Newborn and Childcare Handbook

Newborn & Childcare Handbook:Layout 1 9/16/2015 10:04 AM Page 1

NEWBORN AND CHILDCARE HANDBOOK

Charles V. Terry, M.D. Jocelyn B. Vergara, M.D. Peter S. Heyman, M.D. Lora G. Christian, M.D. Melani B. deSilva, M.D. Christine W. Seliskar, M.D. William C. Hawthorne, D.O. Tina Goodwin, C.P.N.P. Kirsten C. Slagle, C.P.N.P., CLC Elizabeth G. Downey, C.P.N.P. Tiffany C. Lancaster, C.P.N.P. E. Thornton Beale, C.P.N.P., IBCLC Caroline Hughes, C.P.N.P. Kathryn Golay, C.P.N.P. Ann Wallace Tazewell, P.A.- C. Tammy J. Rockwell, R.N., IBCLC

OFFICE LOCATIONS 7000 Patterson Avenue Ridgefield Location Patterson Richmond, Location VA 23226 10410 Ridgefield Parkway 7000 Patterson804-282-9706 Avenue Richmond, VA 23233 S Richmond, VA 23226 804-754-3776 804-282-9706 Southside Location 14400 Sommerville Court Midlothian, VA 23113 804-379-5437

Nights and Weekends 1-877-819-0320 www.rvapediatrics.com

Revised 8/18/20

Name: ______Date of Birth: ______Birth Weight: _____lbs. _____oz. Birth Length: ______

“When I look upon a child, I am filled with admiration for that child- not so much for what it is today, as for what it may become.”

Louis Pasteur

Table of Contents

Introduction eneral ffice Information chedulin ppointments for Well hildren merencies usiness ffice chedule of outine Well hild isits Immuniations ewborn are haracteristics of ewborn abies eedin ottle eedin urpin, pittin p, omitin acifiers, ryin, rettin, assiness itamins udden Infant eath yndrome owel oements onstipation mbilical ord are enital are kin are, athin, iaper are ouhin, neein, asal onestion yes, ear ucts, ucous aundice lothin oin utside the ome ewborn hildhood eelopment ommon ediatric oncerns eer reatment of eer ommon old, ouh, onestion ore hroat arache omitin iarrhea ecommended eadin 2

INTRODUCTION

onratulations on the arrial of your new baby and welcome to our practice. We appreciate the opportunity to proide your pediatric and adolescent care. his booklet contains basic information concernin the care of your newborn infant and common pediatric problems. he rearin of children is challenin and at times frustratin, but ultimately tremendously rewardin. ll new parents are anious with a new baby at home. It will come as no surprise that parentin skills are learned and not inborn. espite the ast uantity of helpful confusin adice from family and friends, you will uickly ain the confidence necessary to care for your child. uckily there are no absolutely correct ways to deal with newborn problems. our parental instincts and common sense are usually uite appropriate. ur practice is aailable to answer any uestions and we hope that you will call if you feel it is necessary. urin your hospital stay, your baby will be taken care of by pediatricians who are based in the hospital. nce you are dischared from the hospital and arrie at home, it is often the case that there are more uestions than you imained. It is best to set up your child’s first appointment with us within 24 hours of oin home. he hospital may recommend that you brin your child in within hours if your infant has had aundice, sinificant weiht loss, or other medical concerns. We offer consultation appointments, at our atterson office, with our inhouse lactation specialist, ammy ockwell, .., I. hese isits are offered from onday thru riday between am pm.

GENERAL OFFICE INFORMATION

ll three of our locations are open as follows onday – riday .. – .. .. – ..

dditionall our Ridgefield location is open aturda unda for sic isits aturda – unda – 2

ell child isits are scheduled durin normal usiness hours onda throuh rida aturdas and undas are resered for sic isits howeer durin the summer months we hae a limited numer of weeend checups f our child is sic he or she can e seen on a walin asis etween the hours of – 2 and 2 onda – rida dditionall for our conenience our idefield location is open for sic isits aturda unda from – 2

TIPS FOR SCHEDULING WELL CHILD APPOINTMENTS

ememer to mae our well child isit appointment as far in adance as possile suall 4 wees is needed to schedule a routine visit. Most parents will schedule their child’s next visit after their appointment efore leain our office lease tr to anticipate school nurser camp dacare and sports phsicals and schedule these well in adance ememer eerone starts school in the fall so summer phsicals are numerous hen callin our office to schedule an appointment for a well child isit please call the office at which ou wish to e seen

PHONE CALLS DURING BUSINESS HOURS

hen callin our office to tal with one of our doctors please leae our childs name ae and nature of the call lso please leae another phone numer where ou can e reached later in the da ur calls durin the da for routine care are numerous and will sometimes not e ale to e returned until later in the afternoon f our call is an emerenc please tell our staff and the will arrane for ou to spea with us immediatel

PHONE CALLS AFTER BUSINESS HOURS

f it is necessar to call after reular office hours ou can reach our after hours answerin service dialin our reular phone nuer. lease tell the operator our childs nae date of irth a rief description of the prole alon with our phone nuer. his essae will e relaed to a nurse who will e happ to answer our uestions and address our concerns. ne of our doctors is alwas on call and availale if necessar. lease reserve reuests for prescription refills discussions of routine ehavior andor chronic proles to our reular office hours.

EMERGENCIES

urin the first two onths of life ou should call us for n fever rectal aove . ersistent voitin efusal of several feedins ersistent diarrhea istlessness or unresponsiveness ersistent couhin difficult reathin udden onset of unusual rash

n the event of a lifethreatenin eerenc or a serious accident alwas ca or tae our child to the nearest eerenc roo. f possile have soeone notif the office efore leavin for the hospital.

OTHER EXAMPLES OF EMERGENCIES

ossile inestion of toxic sustances udden onset of difficult of reathin nur resultin in loss of consciousness sinificant leedin suspicion of fracture lacerations or daae to ee eiure or convulsion

EMERGENCY NUMBERS

oison ontrol or escue uad atterson ffice noral hours and after hours idefield ffice noral hours and after hours oerville ffice noral hours and after hours actation urse

BUSINESS OFFICE & INSURANCE POLICIES

usiness office hours are fro .M. until .M. Monda throuh rida. he office polic is that paent in full is expected at the tie of each visit cash chec or credit card. e accept isa Masterard and erican xpress. f full paent is not possile our usiness office will extend a paent plan to those patients who ae arraneents in advance. Our office participates with many HMO’s and PPO’s as well as an other insurance plans. e reuire a cop of our insurance card includin the insurance copan filin address at our first visit. f our anaed care plan includes a copaent or deductile for our office visit please reeer that these paents are due at the tie of service. lease eep us infored of chanes in hoe address telephone nuer and insurance status so that we a serve ou ore efficientl. e as that ou review our particular insurance plan so that ou are failiar with its various reuireents such as co paents deductiles referrals fro our doctors for specialist care eerenc roo visits and restrictions on usin our inoffice laorator services versus outside laorator services. e attept to eep areast of each plans reuireents and tr to advise ou of restrictions. owever reeer that ou are the owner of the polic and ou are ultiatel responsile for nowin the structure of our plan.

e participate with outhern Healthoentry Health nthem and nthem Healtheepers nited Health areMM Optima ina PPO HMO etna Health are PPO HMO Heech treet Priate Health are ystemMultiplan Preferred are of ichmond here may e other plans that we now participate with that are not shown here in this oolet or a complete list of plans or if you hae any uestions concernin your insurance referrals or your account please call our usiness office at etween M – PM Monday throuh riday t your first isit e sure to as the front des to sin you up for our patient portal Once you hae sined up you will e ale to access the portal for records appointment reuests and much more f you hae multiple children you can sin them all up under the same portal account for easier access

SCHEDULE OF ROUTINE WELL CHILD VISITS & IMMUNIZATIONS

he followin is a suested schedule of checup isits and immuniations for your child ased on the recommendations of the merican cademy of Pediatrics e feel as a roup that this schedule enales us to follow your childs rowth and deelopment and allows adeuate schedulin opportunities for routine immuniations and la wor dditionally we feel that this ies us the essential time necessary to offer anticipatory uidance concernin ehaior feedin and deelopmental proress

irth Hep Post dischare days may include lactation isit

– –

NEWBORN CARE

CHARACTERISTICS OF NEWBORN BABIES

Fontanel. Molding of the head. Caput Succedaneum. Cephalohematoma.

Scalp hair. Lanugo (body hair). Folded ears. Ear pits. Swollen eyelids. Hemorrhage on the eye. Eye color.

Flattened nose. Sucking callus or blister. Tongue-tie. Blocked tear duct. Epithelial pearls. Teeth. Swollen breasts.

Female genitals. Swollen labia. Hymenal tags. Vaginal discharge. Male genital. Hydrocele. Undescended testicle. Tight foreskin foreskin that doesn’t allow you to see the head of the penis. This is Erections.

Feet turned up, in, or out. eet ay e turned in any diretion inside the raped uarters of the wo. s lon as your child’s feet are flexible and can be moved easily to normal position, they are noral. Long second toe. The seond toe is loner than the reat toe as a result of heredity in soe ethni roups espeially those that oriinated around the editerranean ea. “Ingrown” toenails. any neworns hae soft nails that end and ure easily. The nails are not truly inrown howeer because they don’t curve into the flesh or ause irritation. Tight hips. hen we eaine your hild we will spread the les apart to ake sure the hips are not too tiht. utward endin of the upper les until the knees touh the surfae the ay is lyin on is called “90° of spread.” (Less than 50% of normal newborn hips an e spread this far. s lon as the upper les an e ent outward to and oth hips are eually fleile they are fine. The ost oon ause of a tiht hip is a disloation. Tibial torsion. The lower le ones tiias norally ure inward in neworns eause the ay was onfined to a rossleed position in the wo. f you stand your ay up you will also notie that the les are owed and the feet are pieonteed. oth of these ures are noral and will straihten out after your hild has een walkin for to onths.

BEHAVIOR

oe thins in neworn aies oonly do onern parents ut they are not sins of illness. ost are harless reflees aused y an iature nerous syste and disappear in or onths. They inlude hin trelin ower lip uierin reuent yawnin iups assin as oises aused y reathin or oeent durin sleep

neein pittin up (small amounts or belchin tartle reflex a brief stiffenin of the body in response to noise or movement (also called the oro reflex or embrace reflex trainin with bowel movements hroat clearin or urlin sounds caused by secretions in the throat. hese are not cause for concern unless your baby is havin labored breathin. rreular breathin. n irreular breathin pattern is not cause for concerns as lon as your baby is content, his breathin rate is less than 0 breaths per minute, pauses between breaths last less than six seconds, and he doesnt turn blue. ccasionally, infants tae rapid, proressively deeper breaths to completely expand the luns. remblin or itteriness of arms and les durin cryin. itters are common in youn infants and parents sometimes worry that their baby is havin a convulsion. eiures are rare, however. urin seiures babies typically mae rhythmic erin movements, blin their eyes, suc rhythmically with their mouths, and dont cry. f you are concerned your baby may be havin a seiure, call our office immediately.

or most mothers, the first wees at home with a new baby are the hardest of their lives. ou will probably feel overwored, even overwhelmed and inadeuate sleep will leave you fatiued. arin for a baby can be a lonely, stressful responsibility. ou may wonder if you will ever catch up on your rest or wor. he solution is to as for help. o one should be expected to care for a youn baby alone.

I I

very youn baby awaens one or more times each niht. he way to avoid sleep deprivation is to now the total amount of sleep you need each day and to et that sleep in bits and pieces. o to bed earlier in the evenin. hen your baby naps, you must also need to nap.

f you still are not ettin enouh sleep, hire a babysitter or brin in a relative to help out. f you dont tae care of yourself, it is harder to tae care of your baby.

ore than 50% of women experience postpartum blues which can start as soon as the third or fourth day after delivery. he symptoms include tearfulness, tiredness, sadness, and difficulty thinin clearly. he main cause of this temporary reaction is probably the sudden decrease of maternal hormones after delivery. ince the symptoms commonly bein on the day the mother comes home from the hospital, the full impact of bein totally responsible for a dependent newborn may also be a contributin factor. any mothers feel let down and uilty about the symptoms because they have been led to believe they should be overoyed about carin for their baby. here are several ways to cope with the postpartum blues

cnowlede your feelins. iscuss them with your husband or partner. f you are feelin trapped and overwhelmed by your seeminly insurmountable new responsibilities, discuss that too. ont try to suppress cryin or put on a super mom show for everyone. et adeuate rest. et help with your wor. ix with other people. ont let yourself become isolated. o out of the house at least once every wee o to the hairdresser, o

15 shoppin, o to the ym, visit a friend, or see a movie. y the third wee, consider settin aside an evenin each wee for a date with your sinificant other. f you dont feel better by the time your baby is month old, tal to your physician about the possibility of counselin or medication for depression.

I I I

emember, everyone needs extra help durin the first few wees alone with a new baby. deally, you should be able to plan for help before your baby is born. he best person to help is usually your mother or motherinlaw. f not, as other relatives or friends to help out or hire a teenaer or adult, perhaps someone from a local hih school or collee, to come in several times a wee to help with housewor or loo after your baby while you o out or et a nap. f you have other youn children, you absolutely will need daily help. ae it clear to helpers that your role is to loo after your baby. he helpers role is to shop, coo, clean, and wash clothes and dishes. f your baby has a medical problem that reuires special care, as our office about how to arrane home visits by a community health nurse. e recommend that any additional careiver have an up to date dap vaccine prior to bein around the new baby.

nly close friends and relatives should visit you durin your first month at home. hey should not visit if they are sic. riends who dont have children may not understand your needs. o prevent unannounced visitors, you can put a sin on the front door that says other and baby sleepin. o visitors. lease call first. f you have other children, encourae visitors to pay special attention to them as well as the baby. t helps to have a stash of small toys, stickers, coloring books, etc, that visitors can “gift” to your older children, helpin them feel as thouh the visitors want to see them too, not ust the new baby.

I I I

our ain assignents during the early onths are loving and feeding your baby ll babies lose a fe ounces during the first fe days after birth oever, they should never lose ore than of their birth eight usually about o ost breastfed and bottlefed babies dont lose any eight after day four and are back to birth eight by days of age hen infants gain aroiately ounce er day during the first onths f ilk is rovided liberally, the noral neborns hunger drive insures aroriate eight gain breastfeeding other often onders if her baby is getting enough calories since she can’t see how many ounces the baby takes our baby is doing fine if he aears satisfied after feedings, takes both breasts at each nursing, and ets si or ore diaers each day Whenever you are worried about your baby’s weight gain, bring hi to our office for a eight check eeding robles detected early are uch easier to reedy than longstanding ones secial eight check one eek after birth is a good idea for infants of a firsttie breastfeeding other or a other concerned about her ilk suly e have a lactation secialist on staff, ay ockell, , , and she can be reached at or at our atterson location he is available onday thru riday for aointents ou ay also call her for your breastfeeding uestions

I I I

ll young babies do soe unelained crying crying not caused by hunger, sickness, or ain rying babies need to be held hey need soeone ith a soothing voice and a soothing touch ick u your baby and cuddle and rock him when he cries. You can’t spoil a baby ith too uch holding during the early onths of life oe babies are very sensitive and need an even gentler touch and ore

17 attention. you think your child is crying because he is sick or in pain or i you need additional help with the crying, call our oice.

You can take your baby outdoors at any age. You already took him outside when you let the hospital, and you will be going outside again when you go or his twoweek checkup. ress the baby in as many layers o clothing as an adult would wear or the outdoor temperature. common mistake is overdressing babies in the summer. n the winter, babies need a hat to protect against heat loss because most body heat is lost through the head. old air or winds do not cause ear inections or pneumonia, however. Babies’ skin is thinner and more sensitive to the sun than the skin o older children. eep sun eposure to small amounts to minutes at a time. rotect your baby’s skin from sunburn with a bonnet and clothing that covers most o his body. ost sunscreens can be used at any age but avoid using those that contain pamino benoic acid, or , until your baby is si months old. You should probably avoid camping and crowds during your baby’s first month of life. Also, try to avoid close contact with people who have inectious illnesses. ter a couple o weeks at home, it is all right to take your inant outside during reasonable weather. nants rarely need to be bundled inside or outside. Whatever the weather dictates that you should wear is probably appropriate or your inant. emember, i you are hot or cold outside, there’s a good chance your baby is also. or the irst couple o months, it is appropriate to avoid crowds such as in the shopping mall, grocery store, etc. lso, it is wise to avoid certain nurseries, such as the church nursery or workout nursery. hese nurseries are large sources o viral particles, which are easily conveyed by touch and unnecessarily epose your inant. hose people who handle your baby should reuently wash their hands, since it is by hand to nose or mouth transmissions that most o our colds or viruses are passed

his checku is robably the most imortant medical visit during your baby’s first year. By two weeks of age, babies usually have develoed symtoms of any hysical condition that was not detectable during their hosital stay. By this oint too, your childs hysician will be able to udge how well he is growing on his from his height, weight, and head circumference. his is also the time your family is under the most stress from adating to a new baby and may be esecially in need of information and suort. ry to develo a habit of otting down uestions about your childs health or behavior. Bring this list with you to office visits. e welcome the oortunity to address your uestions and concerns, esecially ones that cannot be answered easily by reading or talking with other mothers. f at all ossible, have your husband or artner oin you when you bring your baby for checkus. e refer to get to know the husband or artner during a routine visit rather than during the crisis of on acute illness. f you think your baby is sick between checkus, be sure to call our office for hel.

I Breast milk rovides the ideal nutrition for your baby. n the hosital you will receive instructions and hel on how to initiate breastfeeding including the roer latching on techniue and ositioning. hortly after birth most babies will latch on and nurse well. his tye of successful feeding, however, may be intermittent over the net few days. t is most imortant in these first few days to master the roer latching on techniue and ositioning of your

ositioning tis . se different ositions to hel comletely emty each breast.

2. Attempt to align your baby’s head, shoulders, and buttos. . se a pillo to help support your baby to the height o your breast. our breasts initially produe olostrum, hih is thi high, protein substane rih in nutrients and antibodies. our mil supply ill usually be present beginning approimately days ater birth. ntil your mil supply is ell established, and your baby is gaining eight usually 2 ees, nurse your inant heneer he ries or seems hungry demand eeding. Ater your baby is month o age, and your mild supply is in, babies an reeie adeuate breast mil by nursing eery 22. hours. ost inants ill eed eery 2 hours hoeer, some ill try to sleep longer. your baby attempts to sleep longer than hours during the daytime it ould be adantageous to ae the baby up so the baby doesnt start to onuse daytime and nighttime shedule. oeer, i you hae nursed your baby around midnight and the baby has slept until A.., this ould be all right. ost mothers are unertain o the amount o breast mil their baby is reeiing. hese are seeral signs that ill help assume you trust your baby is getting enough breast mil. . 2 stools in 2hour period during the irst 2 ees o lie 2. et diapers per day . Audible salloing during eedings . our inant seems satisied beteen eedings

he most important ators to ensure an adeuate supply o mil are or mothers to get plenty o rest, eat a healthy ell balaned diet and drin plenty o luids. ontrary to popular belie, it is not neessary to drin mil in order to produe mil. asionally, mothers ill ind ertain oods ill aet their babies. hese are ommonly os mil, garli, spiy oods, and aeine. hile mothers are breasteeding, it is important or them to ontinue their presribed prenatal itamins. itamins and luoride supplementation or your baby ill start around months o age.

Also, other mediations that ere alloed hile you ere pregnant are also alloed hile nursing. you are unsure about a partiular mediation presription or oertheounter please all our oie. ne your breast mil is ell established, you may hoose to pump or epress your breast mil. his mil an be ept in the rerigerator or to to ie days or may be roen or months.

ommerially prepared ormulas hae been shon to be adeuate in proiding nutrition or groth and deelopment. t is not neessary to hae itamin supplementation or most ormula ed babies hoeer, the AA reommends itamin supplementation in ormula ed babies ho are not yet drining at lease 2 ounes o ormula a day, hih is most babies under months old. ommerial ormulas ome in three dierent preparations ready to eed, onentrate, and poder. All o these ontain the same nutritional alue, yet appearanes are uite dierent. his is due to the indiidual mae up o eah produt and its solubility. nitially, you ill ind that babies tend to tae about 2 o. o ormula. his ill usually result in a eeding shedule o about hours. As the time beteen eedings shortens, the baby should be inreased to 2 o. o ormula. he optimal shedule or eedings should be hour interals and the ultimate olume o ormula ill usually be o. per bottle or 22 o. per day. his olume and shedule ill usually tae ees to ahiee. ormula may be prepared earlier and ept in the rerigerator or 2 hours. ou may arm the ormula using a pot o ater or a bottle armer not a miroae, hoeer be sure to he the temperature o the ormula and nipple prior to eeding.

I II II

pitting up also alled regurgitation or relu is the eortless spitting up o one or to mouthuls o stomah ontents.

ormula or breast mil ust rolls out o the mouth, oten ith a burp. pitting up is harmless as long as your infant doesn’t spit up large amounts that interere ith normal eight gain. t results rom poor losure o the ale ring o musles at the top o the stomah. rom time to time all inants ill hae oreul omiting hih is often descried as “projectile.” This occurs on an infrequent basis and usually does not indiate that anything is rong, hoeer, i this type o oreul omiting ours reuently, or i the omitus is green in olor, you should inorm the dotor.

II I I I

n the irst e months o lie inants ill need to su een though they are not hungry. aiiers an sere a ery useul purpose during this time. t is muh easier to tae the paiier aay later on than it is to tae aay the thumb or ingers i your inant inds these in this early time. rying and retting are ery normal behaior or inants to ehibit. er time you ill be able to distinguish eatly hat is being inerred. All inants should be attended to initially, hoeer i they hae been ed, burped, hanged and are seemingly in no apparent physial disomort, a short period o retulness rying is all right. ome inants ill deelop a speii time o day during hih they are uite ussy. here are as many remedies to ussiness o inants as there are relaties. sually these episodes are sel limiting and suriable. ome helpul tehniues inlude physially aling or driing the inant around or plaing the inant seurely in a ar seat on top o a running dryer or short periods o time but do not leae him unattended. assiness is oten not only the ause o ussiness rying, but a result o ussinessrying. As inants ry they sallo air the more they ry, the more air is salloed. hould this ussiness be unmanageable, please disuss it ith your dotor.

The merican cademy of ediatrics no recommends itamin supplementation for infants ho are eclusiely reast fed. This is easily accomplished ith an oerthecounter itamin solution.

I I

The merican cademy of ediatrics recommends that all infants sleep on their acs as it reduces the ris of y at least . aies ho sleep on their stomachs hae a times greater ris of and side sleeping has tice the ris of hen compared to aies ho sleep on their acs. The folloing are main things you can do that ill significantly lessen your infant’s risk of SIDS: irm mattress soft edding and pads are associated ith increased ris of . nfant cri mattresses are purposefully firm for this reason and your ed is inherently dangerous een if you eliee you are taing other measures to preent suffocation. eep soft ojects out of the cri There should e no umpers lanets stuffed animals pillos or edges in your baby’s cri as this increase the ris of suffocation and . This includes stuffed animals attached to pacifiers. ot moing aing smoe residue in your house is significantly associated ith increased ris of ecause the chemicals appear to interfere with the infant’s brain regulation of reathing. lat urface cured and upright surfaces such as ouncy seats, swings, rock n’plays and car seats should not e used for unosered sleep. These positioning deices are also associated ith increased ris of . or more information you can go to the .org esite and follo this lin https.aap.orgenusadocacyand

23 policyaaphealthinitiatieshealthychildcareagesSafe Sleepasp

During your stay in the hospital and after the first few days home, your infants stools may be thick and dark green his stool is called meconium hese will change fairly uickly to a loose yellow seedy stool for both breastfed and bottlefed infants reastfed infants possibly can stool each time they are fed, whereas bottle fed infants may stool around times a day he color and freuency of stools are generally not important howeer, if your child has white or light grey stools in the first month of life, please immediately bring it to the attention of your doctor er time both breastfed and bottlefed infants may eperience a time period of a couple of days without a bowel moement he stool consistency at this time may be soft, runny, pasty or claylike, and your infant may strain and turn red attempting to pass this stool his is completely normal and does not constitute constipation onstipation refers to the consistency of the stool and the infreuency of the bowel moement constipated stool would be a hard pelletlike stool lease contact your doctor if you are concerned your child may hae significant constipation

II I

he cord usually remains attached firmly for weeks It may fall off sooner which is all right, but most are attached well after the week isit During the time the cord is attached you may see a slight amount of bleeding and brown mucous formation, both of which are normal It is important not to place your infant in water for a bath until the cord has fallen off If you notice the area of skin surrounding the cord has become red, streaked, or has pimples or blisters, please contact your doctor

24 If your child has been circumcised, this procedure has usually been done on the second or third day of life by your obstetrician he foreskin has been remoed and the tip area of the penis is swollen and red er the net days it will be important to change the dressing gaue pad and aseline with each diaper change his will be reiewed with you before discharge fter fie days you may continue using aseline with each diaper change until we see you at the week isit or uncircumcised male infants, gently pull back the foreskin and wash the area with a warm washcloth emember, the foreskin of an uncircumcised male infant may not be fully retractable until years of age or female infants, gently separate the labial area and clean with a washcloth here is often a white discharge or een slightly bloody mucous seen in this area hese are due to maternal hormones during pregnancy and are of no concern

I I I

our infants bath should be a pleasant procedure, as most infants enoy getting their clothes off and kicking a little while before the bath ntil the umbilical cord has fallen off, infants can be gien a sponge bath with mild soap fragrance free soap and water fter the cord has fallen off, regular baths in a baby tub, kitchen sink or bathinette are all right In washing your infant, most attention should be gien to the hands, feet and bottom ashing does not need to be done eery day, een once weekly is acceptable in your infants ll infants will hae an increased amount of dry skin, scaling and peeling hen this occurs on the scalp the best thing to do is to brush with a soft brush and aoid oils or lotions on the scalp Similarly, your infant may hae a scattered red, white pimply rash oer the face, scalp neck, cheeks, shoulders and upper back his rash is called milia and will persist for months intermittently resoling here is nothing that will improe this rash, howeer using face oils or lotions may actually make it worse he best way to wash the face is with warm water he rash will not leae any scaring and

25 looks worse after the baby lays on a particular side for feedings s for the peeling and scaling on the rest of the body, it is all right to use lotions on these areas

I I I

Infants are predominately nose breathers herefore, regardless of the season, they tend to create thicker mucus his usually occurs more in the eening hours or early morning his thickened mucus causes the defensie techniues of sneeing and coughing to occur hese are done in an effort to clear the nasal passage and throat and are not indicatie of a cold or allergy ost infants can be helped with this thick mucus by these suggestions: se a nasal aspirator blue bulb if mucus can be reached or aspirated, if not then dd a few drops of saline solution to help loosen the mucus and allow it to be suctioned out Sometimes ust using the saline nose drops may be ust as beneficial Saline nose drops can be purchased oer the counter t this age we try to aoid any of the oerthecounter decongestant agents

In the first few months of life, infants often appear to be crosseyed or unable to fiate on an obect at a distance lso, you may notice an increased amount of tearing or a yellowgreenish mucus build up in the morning his is the result of a blocked tear duct he tear duct in the corner of the eye nearest the nose allows tears to flow from the eye into the nose, howeer if this is blocked the mucus builds up and results in the condition described aboe o reliee this, you can use a warm washcloth and clean out the eyes as often as necessary lso, by massaging toward the corner of the eye tear duct seeral times a day, you can help loosen the mucus and improe the drainage

ost infants will appear slightly yellow or aundiced by the second to fourth day of life his is due to a build up of bilirubin in the infant’s tissue and blood ilirubin is the pigment of red blood cells, and in older infants, children and adults, this pigment is broken down in the lier, so it can be passed out of the body by the kidneys in the urine oweer, in the day old infant, the lier is not functioning up to full capacity herefore, bilirubin is transferred to the skin, so sunlight can change it to the form, which can be ecreted by the kidneys his is what gies infants the yellowish hue to the skin and sometimes to the white part sclera of the eyes sually aundice is longer lasting in breastfed infants than in formulafed infants he aundice coloration of the skin usually resoles in days his process is normal in most cases and can be helped along by allowing your infant to be eposed to daylight not direct sunlight in a wellheated room of your house s feedings pick up and stools become more freuent, yellow and seedy this also results in a decrease in bilirubin oweer, if your infant seems to be increasingly yellow with decreasing stools or is more lethargic after days, please contact your doctor

I I I

fter a couple of weeks at home it is all right to take your infant outside during reasonable weather Infants rarely need to be bundled inside or outside hateer the weather dictates that you should wear is probably appropriate for your infant emember if you are hot or cold outside, theres a good chance your baby is also or the first few months is it appropriate to aoid crowds such as in the shopping mall, grocery store, etc lso, it is wise to aoid certain nurseries such as the church nursery or workout nursery hese nurseries are large sources of iral particles, which are easily coneyed by touch and unnecessarily epose your infant hose people who handle your baby should freuently wash their

27 hans sine it is han t nse th tansissins that st f s ises ae asse

nths ensit ei a ines ait an isa ts an se is an an ines attin an tansfein f ne han t the the t the en f this ei e nte as s nths atie is eae t as thin anin an einnin nestanin f ase an effet nths he ae f eatin se inates eieate eease f as hinta s te atiit entes t se ase effet an et eanene s s ss a eeenta staes an a a i role in a child’s cognitive and language development a in ife iht e s isain attens a e se f tain an thin hen hien ae nths s isain htahs ith aa aes f se tnin ae eeent as e as ea f ites isae as ne ite e ae

eas he tie ei se ines ae se eent efine as t aniate ts sin fines eitin an sn tin an aein sis f seeh an anae eeent eas he esh eas s hae t ith eaaei sis stin shae an sie ite athin an es iainatin an siaiatin

isted elo are age appropriate speech language and motor sills our child should e demonstrating those sills that coincide ith their speciic age level hree onths tartles andor cries to loud noises istens to sounds and voices ses dierent cries or hunger pain etc oos and gurgles miles ands are open reuentl omentaril supports head hile holding upright hree to i onths esponds to noise and voices turning head ueals and laughs egins to ale ie repeats series o voel and consonant sounds las maing sounds and noises hile alone or ith others its supported or short period o time egins to see small oects ouches hands together i to ine onths esponds to on name nderstands gestures ie outstretched arms egins to imitate motions ie aving shaing tops activit in response to no imics the sounds and numer o sllales used others egins to loo up or sounds egins to support eight ith arms hile on stomach egins to ear eight on legs hile holding upright egins to scoot and hold ottle ine to elve onths

egins to understand simple reuests accompanied gesture egins to understand the names o amiliar peopleoects ttempts to imitate ords and or egin to sa irst ords ses argon aling ith intonation that sounds lie speech egins to cral attempts to pull up and cruise around urniture egins to localie sound turning head elve to ighteen onths nderstands simple commands sentences and uestions (i.e., "Where's Momma?” "Give me your cup.") oints to a e od parts egins to point to named pictures in oos ses a e single ords meaningull ses a e ords along ith argon peech is intelligile egins to al ell ithout support egins to eed sel and tae o shoes ighteen to entour onths istens to amiliar stories egins putting ords together (i.e., "Eat Cookie.” add ee car ames most common oects and pictures peech is intelligile ttempts to tell aout eperiences using a comination o argon and some true ords egins to run loos at oos pictures egins to undress o to o and neal ears nderstands action ords nderstands prepositions such as in or on ollos topart directions o get our shoes and sit on the couch as a vocaular o approimatel ords understands approimatel ords

eers to se y ame ses three or seteces o a ea to hree ears erstas more compe seteces ses proous reuety ses vers eig ith "ig" Uses some "wh” questions (who, when, where, what) etece egth is ors as arou ors i speakig vocauary egis to thro a overha egis to aser simpe uestios egis to ko his or her se hree to our ears erstas reereces to past a uture evets erstas a uses "h" uestios ses past tese vers (et, ake) sks "hy" uestios ses compete seteces most o the time ocauary approimatey ors ses or seteces peech is iteigie egis to pay games (hie seek, cops roers, etc.) ames pictures i ooks es actio takig pace i pictures May have imagiary compaio(s) you have ay uestios, or i your chi is ot emostratig those skis that coicie ith the chi's age eve, speak ith your peiatricia.

orma oy temperature is geeray arou . ever is usuay reerre to as temperature eevatio aove .. hough ever is usuay a maor cocer ith parets, it oes ot ee to e met ith paic i chire over moths o. ever tes

31 to mae hiren somewhat more ethari, ran an more in than usua ne the eer omes own, hiren ten to return to their norma atiities hie eer shou aert ou that our hi is i, it is rare a ause or aarm, sine the eree o eeation o temerature is not a reiae iniation or the seriousness o the iness easurin temerature aurate is most imortant here are now seera aanes in thermometers, whih inue iita rea out, eer stris an ear thermometers hie a o those methos ertain are onenient, some require (ear thermometer) a sie aroah to ensure aura n ouner hiren it is est not to use the ear thermometer or inants, i is est to measure temerature reta) toers are est measure aiar methos an oer hiren ora or ear thermometer he o roues eer in a norma resonse to iness or inetions itiona, eer has een oun to he our immune sstem wor an hiner roression o inetions he est wa to etermine whether or not to treat a eer, is i our hi is eerienin siniiant here are some ommon mths rearin eer we wou ie to ut to rest th eers an ause rain amae or eers an e anerous at: Fevers from infection don’t cause brain damage. rain amae an only occur when the body’s temperature rises aoe ue to enironmenta temeratures (ie ein et in a hot ar)

th none an hae a erie seiure at n o hiren hae erie seiures itiona, erie seiures are not harmu an amost awas sto on their own in ess than minutes

th ith meiine, eers shou ome own to norma at eers oten ome own erees with meiine suh as eno (aetaminohen) or otrin (iuroen)

yth: nce the fever comes down it should not come bac. Fact: Fevers will often come bac when the medication wears off and that can occur for days in a row.

yth: emperatures between .F and F are “low grade” Fact: The body’s normal temperature changes throughout the day and peas in the late afternoon and early evening. Even if you believe your child’s normal body temperature is in the F range a temperature of F does not indicate fever. t is worth noting that the absence of fever does not mean your child is not ill as not all children get fevers with all illnesses.

arents often wonder when to inform the doctor about fever. ur practice feels that if your child is months of age or younger and has a temperature above .F that you should inform your doctor immediately. For older children a temperature above F for more than hours deserves to be discussed with your doctor.

. llow the child to drin plenty of fluids. . ou may bathe the child in a warm bath but since fevers are not dangerous you do not need to use a cool bath to bring your child’s temperature down. . o not sponge with alcohol. his will also cause chills and may lower temperature too uicly. . ou do not need to prevent your ids from cuddling under a blanet when they have chills with fever. he chills are there as the body attempts to raise its temperature and the faster they warm up the faster the chills will improve.

. edication never use aspirin in children. cetaminophen Tylenol may be used for all children. f your child is under months of age please contact your doctor prior to using cetaminophen Tylenol. otrindvil buprofen should only be used in ids over months of age.

I lenol

For your convenience a chart containing dosage information for acetaminophen has been inserted below. This chart as well as others are available and are updated on the Tylenol website. lease visit this website at www.Tylenol.com. This chart is only a guide f you have any uestions when using this guide please call our office to spea with one of our providers.

Children’s unior trength uspension iuid hewable unior Tylenolcetaminophen riginal Eliir Tablets trength ge eight lbs mg m mg tabs mg each mos . ml ot ot recommended recommended mos tsp. or ot ot . m recommended recommended mos tsp. or ot ot . m recommended recommended yrs tsp. or tablets ot m recommended yrs tsp. or tablets ot . m recommended yrs tsp. or m tablets tablets yrs tsp. or tablets tablets . m yrs tsp. or m tablets tablets yrs ot recommended ot tablets recommended

n this day and age often both parents are woring daycare or some ind of baby sitter arrangements are sometimes necessary. t follows that with an increasing eposure to children in the early 34 ers lie here ill e n inresin ner illnesses s hildren ill he eeen lds eh er in heir irs e ers hese lds re de irses nd re ssed ie esil r hnds hs r nses h ld ls ds deendin n he rilr irs h siers hse dre r nrser he re hn ne rilr e irs s sll re rnn nse nesin sneein nd h e hildren he eer r ld eer r ld ill rs he einnin he illness ihin d r hen he ss irs sr eers h deel er r hild hs lred een ill r ds shld e eled ne r riders

n hildren eeriene sre hr he en d n lin heir hrs hese hildren en he deresed eie nd rese drin r een sll ies he ill refer to sore throat pain as "my mouth hurts,” "my neck hurts,” or "my tongue hurts.” Sore throats, however, are mostly associated ih irl inein r irriin r lleries in he srin r hlrine in he ser s hese irl ineins ls he ss eer shhe hedhe nd sllen lnds hese ss re ls ehiied ih srel sre hr ineins re ineins reire niii reen ire heres irl ineins ill n resnd niiis nd ss ls r ds he es disinish eeen hese siilr resenin illnesses is inin sre es nd e lre his lre reires hrs lee nd is ie re n enerl reen sre hrs is es lished sin einhen r ren r eer nd in relie nd sin ld liids iC lid rde e siles r ie re she he hr r lder hildren h lers sh s hse sed hnd h disese n e shed sin inin

enadryl llergy and aalo antacid mi these in eual parts ased on the appropriate enadryl dose for age. llow the child to swish this miture around in their mouth, gargle and spit out. his can e done as needed.

ar pain is a common prolem of childhood. sually it is confined to two particular prolems eternal otitis swimmers ear, and middle ear infection. Swimmers ear usually occurs in the summer months however, it may occur yearround. t is due to the collection of water in the ear canal. his water causes local irritation to the skin surface of the ear canal and therey allows infection to occur in the skin of the ear canal. his small area of infection and inflammation results in a great deal of pain. hildren usually complain of pain with movement of the ear, chewing, swallowing or even lying on the particular ear. his infection can e easily seen and treated y your doctor. any parents have found that this type of ear infection can e prevented, especially during the summer months. few drops of a simple solution of white vinegar and ruing alcohol in eual parts placed in each ear after swimming will help evaporate water from the ear canal. he middle ear infection is a common prolem of early childhood. hese infections can e either viral or acterial and often occur days following the onset of cold symptoms. hese infections are occasionally associated with fever, ut often times are not. ur providers should see children with ear pain, so he can evaluate the ear, throat, and sinuses to decide whether antiiotics are necessary. he pain associated with ear infection can e managed y using cetaminophen or uprofen as directed. dditionally, warm compresses or heating pad on low heat will allow some relief, until the doctor can see your child. fter treatment of an ear infection y an antiiotic, there is always a persistence of fluid remaining in the middle ear. his

36 fluid is the result of yproducts of our immune system and the infection itself. his fluid may take anywhere from weeks to totally e cleared out of the middle ear. uring this time your child may feel much etter, yet still continue to "pull at his ears". his doesnt necessarily mean the ear infection has not cleared, simply that the remaining fluid has not een cleared. our doctor may wish to see your child again in weeks to check on the remaining fluid depending on the severity of the initial middle ear infection. maor concern for hearing arises out of the persistence of middle ear fluid for longer than months more so than the numer of ear infections. f you feel your childs hearing has een or is still compromised after month, please contact your doctor.

II I

any different illnesses can cause vomiting and diarrhea. or children these often are the result of intestinal viruses. hese viruses are often seasonal in their occurrence fall and winter months, however, due to nursery, daycare and sitter situations, these now occur throughout the year. hey may present with a host of symptoms fever, stomachache, ody aches, vomiting, stomach cramping, and diarrhea. he management for vomiting is essentially to give nothing y mouth for hours. his allows your childs stomach to settle down. nce this has occurred, you may then start to offer small amounts of clear liuids o. at a time approimately every minutes. f your child shows no improvement in vomiting after several attempts of small volume feeds, please contact your doctor. lear liuids for children less than months of age include edialyte. or older children it is fine to use water or very watered down uice. fter the vomiting has een controlled for a few hours, you may advance their diet initially to include cheerios, crackers and toast, then slowly advance ack to regular diet over the net hours.

iarrhea is the common end result of intestinal viral illnesses. ften times the vomiting is hours in duration followed y days of diarrhea. iarrhea is characteried y freuent, greater than per day, loose watery stools. uring this time, although the diarrhea may e copious, it rarely y itself causes dehydration. more important concern during the following days is with nutrition rather than attempting to stop the diarrhea. he diarrhea actually serves as a method for the ody to rid itself of the virus. s such, do not use antidiarrheal agents such as modium, as these delay the purge, prolonging the duration of diarrhea. s long as your child has loose stools the child should e considered contagious and other arrangements for daycare should e made regardless of whether there is fever present. ietary management of diarrhea can initially e accomplished similarly to management of vomiting. owever, after hours the diet may e advanced, and the child can e "fed through the diarrhea.” f your child has had diarrhea for more than days or if there is high fever, loody diarrhea or your child is not taking fluids well, please contact your doctor. or infants who are reastfed it is appropriate to continue reastfeeding. f your infant is formulafed you may consider using a lactosefree since diarrhea often wipes the colon of the enymes that typically process sugars, giving some a temporary lactose intolerance following these gastrointestinal illnesses. hese formulas may e used for days and then switched ack to regular formula. he following signs should concern you for dehydration our infant months old has not urinated in hours our child months or older has not urinated in hours our child is not producing tears when crying he tongue looks dry and parched f your child is approaching these signs, consider giving ml of water, diluted uice, or edialyte every minutes for hour. t is est to set a timer minutes goes y uickly. fter one hour, if your child has mostly kept this down, you can advance to large

oue. our hid houd uriate ithi to hour o iitiatig thi regie. he ha ot ou houd a our hiia ad a e reerred to the eerge roo or urget are to get uid.

. Your Child’s Health: The Parent’s Oneto eeree uide to to ergeie oo ee ehaior roe eath eeoet arto . hitt ato re . . hid i i ert die or aagig oo ee arto . hitt eria ade o ediatri . oe our hid ee roe. ihard erer. . he or ee outio ete a to e our a ee hrough the ight iaeth ate . It’s No Accident: Breakthrough Solutions to Your Child’s ettig otiatio ad ther ott roe tee odge ad uae hoerg

eathhidre.org idheath.org aetaur.o heareatad.o htt.ho.edueterrograaieeduatioeter

eied