Newborn Booklet

General Instructions for the care of your newborn

 

Instructions for Baby………………………………………………………..

Birth Date……………………………Birth Weight……………………….. Birth Length…………………………

These instructions will help you meet the needs common to newborn babies and give you some helpful hints on how to keep your baby healthy and happy.

Your child is an individual from the day he/she is born. When necessary, we will assist you in adapting the general guidelines in this booklet to suit the individual needs of your baby. We will be happy to answer your questions and give you guidance while you are in the hospital and later by phone and during visits to the office. You will realize quickly that there is a great deal of flexibility in raising your newborn. Many medical principles prevalent when you were a child have changed. Therefore, educating you is one of our principle functions.

It is important that your baby be examined at regular intervals and that he or she receive immunizations (shots). These office visits and immunizations are intended to keep your baby healthy and give you guidance in caring for your baby. At each visit your baby will be evaluated in terms of his/her physical and emotional development.

Your baby should have his/her first office visit 2-3 days after discharge from the hospital. Please call our office and make arrangements for this first visit as soon as you arrive home from the hospital.

Signs of illness in your newborn which should be reported to us are (a) fever of 100.4 or higher, by rectum; (b) repeated vomiting (not just spitting up), or refusal of food two or more times in a row; (c) excessive crying; (d) listlessness; (e) and any unusual rash.
These people are most interested in your baby and eager to hold and hug him/her.

Everyone who is going to handle your baby should thoroughly wash his/her hands first. Please do your utmost to keep sick visitors and sick children away from your newborn baby until they are no longer contagious.

All babies sneeze, yawn, belch, have hiccoughs, pass gas, cough and cry. Sneezing is the way in which a baby can clear his nose of mucus, lint or milk curds. Hiccoughs are little spasms of the diaphragm and are very common.
Crying is the baby’s way of saying, “I’m hungry, I’m wet, I’m thirsty, I’m too hot, I’m cold, I have a stomach ache, or I’m bored”. You will gradually learn to know what the baby means when he/she cries.
 

FEEDING

Feeding is one of your baby’s first pleasant experiences. At feeding times your baby receives nourishment from his food and nourishment from his mother’s and father’s love. You should be comfortable and relaxed while feeding. Your baby should be warm and dry so that he or she is also comfortable. Hold your baby in your lap with his head slightly raised and resting in the bend of your elbow. Whether breast feeding or bottle feeding hold your baby comfortably close .

Most mothers can successfully nurse their baby. Nature has seen to it that the production of mother’s milk is related to the needs of the newborn infant. For the first few days your baby will sleep much of the time and will be content with the colostrum present in your breast. Your breast milk will come in either gradually or suddenly. This may be accompanied by an uncomfortable fullness which will subside. This fullness can be relieved by letting your baby nurse more frequently or by hand expressing milk. Please be patient and do not be easily discouraged from nursing your baby as you may take a few days to adjust to each other. Sometimes you may need to encourage your baby to nurse. Gently stroke his cheek nearest the breast and he will then usually turn his head to hunt for the nipple. Allow the baby to take as much of the areola (darker area of the breast), as possible into his or her mouth and not just the nipple. This allows your baby to obtain the maximum amount of milk from the milk ducts behind the areola. You can nurse on the first breast until the baby is satisfied, and then offer the second breast if the baby is showing signs of hunger. Alternate the side you begin each nursing with to give each breast equal stimulation. It is best not to pull the nipple from your baby’s mouth since this can hurt your nipple. To break the baby’s suction lift the baby’s lip by putting your clean finger into the corner of his or her mouth. Remember to burp the baby well after each breast feeding session.

The more you nurse, the more milk you will generally have. It is not uncommon for a breast-fed baby to nurse every 2 to 3 hours during the day and night in the beginning. He/she will gradually be content for longer periods between feedings. As your milk supply increases your baby will tend to have more frequent yellow, seedy, loose stools.

In general, your normal diet with an adequate liquid intake and vitamins is your best assurance of an adequate milk supply and a content baby. Most breastfeeding mothers will continue to take their prenatal vitamins; please discuss with -3- your OB-GYN doctor. If your baby does react to something you eat, give up only that food that consistantly bothers him/her. Please check with your obstetrician or us before taking any medication which may be excreted in breast milk and adversely affect your baby. If your nipples become sore, expose them to the air. Alcohol and soap tend to be irritating, so, in general, avoid them.

Seated comfortably and holding your baby with the head supported, tilt the bottle so that the nipple is always filled with formula. This will help your baby get formula instead of air. Air in the stomach may give your baby a false sense of being full and may also make him/her uncomfortable.

Your baby has a strong, natural desire to suck. For him/her, sucking is part of the pleasure of feeding. However, if your baby seems to be taking a long time to feed, please check to see if the nipple hole is clogged or the nipple has collapsed. You may need to change the nipple

Please do not prop your baby’s bottle and leave your baby to feed him/herself. The bottle can easily slip into the wrong position. Remember, too, your baby needs the security and pleasure it gives him/her to be held at feeding time. This is a time for you and your baby to relax and enjoy each other.

To prevent the baby bottle tooth syndrome, please do not allow your baby to use the bottle as a pacifier between feedings and do not leave the bottle in the crib at night at any age.

Burp your baby after several minutes of feeding and again after feeding. Even if he/she is fed properly, your baby usually swallows some air. The way to help your baby get rid of this is to burp him/her. Hold the baby upright over your shoulder, or place him/her face down over your lap and pat or rub his/her back very gently until he/she lets go of the air. It isn’t always necessary to interrupt a feeding to burp your baby, but always burp at the end of each feeding. Breast fed babies usually burp less than bottle fed babies.
Feeding schedules are usually most satisfactory if flexible. Formula fed babies usually feed about every three hours and may often go four hours between feedings. In general, however, feed your baby when he/she seems to be hungry (after a 2 hour period or longer).
The amount of formula your baby takes will vary. Most babies feed for 15 to 20 minutes. Sometimes your baby will take all of his/her bottle and sometimes he/she won’t. Don’t worry, this is normal. As your baby grows and gains weight, he/she will take more formula. When your baby takes all of his/her formula, increase the amount as needed. You will also have to change nipple sizes as your baby grows and gets stronger.
 

* *Please discuss formula choice with your physician. * *

You may clean the bottles in a dishwasher or wash by hand using soap, and rinsing with hot water. Bottle nipples need to be cleaned with a nipple brush to properly clean out the tip.

It is not neccesary to warm a bottle unless you are using it directly from the refrigerator. If you do warm the formula, test the formula by shaking a few drops onto the inside of your wrist. It should feel warm but not hot.

VITAMINS AND SOLID FOODS

Infant formulas contain vitamins, so supplemental vitamins are unnecessary. When your baby comes off formula, vitamins may be recommended in select cases. Your doctor will advise you. If there is no fluoride in your water company’s supply, we will prescribe a fluoride vitamin, or you can use nursery water that comes with fluoride. Please check with your water company to see if your water has fluoride and notify us if not. If you have fluoridated tap water and use a filter, please check with the manufacturer to see if the filter removes the fluoride.

Solid foods are usually started when the baby seems to be hungry on milk alone, usually 4 – 6 months of age. This will vary with the baby’s needs. One of the baby cereals will probably be the first food prescribed. Later, strained fruits, vegetables, and meats will be given depending on the age and size of the baby; we will guide you.

SLEEPING POSITION

We fully support the American Academy of Pediatrics’ recommendation that babies sleep on their backs and that you avoid sheepskins and pillows. Do NOT position baby on his/her belly to sleep. Do not leave loose blankets in the crib. Bumper pads for the crib are no longer recommended. These simple suggestions have significantly reduced the incidence of Sudden Infant Death Syndrome (SIDS)

BABY CARE

Always check the temperature of the bath water to insure that the water is not too hot. Until the cord has fallen off and the circumsicion has healed, wash your baby by sponging him with a cloth. After the cord has dried and fallen off and the circumcision has healed, you may use a tub or bathinette for your baby’s bath.

You may use plain water or mild soap such as Johnson’s, or Dove.

Cleanse the outer areas only with a moist, not wet, cotton tip applicator. Do not attempt to clean the inside of the nose or ears – only the outer openings .
Alcohol is no longer used for umbilical cord stump care. Simply keep diaper below the cord and allow air contact so it can dry. A few drops of blood after the cord falls off is normal and no cause for
You may apply Vaseline and gauze at the time of diaper changes for 2.
There may be some bleeding in the first 3 weeks – this is normal. Some mucous in the vaginal secretions is also normal; wipe it away from front to back.
It is not abnormal for a baby’s (girls or boys) breasts to become swollen. This is due to mother’s hormones and disappears without treatment in several months. Please inform us if the breast is hot, red or tender.

Care of the diaper area: Change your baby’s diaper as soon as possible after each bowel movement or wetting. Wash the diaper area with a soft cloth or cotton ball and soap and water. Diaper wipes are also acceptable. Pat dry with a clean, soft cloth.

An over-the-counter diaper cream or ointment is sufficient to treat most common diaper rashes. Exposure to the air several times a day for a short time is also helpful. If the diaper rash persists, please contact the office; some rashes require special medication.

Your baby may have a bowel movement after each feeding or one or two stools a day. Some babies may go 1 or 2 days without a stool and be normal. Your baby may strain when he/she has a stool, and unless the stool is hard, this is perfectly normal.

Breast fed babies may have more frequent yellow stools, which are usually very loose for the first few weeks.

As solid foods are later added to the diet, the color and consistency of the stools change. If the stools become hard and pellet-like, a teaspoon of dark Karo syrup mixed in the bottle with formula, once or twice daily may help the problem. The Karo may be gradually increased to 4 times per day in the bottle if necessary.

Almost all babies will occasionally regurgitate part of a feeding and many infants spit up frequently. This usually improves by 9 months of age. But if the baby is content, gaining weight adequately, and having normal stools there is usually no cause for concern. If your baby is vomiting large amounts or is very irritable, you should contact the office.
Many newborn babies develop a rash on the face at 3 to 4 weeks of age. It is usually a fine, red bumpy eruption with occasional white heads. It may persist for several weeks, sometimes almost disappearing, then flaring up again. It generally requires no treatment. If the rash appears to have bubbles of pus please notify us. In addition, a rash may occur in the diaper area due to stool or urine. This can be treated with more frequent changing and application of diaper cream or ointment.
Room Temperature: Try to keep an even, comfortable temperature in the baby’s room. Generally what you consider a comfortable temperature for yourself will suit your baby. On cold days check to see that he/she is covered enough to be warm and comfortable.

Sleeping: You may expect your new baby to do a lot of sleeping. However, this varies from baby to baby. Please position the baby on his/her back: do not place the baby on the stomach to sleep.

Bassinet or Crib: The baby’s mattress should be firm and flat. No pillows should be used. Protect the mattres

Clothing: Your baby does not require any more clothing than an adult, so never overclothe or overcover him. Dress him according to the temperature. Some babies are allergic to certain materials, so watch for rashes in clothing contact areas.

Outdoors: A fairly good rule to follow is to take your baby out whenever the weather is pleasant. Babies may be taken out on a nice day after they are two weeks old.

  1. Car accidents are one of the biggest dangers to your child’s life and health. Most auto injuries and deaths can be prevented by the use of an infant car seat every time your child is in the car. Make sure you have adjusted the straps and buckles so your infant is secure and comfortable; review the manual or view an installation video online.
  2. Protect your child from scalding burns by reducing the temperature on your hot water heater to 120° .
  3. Smoke and fire detectors in your home will protect your child’s sleeping area.
  4. If your child has consumed any medication (not prescribed for him/her) or has ingested a poisonous substance please call: POISON CONTROL at 1-800-222-1222.
  5. Please do not leave your child unattended in a bathtub, a wading pool or swimming pool. Protecting your swimming pool with a safety fence is strongly recommended. Above ground pools should have a padlocked cover; remove the entry ladder when not in use. Wading pools should be promptly emptied after each use.
  6. Safety locks on cabinets, and safety plugs on your unused electrical outlets are also recommended.
  7. Please do not use infant walkers with wheels; stationary infant activity centers are a safer alternative.

By providing your child with a safe environment, you can reduce the likelihood of injury as he/she begins to crawl, walk, run, climb, jump and explore his/her surroundings.

 

IILNESS

Please call early in the morning ( before 8. a.rn.) if you desire an early appointment. Early phone calls are especially indicated on Sundays and holidays (before 8:30 a.rn.),

When calling, state your name, the nature of your problem and the telephone number at which you can be reached. Your call will be returned as soon as possible.

If your infant is not acting in a normal manner, or seems ill, please take the temperature per rectum with a rectal thermometer. Do not rely on your own judgement of skin temperature. A digital thermometer is acceptable. If there is a fever, it is advisable to phone the office promptly and not wait until late in the day or evening.

EMERGENCIES

Phone calls after office hours (4:45 p.rn. weekdays, 11:45 a.m. on Saturdays) should be limited to urgent matters only. Unnecessary after hour calls may prevent us from rendering prompt service to a child who is seriously ill. We trust you will exercise your judgement in limiting your calls after hours. However, we encourage you to call if an urgent problem arises. Please do not call for routine prescription refills after hours.

If you call with an urgent matter, and we have not returned your call within 45 minutes, please call us back. It could be that our answering service has not been able to reach us or we have been unable to reach you. If you feel your child may require immediate emergency attention call 911 or PROCEED TO THE NEAREST EMERGENCY ROOM OF A MAJOR HOSPITAL ,such as:

BAPTIST HOSPITAL on Kendall Drive & S.W. 89th Ave., or

NICKLAUS CHILDREN’S HOSPITAL on S.W. 31 St. and S.W. 62nd Ave.

If your child has consumed any medication not prescribed for him/her or has ingested a poisonous substance please call: POISON CONTROL at 1-800-222-1222.

**IF A TRUE “LIFE OR DEATH” EMERGENCY ARISES: DIAL 911 **

OFFICE HOURS

8:30 a.m. to 11:45 am, 1 p.m. to 4:45 p.m. – Monday through Friday

8:30 a.m. to 11:45 am – Saturdays

For urgent visits only, 9:00 a.m to 11:00 a.m – Sundays*

*When certain holidays occur on a Sunday, the office will be closed. Please call ahead to verify that the office will be open.

Schedule of Immunizations and Checkups

2 Weeks Check up
1 Month Check up
2 Months Pediarix#I, HIB#I, Prevnar#I, Rotavirus#I, Check up
4 Months
Pediarix#2, HIB#2, Prevnar#2, Rotavirus#2,
Check up
6 Months
Pediarix#3, HIB#3, Prevnar#3, Rotavirus#3, Hgb,
Check up
9 Months Urine, Check up
12 Months
MMR#I, ChickenPox#I, Hgb,
Check up
15 Months
HIB#4, Prevnar#4,
Check up
18 Months
DTaP#4, HepA#l,
Check up
2 Years
HepA#2, Hgb,Urine,
Check up
3 Years Urine, Check up
4 Years
MMR#2, ChickenPox#2, Urine, 
Check up
5 Years Kinrix, Hgb, Urine,  Check up
Ages 6 thru 11 Years  Hgb, Cholesterol**, Urine, Annual Check up
Age 12 Years Tdap, Hgb, Urine Check up
Ages 13  Years and Older Hgb, Urine, Annual Check up
*Pediarix = DTaP, Polio,HepB 
*Kinrix = DTaP, Polio

The Meningococcal vaccine is given twice during adolescence, starting at age 11-12 years, for protection against this serious bacterial disease. The second dose is given 3-5 years after the first.

The HPV vaccine series, 3 shots given over 6 months, is approved for ages 9 years through 26 years to help prevent cervical cancer, genital warts, and anal cancer. It is now recommended for boys as well as girls.
After age 6 months, the influenza vaccine is recommended annually. The flu vaccine is available as a shot.
A routine Hemoglobin(Hgb) test to screen for possible anemia is done at approximately 6 months and 12 months of age and periodically thereafter.
* *The cholesterol test is performed between 9-12 years of age. Recent medical research has shown that high cholesterol levels in children may predispose to the development of subsequent early coronary heart disease. Proper precautions taken early may prevent or delay this possibility. High risk families will be tested more often.

A Tuberculosis test may be done selectively to detect this disease. Please let your doctor know if a family member or a close contact of your child has been diagnosed with TB or if your child has traveled to an area where TB is common.

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