Congratulations – The Big Day Has Arrived!
Welcoming your new baby into the world can be both exciting and daunting. Regardless of whether you have been preparing for months, or you were caught by surprise, it is natural to have many questions. This packet is designed as a survival guide to help arm you with the tools needed to successfully navigate the first few weeks. ……And of course, Doctors’ Pediatric is right here with you.
Feeding: Breast vs. Formula
A healthy baby is a fed baby! The AAP recommends breastfeeding for at least the first 6 months of baby’s life. Breast milk provides important nourishment and protection for your baby. Human milk contains essential ingredients that bolster the immune system and may help to lessen your baby’s chance of developing certain allergies. We recognize, however, that breastfeeding may not be possible for all families. New moms and dads should feel comfortable choosing whatever is best for your family in regards to breastfeeding vs formula. Whatever your decision, we hope to provide the necessary support so that your baby may be healthy and strong. If breastfeeding is something that you would like to do (or try), we provide in-house lactation services for you and your baby.
Breastfeeding is full of positives: it is always available, less expensive, and excellent for baby’s health. Some moms and babies will adapt very quickly to nursing. For others, it may require practice, patience, and perseverance.
When possible, encourage breastfeeding within the first half hour of the baby’s birth. The baby should be put to breast 8-12 times in the first 24 hours. Don’t be discouraged if it seems that the feedings are not going well or that your baby is very sleepy. Nature has built in a wonderful cushion to help you and your baby navigate through the first few days. If baby is very sleepy, wake him/her by undressing and placing baby skin to skin prior to attempting nursing. Rubbing a cool washcloth on baby’s back or feet can also help to keep baby awake.
Make every effort to use the resources available at the hospital. Many of the nurses are trained lactation professionals, and they may offer the much needed tips and techniques to make nursing pleasurable and productive. Sometimes the most important and pressing nursing questions occur after you have left the hospital. We provide lactation specialists right here in our office, and we encourage all mothers who are attempting to breastfeed to have a lactation visit around day #5-8 of baby’s life.
Breastfeeding usually occurs on demand, every 2-3 hours. If your baby is sleepy, go ahead and wake them up to feed. After the first week or two, night feedings are sometimes spread out a little more. It is safe to let your baby tell you how often they need to feed overnight after the first 2-3 weeks.
The duration of feeds should be about 15-20 minutes on each side of the breast. If your baby is sleepy or distracted, this can sometimes be significantly prolonged. In order to provide a respite between feeds, feel free to “de-latch” the baby after 20-30 minutes of nursing. Give it another go in 2-3 hours. Try massaging your breast the entire time so that the milk is brought to the tip of the nipple. This helps to empty the breast (providing better cues to your body) as well as helping baby nurse more efficiently.
Some babies need more frequent burping than others. Always attempt burping at the end of nursing. If your baby spits up a lot, or seems very gassy, you may need to interrupt the nursing to burp. Try burping for about 2-3 minutes. If your baby doesn’t burp, feel free to resume feeding. Once some of the air is relieved from the stomach, your baby may nurse more successfully for the rest of the feed.
“Nipple confusion” used to be a significant worry for both parents and doctors. As more information has become available, we now know that switching between the breast and a bottle is not going to be harmful for your baby in the long run. Not every baby is the same, so it is a good idea to become skilled at nursing (2 weeks) before the bottle is introduced. However, we recognize that this scenario is not always possible for every family. Introducing the bottle before that time can be done successfully. Please ask us for guidance or advice if you have questions.
Breast milk is adequate hydration for your baby. Please do not feed your new baby water.
There are so many formulas out there….how do you choose? Formula comes in many different forms: “ready to use”, liquid concentrate, and dry powder. The “ready to use” is the most expensive, and the dry powder is the least expensive. The one aspect of formula that is recommended is that babies are fed formula fortified with iron.
Although it may seem like a good idea to “stretch” out formula if you are running low, it is important NEVER to dilute formula by adding more water than directed. Babies need a specific balance of salt and nutrients, and they can become ill if given something different.
During the first month, most babies will work up to eating about 3-4 ounces every 3 hours. Every baby is different, so take cues from your baby. Babies will usually take about 6-8 bottles a day. Your baby’s weight gain is a much better indicator of his/her nutrition than the actual ounces he/she eats. If you have questions, please let us know so that we can help guide you.
When preparing formula, always wash your hands well with soap and hot water. Use bottles, caps, and nipples that have been cleaned in the dishwasher. If washing by hand, be sure to use a bottle brush. Use each bottle as you make it. Please discard any formula that remains in the bottle after each feeding. Discarding the remaining formula prevents your baby from getting ill from any bacteria that has made its way into the bottle from the baby’s mouth.
If the formula is the liquid concentrate, then any opened can needs to be refrigerated. It can be safely stored in the fridge for up to 48 hours. If the formula is made from the powdered form, then it should be stored in the fridge for only 24 hours. The opened can of powdered formula should be used within a month, and it should be stored in a cool, dry place. Please do not freeze formula because the product’s components may separate.
Depending on the baby and the situation, a baby’s skin can have lots of different spots, marks, etc. It is not uncommon for a baby’s skin to look very scaly. You might be thinking that you should spread on lotion to make it less dry. The dryness is very normal. Your baby has been submerged in liquid for 9 months. The skin is bound to get a little “pruney” after all that time. Once the baby is born, that “pruney” skin starts to scale off and look dry. This is the baby’s way of sloughing off the older skin. If the dryness bothers you from a cosmetic standpoint, then you may use a little bit of Vaseline or aquaphor. Otherwise, there is no need for lotion (especially lotions with fragrances). Other skin findings, including a whole host of rashes, can be normal. Please don’t hesitate to ask us if this crops up in between visits. Hopefully the answer will be reassurance. If the skin finding is anything to be concerned about, we can figure things out in a timely manner.
The umbilical “stump” often stumps parents. It seems fragile, potentially painful, and complicated. The good news is that the umbilical stump is the ONLY self sufficient aspect of your baby. The belly button area does not have pain receptors, meaning this is not a painful area for the baby. If the diaper touches the leftover cord, the baby is not bothered. The stump usually falls off on its own between 1-3 weeks after delivery. While it is still attached, we ask that you sponge bathe the baby so that the stump isn’t submerged in water. After it falls off, you may begin doing more typical baths with a baby bathtub. If you notice any drainage from the belly button once it falls off, give us a call. Occasionally, we need to do a simple (non painful) procedure in the office to seal up the area.
There is no getting around it, babies love to spit up! More times than not, this is a normal phenomenon based on the way that their body is developing. In between the esophagus (the tube from the mouth to the stomach) and the stomach, there is a valve. This valve is very loose. It doesn’t tighten up until a baby gets to be about 9 months old. Because the valve is so loose, it lets lots of food pass back from the stomach, up the esophagus, and out the mouth. (hence, the constant outfit changes at inopportune times). Occasionally, the spit up can be bothersome for babies. These babies usually arch their backs, get very red, and are relatively inconsolable for a while after feeds. If you have concerns that your baby fits into this category, please let us know.
Colic is a normal, yet difficult, behavior exhibited by some babies during the first months of life. The typical story for a baby with colic is that the baby becomes very fussy (crying, difficult to console) around the early-evening to evening hours. Some babies may cry for several hours straight. As a parent, this can not only be upsetting, but it can also be frustrating. For the tired parent, it might feel as if the baby is pushing you to the end of your rope. The best thing that you can do at this point, is to give yourself a 10 minute time out. Put your baby down in the crib on his/her back for 10 minutes. It is okay if the baby continues to cry. After safely putting the baby in the crib, remove yourself from the room and take 10 minutes to do some deep breathing or stretching. Once you feel more in control of your emotions and frustrations, go back and retrieve your baby. It is safer for parents to take a break when they are at the end of their rope than it is for parents to stick it out when they feel as if they are at their breaking point.
How do you know when your baby is ill? Although this may seem like a daunting task, your baby communicates on many levels (none of which include speech). First things first, a rectal thermometer is your most accurate assessment of their core (inside) body temperature. Rectal thermometers are safe, non-painful, and easy to use. Put a little Vaseline on the end of the thermometer, rest it on the opening to the baby’s anus, and then gently slide it in about the length of your fingernail (or up to the line provided for you on the thermometer). Although the old mercury thermometer at Grandma/Grandpa’s house may seem tempting, please make sure that the thermometer is an updated digital version. Ear thermometers, forehead tapes, and anything else is not very accurate until the baby gets a little bit bigger. If the temperature reads 100.4 F or above, this is fever. You want to call the office ASAP during the day, or you want to bring your baby to the nearest Emergency Department overnight. During the first 1-3 months, babies have very few immunizations, and we would want to appropriately treat infections before they become serious. Certain infections that would hardly cause a little sniffle to a child or an adult can actually be life threatening to a baby.
That being said, you don’t have to monitor your baby’s temperature every day. Try to think of your baby’s behavior as being on a spectrum. At one end of the spectrum your baby is so so sleepy that he/she won’t really wake up and won’t eat. At the other end of the spectrum, your baby is so fussy and irritable you can’t console them. If your baby falls into one of these categories, go ahead and obtain a rectal temperature. You may also take a temperature if the baby feels warm to touch.
What is jaundice? The word jaundice relates to the yellow color of some new babies’ skin. Jaundice comes from a substance in the body called bilirubin. In children and adults, the bilirubin gets excreted and/or reabsorbed. Infants don’t do this as well, and the bilirubin builds up in the skin. The yellow color usually develops in the first few days, and then it peaks around day of life 4-7. The yellow color starts on the head and spreads down to the belly and thighs. It disappears in the opposite direction (thighs, to belly, to head). At low levels, the yellow color is not a problem. However, if your baby gets too yellow too fast, the bilirubin can be unsafe. As pediatricians, it is our job to monitor the level of bilirubin in the baby, and to make sure that we keep that level safe. If you notice that your baby’s thighs are getting yellow, please let us know. Occasionally, some babies need a little help getting rid of the yellow color. If that is the case, we can put babies under bright blue lights that help to dissolve the yellow color in their skin.
What color is normal? Reassuringly, there are many scenarios that are completely normal. In fact, it is easier to discuss what is NOT normal before trying to nail down ALL that is normal. The color of your baby’s bowel movements is NOT normal if it is bright red (like blood), white (no color at all), or black as night. Any other shade of green, yellow, brown, orange, or tan is completely normal.
How often should my child have a bowel movement? Some babies really like to put their parents to the test. They may have you changing dirty diapers several times a day. Other babies like to spread things out. It is not uncommon for some babies (after 4 weeks of age) to go 4-7 days without a bowel movement. Many adults cringe when they hear this. However, for babies, this can be normal and not uncomfortable.
Why does my baby get red in the face and scrunch up her legs? When a child or adult walks around all day long, their stomach muscles get automatically contracted by the movement of their body. This pushes gas and stool through their intestine. When it comes time to have a bowel movement, that same adult is usually in an upright position. Babies have it kind of tough. Not only do they not have the option of walking around all day to naturally contract their muscles, but they also are not upright when they have a bowel movement. Therefore, babies need to generate enough force, on their back, to push the stool through their intestines. When babies get red in the face and scrunch up their legs, they are doing what you do on a day to day basis without even thinking about it.
Although babies’ sleep patterns seem like they should be very intuitive, sleep can actually be a point of confusion for new parents. Here are some basics to guide you through the first few weeks. Newborn babies sleep for a total of about sixteen to seventeen hours a day. However, each sleep interval is usually about 1-3 hours. Each sleep interval will be interrupted by babies waking to eat. It is normal for your baby to need a reminder to wake up in the first week of life. They may be a little extra sleepy. It is appropriate for you to wake up your baby every 2-3 hours to eat. If your baby is dozing off while trying to eat, be sure to undress your baby and get him stimulated. This will help your baby to stay awake a little longer. Your baby will continue the same sleep/wake pattern overnight. In the first few weeks, you shouldn’t let your baby go longer than 4-5 hours without eating. Their little bodies are not quite prepared for such a long duration, and they need the added sugar that eating offers. By the time that your baby is 3-4 months, she will only need to sleep about fifteen hours a day, and she may have prolonged sleep intervals at night to about 4-8 hours.
Your baby should be on her BACK to sleep.
Your baby should be sitting in a BACKWARD facing car seat in the BACKSEAT of the car
Your hot water heater should be turned down to less than 125 degrees Fahrenheit
Your baby should NEVER be left unattended on a changing table, couch, bath, or bed.