually clear the condition. Many babies develop a slight rash on the face, neck or head. This, too, is normal and should not cause alarm.

SCALP - The scalp should be cleaned 1 to 2 times a week with baby shampoo, rinsing the scalp thoroughly with water and drying the scalp with a towel. You may brush the baby’s hair with a baby brush or fine comb. If the scalp becomes dry and scaly you may apply a few drops of lotion or baby oil-don’t be afraid of the "soft spot" and keep it as clean as the rest of the scalp. If "cradle cap" develops apply a small amount of mineral oil/baby oil and massage the scalp with a soft brush, then wash the baby’s scalp with baby shampoo. Alternatively, you may apply Vaseline to the baby’s scalp at night and the following morning remove the crusts with a soft brush followed by shampooing the hair with baby shampoo.

EYE CARE - The baby’s eyes may be puffy for the first few days of life. There may be a blood spot on the white of one or both of the baby’s eyes. This is normal after a vaginal delivery and will clear in several weeks. There may be a small amount of yellow drainage from the eyes the first days, which is also normal. Occasionally, white mucus may collect in the corner of the eyes and may be wiped away with a cotton ball moistened with water. If the baby develops a green discharge or persistent eye irritation the baby should be seen. The baby will not develop tears until 1 to 2 months of age. It is also common for newborn babies to cross their eyes or one to look inward or outward, when the other isn’t.

NOSE CARE - The baby’s nose does not ordinarily require attention. All babies breathe noisily for the first month or two, this is normal. If the nose should become stuffy or crusted, clean it with a washcloth dipped in water. Saline (salt-water) nose drops can also be use as directed by a physician. The use of a nasal aspirator, gotten at the time of discharge from the hospital, may be used after the saline drops are placed in the nose.

EAR CARE - Clean the outer ear with a washcloth dipped in water. Do not attempt to put cotton swabs into the ear canals to clean wax. Remove only the wax in the ears that is almost ready to fall out.

NAVEL CARE - If the cord is attached clean four times daily with cotton dipped in rubbing alcohol. If skin around the cord becomes red and inflamed or the area develops a discharge or fetid odor, please call our office. After the cord has fallen off, the navel should be cleaned with soap and water at bath time.

NIPPLE CARE - Occasionally, the breasts of both newborn boys and girls may be slightly enlarged. This is usually due to hormones that the baby received from the mother during pregnancy. This is normal and will decrease over time.

GENITALS AND URINATION - No special care is needed for the uncircumcised penis during infancy. Do not attempt to forcibly retract the foreskin of the penis since this may harm the baby. Soap and water can be used externally just as with the rest of the body. After circumcision, wait for the yellow gauze surrounding the head of the penis to fall off. After that, pull the shaft of the penis down and put Bacitracin around the newly cut skin. Do this for another five to seven days, to avoid healing of the cut foreskin to the head of the penis. It is normal for girls to have a creamy white or even bloody discharge for approximately the first week. You may spread the vaginal lips and clean with a wet wipe. ALWAYS front to back, NEVER back to front.  Babies should urinate four to six times per day.  If it less then this please call the office.

BOWEL MOVEMENTS - This is often a matter of much unnecessary concern. The number of movements is quite variable, especially breast-fed babies, and unimportant as long as the consistency is good. The young baby’s stool is usually like soft scrambled eggs and then later becomes pasty. Sometimes little white seedy particles are seen and are normal. Constipation, although a frequent cause of parental concern, rarely causes any real difficulty in the newborn or young infant. Some straining with reddening of the face is normal just before a bowel movement. The definition of constipation is not how often your baby goes, but does it come out hard…"like rabbit pellets".

Giving ½ ounce of prune juice mixed with ½ ounce of water 1 to 2 times a day can often soften hard stools in young infants. If the baby’s stool is hard and bowel movements are accompanied by obvious discomfort a glycerin suppository or Vaseline on a rectal thermometer may be inserted into the rectum. This should not be repeated frequently.

Extremely loose or watery stools, sometimes explosive, with an increase in frequency, greater than three to five times per day may be diarrhea. If the problem should persist for more than 1 day consult the doctor.

FEEDING

Feeding is one of your baby’s most pleasant experiences. At feeding time the baby receives nourishment and a feeling of security from the parents’ loving arms. The food, correctly taken, helps your baby to grow healthy and strong. Parental love, generously given, starts your baby in the development of a secure and stable personality.

Both baby and feeder should be comfortable at feeding time. Choose a position that will help you relax as you feed your baby. Make sure the baby is warm and dry and hold your baby close. The baby’s head should be slightly raised and rest in the bend of your elbow.

BREASTFEEDING - The decision you make to breastfeed your baby or not is entirely up to you. Make it freely and according to your own judgment and feelings. You should, however, be as well informed as possible and you should feel free to discuss it with the doctor. Today, both medical and popular opinion favor breastfeeding because of its benefits to mother and baby. For the baby, breast milk is more easily digested, provides the best nutrition for your child in all the right amounts, and contains antibodies that help fight infection. For the mother, breastfeeding helps speed the uterus to return to its pre-pregnant size, reduces of the risk of breast and ovarian cancer, burns more calories and helps you get back to your prepregnancy weight more quickly, builds bone strength to protect against bone fractures in older age, and releases the ‘motherly" hormone prolactin, which helps her relax. Breastfeeding is also generally found to be both economical and convenient. Success is directly related to how comfortable the mother is breastfeeding. Many resources besides us are available. You should seek out the hospital lactation consultants during your stay as well as afterwards. For telephone and direct consultation.

THE FIRST DAYS OF NURSING - You usually begin nursing your baby during your hospital stay, where you will get the support and encouragement from the hospital staff. Remember that a good breastfeeding relationship takes time to establish.

Make yourself as comfortable as possible so you will be relaxed. Hold your baby so his tummy is facing your tummy, with his head a little higher than his tummy. This position will prevent your baby from having to turn her head while nursing. You may prefer to nurse lying sown. If you sit up to nurse, a pillow on your lap may be help to support the baby.

Your first goal is to stimulate the baby to root and then bring them onto the nipple. Touch the baby’s lips to your nipple until he opens very wide, and quickly bring them onto the breast. They will be correctly positioned when her gums are covering the greater part of the areola (the dark area around the nipple). If the baby latches on to he nipple only, you will probably get sore nipples and the baby may not get enough milk. Be patient. Some babies catch on very quickly, others need quite a bit of practice to latch on properly.

Try to use both breasts at each feeding and alternate the breast with which you begin feeding. Your baby will nurse for a shorter time and less vigorously at the second breast. The next time you feed your baby, start on the breast that you ended on the last feeding.

Never pull your nipple from the baby’s mouth when the baby is firmly latched to your breast. If the baby does not let go breast by himself, you can break the suction by gently inserting your finger into their mouth.

The early milk is called colostrum and is yellowish in appearance. Colostrum is very healthy for your newborn and is all the baby requires. Once you milk is established it may be thin and watery in appearance, much like skim milk. This is normal.

Your breasts will get softer and more normal in size. This does not mean that you have lost your ability to produce milk.

Rest as much as you can the first few weeks. You will get off to a better start at breastfeeding if you are able to rest and nap during the early weeks.

A healthy diet is important. A varied diet including fruits and vegetables and plenty of water is recommended. Drinking about two quarts of fluid per day and eating 200 to 300 calories per day is suggested. Continue your prenatal vitamins. It is not necessary for you to drink milk to make milk. Breastfeeding will not make you gain weight but cake, candy and soda will. Avoid caffeine or at least reduce your intake while your are breastfeeding. Avoid alcohol while you are breastfeeding because it can pass through your milk to your baby.

Babies are not allergic to breast milk. It is possible, although not likely, that your baby may be bothered by something you eat. Don’t give up any food unless it regularly bothers your baby.

Check with your doctor before taking any medication.

A working mother can breastfeed. If you go back to work you can still nurse your baby during the hours you are home. You can pump your breasts while at work until they have adjusted to your new schedule. Your baby will continue to receive the benefits of beast milk if you continue to nurse him.

Remember that your milk is produced in response to your baby’s needs. Once you have established a satisfactory nursing pattern with your baby there may still be times when your baby seems hungrier and less satisfied than usual. This does not mean that your milk supply is drying up but that the baby is growing and is requiring more milk. In a few days your supply will catch up with their needs.

HOW TO TELL IF YOUR BREASTFED BABY IS GETTING ENOUGH:

• Have 5-6 wet diapers a day
• Have 2-5 bowel movements a day after the meconium is passed
• Have a weight gain of 4-7 ounces per week or at least 1 pound per month
• Nurse approximately 8 times per day in the beginning
• Look healthy with good color and be alert and active
• Gain weight and grow in length

FORMULA FEEDING - If you elect to bottle feed, we recommend formula with iron. Formulas are packaged as, ready-to-feed, concentrated liquid, and powder. Please remember that newborns may not drink very much formula during the first days of life. We will suggest the appropriate amount to give to your baby when discharged from the hospital.

While seated comfortably, hold the bottle so that the neck of the bottle and nipple are always filled with formula, this helps your baby get the formula instead of air. Air in your baby’s stomach may give them a sense of being full and may also make them uncomfortable as well as cause hiccoughs.

Your baby has a strong and natural desire to suck. Sucking is part of the pleasure of feeding. A baby will keep sucking on a nipple even after it has collapsed. Therefore, occasionally take the nipple out of the baby’s mouth to keep it from collapsing.

Never prop a bottle and leave your baby to feed himself since the bottle can easily slip into the wrong position. Remember, too, our baby needs the security and pleasure it gives him to be helped at feeding time. This time is ideal for both of you to relax and enjoy being together.

Bottles and nipples do not have to be sterilized but should be cleaned thoroughly with soap and water.

BURPING - Burping your baby helps her to remove any swallowed air. There are different positions by which you can burp your baby: upright over your shoulder, sitting slightly forward on your lap, face down on your lap. Whichever position you choose, simply rub or pat your baby’s back. Don’t be alarmed if your baby spits up when burped. Finding the best position is best found by trial and error. Be patient. Find the best for the both of you.

It isn’t always necessary for you to interrupt a feeding to burp your baby, but always burp your baby after a feeding. Don’t worry if your first few attempts are not successful.

A SCHEDULE WITH FLEXIBILITY - A feeding schedule is usually most successful if it is flexible and the baby is allowed to eat when the baby is hungry. A newborn baby that is formula fed will usually feed every 3 to 4 hours, but may go up to 5 hours between feedings. It is not necessary to wake a baby to feed unless it has been at least 5 hours between feedings. Should your baby awaken and cry less than 2 to 2 ½ hours after a feeding he is probably is not hungry. If your baby persistently awakens and cries after 2 to 2 ½ hours, you may have to increase the amount of formula given at a feeding.

HOW MUCH FORMULA - The amount of formula your baby will take varies. A newborn baby that is formula fed will usually take between 2 to 3 ounces at a feeding. There will be times when your baby is more or less hungry and you cannot make a baby want to eat. Most babies spend 15 to 20 minutes feeding; never spend more than 30 minutes trying to feed your baby.

WARMING FORMULA - Formula can be given at room temperature. If a bottle is refrigerated, warm it in a pan of hot but not boiling water or use a bottle warmer. Test the formula by shaking a few drops onto the inside of your wrist. It should feel warm but not hot. It is recommended that you do not use a microwave oven to warm bottles.

WATER - In general, newborn babies do not need water given in addition to formula. You may give your baby small amounts of water in between feedings as long as it does not substitute for formula.

WEANING