The physicians of Laurelwood Pediatrics welcome your new baby. We are happy you have chosen us to provide medical care and assistance to you and your newest family member. To help you get started we have put together this brochure to answer the most frequently asked questions and concerns. Please use it as a reference at home. It is a good idea for you to keep a list of questions and concerns as they arise to discuss with us when you come in for routine visits. We are glad to discuss any questions you might have regarding anything covered in this brochure or otherwise.
Do not take your baby home unless he/she is secured in a safety seat. Restraint devices are required by law. When babies go home from the hospital nursery, everyone wants to see them. A new baby generally gets a lot of callers. For a few weeks, limit your baby’s visitors, especially children. The baby needs a little time to build resistance to common infections. You don’t know who might have a sore throat, cough or other infectious condition. It is a good idea to keep the baby out of large crowds for a few weeks. If your baby comes home from the hospital after one day, we would like to see him/her at 3-4 days old. If the baby stayed longer than that, the first check-up will be at two weeks. Please call the office at 683-9371 as soon as the baby goes home from the hospital to schedule this first check-up. If a problem should arise before this time, please call the office and we will schedule to see the baby immediately.
The American Academy of Pediatrics has a recommended schedule of well-baby visits during your child’s first two years.
Recommended Office Visits
|Age||Reason for Visit|
|2 weeks Check-up|
|2 months Check-up||Vaccines|
|4 months Check-up||Vaccines|
|6 months Check-up||Vaccines|
|9 months Check-up|
|1 year Check-up||Vaccines|
|15 months Check-up||Vaccines|
|18 months Check-up||Vaccines|
|2 years Check-up|
|After 2 years Annually|
Feeding Your Newborn
Initially most newborns have little appetite. They were well nourished prior to delivery and are born with a small amount of extra fluid in their bodies which helps them tolerate smaller fluid intake during the first few days. Most babies normally lose up to 10% of their birth weight (or 4-10 ounces) in the first week. This is no cause for concern. It is all part of your baby’s adjustment to the outside world, and most of the weight loss is water. By 10 days of age, most babies gain back what they lost. Do not be too concerned if there is seeming lack of interest in feeding for the first few days.
Babies differ in their feeding needs and preferences, but most breast-fed babies need to be fed every 2 to 3 hours and nurse 10 to 20 minutes on each breast. Formula-fed babies usually feed every 3 to 4 hours and finish a bottle in 30 minutes or less. Bottle-fed infants drink about 2 to 3 ounces at first. By the time they are a few weeks old, their formula consumption has generally doubled. The maximum amount recommended per day is 32 ounces. Overfeeding can cause vomiting, diarrhea, or excessive weight gain.Your new baby may cry as though asking to be fed as often as every 2 hours. Keep in mind though, that babies don’t need to be fed every time they cry. When a baby cries for a short time on a regular basis, he/she may just need more milk at each feeding. Or he/she may be protesting that his/her diaper is wet or that he/she is hot. It is best not to get into the habit of offering frequent small feedings to please a fussy baby. So before you offer the breast or bottle, be sure your baby is not crying for some reason unrelated to hunger.
Your baby should not be allowed to sleep more than 4 hours during the day without feeding. Otherwise, there is a risk that the baby will reverse day and night and feed at night rather than during the day. Make nighttime feedings brief and boring. Feed quickly and quietly and don’t stimulate the baby.
How Much Is Enough?
The best gauge of good nourishment is growth. This is measured by weight and length. During regular check-ups your baby will be weighed and measured. Breast-fed babies may lose a little more weight. Healthy, well-fed babies usually double their birth weight by 5 months and triple it by one year.
Signs of a well-fed baby:
- Looks and acts satisfied after feedings
- Wets six or more diapers daily (after 4-5 days of age)
- Has yellow stools or frequent dark stools (after 4-5 days of age)
Babies do not routinely need extra water. Until 4 months, the formula or breast milk will meet your baby’s fluid requirements. Water need not be sterilized unless it is “well” water.No Cow’s Milk! Cow’s milk in any form, whole, 2 percent, or skim, should not be given until your baby is one year old. Cow’s milk doesn’t supply the balanced nutrition your baby needs, and it is often hard on babies’ sensitive digestive systems. Solid foods should not be started until the fourth to sixth month.
How to Feed
You should sit upright in a comfortable chair and hold the baby in your arms in a semi-upright position to feed. When the baby appears to be satisfied, put him/her on your shoulder and gently pat his/her back just below the shoulder blades until he/she burps. Then offer feeding again. This should be repeated as often as necessary through the meal until the baby is full and will take no more, usually after 2-3 oz. of formula or after 5-10 minutes nursing. Your baby may spit up small amounts of formula or breast milk. Don’t be alarmed. This happens to all babies. You may be able to reduce the spitting up by burping your baby more often or longer during and after feedings.Mealtime is more than an opportunity to get nutrients into your baby. It is a time for closeness and sharing. Your baby’s meals are as much for emotional pleasure as physical well-being. Maintain eye contact with your baby while you feed him/ her. Hold him/her comfortably close to you and talk to him/her softly during the feeding.
Babies who are breastfed have fewer infections and allergies during the first year of life than babies who are fed formula. Breast milk is also inexpensive and served at the perfect temperature. Breastfeeding becomes especially convenient when a mother is traveling with her baby. Overall, breast milk is nature’s best food for young babies. The first few days of nursing will be a time of learning for you and your baby. Neither of you may accomplish a lot on your first few tries. Clear or yellowish fluid called colostrum that is extra rich in nutrients will come from your breasts. Although the amount will be small, it is close to what your newborn’s stomach can hold. At first your new baby will nurse often, eight or more times in 24 hours.
To begin breastfeeding, rinse your nipples with plain water and dry them gently. Try to nurse from both breasts at each feeding. As long as you are holding your baby in the correct position and nursing is comfortable, there is no need to limit the time your baby nurses at each breast. Generally 20 minutes of breastfeeding is sufficient. It’s common to need to stimulate your baby before he/she will take the second breast. At the next feeding, begin at the breast where the last feeding was completed. Some mothers pin a safety pin to their bra on the side last used to remind themselves where to start the next time. If you have trouble with sore nipples, make sure that your baby has “latched on” correctly. Also, start nursing on the side that bothers you least. If you need to skip any feedings due to sore breasts, express your milk by hand or with a pump at the baby’s regular feeding times so you’ll maintain your milk supply. Mothers with colds or minor illnesses may continue to breastfeed their babies. Medications taken by a mother can pass into her breast milk. Examples are sedatives, tranquilizing agents, mood-altering drugs, laxatives, and antibiotics. If you are breastfeeding, please check with our office before taking any medications.
As a nursing mother, you will need to eat a balanced diet that contains 500-600 calories more per day than the diet you needed before pregnancy. Your daily food intake should contain a lot of protein foods, and at least one quart of milk; these foods provide you with enough calcium for both you and your baby. If you are unable to drink milk or eat high-calcium foods, ask your doctor to recommend a calcium supplement. Foods in your diet rarely have a disturbing effect on the baby. Certain foods such as tomatoes, onions, garlic, broccoli, cabbage, chocolate and spicy foods can cause loose stools, colic, or excess gas. If your baby has any of these symptoms, review your diet for the previous 24 hours and eliminate foods on the above list and see if it helps. If you are having trouble breastfeeding and would like assistance, please call our office for references and suggestions.
If you are bottle-feeding your baby, infant formula should be the only form of milk your baby gets during the first year of life. If you are using concentrate or powder, you will need to dilute with water. It is not necessary to sterilize the water unless it is “well” water. Be careful about keeping formula containers, bottles, nipples, and utensils free of germs. Everything should be washed thoroughly in hot soapy water and rinsed with plain hot water. You should wash your hands well with soap and water before beginning formula preparation. Do not change your baby’s formula unless directed by your physician!
Many parents are proud of the day their baby begins to take solid food, including cereals. They view it as an accomplishment. As a result, many babies are started on solid foods before their digestive systems are really ready. From a nutritional standpoint, solid foods are not necessary during the first 4 to 6 months of life. Breast milk or full-year formula provides all the nutrients a baby needs. In fact, the earlier any foods are introduced, the greater the chances are that the baby will have problems with solids. Your physician will discuss with you the best time to introduce solid foods. New foods should be introduced once at a time. When a new food is introduced, no other new foods should be given over the next week. Unless instructed by your physician, you should not change formulas at the same time you are introducing new solid foods. If the food causes diarrhea, constipation, or a rash you should stop giving the particular food. By introducing new foods slowly, you give your baby’s system a chance to adjust, and it is easier to trace problems back to the source. If a food does not agree with your baby, try it again when the baby is older.
A true allergy to a food is not very common in infants, and can be controlled by changing the formula or diet. The best way to help your baby avoid allergies is to breastfeed. Occasionally a formula-fed baby may develop symptoms that might indicate an allergy such as colic, severe rash, eczema, or diarrhea that won’t clear up. If there is a history of allergy in your family, these symptoms are even more likely to indicate an allergy. Please alert your physician if allergies run in your family.
For the first few days after your baby comes home, bath time can consist of a gentle once over with a soft, warm, damp wash cloth and a mild soap. Regular baths should wait until what is left of the umbilical cord has come off and in the case of boys, until the circumcision heals. Once your baby is ready for full-fledged baths, be sure the room is warm, with no drafts, and the water is about 85 degrees. When you stick your elbow in the water, it should feel warmer than you skin, but not actually hot. Your baby will find bath time a highlight of the day if you take a few precautions to keep soap out of his/her eyes and mouth and make him/her comfortable. Wash your baby’s face with plain water, a soft cloth and mild soap. Wash you baby’s head gently, working front to back to keep the soap out of his/her eyes.
To clean the area around the eyes, use cotton dipped in cool, clear water. Clean only the outer areas of the nose and ear, using a moist washcloth or cotton ball dipped in water. With a cotton ball, wipe away any yellowed-orange earwax that has collected in the visible part of the ear. It is important not to poke inside the ear; it is risky for your baby, painful and unnecessary. Excessive nasal secretions should be cleared with gentle aspiration by using a rubber ear bulb syringe. Don’t try to clean any areas inside the mouth until the baby starts getting teeth. Then you can teach him/her how to use a toothbrush. Powders and oils are not necessary.
Wash your baby’s hair once or twice weekly with a special baby shampoo that doesn’t sting the eyes. Don’t be concerned about hurting the anterior fontanel (soft spot). It is well protected.
During the first 10 to 14 days most newborns will sleep more than they do anything else (as much as 18 to 22 hours a day). Some babies, on the other hand, are awake for longer periods of time with no apparent problems. In either case, it is best to allow your child to determine the amount of sleep wanted and needed. The American Academy of Pediatrics now recommends that infants be placed on their backs when sleeping. This position has been shown to reduce the risk of SIDS (Sudden Infant Death Syndrome) in infants. Never use a pillow in the infant’s bassinet or crib. A triangular wedge, sold in most stores may be used. Babies generally start sleeping through the night around 1 to 2 months of age or when they’ve reached about 12 lbs. of weight. Some babies start sooner. You may have heard that starting solid food will make a baby sleep through the night. There is no evidence that this is true.
Your baby’s stools will probably change in color, softness, and frequency from time to time. Also, each baby’s stool pattern is different. Your baby may have a stool after each feeding or may not have a stool for several days. As long as your baby seems happy and content, is eating normally, and has no signs of illness, don’t worry about minor changes in stools. If your baby strains, turns red in the face, grunts, or cries when having a stool, don’t worry. This is normal as long as the stool is soft.
Most babies start teething at 6 to 7 months. A few begin at 3 to 4 months, but others may not start teething until later. Most babies are not troubled by the teething process. But others get irritable, eat poorly, and have trouble sleeping while teething. Some infants have low grade temperature but not over 100.5 rectally. Teething toys and teething biscuits are helpful while teeth are coming in.
Ways that tiny babies can communicate are limited. Crying is one of them. Crying is how your baby makes his/her needs known and displeasure felt. As you’ll soon find out if this is your first baby, most parents quickly learn to identify whether their baby is crying from hunger, restlessness, pain, anger, or some other reason. Many babies go through unexplainable fussy periods each day as they adjust to living in the world. Don’t worry about spoiling a tiny baby by pampering. He/she needs to know you are there to meet his/her needs.
There are a number of things you can do to comfort your baby:
- Give the baby something to suck, such as a pacifier.
- Lengthen feeding times.
- Give the baby more physical contact and movement, walk, rock, or pat him/her.
- Take the baby for a stroller ride or a car ride.
- “Bundle” the baby snugly in a blanket.
- Check the temperature of the room if you think the baby is too cool or too hot.
- Change the baby’s position.
- Move him/her from his/her back to his/her stomach or vice-versa. If all else fails, just let him/her cry. He/she may need to let off steam and often will fall asleep after a good cry.
Some babies are more prone to diaper rash than others. Almost all babies will have diaper rash at some time. Diaper rashes in infants under the age of 2 months should be seen and evaluated for yeast or bacterial infection.
To treat your baby’s diaper rash:
- Change diapers often. Keeping the area clean and dry allows it to heal.
- Expose the baby’s bottom to air several times a day.
- Avoid plastic pants if you use them with cloth diapers.
- At night, use disposable diapers that pull moisture into the diaper and away from the skin.
- Wash baby’s bottom with warm tap water if diapers contain only urine. Use a mild soap if there was a stool. Rinse thoroughly and pat dry.
- If your baby’s bottom is very raw, soak him/her in a tub of lukewarm water three times daily.
- A moisture repelling ointment, such as A&D Ointment, Desitin or Zinc Oxide may be applied.Call the office if a diaper rash lasts more than 3 days or if the rash spreads beyond the diaper area. You should also call if any blisters, pimples, boils, pus, or yellow crust form on the baby’s buttocks.
Siblings and Pets
A new baby in the family can be a stressful event for the older children. To ease the stress as much as possible, have your older children visit you and the baby in the hospital. Talk with the older children on the phone while you are in the hospital. When you arrive home, have someone else carry the baby inside. This allows you to be free to greet your other children. The new baby will be receiving many gifts. Have gifts for the older children at times. Let the older children help you with the baby as they would like, but don’t force the interaction.
Reinforce the older children’s position and importance in the family by setting aside time to spend with them that is not interrupted by the baby. If you have rivalry problems, please feel free to discuss them with your physician.If you have pets, never leave your pet and the baby alone in the same room. This includes situations where your pet may be able to get your baby without your knowledge. This is for the safety of both your baby and your pet. Regardless of the temperament of your pet, he may become jealous just as an older child might.
Special Medical Care for the Newborn
Your baby’s umbilical cord will fall off by itself in 1 to 4 weeks. Until it does, apply alcohol on a cotton swab to the cord three or four times a day. Pull the skin away from the umbilical cord so the alcohol gets into the base of the cord. If you note large amounts of a yellowish discharge or bleeding, or if the skin around the cord is red and the baby has a fever, call the office. A scanty spotting of blood from the navel just before and for a few days after the core comes off is to be expected.
Circumcision is a common operation in which the foreskin of the penis is removed. Each time you change your baby’s diaper, wash the circumcision with water and apply Neosporin Ointment or Vaseline until the area is healed. Healing will take about 10-14 days. Report any increased drainage, redness, swelling, bleeding, or foul odor to the office. Usually after the circumcision has healed, the penis requires no additional care. Occasionally a small piece of foreskin remains. This should be pulled back gently each time the child is bathed to prevent the formation of adhesions. The groove around the head of the penis should be cleaned.
Care of the Uncircumcised Penis
In the first few months, the baby’s uncircumcised penis should be cleaned with soap and water along with the rest of the diaper area. Initially, the foreskin is attached to the head of the penis by tissue, and you shouldn’t try to retract it. Your doctor will tell you when the foreskin has separated and can be retracted safely. This will not be for several months to years. After the separation occurs, you should retract the foreskin to cleanse underneath the end of the penis.
It is normal for newborns to have white dandruff-like flakes on their scalps. The flakes are old skin being shed and are not a dry scalp condition. Do not use oils, lotions, or Vaseline. This will only paste the flakes to the scalp and make the condition worse. Thick, yellowish scales are called cradle cap, a very common condition in infants. It, too, is associated with old, dead skin, and is only made worse by oils and lotions. You can treat cradle cap by removing scales with a soft brush and washing with a dandruff shampoo a few times a week.
Cut the toenails straight across to prevent ingrown toenails, but round off the corners of the fingernails to prevent unintentional scratches to your baby and others. Trim them weekly after a bath when the nails are softened. Use clippers or special baby scissors. This job usually takes two people unless you do it while your child is asleep.
Below are some warning signs of severe illness. If your infant has one or more of these symptoms, it does not necessarily mean severe illness is present.
However, it could be; therefore, please call the office if you note any of the following:
- Temperature of 100.5°F rectal; in any baby less than three months of age, temperature greater than 101°F (rectal) for more than 24-48 hours in an older baby.
- Vomiting, not just spitting up.
- Refusal to take feedings.
- No energy.
- Diarrhea, especially if there is mucus, blood, or an unusually bad smell.
- Hard crying with no obvious cause.
- Inability to see or hear normally.
- Unusual rash.
If your child is 3 months or younger and has a rectal temperature of 100.5 °F or higher, call the pediatrician immediately (day or night). You may need to notify the doctor if your child is between 3 to 6 months and has a temperature greater than 101 F or is older than 6 months and has a temperature greater than 103 F. An elevated temperature indicates an infection in the body. The infection may require antibiotics for treatment. In many cases involving an older infant, the decision to call the pediatrician will depend upon the symptoms accompanying the fever such as earache, cough or a runny nose.
If your child is over one year of age, is eating and sleeping well and has playful moments, there is usually no need to call the doctor immediately. Your child may have a virus. You may wait to see if the fever resolves on its own after 24 to 48 hours. If the fever persists longer, it is appropriate to call the office. The simplest and most accurate way to take a baby’s temperature is rectally. First, lubricate the bulb of the thermometer with petroleum jelly. Place the baby on his/ her tummy. With your thumb and index finger, spread the baby’s buttocks and insert the tip of the thermometer with your free hand. Remove the thermometer after 1 minute. There is often confusion about “adding a degree” depending on the way the temperature was measured. It is much less confusing if you refer to a temperature with the actual reading and the way it was measured. An example is “101 degrees F, under the arm.” If your baby has a temperature, give him/her extra liquids such as water and juice, If the fever is very high, sponge the baby off with water that is at room temperature or give him/her a bath in water this temperature for 20 to 30 minutes. Don’t make the water too cold or too hot. This can give the baby chills. Do not use plain alcohol either. It can be absorbed by the baby. Fever medications may be helpful, and may be recommended by your doctor. If your baby is younger than 3 months, please do not give fever medicine before calling the doctor.
If the baby has forceful, persistent vomiting at any time in the first 6 months, call the office. Persistent vomiting with fever or abdominal pain needs prompt attention. If your baby bumps his/her head hard, falls headfirst, or is struck in the head and later starts vomiting, call the office.
A baby has diarrhea when he/she passes frequent, loose, or watery stools. Usually diarrhea is not a medical emergency, but it can lead to dehydration, which is a serious complication. Dehydration is caused when minerals and fluids are lost in diarrhea. Dehydration can be prevented by giving your baby the right liquids when he/she gets diarrhea. Not every clear liquid has the right amounts of minerals, salts, or carbohydrates your baby needs when he/she has diarrhea. A commercial oral electrolyte solution such as Pedialyte is recommended. This has the proper balance of minerals, salts, and carbohydrates. These solutions can be found in most drug stores and some grocery stores. It is a good idea to have a bottle on hand, just in case.
When your baby has diarrhea, you should call the office if you notice any of the following:
- Mild diarrhea that lasts more than 2-3 days
- Severe diarrhea (6-8 stools in 6-8 hours)
- Fever above 100.5 F rectally that lasts longer than 24-48 hours
- Vomiting 2-3 times in a 2-3 hour period
- Vomiting for more than 24-48 hours
- Blood in the stool
- Infrequent wet diapers (further apart than every 2-3 hours)
- Darkly colored urine
- Lethargy or excessive sleepiness
- Acting very sick.
If the skin of your baby’s buttocks gets red or sore from the diarrhea, especially the area around the anus, wash it after each bowel movement. Then apply a thick layer of petroleum jelly. Change diapers immediately after each bowel movement. Most cases of diarrhea are caused by intestinal viruses and is very contagious. Wash your hands well after diaper-changing or using the toilet to prevent the virus from spreading to other family members.
Colic is limited to newborn infants and the cause is usually unknown. Colic usually clears up before the third or fourth month of life. The infant with colic may have cramping abdominal pain and may cry for long periods of time, usually starting in the early evening. The infant will draw up his/her legs, chew on his/ her fist, and act hungry. Do not feed an infant with colic more than every 3 hours as this will make the colic worse. There is no cure for colic; it must run its course. Some medication or change in feeding may be suggested by your physician to help your infant feel more comfortable.
Occasional colds are unavoidable in babies and children. Usually colds involve no more than a runny or stopped-up nose and mild cough can be handled at home. If your baby has vomiting or high fever along with a cold, call the office. During the first month or two of life, most newborns have some nasal mucus that can cause sneezing and noisy breathing. Salt water drops instilled into the nostrils may loosen congestion. Then a nasal bulb may be used to remove the secretions. A vaporizer of the cool mist type in your baby’s room might also help.
All of your family’s medications should have child-proof caps. They should be kept in locked or out-of-reach cabinets. You should also store soaps, cleaning agents, and painting supplies in a secure place. It is surprising how quickly little fingers become nimble enough to open drawers and doors and pry the lids off things. If you have seen your child swallow medicine or poison, call the office or Poison Control Center (901) 528-6048 at once. Keep syrup of ipecac on hand in your home to induce vomiting. Do not administer it until you have talked with the office or Poison Control Center. If your child has swallowed an acid-type chemical or kerosene, gasoline, or other petroleum product, you will be instructed not to induce vomiting but to take the child immediately to the emergency room.
Remember to schedule your first office visit, which is in a few days or at two weeks of age, as soon as the baby goes home from the hospital. Appointments can be made by calling 683-9371. You can use this number to schedule future appointments as well. All appointments should be made at least a couple of weeks in advance to ensure a time that works best for you. We do provide a well-baby waiting area in the office to reduce the chance of your baby coming in contact with sick children. Please see our Location and Hours page for specific schedule informationIf an emergency arises, you may call 683-9371, 24 hours a day. At night, you will speak to a pediatric nurse who will be able to help with many common problems. If additional help is needed, there is a physician on call. This page will not answer every question you have about the first few weeks and months of your baby’s life. We hope that it provides you with some useful guidelines and answers some basic questions. Please do not hesitate to call the office with any questions or concerns you have.
We are here to serve you and are happy to provide any information you need. Please do not hesitate to provide us with feedback as well. We welcome your suggestions and comments.