Congratulations on Your New Baby!

Feeding solutions to support baby’s growth and development

FOR ROUTINE FEEDING FOR SENSITIVE TUMMIES FOR FOOD ALLERGIES CONGRATULATIONS ON YOUR NEW BABY! Similac Pro-Advance™† Similac Pro-Sensitive™† Similac® Alimentum® Complete nutrition for baby’s first year Gentle nutrition for fussiness,‡ gas,‡ Extensively hydrolyzed protein and 2’-FL HMO for immune support or mild spit-up and 2’-FL HMO for for food allergies and colic§ immune support

® ®† ®† ® Similac Advance Similac Sensitive EleCare for Infants ® and Similac® Advance® and Similac Sensitive Hypoallergenic amino † † for Neuro Support for Neuro Support acid-based formula Complete nutrition for Gentle nutrition for for infants who cannot ‡ ‡ baby’s first year fussiness, gas, or tolerate intact or mild spit-up hydrolyzed protein

Similac® For ® † Supplementation† Similac for Spit-Up Added rice starch to help Designed for breastfeeding reduce frequent spit-up in moms who choose to healthy babies www.augustapediatrics.com introduce formula

† Similac® Organic Similac Pro-Total Certified USDA organic Comfort™† nutrition for baby’s 2’-FL HMO for immune first year support; gentle protein for easy digestion

PREMATURE FORMULA Similac® Soy Isomil® Soy for lactose-free nutrition

Similac® NeoSure®† Nutrient-enrichedll formula for babies who were born prematurely

† Not for infants or children with galactosemia. ‡ Due to lactose sensitivity. § Due to protein sensitivity. ll Increased protein, vitamins, and minerals compared to term infant formula.

______YOUR NEW BABY ______CONGRATULATIONS!! You have just become new parents and so many exciting and wonderful times are ahead of you and your ______new addition. We are honored that you have chosen our practice to ______walk with you through the coming season of your life. It is our privilege to care for the medical needs of your new baby and your ______other children. We will do all we can to give you the best medical care and to help you to be the excellent parents you want to be. ______This booklet has been developed with you and your child in mind. It originated in Houston, Texas and was originally written ______by Susan Cooley, RN, PNP at the University Of Texas Medical School at Houston. We have refined it over many years and ______many editions. ______47

2 NOTES REFERENCES INTRODUCTION TO OUR GROUP Our pediatric group seeks to help you provide a good and 1. First Twelve Months of Life, Frank Caplan. This is an healthy childhood for your children. Our approach is to treat the excellent pictorial and graphic book on your baby’s growth and whole child: physical, spiritual, emotional and mental. development. It makes growing up with baby a lot of fun. Our practice of pediatrics and adolescent medicine by definition includes newborns, infants, children and adolescents through age 21. Pediatricians are trained to treat these age groups by 2. The Womanly Art of Breast Feeding, M.B. Carson. This spending from three to four years beyond medical school in a is a good reference book for those mothers who desire to learn pediatric residency. A pediatrician is a specialist in the diseases of more about breast feeding. infants, children and adolescents as well as their normal growth and

development. 3. Dare to Discipline, Dr. James Dobson. Dr. Newton graduated from the Medical College of Georgia and continued his pediatric training at Vanderbilt University School 4. Caring for Your Baby and Young Child, Birth to age 5, by of Medicine in Nashville, Tennessee. Stephen Shelov, Boston Press. Dr. Hanna graduated from the Medical College of Georgia and completed his pediatric training at Brenner Children’s Hospital of 5. Shepherding a Child’s Heart, Tedd Tripp. Shepherd Press, Wake Forest University Baptist Medical Center in Winston-Salem, 1-800-338-1445. North Carolina. Dr. Threadgill graduated from the Medical College of Georgia 6. The Complete Book of Baby and Child Care by Focus on and continued there to complete his pediatric training. the Family’s Physicians Resource Council, obtained at most Dr. Leverett received her M.D. from the Medical University of Christian bookstores or by phoning Focus on the Family at South Carolina and continued there to complete her pediatric residency. 1-800-232-6459. Dr. Drake graduated from the Medical College of Georgia and completed her pediatric training at Cincinnati Children’s Medical Center in Cincinnati, Ohio.

7. New Mother’s Guide to Breastfeeding This is an excellent Dr. Massey graduated from the Medical University of South source of breastfeeding information published by the American Carolina in Charleston and continued there for her pediatric training Academy of Pediatrics. as well.

Dr. Lazari graduated from the Medical College of Georgia in

2012, and completed his pediatric residency at the Children's Hospital The Augusta Pediatric Associates, P.C. website: of Georgia serving as chief resident his last year there. www.augustapediatrics.com

The American Academy of Pediatrics website: www.aap.org www.healthychildren.org from the American Academy of Pediatrics is a good resource. Their Symptom Checker can be accessed from there and is very useful.

Focus on the family website: www.focusonthefamily.com

46 10/16 3 NOTES Dr. Lane graduated from the Medical College of Georgia Five years and received his training in pediatrics at the Children' s Hospital of 1. Copies a square Georgia in Augusta. 2. Knows age (“how old are you?”) 3. Performs three tasks (with one command); for instance: “Put Dr. Wilson graduated from the Medical College of pen on table – close door – bring me the ball.” Georgia at Augusta University and completed his pediatric 4. Knows four colors NOTES residenDr.cy atLane Ch ildregraduatedn’s H ospitalfrom the of Medica Georgial Col in legeAugus of ta.Ge Heorg ia Five5. years Defines use for: “fork – horse – key – pencil, etc.” andworked rec eivedfor eight his yearstraining in thine pediatrmissionics field at the in Cusco,Childr ePerun' s Hospital and has of 6.1. Skips,Copies using a square feet alternately Gereturnedorgia into Aujoing usta.our practice . 7.2. StandsKnows onage one (“how foot old for areseven you?”) to eight seconds 8.3. DrawsPerforms man three with tasks at least (with six one parts command); ; (for instance: for instance: head, arms, “Put Dr. WColemilsonan gr gradaduauatedted from from the the M Medicaledical College College of of legs,pen on eyes, table etc.) – close door – bring me the ball.” Georgia at AuguAugusta University and completed hhisis pediatric 9.4. CountsKnows fourtwelve colors objects correctly residency at Children's’s HHospitalospital ofof GGeorgiaeorgia inin AugusAugusta.ta. He 10.5. CountsDefines numberuse for: of“fork fingers – horse correctly – key – pencil, etc.” worked for eight years in the mission field in Cusco, Peru and has 11.6. NamesSkips, using nickel, feet dime, alternately penny returnedDr. to joinSteve ourn practiceL. Moore. retired from APA in 2018 having 12.7. DressesStands on self one without foot for assistance seven to eight seconds cared for his patients for 30 Years. 13.8. PrintsDraws few man letters with at least six parts ; (for instance: head, arms, Dr. Coleman graduated from the Medical College of 14. Commentslegs, eyes, etc.) on pictures GeorgiaDr. at JerryAugu stA.a UnMilleiversityr, found anerd completed of the pract hiceis pedi, retiredatric in 15.9. AsksCounts meanings twelve objects of words correctly reside2019 afterncy at39 Ch yeildrears ofn's se Hrospitalvice to ofhis G pateorgiaients. in Augusta. 16.10. CanCounts pronounce number correctly;of fingers correctly“T –D –N –G –K –Y.” 17.11. BuildsNames six nickel, block dime, pyramid penny AllDr. ofSteve our nph L.ys Miciansoore are retired certifi fromed by APA the American in 2018 haBoardving of 18.12. KnowsDresses days self without of week assistance Pediatrics. cared for his patients for 30 Years. 19.13. TransportsPrints few letters things in a wagon 20.14. PlaysComments with coloring on pictures set, construction toys, puzzles, jump rope, All of our physicians are on staff at University Hospital and Dr. Jerry A. Miller, founder of the practice, retired in 15. skatesAsks meanings of words Doctor’s Hospital. 2019 after 39 years of service to his patients. 21.16. ParticipatesCan pronounce well correctly; in group play“T – D –N –G –K –Y.” 17. Builds six block pyramid All of our physicians are certified by the American Board of 18. Knows days of week Pediatrics. 19. Transports things in a wagon 20. Plays with coloring set, construction toys, puzzles, jump rope, All of our physicians are on staff at University Hospital and skates Doctor’s Hospital. 21. Participates well in group play

4 6. Knows a few rhymes OFFICE HOURS and EMERGENCY COVERAGE *LYHVDSSURSULDWHDQVZHUVWR´:KDWVZLPV²IOLHV²VKRRWV² Routine office hours are Monday through Friday 9AM-5PM. ALLERGICERLOV²ELWHV²PHOWV"µ REACTIONS: We have emergency hours most Saturdays 10AM-12PM and most 8. &RPSUHKHQGVFRQFHSWVVXFKDV´FROGµ´WLUHGµ´KXQJU\µ Sundays 2PM-4PM. 9. 8QGHUVWDQGVWDNLQJWXUQV Our physicians are in a pediatric call group which provides &RSLHVDFLUFOH seven days per week coverage in the office including Saturdays and &DQSXWRQVKRHV Sundays. We also provide 24 hour per day coverage for emergencies. Alternates feet going upstairs We or the doctor on call for our group may be reached by calling Jumps from bottom stair the office at 706-868-0389. If your child is seen urgently or in an 5LGHVDWULF\FOH emergency by a physician outside of our group, please give us a call Stands on one foot for a moment the nextCONGRATULATIONS morning and let us know how your child is doing. Puts ten pellets into bottle in thirty seconds It is important to remember that although your doctor or one )HHGVVHOIZLWKOLWWOHVSLOOV of the other doctorsON is on call YOUR at all times, the doctor who is taking Pours from a pitcher calls is covering for EMERGENCY CALLS and is also covering for &DQXQGRWZREXWWRQV other pediatriciansNEW besides himself. BABY! If you have a true emergency or a Builds three block pyramid significant problem with your child which cannot wait until office hours, then you should call the office number and the nurse triage Four years system will handle your call. If needed, the nurse will then page one &RXQWVIRXUSHQQLHV of us. Please note that there is a fee of $15.00 when you page our &RPSUHKHQGV´:KDWGR\RXGRLI\RXDUHKXQJU\VOHHS\ nurse triage service so please use it only if you have an urgent need. FROG"µ So that we are able to direct our entire attention to patients who truly 5HSHDWVWHQZRUGVHQWHQFHV need immediate care, we ask respectfully that all other calls be made 5HSHDWVIRXUGLJLWV during routine office hours during the week or at the specified times &RXQWVWKUHHREMHFWVSRLQWLQJFRUUHFWO\ mentioned above on Saturdays and Sundays. It is our office policy CHILDHOOD6. &RSLHVDFURVV DISEASES (and dates:) that medications will not be called in after hours. Please call during &RPSDUHVOLQHV´:KLFKLVORQJHU"µ office hourswww.augustapediatrics.com or leave a message for prescriptions and medication 8. &RPSOHWHVWKUHHSLHFHSX]]OHLQVHFRQGV refills. 9. 'UDZVDPDQZLWKWZRSDUWV There is another option for getting a message to us after Stands on one foot for four to eight seconds hours: you may leave a message for the office staff at no charge, we )ROGVSDSHUWKUHHWLPHV will return your call when the office reopens. To leave a message for %UXVKHVWHHWKZDVKHVKDQGVDQGIDFH the office staff press “0” at any time. 'UHVVHVDQGXQGUHVVHVVHOI VXSHUYLVHG Many major insurance companies offer a nurse line as a /DFHVVKRHV free service to their members: that information would be on your &RRSHUDWHVZLWKRWKHUFKLOGUHQLQSOD\ insurance card. Amerigroup members may call 800-600-4441. Knows at least one color Wellcare members may call 800-919-8807. These numbers are on &DQVHOHFWKHDYLHUIURPOLJKWHUREMHFWV your card and you will need it when you call.

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5 EMERGENCIES NOTESTwo years For true emergencies, please call the office or the answering 1. Says simple phrases service, and we will give you an answer immediately concerning ______2. Uses “I”, “me”, “you” where to go and what to do. If there is no time to call, you should 3. 5HSHDWVWZRGLJLWV DIWHUIHZWULDOV bring your child to the office or take him to the nearest emergency ______4. Distinguishes “in” and “under” room. During times in which the office is closed, you should take ______5. 5HIHUVWRVHOIE\QDPH your child to the nearest emergency room. The emergency room at 6. Knows four body parts the Children’s Medical Center at the Medical College of Georgia is ______7. Asks for things at table by name preferred in the event that an emergency room visit is necessary. 8. 3RLQWVWRSLFWXUHV One of the most common calls we receive is in regard to ______9. Builds 5-6 cube tower fever management. (See section on fever) We usually recommend YOUR NEW BABY ______Cuts with scissors acetaminophen or ibuprofen (if greater than 6 months old) for 11.5HPRYHVZUDSSLQJIURPFDQG\ fever management, and as long as fever can be controlled using the ______12.Claps hands recommendedCONGRATULATIONS!! dosage and as long You as haveyour justchild become feels better new onceparents the and 13.5XQVZLWKRXWIDOOLQJ medicationso many isexciting given it and is fine wonderful to wait untiltimes morning are ahead to of call you the and office your ______14.Goes up and down stairs alone for newan appointment addition. We to arebe seen. honored However, that you if your have child chosen is less our thanpractice six to ______15.Kicks large ball weekswalk old with and you has through a rectal temperaturethe coming season equal toof oryour greater life. thanIt is our100.4 16.Imitates circular strokes or lessprivilege than 2to years care oldfor thewith medical a fever needsof 104 of or your greater, new you baby should and your ______17.3XOOVRQVLPSOHJDUPHQW callother immediately children. no We matter will whatdo all the we time. can to Other give illnessesyou the bestshould medical be 18. Opens door ______ assessedcare and by theto help parent you on to an be individual the excellent basis parents using youyour want own togood be. 19.turns pages in book, singly judgment. Do not hesitate to call in the case of an emergency or if ______Throws ball into a box youThis are unsurebooklet about has been how developed to care for with your you child. and your child in mind. The majority of it is taken from a booklet prepared by the ______Two and One Half Years Ambulatory Pediatric Division of the University of Texas Medical PHONE CALLS DURING OFFICE HOURS ______1. 5HIHUVWRVHOIE\SURQRXQ UDWKHUWKDQQDPH SchoolPhone at Houston, calls for mostappointments of it having can been be made written during by Susan office Cooley, 2. Walks on tiptoes hours.RN, If Pediatric you have Nurse questions, Practitioner. the office There personnel have willbeen discuss many personalthe ______3. Jumps with both feet problemtouches with to you.tailor If the there booklet is an foremergency, our practice you especially will be put in through the areas of 4. Tries standing on one foot to theChild doctor Rearing, immediately. Breastfeeding, Otherwise, Dental either Care one and of Philosophy the office staff of Use of ______5. 3XVKHVWR\ZLWKJRRGVWHHULQJ Medications. This booklet gives the best advice we know of to help or the doctor will call you later in the day. The doctors review all ______6. +HOSVSXWWKLQJVDZD\ messages,in the health and although care and you rearing may ofnot your speak child. to one Your of them child directly is a gift from 7. Can carry breakable objects everyGod time to you.you call, Congratulations you will receive from information all of us! by well-trained ______8. Builds tower of eight cubes personnel who have discussed the problem with the physicians. 9. ______ +ROGVFUD\RQE\ILQJHUV When you call please have the following at hand: Identifies 5-7 pictures 1. Your child’s temperature ______11.Names objects (key, penny, watch) 2. Your pharmacy’s phone number 3. Your child’s weight ______Three Years 4. Pen and paper ______1. Names three or more objects in a picture If you are calling about over-the-counter medication dosages, please 2. 5HSHDWVVL[V\OODEOHV IRULQVWDQFH´,KDYHDOLWWOHGog”) be very specific about the medication you have as dosages vary ______3. 5HSHDWVWKUHHGLJLWV VHYHUDOWULDOV greatly between infant’s and children’s formulations. 4. Gives sex (“Are you a boy or a girl?”) ______5. Gives full name 2 4743

6 EighteenREFERENCES months INTRODUCTIONSIGNS OF ILLNESS TO OUR IN AN GROUP INFANT :DONVZLWKRXWIDOOLQJ OurParents pediatric often group feel seeks unsure to ifhelp their you infant provide could a goodbe developing and 1. First 5XQV VWLIIO\ Twelve Months of Life, Frank Caplan. This is an healthyan illness. childhood Here forare yoursome children. sings to lookOur forapproach when your is to babytreat isthe not excellent :DONVXSVWDLUVRQHKDQGKHOG pictorial and graphic book on your baby’s growth and wholeacting child: like physical, himself: spiritual, emotional and mental. )HYHUHTXDOWRRUJUHDWHUWKDQE\UHFWXP,I\RXUEDE\ development. &OLPEVLQWRFKDLU It makes growing up with baby a lot of fun. Our practice of pediatrics and adolescent medicine by LVOHVVWKDQZHHNVROGZLWKDIHYHURIRUKLJKHUFDOO :DONVEDFNZDUG definition includes newborns, infants, children and adolescents through age the 21. office Pediatricians or answering are trained service toimmediately. treat these age groups by 2. The Womanly3XOOVVWULQJWR\ Art of Breast Feeding, M.B. Carson. This +XUOVEDOO spending from 9RPLWLQJ QRWMXVWVSLWWLQJXS PRUHWKDQRQHIHHGLQJ three to four years beyond medical school in a is a good 7XUQVSDJHV reference book for those mothers who desire to learn pediatric residency. in a day. A pediatrician is a specialist in the diseases of more aboutEXLOGVWRZHURIFXEHV breast feeding. infants, children 'LDUUKHD²ORRVHZDWHU\VWRROVWKDWDUHPRUHIUHTXHQW and adolescents as well as their normal growth and 3XWVWHQFXEHVLQWRFXS development. than usual. 3. Dare 3RLQWVWRDQGQDPHVSLFWXUHVto Discipline, Dr. James Dobson. Dr. 5HIXVDOWRHDWIRUPRUHWKDQRQHIHHGLQJGHFUHDVHLQWKH Miller graduated from the Medical College of Georgia 3RLQWVWRLQGLFDWHZKDWKHZDQWV and then took VWURQJTXDOLW\RIWKHVXFNRUIDOOLQJDVOHHSLQWKHPLGGOHRI his pediatric training in Houston, Texas, at Hermann 4. Caring3RLQWVWRQRVHH\HVKDLU for Your Baby and Young Child, Birth to age 5, by Hospital andsuccessive M.D. Anderson feedings. Hospital in the Department of Stephen)HHGVVHOI ZLWKVSLOOLQJ Shelov, Boston Press. Pediatrics at /HWKDUJ\RUOLVWOHVVQHVVVXGGHQDQGSURORQJHGGHFUHDVHLQ the University of Texas Medical School at Houston. He &DUULHVRUKXJVDGROO was chief residentactivity. of pediatrics his last year there. 5. Shepherding7DNHVRIIVKRHVDQGVRFNV a Child’s Heart, Tedd Tripp. Shepherd Press, Dr. 8QXVXDOVNLQUDVK Moore graduated from the Medical College of Georgia 1-800-3386FULEEOHVVSRQWDQHRXVO\-1445. and received )DVWEUHDWKLQJ RYHUWLPHVSHUPLQXWH RUGLIILFXOW\ his pediatric training at the Fitzsimmons Army Medical Center in Denver.breathing. ,PLWDWHVYHUWLFDOVWURNHRQSDSHU 6D\VZRUGV Dr. &RQYXOVLRQV Newton graduated from the Medical College of Georgia 6. The Complete Book of Baby and Child Care by Focus on &DQVD\´KHOORµDQG´WKDQN\RXµ and continued 3HUVLVWHQWLUULWDELOLW\ his pediatric training at Vanderbilt University School the Family’sFDUULHVRXWWZRGLUHFWLRQV RQHDWDWLPH IRULQVWDQFH´JHW Physicians Resource Council, obtained at most of Medicine in Nashville, Tennessee. ChristianWKHEDOOIURPWKHWDEOHµ²´JLYHWKHEDOOWRPRPP\µ bookstores or by phoning Focus on the Family at MEDICALDr. Hanna EXPENSES graduated from the Medical College of Georgia 1-800-232-6459. and completedOur hispolicy pediatric is that training for scheduled at Brenner appointment Children’s visits Hospital including of Twenty-one months WakeDQQXDOFKHFNXSVURXWLQHQHZERUQFDUHDQGIROORZXSYLVLWVSD\PHQW Forest University Baptist Medical Center in Winston-Salem, 7. New -XPSVDQGUXQVZHOOMother’s Guide to Breastfeeding This is an excellent NorthLVH[SHFWHGDWWKHWLPHWKHVHUYLFHVDUHUHQGHUHG,WLVSUHIHUDEOHWKDW Carolina. source of:DONVGRZQVWDLUVRQHKDQGKHOG breastfeeding information published by the American sick visitsDr. Threadgill and emergency graduated visits from be paid the Medicalfor at the College time services of Georgia are Academy 6TXDWVZKLOHSOD\LQJ of Pediatrics. andUHQGHUHGEXWZHXQGHUVWDQGWKDWWKLVPD\QRWDOZD\VEHSRVVLEO continued there to complete his pediatric training. H .LFNVODUJHEDOO ZKHQGHPRQVWUDWHG &KDUJHVIRUDOOVHUYLFHVZLOOEHIUHHO\GLVFXVVHGZLWK\RXDr. Leverett received her M.D. from the Medical University of

%XLOGVWRZHURIILYHWRVL[FXEHV South CarolinaHospitalization and continued insurance there to is complete very important her pediatric for your residency. baby The Augusta 8VHVVSRRQZHOO Pediatric Associates, P.C. website: DQG\RXUIDPLO\,I\RXKDYHQRWQRWLILHG\RXULQVXUDQFHFRPSDQ\RIDr. Drake graduated from the Medical College of Georgia WKHEDE\·VELUWKSOHDVHGRVRDWWKLVWLPH,I\RXKDYHQRLQVXUDQFH www.augustapediatrics.com 3RXUVZDWHUIURPRQHFXSLQWRDQRWKHU and completed her pediatric training at Cincinnati Children’s 3XOOVSHUVRQWRVKRZVRPHWKLQJ Medicalplease Center do all inyou Cincinnati, can to obtain Ohio. some now. The American )ROGVSDSHURQFHZKHQVKRZQ Academy of Pediatrics website: www.aap.org Dr. Massey graduated from the Medical University of South 7DNHVWKUHHGLUHFWLRQV RQHDWDWLPH IRULQVWDQFH´WDNHEDOO Carolina in Charleston and continued there for her pediatric training www.healthychildren.orgIURPWDEOHµ²´JLYHWKHEDOOWRPRPP\µ²´SXWEDOORQIORRUµ from the American Academy of as well. Pediatrics6SHDNVZRUGV is a good resource. Their Symptom Checker can be Dr. Lazari graduated from the Medical College of Georgia in &RPELQHVWZRWRWKUHHZRUGV accessed from there and is very useful. 2012, and completed his pediatric residency at the Children's Hospital $VNVIRUIRRGGULQN of Georgia serving as chief resident his last year there. (FKRHVWZRRUPRUHZRUGV Focus on the family website: www.focusonthefamily.com

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7 ROUTINEDr. LaneCARE graduated from the Medical College of Georgia FiveOne yearsyear and receivedA safeguard his training to see in that pediatrics your child at the is growing Children' and s Hospital developing of 1. CopiesWalks whena square lead normallyGeorgia in is Augusta.accomplished by routine check-ups. These are 2. KnowsStand alone age (“how (or with old support) are you?”) recommended at the following ages: 3. PerformsCreeps on three hands tasks and (with knees one command); for instance: “Put 2 weeks 12 months pen on table – close door – bring me the ball.” All of our physicians are certified by the American Board of 4. Grasps two cubes in one hand 2 months 15 months 4. Knows four colors Pediatrics. 5. Holds cup to drink 4 months 18 months 5. Defines use for: “fork – horse – key – pencil, etc.” All of our physicians are on staff at University Hospital and 6. Gives toy on request 6 months 24 months 6. Skips, using feet alternately Doctor’s Hospital. 7. Cooperates with dressing 9 months 7.8. StandsPlays with on one cup, foot spoon, for seven saucers to eight seconds At age two a physical examination is recommended annually. 8.9. DrawsPoints withman indexwith at finger least six parts ; (for instance: head, arms, 10.legs,Pokes eyes, finger etc.) (into stethoscope) to explore IMMUNIZATIONS 9.11. CountsSecures twelvesmall objectobjects (raisin) correctly with pincer grasp Over the next few months, your baby will have a series of 10.12. CountsReleases number to into ofyour fingers hand correctly shots for protection from certain life threatening diseases. It is very 11.13. NamesTries to nickel, take cube dime, out penny of a box important for you to keep up with your child’s immunizations in 12.14. DressesUnwraps self a cubewithout assistance order to protect him from serious infectious diseases. The Center for 13.15. PrintsHolds fewcrayon letters Disease Control recommended schedule is the most effective way to 14.16. CommentsTries to imitate on pictures scribble protect your baby from these serious and potentially fatal diseases. 15.17. AsksReacts meanings to music of words 16.18. CanSays pronouncethree words correctly; “T –D –N –G –K –Y.” These immunizations are safe and effective. We strongly 17.19. BuildsBabbles six to block self when pyramid alone recommend them to you. The following are the currently 18.20. KnowsUnderstands days of simple week commands recommended immunizations: 19. Transports things in a wagon '7D3SURWHFWVDJDLQVW'LSKWKHULD3HUWXVVLV Fifteen20. Playsmonths with coloring set, construction toys, puzzles, jump rope, (whooping cough) and Tetanus (lock jaw). 1. skatesStand alone 7GDSLVXVHGLQFKLOGUHQZKRDUHROGHUDQGSURWHFWVDJDLQVW 21.2. ParticipatesCreeps upstairs well in group play 3HUWXVVLV7HWDQXVDQG'LSKWKHULD 3. Walks few steps – starts and stops ,39SURWHFWVDJDLQVWSROLR 4. Gets off floor and walks alone 5RWDYLUXVYDFFLQHSURWHFWV\RXUEDE\DJDLQVWRQHRIWKH 5. Uses spoon but spills common causes of vomiting and diarrhea causing 6. Tilts cup to drink

dehydration. 7. Puts pellet in bottle 005SURWHFWVDJDLQVW0HDVOHV0XPSVDQG5XEHOOD 8. Builds tower of two cubes +LEYDFFLQH KDHPRSKLOXVLQIOXHQ]DW\SHE SURWHFWVDJDLQVW 9. Drops cube into cup a certain type of bacteria that can cause meningitis, 10.Helps turn page in book, pats picture epiglottitis and pneumonia. 11.Helps pull off clothes +%9 KHSDWLWLV%YDFFLQH SURWHFWVDJDLQVWDW\SHRIYLUDO 12. Indicates wants by pointing hepatitis (liver infection). 13.Shows or offers toy 7KH9DULFHOODYDFFLQH 99 SURWHFWV\RXUEDE\DJDLQVW 14.Imitates scribble chicken pox 15.Speaks four to six words, uses jargon

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8 17.6. VocalizesKnows a fewat mirror rhymes image OFFICE 3UHYQDU 3&9 SURWHFWVDJDLQVWSQHXPRFRFFXVZKLFKPD\ HOURS and EMERGENCY COVERAGE 18. Localizes*LYHVDSSURSULDWHDQVZHUVWR´:KDWVZLPV²IOLHV²VKRRWV² source of sound (bell, voice) Routine FDXVHSQHXPRQLDDQGPHQLQJLWLV,WPD\DOVRSURYLGHVRPH office hours are Monday through Friday 9AM-5PM. 19. LaughsERLOV²ELWHV²PHOWV"µ out loud We have SURWHFWLRQDJDLQVWHDULQIHFWLRQV emergency hours most Saturdays 10AM-12PM and most 8. &RPSUHKHQGVFRQFHSWVVXFKDV´FROGµ´WLUHGµ´KXQJU\µ Sundays +HSDWLWLV$YDFFLQH +$9 SURWHFWVDJDLQVWDW\SHRIYLUDO 2PM-4PM. Eight9. months8QGHUVWDQGVWDNLQJWXUQV Our KHSDWLWLV OLYHULQIHFWLRQ physicians are in a pediatric call group which provides 1. Sits&RSLHVDFLUFOH alone seven days 0HQDFWUD 0&9 SURWHFWVDJDLQVWEDFWHULDOPHQLQJLWLVDQ per week coverage in the office including Saturdays and 2. Early&DQSXWRQVKRHV stepping movements Sundays. LQIHFWLRQLQWKHIOXLGDURXQGWKHEUDLQ We also provide 24 hour per day coverage for emergencies. 3. TriesAlternates to crawl feet going upstairs We or +39SURWHFWVDJDLQVWKXPDQSDSLOORPDYLUXVDVH[XDOO\the doctor on call for our group may be reached by calling 4. LeansJumps forwardfrom bottom to get stair an object the office WUDQVPLWWHGGLVHDVHWKDWFDXVHVFHUYLFDOFDQFHUDQGJHQLWDOZDUWV at 706-868-0389. If your child is seen urgently or in an 5. Works5LGHVDWULF\FOH to get toy out of reach • Meningoccal B vaccine protects against a specific bacterial 6. ScoopsStands onpellet one foot for a moment type of meningitis (serogroup B). 7. RingsPuts ten bell pellets purposively into bottle in thirty seconds emergency0RVWRIWKHLPPXQL]DWLRQVFDXVHYHU\IHZVLGHHIIHFWV:HGRQRW by a physician outside of our group, please give us a call 8. Drinks)HHGVVHOIZLWKOLWWOHVSLOOV from cup theQRUPDOO\UHFRPPHQGJLYLQJ7\OHQROIRUDQ\RIWKHLPPXQL]DWLRQV next morning and let us know how your child is doing. 9. LooksPours fromfor fallen a pitcher object XQOHVV\RXUEDE\VHHPVIXVVLHUWKDQXVXDOIROORZLQJWKHVKRWVIt is important to remember that although your doctor or one 10. Bites&DQXQGRWZREXWWRQV and chews toys of

18. Shouts for attention

19. Vocalizes “mama”, “dada”

20. Responds to name

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9 IMMUNIZATIONEMERGENCIES SCHEDULE Two7. years Held erect; pushes feet against table BelowFor true is emergencies,the usual immunization please call theschedule. office orThere the answeringare 1.8. Says Grasps simple rattle phrases severalservice, combination and we will giveinjections you an available answer immediatelythat may be usedconcerning to 2.9. Uses Plays “I”, with “me”, own fingers“you” reducewhere tothe go number and what of injectionsto do. If there required is no to time administer to call, youthe neededshould 3.10. 5HSHDWVWZRGLJLWV DIWHUIHZWULDOV Reaches for object in front of him with both hands immunizations.bring your child to the office or take him to the nearest emergency 4.11. Distinguishes Transfers objects “in” from and hand“under” to hand room. During times in which the office is closed, you should take 5.12. 5HIHUVWRVHOIE\QDPH Pulls dress over face yourBirth-2 child weeks…………………………………HBVto the nearest emergency room. The emergency room at 6.13. Knows Smiles atfour people body parts the2 Children’s months……………………………………….DTaP, Medical Center at the Medical College of Hib, Georgia IPV, is HBV, 7. Asks for things at table by name preferred in the event that an emergency room PCV-13, visit is necessary. Rotavirus Five8. months 3RLQWVWRSLFWXUHV 4 months……………………………………….One of the most common calls we receive DTaP, is in regard Hib, IPV,to HBV, 9.1. Builds Moro reflex5-6 cube gone tower fever management. (See section on fever) We usuallyPCV-13, recommend Rotavirus 2.Cuts Rolls with supine scissors (back to front) acetaminophen6 months………………………………………. or ibuprofen (if greater than 6 months DTaP, old) Hib, for IPV, HBV, 11.3.5HPRYHVZUDSSLQJIURPFDQG\ Rolls side to side fever management, and as long as fever can be PCV-13, controlled Rotavirus using the 12.4.Claps No head hands lag when held by hands and pulled to sitting recommended12 months…………………………………… dosage and as long as your child...MMR, feels better VV, once HAV the 13.5XQVZLWKRXWIDOOLQJposition medication15 months…………………………………… is given it is fine to wait until morning...Hib, to call PCV-13 the office 14.5.Goes Full head up and control down when stairs sitting alone for18 an months………………………………………DTaP, appointment to be seen. However, if your child is lessHAV than six 15.6.Kicks Grasps large dangling ball object weeks4 years…………………………………………..DTaP, old and has a rectal temperature equal to or greater IPV, than MMR, 100.4 VV 16.7.Imitates Reaches circularfor toy with strokes both hands or less11-12 than years………………………………… 2 years old with a fever of 104 or ....TdaP,greater, you MCV-4, should HPV 17.8.3XOOVRQVLPSOHJDUPHQW Scratches on table top 16 years...... Menactra (MCV-4) 18.9.Opens Pushes door chest off table when prone 17 years...... Meningitis B 19.10.turns Smiles pages at mirror in book, image singly call immediately no matter what the time. Other illnesses should be 11.Throws Jabbers, ballsqueals into witha box high voice PHILOSOPHYassessed by the parent OF USE on anOF individual MEDICATIONS basis using your own good 12. Regards toy in hand judgment.Medications Do not hesitate are useful to call in inthe the treatment case of anof anemergency illness when or if Two13. and Recognizes One Half familiarYears voices theyyou areare unsureused specifically about how and to carewith for an youreye toward child. the benefit versus 1. 5HIHUVWRVHOIE\SURQRXQ UDWKHUWKDQQDPH the risk of that particular medication. Viruses, such as the common Six 2.months Walks on tiptoes coldPHONE or vomiting CALLS and DURING diarrhea, OFFICE are not affectedHOURS by antibiotics and, 3.1. Jumps Supine; with lifts bothhead feet spontaneously therefore,Phone if your calls child for hasappointments what is presumed can be madeto be aduring viral infection,office 4.2. Tries Bounces standing on feet on when one footheld standing therehours. will If yoube no have antibiotics questions, prescribed. the office We personnel would askwill that discuss you thenever 5.3. 3XVKHVWR\ZLWKJRRGVWHHULQJ Sits briefly (tripod fashion) beginproblem your with child you. on If antibiotics there is an until emergency, you have you spoken will bewith put or through have 6.4. +HOSVSXWWKLQJVDZD\ Rolls front to back (6-7 months) beento the seen doctor by ourimmediately. staff. If your Otherwise, child is diagnosedeither one withof the a officebacterial staff 7.5. Can Grasps carry foot breakable objects infectionor the doctor and willis given call anyou antibiotic, later in the take day. it Theexactly doctors as directed review and all 8.6. Builds Grasps tower cube withof eight palm cubes bemessages, sure to completeand although the full you course may not prescribed. speak to Coughone of themand cold directly 9.7. +ROGVFUD\RQE\ILQJHUV Holds one cube in each hand medicationsevery time you are call, not yourecommended. will receive information by well-trained 8.Identifies Puts cube 5-7in mouth pictures personnel who have discussed the problem with the physicians. 11.9.Names Re-secures objects dropped (key, cubepenny, watch) When you call please have the following at hand: 10. Transfers cube from hand to hand 1. Your child’s temperature Three11. Years Shakes rattle 2. Your pharmacy’s phone number 1.12. Names Bangs spoon three oron more table objects in a picture 3. Your child’s weight 2.13. 5HSHDWVVL[V\OODEOHV IRULQVWDQFH´,KDYHDOLWWOHG Turns head to bell og”) 4. Pen and paper 3.14. 5HSHDWVWKUHHGLJLWV VHYHUDOWULDOV Conscious of strange sights and persons Ifgreatly you arebetween calling infant’s about over-the-counterand children’s formulations. medication dosages, please 4.15. Gives Consistent sex (“Are regard you of objecta boy orand a girl?”)person be very specific about the medication you have as dosages vary 5.16. Gives Makes full four name different sounds 4339

10 TwoEighteen months months SIGNS OF ILLNESS IN AN INFANT 1. Kicks:DONVZLWKRXWIDOOLQJ vigorously BRINGINGParents often feel BABY unsure if their HOME infant could be developing 2. Energetic5XQV VWLIIO\ arm movements an illness. Here are some sings to look for when your baby is not 3. Vigorous:DONVXSVWDLUVRQHKDQGKHOG head turning acting like himself: 4. Ventral&OLPEVLQWRFKDLU suspension (prone); no head drop PREPARATIONS )HYHUHTXDOWRRUJUHDWHUWKDQE\UHFWXP,I\RXUEDE\ FOR BABY 5. Held:DONVEDFNZDUG in sitting position; head erect but bobs Going LVOHVVWKDQZHHNVROGZLWKDIHYHURIRUKLJKHUFDOO to the baby store can be an overwhelming, not to mention 6. Hand3XOOVVWULQJWR\ goes to mouth expensive, the experience.office or answering Here are service some immediately.practical guidelines as to what 7. Hands+XUOVEDOO often open (not clenched) you may 9RPLWLQJ QRWMXVWVSLWWLQJXS PRUHWKDQRQHIHHGLQJ need for your newest family member. 8. Head7XUQVSDJHV and eyes turn toward sound in a day. 9. ListensEXLOGVWRZHURIFXEHV to bell ringing CAR SEAT 'LDUUKHD²ORRVHZDWHU\VWRROVWKDWDUHPRUHIUHTXHQW 10. Cooing3XWVWHQFXEHVLQWRFXS Every than baby usual. must go home in an appropriately sized and tightly 11. Smiles3RLQWVWRDQGQDPHVSLFWXUHV back when talked to installed 5HIXVDOWRHDWIRUPRUHWKDQRQHIHHGLQJGHFUHDVHLQWKH rear facing car seat. The safest place for your baby is in the 12. Follows3RLQWVWRLQGLFDWHZKDWKHZDQWV object past midline center of VWURQJTXDOLW\RIWKHVXFNRUIDOOLQJDVOHHSLQWKHPLGGOHRI the back seat. If this is not possible as some cars do not 13. Alert3RLQWVWRQRVHH\HVKDLU expression have enoughsuccessive room feedings. in the center, the back side is the next alternative. )HHGVVHOI ZLWKVSLOOLQJ Never put /HWKDUJ\RUOLVWOHVVQHVVVXGGHQDQGSURORQJHGGHFUHDVHLQ a rear facing seat in the front seat of a car or truck with a Three months&DUULHVRUKXJVDGROO passengeractivity. side air bag. Car seats involved in a major motor vehicle 1. Lying7DNHVRIIVKRHVDQGVRFNV prone; holds head up 90 degrees collision 8QXVXDOVNLQUDVK should be replaced due to the possibility of unseen damage 2. Lifts6FULEEOHVVSRQWDQHRXVO\ head when lying on back (supine) or stress )DVWEUHDWKLQJ RYHUWLPHVSHUPLQXWH RUGLIILFXOW\ that may not withhold another collision. For this reason, 3. Hold,PLWDWHVYHUWLFDOVWURNHRQSDSHU hands together you shouldbreathing. not purchase a used car seat as you do not know if it is 4. Sucks6D\VZRUGV fingers, inspects fingers safe. &RQYXOVLRQV 5. Reaches&DQVD\´KHOORµDQG´WKDQN\RXµ for but misses objects 3HUVLVWHQWLUULWDELOLW\It is very difficult to properly install car seats—80% are 6. HoldsFDUULHVRXWWZRGLUHFWLRQV RQHDWDWLPH IRULQVWDQFH´JHW toy with active grasp when put into hand installed incorrectly. Follow all instructions. If you would like to 7. PullsWKHEDOOIURPWKHWDEOHµ²´JLYHWKHEDOOWRPRPP\µ at his clothes MEDICALhave your installation EXPENSES checked, which we would recommend, call 8. Rolls side to back 1-866 SEAT-CHECKOur policy is that or visitfor scheduled www.seatcheck.org. appointment visits including Twenty-one9. Rolls monthsobject (toy) side to side (and 180 degrees) DQQXDOFKHFNXSVURXWLQHQHZERUQFDUHDQGIROORZXSYLVLWVSD\PHQW 10. Looks-XPSVDQGUXQVZHOO predominantly at examiner LVH[SHFWHGDWWKHWLPHWKHVHUYLFHVDUHUHQGHUHG,WLVSUHIHUDEOHWKDWBEDDING 11. Glances:DONVGRZQVWDLUVRQHKDQGKHOG at toy when put into hand sickThe visits bed and should emergency have a visitsfirm mattress—abe paid for at baby the timedoes servicesnot care arehow 12. Recognizes6TXDWVZKLOHSOD\LQJ mother and bottle UHQGHUHGEXWZHXQGHUVWDQGWKDWWKLVPD\QRWDOZD\VEHSRVVLEOfancy it looks or how much it costs. It may be a crib or a bassinet.H If 13. Smiles.LFNVODUJHEDOO ZKHQGHPRQVWUDWHG spontaneously &KDUJHVIRUDOOVHUYLFHVZLOOEHIUHHO\GLVFXVVHGZLWK\RXyou choose a crib, be sure that the rails are close enough together that 14. Cooing,%XLOGVWRZHURIILYHWRVL[FXEHV chuckling, squealing, grunting, especially when the baby’sHospitalization head will not insurance get caught is (3-3 very 1/2 important inches). for There your should baby be talked8VHVVSRRQZHOO to DQG\RXUIDPLO\,I\RXKDYHQRWQRWLILHG\RXULQVXUDQFHFRPSDQ\RIsides around the mattress to keep him from falling off. Be sure that 15. Moro3RXUVZDWHUIURPRQHFXSLQWRDQRWKHU reflex begins to disappear WKHEDE\·VELUWKSOHDVHGRVRDWWKLVWLPH,I\RXKDYHQRLQVXUDQFHthe mattress fits snuggly inside so he will not slip between the 16. Grasp3XOOVSHUVRQWRVKRZVRPHWKLQJ reflex nearly gone pleasemattress do and all youthe sidecan toof obtainthe crib. some now. )ROGVSDSHURQFHZKHQVKRZQ Pillows and other fluffy bedding such as comforters and stuffed Four months7DNHVWKUHHGLUHFWLRQV RQHDWDWLPH IRULQVWDQFH´WDNHED OO animals should not be left in the crib. 1. SitsIURPWDEOHµ²´JLYHWKHEDOOWRPRPP\µ²´SXWEDOORQIORRUµ when well supported 2. No6SHDNVZRUGV head lag when pulled to sitting position 3.Turns&RPELQHVWZRWRWKUHHZRUGV head at sound of voice 4. Lifts$VNVIRUIRRGGULQN head (in supine position) in effort to sit 5. Supports(FKRHVWZRRUPRUHZRUGV weight on forearms when prone 6. Lifts head and chest when prone 3842

11 ROUTINE CARE OneNo one year cause has been found, but several associations have been NEWBORNA safeguard DISCHARGE to see that DAY your INSTRUCTIONS child is growing and developing made1. andWalks you whencan decrease lead the chance of SIDS by normally is accomplished by routine check-ups. These are •always2. Stand put your alone baby (or to with sleep support) on his or her back-this one recommended 1) Feedings at the following ages: intervention3. Creeps has on the hands most and dramatic knees effect You should nurse your baby at least eight times per 24 •do 4.not Graspssmoke two cubes in one hand hours (about every three hours on average). You may find your •do 5.not Holdsplace thecup baby’s to drink crib near air vents or drafts baby wanting to feed every two hours occasionally. Do not let •do 6.not Givesput soft toy bedding on request (pillow or comforter, etc) or stuffed animals your baby go beyond 5 hours even at night without feeding for the in your7. Cooperatesbaby’s crib with dressing first two weeks. For additional information see page 19. •use8. a firmPlays mattress with cup, in the spoon, crib saucers 9. Points with index finger Your baby should have 5 to 6 wet diapers per day and at 10. Pokes finger (into stethoscope) to explore least 2 to 4 stools per day; this will tell you your baby is getting 11.Again,Secures we small are delighted object (raisin) to walk with with pincer you graspthrough this exciting plenty of fluid and calories. Stools will begin to lighten in color stage12. ofReleases your lives. to intoWe yourare here hand to help you in any way we can. and should be yellow by day four. Please13. don’tTries everto take hesitate cube toout ask of anya box question or voice any concern. 3HUWXVVLV7HWDQXVDQG'LSKWKHULD We 14.wantUnwraps you to be a cubea confident parent and to know we are always here15. whenHolds you crayon need us. Congratulations… now the fun begins…….! 2) ,39SURWHFWVDJDLQVWSROLR Your baby should always sleep on his back. 16.Tries to imitate scribble 5RWDYLUXVYDFFLQHSURWHFWV\RXUEDE\DJDLQVWRQHRIWKH 17.Reacts to music 3) Ifcommon your baby causes looks of increasingly vomiting and yellow diarrhea or golden causing after you go NORMAL18.Says DEVELOPMENT three words OF CHILDREN homedehydration. please call us so that we may check a bilirubin. 19.EachBabbles child to is self different when aloneand special in his or her own way. You 005SURWHFWVDJDLQVW0HDVOHV0XPSVDQG5XEHOOD will 20.findUnderstands unique traits simple for each commands of your children. There are, however, 4) The umbilical stump should be allowed to dry. Make sure that developmental milestones that most children follow. Some may your baby’s diaper is folded down so it does not irritate the cord or vary, but this list provides estimates of changes and developments allow the cord to get wet with urine. The cord usually separates at Fifteen months you1. will Stand likely alone see. You can use these to prepare for the next phase of approximately 10 to 14 days. After it has fallen off and is well your2. adventure Creeps upstairs with your child. healed for two days you may tub bathe. 3. Walks few steps – starts and stops Birth-One4. Gets month off floor and walks alone 5.1. Uses Moro spoon reflex but(spontaneous spills startle with arms out quickly & in 6. Tiltsslowly cup to tomidline) drink present 7.2. Puts Vigorous pellet sucking in bottle reflex present 8.3. Builds Lying pronetower (faceof two down); cubes lifts head briefly 9.4. Drops Lying prone;cube into makes cup crawling movements with legs 10.5.Helps Held in turn sitting page position; in book, back pats ispicture rounded, head held up 11.Helpsmomentarily pull off clothes 12.6. HandsIndicates tightly wants fisted by pointing 13.7.Shows Reflex graspor offers of objecttoy with palm 14.8.Imitates Startled byscribble sound; quieted by voice 15.9.Speaks Ringing four bell toproduces six words, decrease uses jargon of activity 10. May follow object with eyes to midline

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12 •Buy17. a safety Vocalizes tested at carmirror seat. image Your baby is safest in the Children 5) 3UHYQDU 3&9 SURWHFWVDJDLQVWSQHXPRFRFFXVZKLFKPD\ Circumcision care – Your son’s circumcision should be should18. face Localizes the rear source of the of vehicle sound until(bell, theyvoice) are at least 1 year of age FDXVHSQHXPRQLDDQGPHQLQJLWLV,WPD\DOVRSURYLGHVRPHcleansed with water using a cotton ball or wash cloth to drip and 19.weigh Laughs at least out 20 loud lb to decrease the risk of cervical spine injury in SURWHFWLRQDJDLQVWHDULQIHFWLRQVwater over it. Be sure to apply A & D ointment or Vaseline the event of a crash. Infants who weigh 20 lb before 1 year of age +HSDWLWLV$YDFFLQH +$9 SURWHFWVDJDLQVWDW\SHRIYLUDOto the circumcision site to prevent irritation from the diaper. shouldEight months ride rear facing in a convertible seat or infant seat approved KHSDWLWLV OLYHULQIHFWLRQ This will heal within several days. for higher1. Sits weights alone until at least 1 year of age. If a car safety seat 0HQDFWUD 0&9 SURWHFWVDJDLQVWEDFWHULDOPHQLQJLWLVDQ accommodates2. Early stepping children movements rear facing to higher weights, for optimal 6) LQIHFWLRQLQWKHIOXLGDURXQGWKHEUDLQPlease call the office to schedule a 2-3 day weight check and a protection,3. Tries the to child crawl should remain rear facing until reaching the +39SURWHFWVDJDLQVWKXPDQSDSLOORPDYLUXVDVH[XDOO\2 week check-up. maximum4. Leans weight forward for the to carget safetyan object seat, as long as the top of the head WUDQVPLWWHGGLVHDVHWKDWFDXVHVFHUYLFDOFDQFHUDQGJHQLWDOZDUWV is below5. Works the top to of get the toy seat out back. of reach Studies show that children are safest 0RVWRIWKHLPPXQL]DWLRQVFDXVHYHU\IHZVLGHHIIHFWV:HGRQRW by far6. in Scoops a rear facingpellet car seat until age 2 years. From that point, your QRUPDOO\UHFRPPHQGJLYLQJ7\OHQROIRUDQ\RIWKHLPPXQL]DWLRQV child7. should Rings ride bell in purposively a forward facing car seat and progress to a XQOHVV\RXUEDE\VHHPVIXVVLHUWKDQXVXDOIROORZLQJWKHVKRWV booster.8. Drinks Only whenfrom cupyour child is at least 4’ 9” inches tall and able to

13 IMMUNIZATION SCHEDULE POISONING7. Held erect; OR ACCIDENTALpushes feet against INGESTION table HOMECOMINGBelow is the usual immunization schedule. There are 8. GraspsFrom the rattle time your child begins to crawl until several years Bringing your new baby home is an exciting and sometimes several combination injections available that may be used to thereafter,9. Plays he withor she own will fingers be at high risk for ingesting some form of overwhelming time. Following are some practical suggestions to reduce the number of injections required to administer the needed poison10. or Reaches plant. forThere object are intwo front things of him that with you bothcan do hands to make this help in this time of transition. immunizations. less 11.possible Transfers or, at objects least, to from minimize hand to the hand effects.

12. PullsThe first,dress and over most face important thing, is to keep all NURSERY Birth-2 weeks…………………………………HBV medications,13. Smiles chemicals at people (such as paints, varnishes, cleaning material, Your baby should come home from the hospital to a room of 2 months……………………………………….DTaP, Hib, IPV, HBV, furniture polish, etc.), and poisonous plants out of your child’s reach. his own if possible. This room should be clean, well aired, not drafty PCV-13, Rotavirus These items should be stored in a place which is high above your and about 70-75 degrees. Five months 4 months………………………………………. DTaP, Hib, IPV, HBV, child’s1. reach Moro or reflex behind gone locked doors or child-proof cabinet doors. PCV-13, Rotavirus Remember,2. Rolls this supine applies (back to tograndparents front) and other homes frequently VISITORS6 months………………………………………. DTaP, Hib, IPV, HBV, visited.3. Rolls side to side Visitors and the number of people holding the baby should be PCV-13, Rotavirus 4. NoThe head second lag item when of held importance by hands is and that pulled you should to sitting have the limited during the first week. This is the best way to protect your 12 months……………………………………...MMR, VV, HAV phone numberposition of the Augusta Poison Control Center taped on your baby from contagious diseases. Friends can look but not touch. 15 months……………………………………...Hib, PCV-13 telephone.5. Full If head your control child ingests when sittinga chemical, medication or plant, call 18 months………………………………………DTaP, HAV immediately6. Grasps for dangling advice. objectThe Poison Control Center is part of a SLEEPING4 years…………………………………………..DTaP, POSITION IPV, MMR, VV national7. Reaches network for of toyPoison with Control both hands Centers and will have the best Your newborn baby should be placed on his back to go to 11-12 years…………………………………....TdaP, MCV-4, HPV information8. Scratches available on table to you. top The number is 1-800-222-1222. sleep. NEVER put your baby on his stomach to go to sleep. Back 9. PushesIn the past, chest Syrup off table of Ipecac when pronewas recommended in order to sleeping is the best and safest, significantly reducing the risk of SIDS. PHILOSOPHY OF USE OF MEDICATIONS induce10. vomiting Smiles at inmirror the case image of an ingestion. Currently, this is NOT As your baby gets older and develops better head control, time on their Medications are useful in the treatment of an illness when recommended11. Jabbers, and squeals should with not high be given voice as some substances can be stomach while awake is a good idea because this will help prevent they are used specifically and with an eye toward the benefit versus harmful12. Regards when vomited toy in hand and it may interfere with other needed flattening of the back of the head and encourage development and the risk of that particular medication. Viruses, such as the common treatments.13. Recognizes Therefore, familiar if you voices have a supply, you should discard it. strength. cold or vomiting and diarrhea, are not affected by antibiotics and, therefore, if your child has what is presumed to be a viral infection, SixSAFETY months DRESSINGthere will be noYOUR antibiotics BABY prescribed. We would ask that you never 1.A Supine; major cause lifts head of death spontaneously in young children and babies is begin yourYou child should on antibioticsdress your babyuntil youas you have dress spoken yourself. with orLayer have the accidents.2. Bounces Here areon feetsome when common held standingareas that need to be baby’sbeen seen clothes by our in coolstaff. weather If your childand do is notdiagnosed overdress with the a bacterialbaby in hot addressed3. Sits to briefly make (tripodyour home fashion) safe for your children. weather.infection andKeeping is given him an too antibiotic, warm can take be itas exactly harmful as asdirected letting andhim be 4. Rolls front to back (6-7 months) toobe sure cold. to complete the full course prescribed. Cough and cold •Be 5.sure Grasps that the foot rails on the baby’s crib are close enough together (3- medicationsBuy flameare not retardant recommended. items that are easy to launder. Wash 3 1/26. inches) Grasps so cube that withthe baby’s palm head and body can’t slip or get stuck. items before the baby wears them. Remember that babies grow •Always7. Holds keep theone sidecube rail in eachup on hand his crib and never leave him alone quickly, so buy items big enough to last a while. on a8. table Puts top, cube bed in or mouth chair to prevent falls. Always keep at least one hand9. on Re-secures your baby droppedwhile changing cube him; do not take your eyes off of SCHEDULE him.10. Babies Transfers roll orcube flip from suddenly. hand to hand During the first several weeks, your baby will sleep the •Check11. Shakeshis bath rattle water to make sure it will not scald him and always majority of the time. Awake times will consist of eating, periods of hold12. him Bangs while spoon bathing on him.table You should set your hot water heater quiet wakefulness and periods of crying. Each baby is different and less 13.than Turns 120 degrees head to Fahrenheit. bell you will quickly get to know your baby and his or her schedule. You •Be 14.alert Consc to anyious windows of strange through sights which and persons or stairs down which your can work with your baby over time to develop a schedule that is baby15. could Consistent fall. Use regard appropriate of object safeguards—childproof and person gates or acceptable to the entire family. window16. Makes guards. four different sounds 3935

14 FEARTwo months OF FEVER 1.Many Kicks vigorouslypeople are frightened by high fevers in children. In BRINGINGWHAT A CUTIE! BABY HOME general,2. Energeticthe height arm of the movements fever does not reflect seriousness of diseases.3. Vigorous Many times head viralturning infections will cause much higher fever Every baby is beautiful and you will want to admire every aspect of than4. more Ventral severe suspension bacterial infections.(prone); no Children head drop typically run much PREPARATIONSthis new creation. Here FOR are BABY some normal things you may notice higher5. fevers Held inthan sitting adults. position; The two head things erect which but bobs most people are aboutGoing your to new the babybaby. store can be an overwhelming, not to mention concerned6. Hand about goes with to mouthhigh fevers are: expensive, experience. Here are some practical guidelines as to what • 7.seizures Hands often open (not clenched) youHEAD may need for your newest family member. • 8.brain Head damage and eyes turn toward sound The head may appear large in relation to the rest of the body. 9.Approximately Listens to bell ringing four percent of children have seizures CARIt may SEAT also have a peculiar shape right after birth. This is called resulting10. Cooing from fevers - called febrile seizures. Seeing your child have a moldingEvery andbaby is must due to go the home skull in bones an appropriately overlapping sized as the and baby tightly passes seizure-even11. Smiles a shortback whenone-is talkedof course to a scary experience. However, installedthrough therear birth facing canal. car seat. This Theshould safest return place to fornormal your inbaby a few is in days. the these12. types Follows of seizures object arepast usually midline not harmful and do not lead to centerYou may of the also back be able seat. to If feel this the is notsutures-the possible place as some where cars one do bonenot future13. epilepsy. Alert expression They are not preventable. havemeets enough the next-as room a inraised the center,area on the the back head. side is the next alternative. Fever does not cause brain damage until it gets up to at least Never putThe a rearsoft spotfacing (fontanelle) seat in the on front the seattop of thea car baby’s or truck head with is a a 107Three or months108. Many children typically run 104 to 105 fever with passengerplace where side the air bones bag. have Car seatsnot yet involved come together. in a major It motor is natural vehicle for routine1. viral Lying infections. prone; holds Acetaminophen head up 90 degrees usually will not lower the collisionthe soft spot should to move be replaced up and due down to thein rhythm possibility with of the unseen heart damage beat or fever2. to Liftsa normal head temperature when lying onrange back but (supine) should lower it to a 102-103 orbreathing. stress that This may will not decrease withhold in another size and collision. disappear For by aboutthis reason, 12-18 range.3. Hold hands together youmonths. should not purchase a used car seat as you do not know if it is 4.The Sucks main fingers, key toinspects a child’s fingers fever is really how the child behaves safe. and 5.acts. Reaches Usually for fever but itselfmisses makes objects a child feel bad. If the fever EYES It is very difficult to properly install car seats—80% are comes6. down Holds and toy the with child active seems grasp to whenperk up, put then into youhand can usually be installedBabies incorrectly. are occasionally Follow all cross-eyed. instructions. Eye If youbalance would is poor like to assured7. Pullsthat there at his is clothes nothing seriously wrong with your child. haveduring your the installationfirst few months checked, of life which so do we not would worry recommend, if your baby call However,8. Rolls if your side childto back becomes more and more lethargic or irritable, 1-866sometimes SEAT-CHECK looks at you or cross-eyed. visit wwwseatcheck.org. If this continues past the third then9. you Rolls should object call (toy) immediately. side to side If (andthe child 180 degrees)is given month of life or is persistent ask your doctor about it. acetaminophen10. Looks predominantly and the temperature at examiner does not come down to the 102- BEDDINGThe color of the baby’s eyes can change up to 6 months of 103 11.range Glances after 30 at minutes,toy when then put youinto shouldhand place him in lukewarm age.The bed should have a firm mattress—a baby does not care how water12. in Recognizes the bathtub. mother He should and bottle soak in the lukewarm water for fancy it looks or how much it costs. It may be a crib or a bassinet. If approximately13. Smiles spontaneouslyten to fifteen minutes and you should sponge him youSKIN choose a crib, be sure that the rails are close enough together that from14. the Cooing, head down chuckling, during squealing,that time. grunting, Do not place especially him in when cold the baby’sThe head skin will may not vary get in caught color (3-3from 1/2 light inches). pink to Therelobster should red. It be water andtalked do not to use alcohol to bring the fever down. Do not use an sidesmay alsoaround appear the mattresssomewhat to drykeep and him cracked from falling as the off.outer Be layer sure peels that ice water15. Moro enema. reflex If yourbegins child to disappear begins to shiver while in the bathtub, theoff withinmattress the fits first snuggly few weeks. inside Lotionso he will will not help slip but between is not necessary. the remove16. Grasphim from reflex the nearly tub; shivering gone will cause a fever to go back up. mattressSmall and the white side dots of the may crib. be on the baby’s face. These are called It is important to realize that sponging in lukewarm water will not be miliaPillows (or “milk and otherbumps”) fluffy and bedding should such disappear as comforters over several and weeks.stuffed effectiveFour months unless the child has had acetaminophen in his system for animalsSmall red should dots on not the be skin left inare the called crib. miliaria (or “prickly heat”) and approximately1. Sits when forty-five well supported minutes to one hour. Do not place your only require that you do not over dress the baby. At approximately 1 child2. in Noa lukewarm head lag whenbath if pulled he does to sittingnot have position any acetaminophen in month of age, many babies develop infant acne. This is normal and his system.3. Turns head at sound of voice will go away in 1-2 weeks without treatment. 4. Lifts head (in supine position) in effort to sit Smooth red birthmarks sometimes appear in the nape of the 5. Supports weight on forearms when prone neck and over the eyes. These are called “stork bites” or “angel 6. Lifts head and chest when prone kisses”. These marks over the eyes should fade away over the first 3438

15 year of life. Sometimes when the baby cries these marks will become No one Whencause hasthe beenfever found,is 102 orbut greater, several it associations is wise to give have carefully been moreNEWBORN red-this DISCHARGEis normal. DAY INSTRUCTIONS maderegulated and amountsyou can decreaseof medication. the chance Usually of SIDS a child by does not feel bad Mongolian spots are dark bluish, bruised looking areas over •alwaysfrom fever put alone your untilbaby histo sleepfever onis at his least or her 102. back-this one the buttocks1) Feedings and back occurring in some infants. These have no interventionAs the has child’s the most temperature dramatic goes effect up, so does his fluid medicala. significance For breast fed and babies will go you away should as the nurse baby your gets baby older. 3 to 5 •dorequirement. not smoke All children with fever should be given increased •doamounts not place of fluids. the baby’s Infants crib can near be airgiven vents extra or draftsfeedings of Pedialyte® or HAIR •dojuices. not Olderput soft children bedding can (pillow take Pedialyte or comforter,® , juices etc) or or Gatorade. stuffed animals to 15A minutes newborn per may side have the fourthlong hair day. or Youno hair should at all. nurse Usually your the in your baby’sDo not crib overdress a child with fever. This will only cause his first hair is lost. Frequently, body hair (lanugo) is present at birth and •usefever a to firm go higher.mattress He in theshould crib be in the very minimum amount of will disappear with time. clothes, e.g. just a diaper. Never give aspirin to a child. hours between feedings occasionally. Do not let your baby go TREATMENTAgain, we are delighted to walk with you through this exciting FINGERNAILSbeyond 5 hours even at night without feeding for these first few stage of Acetaminophenyour lives. We are or ibuprofenhere to help are you the in recommended any way we can.drugs of weeks.Fingernails may be quite long at birth. It is important to keep Pleasechoice don’tfor fever ever in hesitate children to and ask adolescents.any question NEVER or voice USE any concern.ASPIRIN. them clipped or covered to prevent the child from scratching himself. WeIbuprofen want you should to be not a confidentbe used in parent babies and under to know6 months we are old. always Follow DuringYour the firstbaby week should of life,have the 5 tonails 6 wet are diapers usually per attached day and to atthe least skin herepackage when instructions you need us.for dosing.Congratulations… now the fun begins…….! andtwo clipping stools can per cause day; thisthem will to tellbleed. you Afteryour thisbaby time, is getting the nails plenty can of Acetaminophen in over dosage can be fatal, so please keep all be clippedfluid and when calories. the baby is asleep using a small sharp pair of scissors preparations out of your child’s reach. or fingernail clippers. Do not file or bite the nails off. NORMALAlternating DEVELOPMENT acetaminophen OF CHILDRENand ibuprofen is not b. If your baby is bottle-fed please use the formula sent home recommended.Each child is different and special in his or her own way. You MOUTHwith you from the hospital. Your baby should take approximately willHOW find TO unique TAKE traits A RECTAL for each of TEMPERATURE your children. There are, however, 1 to 2Small ounces white per “pearls”feeding initiallymay be butfound should inside rapidly the roof increase of the to 3 developmentalIf you think milestones your infant that most is ill, children an accurate follow. temperature Some may is mouth.to 4 ounces They are per normal. feeding by the end of ten to fourteen days of age. vary,essential. but this Use list a digitalprovides thermometer—mercury estimates of changes andthermometers developments should Your baby should be fed approximately every four hours even at yoube discarded will likely and see. ear You thermometers can use these are to not prepare reliable. for Ourthe next staff phasewill be of BREASTSnight during the first few weeks. If after five hours or so your baby yourglad toadventure discuss orwith demonstrate your child. the following with you is stillBreast sleeping enlargement please wake in the him/her newborn to be infant fed. (both Burping boys should and be 1. Turn the thermometer on. girls)done is often at least present every for ½ aonce few toweeks. 1 once. This is caused by hormones Birth-One2. Coat month the bulb with petroleum jelly or cold cream. which stimulated the mother’s breast to produce milk during the 1.3. MoroRemove reflex the (spontaneousbaby’s diaper. startle with arms out quickly & in latter2) part Your of pregnancy. baby should It always may persist sleep foron hisseveral back. months. 4.slowly Place the to midline)baby on hispresent stomach Sometimes a white discharge (“witches’ milk”) drains from the 2.5. VigorousHold the babysucking to keepreflex him present from wiggling. nipples.3) If This your is baby normal. looks Do increasingly not try to expressyellow orthe golden milk. afterIf the you breast go 3.6. LyingSpread prone the cheeks (face down);of the buttocks. lifts head briefly turns redhome or appears please inflamed,call us so callthat yourwe may doctor. check a bilirubin. 4.7. LyingGently prone; insert makesthe end crawling of the thermometer movements intowith the legs rectum. 5. HeldThe baby in sitting will normallyposition; pushback isagainst rounded, it. Wait head until held heup relaxes GENITALIA4) Cord care is accomplished using alcohol wipes three or four momentarilyand the thermometer will slip in on its own. Thetimes female per day. infant Make genitalia sure that are youroften baby’senlarged diaper at birth is folded due to 6.8. HandsThe thermometer tightly fisted should go in about an inch. hormonesdown passed so it from does the not mother irritate tothe the cord baby or beforeallow thebirth. cord to get 7.9. ReflexHold the grasp thermometer of object with in place palm for two to three minutes or Sometimeswet therewith urine.may be The a white cord creamy usually vaginal separates discharge at approximately for a few 8. Startleduntil the by temperature sound; quieted stops by rising voice and beeps. Never let go of days. This10 to can 14 be days. wiped After away it haswith fallen cotton off and and warm is well water. healed for two 9. Ringingthe thermometer. bell produces decrease of activity Occasionally,days you a small may amounttub bathe. of bleeding will be present from the 10. MayRead follow the thermometer object with scale. eyes to midline vagina. This usually occurs around the seventh to tenth day of life. 11. Clean the thermometer with alcohol.

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16 •Buy a safetyA visit tested to the car doctor seat. should Your babybe regarded is safest as in a the matter Children of fact This5) is not Circumcision unusual unless care –the Your bleeding son’s persistscircumcision for several should days be experienceshould face without the rear bribery, of the vehicle threats until or false they assurances. are at least Preparing1 year of age the and/or cleansedincreases within amount. water using a cotton ball or wash cloth to drip childand weigh with storiesat least or 20 books lb to decreaseabout his the visit risk to ofthe cervical doctor spinemay be injury very in waterFor boys, over the it. circumcisionBe sure to apply need A not & Dbe ointment bandaged. or Vaseline helpfulthe event in ofexplaining a crash. Infantsto the child who whatweigh is 20 likely lb before to happen 1 year in of the age applied toto thethe circumcisionarea for the first site few to prevent days will irritation prevent from the end the ofdiaper. the doctor’sshould ride office. rear Thesefacing storyin a convertible books are available seat or infant in bookstores seat approved or at penis fromThis sticking will heal to withinthe diaper. several As days. this area heals, it will normally yourfor higher local weightslibrary. until at least 1 year of age. If a car safety seat appear yellowish then brown. If a plastic bell has been used, this accommodatesWhen a childrenchild understands rear facing that to higher a stethoscope weights, is for like optimal a usually6) Pleasefalls off call at aboutthe office one toweek. schedule a 2-3 day weight check and a telephoneprotection, and the thatchild its should placement remain on rearthe child’sfacing untilchest reachingshould not the 2 week check-up. bothermaximum him, weight he will for not the be car afraid. safety When seat, ashe longunderstands as the top that of athe head BELLY BUTTON thermometeris below the top is not of thea shot seat and back. that Studies an otoscope show that(ear childrenlight) is justare safestlike a The umbilicus (belly button) will begin drying up and the cord flashlightby far in a (used rear facingfor looking car seat in theuntil ears), age 2the years. fears From of uncertainties that point, canyour will drop off by the seventh to fourteenth day. A small amount of bechild removed. should rideIt is inimportant a forward that facing you carpractice seat and things progress with your to a child bleeding normally occurs when the stump falls off and for a few days beforebooster. you Only bring when him yourto the child doctor. is at least 4’ 9” inches tall and able to thereafter. Keep the cord exposed to air as much as possible and fold wear a beltThe that child fits should properly never over be thethreatened lap and withshoulder a shot should if he ishe the diaper down in toward the skin in order to keep urine off of the naughtygraduate or to cries,a seat or belt. for anyYour other child reason. should Likewise,not sit in thehe shouldfront seat never stump. The stump (navel) should be kept dry at all times. Do not beuntil promised age 13. that he will not be given a shot or that a procedure will bandage, tape, or use a belly band over the belly button. If the area not•Be hurt.careful We not try to to leave be honest him with with a brotherchildren or in sister telling because them if they may continues to drain or show signs of bleeding for more than two days, somethingharm the baby is going without to hurt. realizing it. call your doctor for advice. •It is importantIf a child that does the receive furniture a needed and toys injection, you buy a parentfor the shouldbaby be not Sometimes babies have an umbilical hernia (or protrusion of laughsafe. Whenat him. selecting It is probably toys, be best sure for that other the children baby cannot to wait break in the them the belly button) due to an opening in the muscles of the abdomen. waitingand check room to see during that thesmall injection. objects suchA child as button can be eyesexpected cannot to fallcry off. Most of these go away on their own. Again, do not bandage, tape or afterThe babyan injection might swallow and this them should and be choke. regarded as a natural response. use a belly band over the hernias since this will only cause irritation A•Never little loveuse a and microwave assurance to followed heat your by baby’s a quick bottle. change of the subject to the skin and will not make the hernia heal any more quickly. after•Avoid the popcorn injection and are peanuts better than until saying the child’s the doctor sixth birthday.is mean or These the nursecan be is sucked bad. into the lungs. LEGS •Never letEven your with baby the or best child of handling,sleep in bed many with children you. This object is to being Occasionally, babies have bowed legs, so their feet may not examineddangerous. between about 9 months and 4 years of age. look exactly straight to you. This is usually due to the position the •Buy safety plugs for electrical outlets when your baby is about six baby was held in the uterus. The legs and feet will slowly straighten FEVER:months old. but may continue to look abnormal for a few months after the baby •Remember that some house plants are poisonous (for example, walks. DEFINITIONpoinsettia, Dieffenbachia or dumb cane and philodendron). •Install smokeFever alarmsis defined in youras a rectalbaby’s temperature room and in of other 100.4 strategic or greater ______andplaces is onein the of house.the most common problems parents present to the doctor.•Always Fever keep firearmsis the body’s locked defense away mechanismand unloaded. against infection or inflammation.•Never use a walker. They can result in severe head injuries from BEHAVIORS: falls downIt is stairs important or when to knowbabies when pull heavyand how objects to regulate from tables. a sick child’s temperature. Keep a digital thermometer in your home to BREATHING measureSIDS the temperature in a sick child. Guessing at a temperature There are many normal variations in a newborn’s breathing by feelingA fear or lookingof most isnew not parents, satisfactory SIDS and (Sudden the unnecessary Infant Death use of patterns. The rate may vary-it may be slow and then become very acetaminophenSyndrome or Crib (Tylenol) Death) isis nota somewhat wise. If youpreventable are unsure disorder. how to Much take fast or even have short pauses. aresearch temperature, has been one done of the to office determine staff willthe causebe glad of to this teach tragic you. problem. 3236

17 SPITTING UP POISONINGwill be much less OR painful ACCIDENTAL or even painless. INGESTION This cleansing process HOMECOMINGSpitting up usually occurs shortly after a feeding, and may will be continuedFrom the timeuntil yourabout child 12 months begins toof crawlage. When until several the first years tooth Bringing your new baby home is an exciting and sometimes indicate over-feeding or lack of burping. If your baby spits up after thereafter,comes in at he about or she 6 monthswill be at of high age, riskthe gumfor ingesting cleansing some may form be of overwhelming time. Following are some practical suggestions to routine burping, try holding him upright in your arms for about thirty poisonstopped, or but plant. brushing There needs are two to bethings continued that you and can soon do toshould make be this done help in this time of transition. minutes after meals. However, many babies spit up 1-2 tablespoons lesstwice possible a day-once or, at after least, the to early minimize morning the effects.meal and once before with almost every feeding or between feedings for the first several bedtime. The Unless first, it and is advised most important by your child’sthing, ispediatrician to keep all or pediatric NURSERY months; this is normal for infants. medications,dentist, do not chemicals use fluoride (such containing as paints, toothpaste varnishes, until cleaning age 2-3material, or Your baby should come home from the hospital to a room of Vigorous spitting – vomiting an entire feeding or vomiting furnitureuntil your polish, child isetc.), able and to spit poisonous it out. Byplants age out2, the of childyour child’scan begin reach. his own if possible. This room should be clean, well aired, not drafty over quite a distance of 2-3 feet- should warrant a call to your doctor Thesebrushing items himself, should but be you stored will in need a place to follow which him is high with above your yourown and about 70-75 degrees. if it happens more than occasionally (more than once a week). child’sround ofreach brushing or behind in order locked to assure doors qualityor child-proof and thoroughness. cabinet doors.

Remember,Daily this dental applies flossing to grandparents should be added and other to the homes routine frequently at about VISITORS visited.5 years of age. Especially important areas to floss are the areas BEHAVIORVisitors & andCRYING the number of people holding the baby should be No two infants are exactly alike, so do not compare your betweenThe the secondback two item teeth of importanceof each jaw. is that you should have the limited during the first week. This is the best way to protect your baby’s behavior to that of a friend or even to a previous child. When phone numberThe first of visit the Augustato the dentist Poison should Control be at Center about taped1-2 years on your old. baby from contagious diseases. Friends can look but not touch. your baby comes home, he will spend most of his time sleeping; the telephone.Fluoride If your supplementation child ingests a chemical,is essential medication to the health or plant,of your call rest of the time, he will be eating or having brief periods of crying. immediatelychild’s teeth, forand advice. this will The be prescribedPoison Control as needed. Center If is you part are of usinga SomeSLEEPING babies POSITIONare quiet and seem to fuss very little. Other babies seem nationalwell water, network your child of Poison may needControl some Centers fluoride and supplements will have the in best his Your newborn baby should be placed on his back to go to active from the first day of life and demand a lot of attention. informationvitamins; city available water is tousually you. Thefluoridated. number is 1-800-222-1222. sleep. NEVER put your baby on his stomach to go to sleep. Back Neither extreme means that there is anything wrong with your child. In the past, Syrup of Ipecac was recommended in order to sleeping is the best and safest, significantly reducing the risk of SIDS. All infants cry and should be expected to do so. Crying is the baby’s induceThe keys vomiting to healthy in the teeth case are: of an ingestion. Currently, this is NOT As your baby gets older and develops better head control, time on his first form of communication. By crying, he lets you know when he recommended1. Good hygiene(brushing, and should not be flossing,given as cleansing)some substances can be stomach while awake is a good idea because this will help prevent needs something. He may be hungry, thirsty, tired, uncomfortable, harmful2. Smallwhen intakevomited of andsugar it (sucrose)-especiallymay interfere with other candies, needed cookies, flattening of the back of the head and encourage development and frustrated or just want his position to be changed. Some babies cry treatments.sugar Therefore, coated cereal, if you etc. have (If athese supply, must you be shouldeaten a discardgood rule it. is strength. when they have bowel movements, some babies cry for no apparent to brush well after each time; a better idea is to substitute reason. Many babies increase their crying time up to a peak at about SAFETYcarrots, celery, bell pepper strips, etc., for sugary snacks) 6DRESSING weeks of age. YOUR BABY 3.A Limitmajor juices cause to of 4-6 death ounces in young per day children and do and not babies allow isa child to PleaseYou should avoid dress feeding your your baby baby as youevery dress time yourself. he cries. Layer Often, the a accidents.carry Here a cup are of some juice common around andareas sip that on needit all day.to be changebaby’s clothes of diaper, in coola new weather sleeping and position, do not overdressa pat on the the back baby or in a hot addressed4. No to bottles make oryour cups home in bed. safe Weanfor your from children. bottle by 12 months of pacifierweather. may Keeping be enough him tooto satisfy warm hiscan needs be as andharmful quiet as the letting baby. him be age. Duringtoo cold. a crying spell, try to handle your baby in a soothing, loving •Be 5.sure Use that of the fluoridated rails on the water baby’s and crib toothpaste. are close enoughFluoride together vitamins (3- manner;Buy rock flame him, retardantcuddle him items or speak that are softly easy to to him. launder. If the Wash crying 3 1/2 inches)only if so instructed that the baby’sto do so head by yourand body pediatrician can’t slip or or pediatric get stuck. persistsitems before and does the baby not respond wears them. to the Remember usual tricks, that check babies the growbaby for •Alwaysdentist. keep the side rail up on his crib and never leave him alone signsquickly, of illness.so buy items big enough to last a while. on a6. table Early top, intervention bed or chair and to prevent good follow falls. upAlways by your keep dentist. at least one Call your doctor if the baby is not consolable, extremely hand on your baby while changing him; do not take your eyes off of irritable,SCHEDULE has a fever or refuses to eat normally. him.FEAR Babies OF THE roll orDOCTOR flip suddenly. IfDuring you feel the like first you several are losingweeks, your your patience baby will or sleepthat youthe may •Check hisA child bath iswater not bornto make afraid sure of itdoctors will not any scald more him than and he always is born harmmajority your of baby, the time. please Awake ask for times help will from consist a friend of oreating, family periods member of holdafraid him of anythingwhile bathing else. him.Fear isYou a learned should attitude. set your hotFor watersome heaterchildren, inquiet order wakefulness to give yourself and periods a break. of crying.If you have Each no baby one isto different call, please and lessfear thanof the 120 doctor degrees is due Fahrenheit. to his association with injections. This is callyou ourwill office. quickly No get matter to know how your frustrated baby and you his get or with her schedule.your baby, You •Beoften alert too togreatly any windows emphasized through by inappropriate which or stairs remarks down bywhich parents your can work with your baby over time to develop a schedule that is NEVER SHAKE YOUR BABY! This can cause serious injury or babyand others. could fall. Use appropriate safeguards—childproof gates or death.acceptable to the entire family. window guards. 3531

18 TheFEAR episodes OF FEVER may last from fifteen minutes to several hours and SNEEZING, YAWNING, BELCHING, HICCOUGHING usually occurMany inpeople late afternoon are frightened or early by highevening, fevers often in children. daily, but In can WHATAll babies A sneeze, CUTIE! yawn, belch, hiccough, pass gas and cry. occurgeneral, at anythe heighttime of of the the day fever or doesnight. not They reflect usually seriousness end with of Sneezing and coughing are the baby’s way of clearing his nose and exhaustiondiseases. Many or passage times viralof stool infections or gas. willColic cause is generally much higher not present fever Everythroat baby– it usually is beautiful does notand meanyou will he haswant a tocold. admire Many every babies aspect sound of untilthan morea child severe is about bacterial three weeksinfections. of age Children and is rarely typically seen run after much four thiscongested; new creation. this is normal. Here are Belching some normal and hiccoughing things you mayafter noticea feeding is monthshigher fevers of age. than adults. The two things which most people are aboutnormal your and new should baby. not cause the baby discomfort. concernedAlthough about withthe actual high fevers cause are:is not understood, it may be associated• seizures with overfeeding or certain environmental factors. It HEADBOWEL MOVEMENTS occurs• brain frequently damage in first born children. Allergies (to formula or TheBreast head fed may babies appear normally large have in relation four to to eight the restyellow-greenish, of the body. otherwise)Approximately rarely play a fourrole. percent Fortunately of children for the have parent seizures and child, Itsemi-solid may also to have liquid a peculiar stools a shapeday. Someright after babies, birth. however, This is may called have thereresulting are nofrom lasting fevers effects - called and febrile the problem seizures. will Seeing gradually your childdisappear have a moldingonly one andstool is ordue even to theone skull every bones third overlapping day, and this as may the babybe normal. passes withseizure-even time. a short one-is of course a scary experience. However, throughAs long asthe the birth baby canal. shows This no shoulddiscomfort, return treatment to normal is innot a necessary.few days. these typesA number of seizures of remedies are usually have not been harmful suggested. and do These not lead include: to You mayFormula also be fedable babies to feel usually the sutures-the have pale place yellow, where pasty one stools bone frequentfuture epilepsy. burping, They formula are notchanges preventable. and sedation. However, the first meetsabout onethe next-asto four atimes raised a day.area onAgain, the head. it may be normal for formula two do notFever usually does worknot cause and brainthe last damage is potentially until it dangerous.gets up to at least fed babiesThe to soft have spot one (fontanelle) stool every on other the daytop ofor theevery baby’s third head day. is a Recently,107 or 108. there Many have children been several typically over-the-counter run 104 to 105 products fever with claiming place whereBabies the often bones grunt, have strain, not yet or come turn together.red or purple It is when natural having for a toroutine be colic viral treatments. infections. As Acetaminophen none of these have usually had will any not testing lower or the thebowel soft movement. spot to move This up isand usually down normal, in rhythm and with if the the stool heart is beatsoft, orthis regulation,fever to a normal we do temperaturenot recommend range their but use. should Application lower it to of a warmth102-103 breathing.does not mean This the will baby decrease is constipated. in size and However, disappear if by your about baby 12-18 seems torange. the abdomen and rhythmic rocking may soothe the child. DO months.to have unusually hard stool, call your doctor for advice. NOT changeThe main the baby’s key to formulaa child’s or fever give is any really medication how the childwithout behaves If your baby seems constipated, contact your doctor: DO consultingand acts. Usually your physician. fever itself makes a child feel bad. If the fever EYESNOT give your baby a laxative, suppository or enema. These can be comes downIf your and baby the has child colic, seems please to perk make up, an then appointment you can usually to bring be very dangerous.Babies are occasionally cross-eyed. Eye balance is poor himassured in so that we there can rule is nothing out any seriously physical wrong causes. with your child. during the first few months of life so do not worry if your baby However, if your child becomes more and more lethargic or irritable, sometimesINFANT FEEDING looks at you cross-eyed. If this continues past the third DENTALthen you should CARE call immediately. If the child is given Whether you choose to breast feed or bottle feed your baby, acetaminophenCare of yourand thechild’s temperature teeth is a does process not thatcome should down begin to the 102- this shouldThe color be aof special the baby’s time eyesfor both can changeof you. up It isto one 6 months of the of actively103 range soon after after 30 minutes,birth even then before you your should child place has himany invisible lukewarm teeth. baby’s first pleasant experiences and should be very rewarding and Breastwater infeeding the bathtub. is best for He the should development soak in the of lukewarmteeth, facial water bones for and pleasant for both parent and child. theapproximately muscles of chewingten to fifteen and sucking.minutes and If you you are should bottle sponge feeding, him it is SKIN bestfrom to the feed head your down baby during in a semi-upright that time. Do position not place and himto use in acold nipple BREASTThe FEEDING skin may vary in color from light pink to lobster red. It whichwater andmakes do yournot use baby alcohol work toa littlebring for the the fever formula. down. Never Do not allow use an Breast feeding is the most natural way of feeding your baby. yourice water baby enema. to use the If yourbottle child as a beginspacifier; to nevershiver give while your in thebaby bathtub, his We recommend it heartily. In general, most women who want to bottleremove while him hefrom is in the his tub; bed. shivering Begin using will cause a cup a as fever soon to as go your back baby up. breastfeed their baby can do so. If you do desire to breast feed and are canIt is useimportant it (“sippie to realize cup” type); that sponging this will occurin lukewarm sometime water in the will six not to be having difficulties, please DON’T GIVE UP. Call our office and we twelveeffective months unless agethe range.child has Never had sweetenacetaminophen your baby’s in his pacifier system withfor can give you advice and support to continue. honey,approximately sugar, etc. forty-five minutes to one hour. Do not place your If you find you are having trouble breast feeding, we will try child in Cleansinga lukewarm of yourbath baby’sif he does mouth not haveshould any be acetaminophen started at in to help you overcome the problem. Please call our office if you have approximatelyhis system. 2 months of age by simply wiping both upper and questions. Another excellent source is a lactation specialist. Each lower gums each day with a damp washcloth or a 2x2 inch piece of hospital has several nurses who specialize in helping mothers and damp gauze. By doing this the gums will be healthier and teething

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babies with nursing and are available to you even after you take your COLDSWhen the fever is 102 or greater, it is wise to give carefully baby home. Call the hospital where your baby was born for a consult. regulatedColds, amounts or upper of medication. respiratory Usuallyinfections a child (URI) does are notone feel of the bad You will be hungry and should eat a well balanced diet, and frommost fevercommon alone and until contagious his fever reasonsis at least of 102.illness in infants and young

obey your appetite. This is not the time to crash diet. children.As They the child’s are caused temperature by viral goesinfections up, so and does do his not fluid need Daily fluid intake doesn’t necessarily need to increase for requirement.treatment with All antibiotics. children with They fever usually should last be 7-14 given days. increased breastfeeding. You should drink enough fluid so that your urine is amountsIf of your fluids. child Infants has a stoppedcan be given up nose, extra you feedings may want of Pedialyte to use ® or clear to pale yellow. This can vary widely. juices.saline nose Older drops. children You can can take make Pedialyte these by® , juicesadding or ½ Gatorade. teaspoon of Daily calcium requirements do not change while breastfeeding table saltDo to not 1 cup overdress of boiled a childwater. with After fever. the solutionThis will has only come cause to his so you do not need to take extra calcium. There is about 3-9% bone feverroom totemperature, go higher. Heput shouldone drop be inin eachthe very nostril minimum then suck amount with theof 1 loss while breastfeeding but it will be regained once your baby is clothes,ounce rubber e.g. just syringe a diaper. (suction bulb). Do this before each feeding and weaned. at bed time.Never This give will aspirin make to ita easierchild. for the child to breathe. If you breast feed, avoid all medications unless you consult TREATMENTCough and cold medications not recommended. your pediatrician. Acetaminophen or ibuprofen are the recommended drugs of Also avoid excessive use of alcohol, caffeine, caffeine choiceCOLDS--COMPLICATIONS for fever in children and adolescents. NEVER USE ASPIRIN. containing beverages (Coke, tea, coffee). IbuprofenAs discussed should not above, be used the in vast babies majority under of 6 coldsmonths are old. benign Follow and Smoking cigarettes isn’t contraindicated for nursing mothers packagewill go away instructions without for any dosing. difficulties. Rarely, a complication but we strongly advise you to stop smoking. Now is a great time to can arise.Acetaminophen If you see any in of over the followingdosage can signs, be fatal, please so bringplease keep all quit! preparationsyour child in outto be of seen.your child’s reach. •Pneumonia-coughAlternating acetaminophenproducing a lot ofand mucous; ibuprofen pain is onnot breathing; TO GET STARTED recommended.high temperature; shortness of breath; rapid or labored breathing. Find a comfortable position—most mothers prefer to sit in HOW•Ear infection-plugged TO TAKE A RECTAL or painful TEMPERATURE ears or pulling at the ears in young a comfortable chair with a foot stool or lie in the bed on one side. childrenIf with you fever.think your However, infant many is ill, anbabies accurate pull andtemperature play with is their Choose a quiet place that is free of distractions for best results. essential.ears when Usethey a do digital not have thermometer—mercury ear infections. thermometers should Hold the baby in one arm with the baby’s head higher be•Sinusitis-tenderness discarded and ear thermometersand pain above are or notbelow reliable. the eye Our or puffinessstaff will be than the stomach. Turn the baby’s entire body toward your body gladaround to discussthe eyes or in demonstrate infants. the following with you so that his stomach is against yours. Lift the breast with the If your1. child Turn developsthe thermometer a fever several on. days after he has a cold, he will opposite hand, holding, but not squeezing the breast between the probably2. Coat need the to bulbbe checked with petroleum by the doctor. jelly or cold cream. index finger and middle finger. Push the breast to the baby’s 3. Remove the baby’s diaper. cheek; he will turn his mouth toward the nipple. As the baby COLIC4. Place the baby on his stomach presses the nipple, milk will spray into his mouth. This may 5. HoldThe term the babycolic tois ankeep often him misused from wiggling. term to describe any type cause him to gag at first. If so, pull away for a few seconds until of irritability6. Spread or the crying cheeks in the of theyoung buttocks. infant. Remember, all babies will the flow decreases and try again. cry and7. Gentlynormal insert crying the usually end of peaks the thermometer at about 6 weeks into theof age. rectum. The amount of areola (colored part of the nipple) that goes in TheTypically, baby will colic normally is a combination push against of symptoms it. Wait until which he is relaxes quite the mouth is irrelevant. The sizes of mom’s areola differ greatly. The characteristic.and the Itthermometer usually has awill rather slip suddenin on its onset own. of a loud most important thing for mom and her support person to look at is continuous8. The cry;thermometer the knees shouldare frequently go in about drawn an upinch. to the abdomen the corner of the baby’s mouth. It should be a wide angle – like a and 9.the Holdfists are the clenched thermometer tight. in There place isfor no two apparent to three reason minutes for orthe rainbow, not a sharp angel. crying e.g.until no the dirty temperature diaper, the stops infant rising is not and hungry beeps. or Never uncomfortable. let go of Burp the baby when changing sides of breast and burp again the thermometer. after the entire feeding. You only need to burp for 1-2 minutes. You 10. Read the thermometer scale. may find you don’t need to burp this often. 11. Clean the thermometer with alcohol.

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20 SPECIALA visit to the TOPICS doctor -should LISTED be regarded ALPHABETICALLY as a matter of fact To help prevent soreness of the nipples, break the suction experience without bribery, threats or false assurances. Preparing the by inserting your finger at the corner of the baby’s mouth. CHILDchild with REARING stories or booksAND aboutDISCIPLINE his visit to the doctor may be very helpful inThere explaining is a verse to inthe the child Bible what which is likely states to that happen “children in the are For best milk production, feed the baby every 2-4 hours. likedoctor’s arrows”; office. the These idea is story that, books just as are an available arrow needs in bookstores to be directed or at to ayour target, local so library. a child needs to be directed to those things which the COLOSTRUM parents Whenbelieve a are child important understands for their that children a stethoscope to attain. is like The a highest During the first few days of breast feeding, the baby will get goaltelephone any parent and that can its have placement for his or on her the child child’s is thatchest the should child notlearn to mostly colostrum. Colostrum is rich in proteins and lovebother and him, obey he God will andnot become afraid. into Whenpersonal he knowledgeunderstands of that God a immunoglobulins which offer the baby additional protection from throughthermometer his Son, is not Jesus a shot Christ. and thatOther an goals otoscope which (ear are light) important is just like a certain illnesses as well as allergies. mightflashlight include (used such for lookingthings as in the the child ears), excelling the fears in of school, uncertainties sports, can There is no need to worry that your baby will starve before music,be removed. etc., and, It is in important general, havingthat you a happypractice and things fulfilling with childhood;your child your milk comes in; babies have good nutritional stores in reserve ultimatebefore you goals bring should him toinclude the doctor. those things which accompany a when they are born. Consider the colostrum to be “learning milk”. fulfillingThe and child productive should adulthood.never be threatened with a shot if he is It allows your baby to learn to nurse and your body to have time to naughtyThe or cries, direction or for the any child other takes reason. is in large Likewise, part the he responsibilityshould never recover from labor and birth before making larger volumes of milk. ofbe thepromised parents, that and he therefore, will not be child given rearing a shot is or a verythat aimportant procedure area will to The first day, about 3 Tablespoons will be produced—this is consider.not hurt. WeThe try rearing to be ofhonest a child with must children occur in atelling loving them environment; if adequate. The second day, your supply will double and then the thissomething love must is going be as tomuch hurt. as is possible an unselfish love. This love third or fourth day, the true milk will “come in” as your production may be Iffurther a child broken does receivedown into a needed nurturing injection, and discipline. a parent should Nurturing not increases. These small amounts are adequate, so don’t worry! referslaugh toat thehim. parents’ It is probably caring for best the for child’s other physical,children toemotional, wait in the spiritualwaiting roomand social during well the being. injection. Discipline A child refers can be to expectedthe necessity to cry that ENGORGEMENT certainafter an restrictions injection and be placedthis should on a bechild regarded for his as own a natural good and response. safety, When your milk supply begins to increase, you will likely andA little that love when and these assurance limits arefollowed violated, by athe quick child change is swiftly of the and subject clearly have 1-2 days of uncomfortable engorgement. This usually occurs 3 shownafter the that injection he has aredone better wrong. than A saying common the doctormistake is mademean todayor the is days after your baby’s birth. You should continue to nurse as you thatnurse parents is bad. allow their children to be disobedient or rebel against the have been, but you may continue to feel full after your baby is parents’Even authority. with the It is best essential of handling, that parents many setchildren realistic object demands to being finished nursing. Effective feeding during the first 3 days will greatly uponexamined their betweenchildren aboutand then 9 months require and that 4 theiryears children of age. live within decrease the risk of breast engorgement. You may still be full – harder these limits. To repeat, discipline is one large aspect of love. A than normal fullness with tight, shiny, hard areola and may have some parentFEVER: who truly loves his child will discipline his child, and will do pain but not engorged. it, not out of anger, but in a loving and firm manner. ThereDEFINITION are several good books on child rearing. We would recommendFever most is defined highly Dareas a rectal to Discipline temperature, by Dr. of 100.4James or Dobson. greater Heand has is one several of the other most books common such problemsas The Strong parents Willed present Child to thewhich woulddoctor. be Fever very usefulis the body’s to you defensebut this mechanismis a good starting against point. infection or Ainflammation. second book that is highly recommended is Shepherding a Child’s Heart byIt Tedd is important Tripp. to know when and how to regulate a sick child’s temperature. Keep a digital thermometer in your home to measure the temperature in a sick child. Guessing at a temperature by feeling or looking is not satisfactory and the unnecessary use of acetaminophen (Tylenol) is not wise. If you are unsure how to take a temperature, one of the office staff will be glad to teach you. 2832

21 BREAST CARE willreceiving be much blanket. less painful Do not or use even baby painless. oil as this This can cleansing cause rashes. process Baby Breasts and nipples should be washed at least once a day with willlotion be can continued be used until but isabout usually 12 monthsnot necessary. of age. When the first tooth warm soapy water. comesNEVER in TAKEat about YOUR 6 months HANDS of age, OFF the gumTHE cleansing BABY DURING may be THE You can expect a small amount of milk to leak from the stopped,BATH OR but LEAVE brushing THE needs BABY to be UNATTENDEDcontinued and soon IN should HIS TUB. be done breasts between feedings. Nursing pads will prevent leakage onto twice a day-once after the early morning meal and once before clothing. bedtime.DIAPER UnlessCHANGING it is advised by your child’s pediatrician or pediatric If your breasts become cracked or dry, moisturize with dentist, Betweendo not use baths, fluoride the diapercontaining area toothpasteshould be cleaneduntil age as 2-3 soon or as expressed breastmilk and expose them to the air. Avoid using creams untilpossible your after child each is able stool to or spit wetting. it out. YouBy age should 2, the wash child the can diaper begin area and ointments like lanolin as they can cause the baby’s latch to slip. brushingat each diaper himself, change but you with will soap, need water to follow and a himsoft clothwith youror a babyown Breasts are usually sore at the beginning of each feeding especially roundwipe. ofWhen brushing cleaning in order little togirls, assure remember quality toand wipe thoroughness. away from the during the first week. This will decrease over time. Any soreness that vagina (fromDaily frontdental to flossing back) and should when be cleaning added to little the boys,routine be at sure about to persists, or any local area of redness or soreness that is apparent for 5clean years material of age. from Especially the folds important of the scrotum. areas to floss are the areas more than two feedings in a row should be reported to the doctor. betweenIf the a rash back begins two teeth to develop, of each usejaw. a cream such as Vaseline, A supportive bra is essential. It should have good uplift and Desitin Theor A&D first visitOintment. to the dentist If this doesshould not be clear at about the rash 1-2 withinyears old. 2-3 snaps that allow ready exposure of the breasts. days, callFluoride your doctor. supplementation is essential to the health of your Some babies are quiet and seem to fuss very little. Other babies seem child’s teeth, and this will be prescribed as needed. If you are using PUMPINGactive from theBREAST first day MILK of life and demand a lot of attention. well water, your child may need some fluoride supplements in his Neither Forextreme many means women that who there plan is toanything return towrong work, with pumping your child. is an vitamins; city water is usually fluoridated. excellentAll infants way cry to and continue should nursingbe expected and providingto do so. Cryingbreast milk is the to baby’s their babyfirst form while of they communication. are away. Also, By everycrying, mom he lets needs you a know break, when so an he The keys to healthy teeth are: occasionalneeds something. bottle of He breast may milk be hungry, may be thirsty, needed tired, as well. uncomfortable, 1. Good hygiene(brushing, flossing, cleansing) frustratedIf youor just plan want to pump his position only rarely, to be changed.a simple hand Some pump babies is cry 2. Small intake of sugar (sucrose)-especially candies, cookies, usuallywhen they adequate. have bowel If you movements, will be pumping some babieson a regular cry for basis, no apparent an sugar coated cereal, etc. (If these must be eaten a good rule is electricreason. pump Many is babies a worthwhile increase investment.their crying timePump up in to a aquiet, peak calmat about to brush well after each time; a better idea is to substitute place6 weeks if possible. of age. Make sure you store your pumped milk carrots, celery, bell pepper strips, etc., for sugary snacks) appropriately.Please avoidIt can feedingbe left at your room baby temperature every time for he 6 cries. hours, Often, a 3. Limit juices to 4-6 ounces per day and do not allow a child to refrigeratedchange of diaper, for 6 days a new or sleeping frozen for position, 6 months a pat or onmore the if back stored or ina carry a cup of juice around and sip on it all day. airtightpacifier containersmay be enough in a deep to satisfy freezer his or needs in the and back quiet of a the regular baby. freezer 4. No bottles or cups in bed. Wean from bottle by 12 months of (doDuring not leavea crying it in spell, the door).try to handle These yourdiffer baby from in formula a soothing, due to loving natural age. antibacterialmanner; rock properties him, cuddle of humanhim or milk.speak softlyMilk fromto him. two If or the more crying 5. Use of fluoridated water and toothpaste. Fluoride vitamins pumpingpersists and sessions does not can respond be combined, to the usualbut should tricks, be check cooled the to baby the samefor only if instructed to do so by your pediatrician or pediatric temperaturesigns of illness. before doing so. dentist. When Call your preparing doctor a if bottle the baby from is pumped not consolable, milk, gently extremely swirl— 6. Early intervention and good follow up by your dentist. don’tirritable, shake-- has athe fever milk or to refuses loosen to the eat fat normally. layer from the bottle. Heat under runningIf you feelwater like or you in a are bottle losing warmer your patienceor pan of or warm that water.you may FEAR OF THE DOCTOR Neverharm your microwave baby, please any milk ask for yourhelp frombaby. a Dofriend not or rewarm family anmember A child is not born afraid of doctors any more than he is born unfinishedin order to bottle.give yourself a break. If you have no one to call, please afraid of anything else. Fear is a learned attitude. For some children, call ourVitamin office. D No is matteran essential how frustratedvitamin for you absorption get with yourof calcium baby, and fear of the doctor is due to his association with injections. This is boneNEVER development. SHAKE YOUR It’s poorly BABY! represented This can in cause breast serious milk. injury It is or often too greatly emphasized by inappropriate remarks by parents recommendeddeath. that exclusively breast fed babies or babies fed with and others. less than 16 oz. of formula supplements per day be given a vitamin D supplement. 3127

8-9The months episodes may last from fifteen minutes to several hours and FORMULA FEEDING ~Eggusually yolks occur in late afternoon or early evening, often daily, but can Infant formulas are made from cows’ milk that has been ~Meats-occur at anybegin time with of whitethe day meats or night. (turkey, They chicken); usually then end usewith dark specially treated so that the baby can digest it easily. These formulas meatsexhaustion (beef, or liver, passage lamb) of stool or gas. Colic is generally not present are fortified with vitamins and iron. They come as ready to feed ~Realizeuntil a child that is meat about dinners three weeks and meat of age and and vegetable is rarely dinners seen after do notfour formulas, as a powder or as concentrate. Be sure to read the havemonths as muchof age. protein as meats alone. The “meat with vegetables” instructions on the label carefully and mix exactly as instructed. The dinners Althoughhave more the meat actual that cause the “vegetable is not understood, with meat” it may dinners. be concentrate is cheaper than the ready-to-feed formulas. 12associated months with overfeeding or certain environmental factors. It Use only the formula that your doctor recommends. ~Wholeoccurs frequently milk in first born children. Allergies (to formula or Be sure to use clean bottles and nipples. A bottle brush is ~Byotherwise) this time rarely your play baby a role. should Fortunately be off a bottle for the and parent on a cup and child, sometimes necessary to remove all the debris from the rims. Force completely.there are no lasting effects and the problem will gradually disappear hot water through the nipples to be sure they are not clogged. It is with time. better to let the bottles, lids and nipples drain dry than towel dry A number of remedies have been suggested. These include: them. frequent burping, formula changes and sedation. However, the first If you have well water, boil it for ten minutes prior to using it to BATHINGtwo do not usually THE BABY work and the last is potentially dangerous. mix the formula. Recently,Bath there time have can been be an several enjoyable over-the-counter time for both products you and claimingyour Please read carefully and follow the safety instructions that baby.to be colic Until treatments. the navel is As healed, none onlyof these sponge have bathing had any should testing be or used. accompany your formula. Tryregulation, to bathe we the do baby not atrecommend the same time their each use. day. Application The routine of warmth is nice forto the both abdomen of you. andIf your rhythmic baby’s rocking skin is excessivelymay soothe dry, the youchild. may DO not FEEDING SCHEDULE wantNOT tochange bathe theyour baby’s baby formulamore than or giveevery any 2-3 medication days in order without to avoid We recommend a flexible feeding schedule in which the baby excessiveconsulting drying. your physician. Have all of your supplies together in one place and eats every 3-5 hours. Crying earlier than 3 hours usually suggests within easyIf your reach. baby Some has colic, mothers please prefer make to makean appointment a bath tray. to Thebring something other than hunger. Please do not fall into the trap of roomhim in temperature so we can rule during out bathingany physical should causes. be about 75 degrees and the feeding your baby every time he cries! room should be free of drafts. Fill the tub with about 2-3 inches of water.DENTAL Check CARE the water temperature with your hand or arm before using it Careon the of baby. your child’s teeth is a process that should begin activelyWash soon afterthe face birth first even with before plain your water child (no has soap). any Cleanvisible the teeth. eyes withBreast cotton feeding balls is bestdipped for inthe cool development water without of teeth, soap. facial Clean bones the and outer areasthe muscles of the of nosechewing and and ears sucking. with aIf yousoft aresponge bottle or feeding, corner it isof a washcloth.best to feed yourDo not baby attempt in a semi-upright to clean nostrils position or ear and canals to use with a nipple q-tips orwhich cotton makes swabs. your This baby can work do morea little harm for the than formula. good. Never allow your baby The to head use theshould bottle be as gently a pacifier; lathered never with give soap your and baby washed his frombottle the while front he to is thein his back bed. to avoidBegin gettingusing a soap cup asin soonthe eyes. as your You baby can usecan ause soft it toothbrush(“sippie cup” or type);fingernail this brushwill occur if the sometime child has incradle the six cap. to Don’ttwelve forget months to agescrub range. the soft Never spot. sweeten You may your use baby’s soap pacifieror baby with shampoo.honey, sugar, Shampooing etc. is not necessary more often than every 3-4 days. WashCleansing the rest of ofyour the baby’s baby’s mouth body with should warm be startedsoapy waterat find you are having trouble breast feeding, we will try to help you payingapproximately careful attention2 months to of the age skin by simply folds around wiping the both neck, upper arms and and overcome the problem. Please call our office if you have questions. groin.lower gums Rinse each well day with with warm a damp water washcloth and pat dry or witha 2x2 a inchsoft towelpiece orof Another excellent source is a lactation specialist. Each hospital has damp gauze. By doing this the gums will be healthier and teething several nurses who specialize in helping mothers and babies with

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HOW MUCH TO FEED THE BABY? COLDSWHEN TO ADD SOLIDS Most nursing babies will be satisfied after approximately 30 Colds,The tendency or upper in respiratory most mothers infections is to want (URI) to addare onesolids of toothe minutes. If feedings consistently take longer a lactation consultation is mostearly. common The current and thinkingcontagious in thereasons medical of illness community in infants is that and babies young recommended. Bottle fed babies should usually feed for 15 to 30 children.need nothing They besides are caused fortified by viralformula infections or breast and milk do notuntil need five or six minutes. treatmentmonths. with antibiotics. They usually last 7-14 days. Below is a guide to the amount of formula your baby needs: IfDo your not childgive anyhas cereala stopped or other up nose, solid you foods may before want six to monthsuse salineof age noseunless drops. you have You specific can make instructions these by addingto do so. ½ teaspoon of Age Number feedings/day Formula/ feeding table saltEach to 1 infant’scup of boiled pattern water. is different. After the Please solution try not has to come add foodsto 0-1 mos 6-7 2 ½ - 4 oz roomtoo early. temperature, You will put know one it drop is time in eachfor more nostril when then the suck baby with the 1 3 mos 4-6 4-6 oz ounceconsistently rubber sucks syringe dry (suction his bottle bulb). and is Do not this satisfied, before beginseach feeding to wake and 4 mos 4-5 5-6 oz atearlier bed time.than every This will3-4 hours, make itstops easier sleeping for the through child to thebreathe. night or 5 mos 4-5 5-6 oz consistentlyCough exceeds and cold 32 ouncesmedications of formula not recommended. in 24 hours. Do not add 6-9 mos 4 6 oz solids until the baby gives the sign that it is time. 10-12 mos 3 8 oz COLDS--COMPLICATIONSAdd one new food at a time and then wait 5-7 days. If no If he consistently empties his bottle at each feeding and cries rash, diarrheaAs discussed or runny above, nose the develops, vast majority you may of colds add areanother. benign This and for more, increase the feeding by one ounce willway goyou away will withoutbe able toany tell difficulties. if the baby Rarely,is not going a complication to tolerate a In general, no infant should get more than one can of formula cancertain arise. food. If you see any of the following signs, please bring in 24 hours (this is about 24 ounces) in the first 1-2 months or 32 your childDesserts, in to be candies, seen. cookies and soft drinks are not good for ounces at 2-4 months. By 4 months he should be back to 24-26 •Pneumonia-coughbabies and should be producing avoided. a lot of mucous; pain on breathing; ounces. high temperature;Never add shortnessseasonings of to breath; your baby’srapid or foods labored (salt, breathing. sugar) A baby does not have to finish each bottle, but if your baby •Ear infection-pluggedAt about 7-9 months, or painful table ears and or finger pulling foods at the should ears inbe young consistently refuses to eat normally or falls asleep in the middle of a childrenintroduced with even fever. if there However, are no manyor few babies teeth. pull By 12and months play with of age, their feeding more than twice in a row, call your doctor as this may be a earsbabies when should they be do entirely not have on eartable infections. foods and should be feeding sign of illness. •Sinusitis-tendernessthemselves mostly with and their pain fingers. above or below the eye or puffiness around the eyes in infants. ADDITIONAL NOTES ON FEEDING IfBelow your ischild a general develops guide a fever for when several to adddays foods: after he has a cold, he will Honey should be avoided until after 1 year of age because it probably6 months need to be checked by the doctor. may contain botulism toxin. Formula does not have to be warmed; it ~Cereal-rice cereal is usually tolerated best (1-2 tablespoons morning can be given at room temperature or at refrigerator temperature. COLICand evening mixed with formula or breast milk until forming a soupy Cold milk will not harm the baby in any way. If you want to warm mixture.The Feed term cereal colic with is an a oftenspoon. misused Do not term feed to cereal describe in a any bottle). type the formula be sure to test on your arm before letting the baby drink ofDO irritability NOT PUT or SUGARcrying in ORthe youngHONEY infant. IN CEREAL. Remember, all babies will it. cry~Fruits- and normal apricots, crying applesauce usually and peaks pears. at about Begin 6 weeksby offering of age. one Never warm milk or formula using a microwave. teaspoonTypically, and gradually colic isincrease a combination this amount of symptoms to three which is quite Never prop the baby’s bottle during a feeding. Always hold characteristic.tablespoons/day. It usually It may has be mixeda rather with sudden rice cereal.onset of a loud him in your arms when you feed him. continuous cry; the knees are frequently drawn up to the abdomen DO NOT put your baby to bed with a bottle or nurse 7 months and~Yellow the fists vegetables-squash, are clenched tight. carrots; There all is fruits no apparent and cereals; reason cottage for the continuously overnight—this can cause severe tooth decay and cryingcheese; e.g. yogurt no dirty diaper, the infant is not hungry or uncomfortable. cavities. ~Green vegetables-spinach, green beans and green peas. Begin

vegetables with one teaspoon working slowly up to three PACIFIERS tablespoons/day. Most infants have a strong sucking reflex. A pacifier to suck

between feedings will satisfy this reflex. 2925

24 HOW MUCHSPECIAL TO TOPICS FEED THE - LISTED BABY? ALPHABETICALLY WHEN TO ADD SOLIDS Babies usually breast feed for about fifteen minutes on each Feeding your baby new foods is an exciting developmental milestone. breastCHILD or REARINGbottle feed for AND 15-30 DISCIPLINE minutes. Thirty minutes is the However, many parents begin foods too early. The current research maximumThere amount is a verse of time in theyou Bible should which allow states for athat feeding. “children are shows that no supplemental foods are needed before 4 months of age. Belowlike arrows”; is a guide the toidea the is amount that, just of as formula an arrow your needs baby to needs: be directed to Adequate intake of formula or breast milk alone can meet the a target, so a child needs to be directed to those things which the nutritional requirements of an infant even up to 6 months of age. Many Ageparents believe Number are important feedings/day for their children Formula/ to attain. feeding The highest babies, however, will need to begin introducing foods as early as 4 0-1goal mos any parent can have6-7 for his or her child is2 that½ - 4the oz child learn to months due to growth and development. By 6 months, the nutritional 3love mos and obey God and 4-6come into personal knowledge4-6 oz of God demands of continued growth make additional foods necessary. 4through mos his Son, Jesus Christ.4-5 Other goals which5-6 are oz important There may be special circumstances, such as reflux, that 5might mos include such things4-5 as the child excelling 5-6in school,oz sports, necessitate the addition of cereal earlier than 4 months. This will be 6-9music, mos etc., and, in general,4 having a happy and 6fulfilling oz childhood; discussed with your doctor on an individual basis at your office visits. 10-12ultimate mos goals should include3 those things which8 accompany oz a In the 4-6 month range, you will likely begin to see signs that fulfillingIf and he consistentlyproductive adulthood.empties his bottle at each feeding and cries the baby is ready for more when he or she seems unsatisfied with bottle for more,The increase direction the thefeeding child by takes one is ounce in large part the responsibility or breast feedings, begins to wake consistently earlier than every 3-4 of the parents,In general, and notherefore, infant should child rearing get more is athan very one important can of formulaarea to hours, stops sleeping through the night or consistently exceeds 32 inconsider. 24 hours The (this rearing is about of a24 child ounces) must in occur the first in a1-2 loving months environment; or 32 ounces of formula in 24 hours. There is no need to add solids until the ouncesthis love at must 2-4 months. be as much By as4 months is possible he shouldan unselfish be back love. to 24-26 This love baby gives the sign that it is time. ounces.may be further broken down into nurturing and discipline. Nurturing Below is a general guide for feeding your baby beginning at 4-6 refers toA the baby parents’ does notcaring have for to the finish child’s each physical, bottle, but emotional, if your baby months when they show signs they are ready: consistentlyspiritual and refuses social wellto eat being. normally Discipline or falls refers asleep to in the the necessity middle of that a ~Foods should contain only single ingredients during the early stages. feedingcertain restrictionsmore than twicebe placed in a row,on a childcall your for hisdoctor own as good this andmay safety, be a sign of illness. and that when these limits are violated, the child is swiftly and clearly ~When adding new foods, add one at a time and then wait 3-5 days. If no rash, shown that he has done wrong. A common mistake made today is diarrhea or runny nose develops, you may add another. This will help you tell if ADDITIONALthat parents allow NOTES their children ON FEEDING to be disobedient or rebel against the they baby is tolerating a new food. parents’Honey authority. should It is be essential avoided that until parents after 1 setyear realistic of age demandsbecause it mayupon contain their children botulism and toxin. then Formularequire that does their not children have to belive warmed; within it ~Cereal is an excellent choice for a first food. Rice cereal is usually tolerated best canthese be limits. given atTo room repeat, temperature discipline oris oneat refrigerator large aspect temperature. of love. A and is the least likely to have issues with allergies. Other cereals such as oats and Coldparent milk who will truly not loves harm his the child baby will in disciplineany way. hisIf you child, want and to will warm do barley are also available. These fortified cereals provide needed zinc and iron that theit, not formula out of be anger, sure tobut test in aon loving your armand firmbefore manner. letting the baby drink are limited in milk alone. Cereal can be made with breast milk, formula or water. Feed cereal with a spoon, not in the bottle, to help your baby learn the oral motor it.There are several good books on child rearing. We would Never warm milk or formula using a microwave. skill of eating from a spoon, this will also help with speech development. At first, recommend most highly Dare to Discipline, by Dr. James Dobson. you should offer about 1 teaspoon of cereal after breast or bottle feeding and Never prop the baby’s bottle during a feeding. Always hold He has several other books such as The Strong Willed Child which slowly increase until taking about 1/2 cup daily by 6-8 months. This should remain himwould in beyour very arms useful when to you butfeed this him. is a good starting point. a staple in their diet for the first year. A secondDO book NOT that put is yourhighly baby recommended to bed with is a Shepherdingbottle or nurse a Child’s Heartcontinuously by Tedd overnight—this Tripp. can cause severe tooth decay and ~Pureed meats provide also provide zinc and iron and are recommended as first cavities. foods. ~Fruits and vegetables can then be added one at a time. PACIFIERS ~The order of introduction does not seem to change a baby’s acceptance of new Most infants have a strong sucking reflex. A pacifier to suck between feedings will satisfy this reflex. foods. Your baby may not accept a new food the first time you offer it. That is ok. Continue to offer a variety

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25 of healthy options. Sometimes it can take as many as 15 times for a baby to accept a new food.

~Purchased baby foods in jars/containers and home-made foods are both healthy choices for your baby.

~Jar foods may be safely kept refrigerated for 48 hours after opening.

~You may use combination foods once your baby has had all of the individual ingredients.

~The amount to feed should be regulated by the baby. When they turn away or stop being interested in eating, you can stop feeding them. Avoid forcing them to finish a certain amount or overfeeding as this will decrease their ability to self-regulate intake and can lead to overeating and obesity later in life.

~Around 6 months when your baby is sitting and begins to reach for foods, thicker purees can be used.

~Babies will progress from purees to foods with more consistency and texture at around 7-8 months. (Ground foods, mashed foods with soft lumps)

~Finger foods usually are accepted when the baby develops a grasp at around 8-9 months. Small pieces of soft foods--fruits, cooked vegetables or small pieces of crackers or cereal can be used as first finger foods. Chewing becomes more prominent at this stage. The absence or number of teeth need not limit feedings as most of this chewing is done with the gums.

SPECIFIC RECOMMENDATIONS:

~Allergenic Foods-Current research shows no benefit from delayed introduction of allergy prone foods, such as eggs, peanut butter and fish and likely benefit from early introduction at 4 months in patients who are high risk for developing allergies, such as those with eczema or a family history of eczema and allergies. These foods can be introduced as early as 4 months of age in appropriate textures.

~Choking-Always make sure the foods you give your baby are safe for their age and development. Choking hazards such as hard, round foods--carrots, whole grapes, nuts--should be avoided until after the age of 3-4.

~Desserts, candies, cookies, soft drinks or other sugary drinks are not good for babies and should be avoided.

~No seasonings should be added to baby foods. (Salt, sugar)

~Never give honey to a baby under a year of age.

~Juice-Fruit juice sounds healthy. However, when fruits are made into juices, the health benefits of fruits are reduced and it is basically sugar water. There is generally no need for fruit juice.

~Other sweet beverages-there is never a need for soft drinks, tea, Kool- Aid, etc. and these should be avoided. 26

~Drinking From a Cup-Sometime between 6-12 months of age, babies can begin to drink from a cup. As they accept this, you can move away from the bottle and 8-9BREAST months CARE discontinue it at around 12 months of age. Your baby should never have a drink or ~Egg yolksBreasts and nipples should be washed at least once a day with bottle in bed as this can lead to dental decay. ~Meats-warm soapy begin water. with whiteClean meatseach breast (turkey, with chicken); clear water then before use dark meatsfeeding. (beef, After liver, feeding, lamb) clean the breast with clear water and allow to ~Cow’s milk may be introduced after 12 months of age. Foods that contain small amounts of milk such as yogurt and cheese can be given earlier when texture is ~Realizeair dry. This that preventsmeat dinners irritation. and meat and vegetable dinners do not appropriate. have as Youmuch can protein expect as a meats small alone.amount The of milk“meat to withleak vegetables”from the dinnersbreasts betweenhave more feedings. meat that Nursing the “vegetable pads will with prevent meat” leakage dinners. onto ~Meal time-Family time is precious and meal time should be enjoyable for all of you. 12clothing. months Allow your baby to watch you making healthy choices of foods. Sit and interact with ~WholeIf milk your breasts become cracked or dry, use lanolin cream and your family without the distraction of TV or phones and make the family table a special ~Byexpose this them time to your the babyair. Breasts should arebe offusually a bottle sore and at theon abeginning cup of place that your children will want to join for years to come. completely.each feeding especially during the first week. This will decrease over

time. Any soreness that persists, or any local area of redness or BATHING THE BABY soreness that is apparent for more than two feedings in a row should Bath time can be an enjoyable time for both you and your be reported to the doctor. baby. Until the navel is healed, only sponge bathing should be used. A supportive bra is essential. It should have good uplift and BATHING THE BABY Try to bathe the baby at the same time each day. The routine is nice snaps thatBath allow time ready can be exposure an enjoyable of the timebreasts. for both you and your for both of you. If your baby’s skin is excessively dry, you may not baby. Until the navel is healed, only sponge bathing should be used. want to bathe your baby more than every 2-3 days in order to avoid Try to bathe the baby at the same time each day. The routine is nice PUMPING BREAST MILK excessive drying. Have all of your supplies together in one place and For many women who plan to return to work, pumping is an for both of you. If your baby’s skin is excessively dry, you may not within easy reach. Some parents prefer to make a bath tray. The excellent way to continue nursing and providing breast milk to their want to bathe your baby more than every 2-3 days in order to avoid room temperature during bathing should be about 75 degrees and the baby while they are away. Also, every mom needs a break, so an excessive drying. Have all of your supplies together in one place and room should be free of drafts. Fill the tub with about 2-3 inches of withinoccasional easy bottle reach. of Some breast mothers milk may prefer be needed to make as awell. bath tray. The water. Check the water temperature with your hand or arm before room temperatureIf you plan during to pump bathing only rarely,should a be simple about hand 75 degrees pump isand the using it on the baby. roomusually should adequate. be free If ofyou drafts. will be Fill pumping the tub onwith a regularabout 2-3 basis, inches an of Wash the face first with plain water (no soap). Clean the eyes water.electric Checkpump isthe a waterworthwhile temperature investment. with your Pump hand in a or quiet, arm calmbefore with cotton balls dipped in cool water without soap. Clean the outer usingplace ifit possible.on the baby. Make sure you store your pumped milk areas of the nose and ears with a soft sponge or corner of a appropriately.Wash the It canface be first left with at room plain temperature water (no soap). for 6 hours,Clean the eyes washcloth. Do not attempt to clean nostrils or ear canals with q-tips withrefrigerated cotton forballs 6 daysdipped or infrozen cool forwater 6 months without or soap. more Cleanif stored the in outer or cotton swabs. This can do more harm than good. areasairtight of containers the nose in and a deep ears freezer with or a insoft the backsponge of aor regular corner freezer of a The head should be gently lathered with soap and washed washcloth.(do not leave Do it innot the attempt door). to These clean differ nostrils from or formula ear canals due with to natural q-tips from the front to the back to avoid getting soap in the eyes. You can orantibacterial cotton swabs. properties This can of humando more milk. harm Milk than from good. two or more use a soft toothbrush or fingernail brush if the child has cradle cap. pumping sessions can be combined, but should be cooled to the same The head should be gently lathered with soap and washed Don’t forget to scrub the soft spot. You may use soap or baby temperature before doing so. from the front to the back to avoid getting soap in the eyes. You can shampoo. Shampooing is not necessary more often than every 3-4 When preparing a bottle from pumped milk, gently swirl— use a soft toothbrush or fingernail brush if the child has cradle cap. days. Wash the rest of the baby’s body with warm soapy water don’t shake-- the milk to loosen the fat layer from the bottle. Heat Don’t forget to scrub the soft spot. You may use soap or baby paying careful attention to the skin folds around the neck, arms and shampoo.under running Shampooing water or inis anot bottle necessary warmer more or pan often of thanwarm every water. 3-4 groin. Rinse well with warm water and pat dry with a soft towel or days.Never Washmicrowave the rest any of milk the baby’s for your body baby. with Do warm not rewarmsoapy water an receiving blanket. Do not use baby oil as this can cause rashes. Baby payingunfinished careful bottle. attention to the skin folds around the neck, arms and lotion can be used but is usually not necessary. groin. Vitamin Rinse well D is with an essentialwarm water vitamin and forpat absorptiondry with a softof calcium towel or and bone development. It’s poorly represented in breast milk. It is NEVER TAKE YOUR HANDS OFF THE BABY DURING THE recommended that exclusively breast fed babies or babies fed with BATH OR LEAVE THE BABY UNATTENDED IN HIS TUB. 2622

27 DIAPER CHANGING Between baths, the diaper area should be cleaned as soon as possible after each stool or wetting. You should wash the diaper area at each diaper change with soap, water and a soft cloth or a baby wipe. When cleaning little girls, remember to wipe away from the vagina (from front to back) and when cleaning little boys, be sure to clean material from the folds of the scrotum. If a rash begins to develop, use a cream such as Vaseline, Desitin or A&D Ointment. If this does not clear the rash within 2-3 days, call your doctor.

SPECIAL TOPICS - LISTED ALPHABETICALLY CHILD REARING AND DISCIPLINE There is a verse in the Bible which states that “children are like arrows”; the idea is that, just as an arrow needs to be directed to a target, so a child needs to be directed to those things which the parents believe are important for their children to attain. The highest goal any parent can have for his or her child is that the child learn to love and obey God and come into personal knowledge of God through his Son, Jesus Christ. Other goals which are important might include such things as the child excelling in school, sports, music, etc., and, in general, having a happy and fulfilling childhood; ultimate goals should include those things which accompany a fulfilling and productive adulthood. The direction the child takes is in large part the responsibility of the parents, and therefore, child rearing is a very important area to consider. The rearing of a child must occur in a loving environment; this love must be as much as is possible an unselfish love. This love may be further broken down into nurturing and discipline. Nurturing refers to the parents’ caring for the child’s physical, emotional, spiritual and social well being. Discipline refers to the necessity that certain restrictions be placed on a child for his own good and safety, and that when these limits are violated, the child is swiftly and clearly shown that he has done wrong. A common mistake made today is that parents allow their children to be disobedient or rebel against the parents’ authority. It is essential that parents set realistic demands upon their children and then require that their children live within these limits. To repeat, discipline is one large aspect of love. A parent who truly loves his child will discipline his child, and will do it, not out of anger, but in a loving and firm manner.

28 There are several good books on child rearing. We would recommend most highly Dare to Discipline, by Dr. James Dobson. HOW MUCH TO FEED THE BABY? He has several other books such as The Strong Willed Child which Most nursing babies will be satisfied after approximately 30 would be very useful to you but this is a good starting point. minutes. If feedings consistently take longer a lactation consultation is A second book that is highly recommended is Shepherding a Child’s recommended. Bottle fed babies should usually feed for 15 to 30 Heart by Tedd Tripp. minutes. Below is a guide to the amount of formula your baby needs: COLDSWHEN TO ADD SOLIDS Colds,The tendency or upper in respiratory most mothers infections is to want (URI) to addare onesolids of toothe Age Number feedings/day Formula/ feeding mostearly. common The current and thinkingcontagious in thereasons medical of illness community in infants is that and babies young 0-1 mos 6-7 2 ½ - 4 oz children.need nothing They besides are caused fortified by viralformula infections or breast and milk do notuntil need five or six 3 mos 4-6 4-6 oz treatmentmonths. with antibiotics. They usually last 7-14 days. 4 mos 4-5 5-6 oz If your child has a stuffed up nose, you may want to use 5 mos 4-5 5-6 oz saline nose drops. You can make these by adding ½ teaspoon of table 6-9 mos 4 6 oz salt to 1 cup of boiled water or purchase at a pharmacy. After the 10-12 mos 3 8 oz solution has come to room temperature, put one drop in each nostril If he consistently empties his bottle at each feeding and cries then suck with the 1 ounce rubber syringe (suction bulb). Do this for more, increase the feeding by one ounce before each feeding and at bed time. This will make it easier for the In general, no infant should get more than one can of formula childconsistentlyto breathe. exceeds 32 ounces of formula in 24 hours. Do not add in 24 hours (this is about 24 ounces) in the first 1-2 months or 32 solids untilCough the andbaby cold gives medications the sign that not it recommended.is time. ounces at 2-4 months. By 4 months he should be back to 24-26 COLDS--COMPLICATIONSAdd one new food at a time and then wait 5-7 days. If no ounces. rash, diarrheaAs discussed or runny above, nose the develops, vast majority you may of colds add areanother. benign This and A baby does not have to finish each bottle, but if your baby willway goyou away will withoutbe able toany tell difficulties. if the baby Rarely,is not going a complication to tolerate a consistently refuses to eat normally or falls asleep in the middle of a cancertain arise. food. If you see any of the following signs, please bring feeding more than twice in a row, call your doctor as this may be a your childDesserts, in to be candies, seen. cookies and soft drinks are not good for sign of illness. •Pneumonia-coughbabies and should be producing avoided. a lot of mucous; pain on breathing; high temperature;Never add shortnessseasonings of to breath; your baby’srapid or foods labored (salt, breathing. sugar) ADDITIONAL NOTES ON FEEDING •Ear infection-pluggedAt about 7-9 months, or painful table ears and or finger pulling foods at the should ears inbe young Honey should be avoided until after 1 year of age because it childrenintroduced with even fever. if there However, are no manyor few babies teeth. pull By 12and months play with of age, their may contain botulism toxin. Formula does not have to be warmed; it earsbabies when should they be do entirely not have on eartable infections. foods and should be feeding can be given at room temperature or at refrigerator temperature. •Sinusitis-tendernessthemselves mostly with and their pain fingers. above or below the eye or puffiness Cold milk will not harm the baby in any way. If you want to warm around the eyes in infants. the formula be sure to test on your arm before letting the baby drink IfBelow your ischild a general develops guide a fever for when several to adddays foods: after he has a cold, he will it. probably6 months need to be checked by the doctor. Never warm milk or formula using a microwave. ~Cereal-rice cereal is usually tolerated best (1-2 tablespoons morning Never prop the baby’s bottle during a feeding. Always hold COLICand evening mixed with formula or breast milk until forming a soupy him in your arms when you feed him. mixture.The Feed term cereal colic with is an a oftenspoon. misused Do not term feed to cereal describe in a any bottle). type DO NOT put your baby to bed with a bottle or nurse ofDO irritability NOT PUT or SUGARcrying in ORthe youngHONEY infant. IN CEREAL. Remember, all babies will continuously overnight—this can cause severe tooth decay and cry~Fruits- and normal apricots, crying applesauce usually and peaks pears. at about Begin 6 weeksby offering of age. one cavities. teaspoonTypically, and gradually colic isincrease a combination this amount of symptoms to three which is quite characteristic.tablespoons/day. It usually It may has be mixeda rather with sudden rice cereal.onset of a loud PACIFIERS continuous7 months cry; the knees are frequently drawn up to the abdomen

Most infants have a strong sucking reflex. A pacifier to suck and~Yellowvegetables the fists vegetables-squash, with are oneclenched teaspoon tight. carrots; working There all isslowly fruits no apparent andup to cereals; three reason cottage for the between feedings will satisfy this reflex. cryingcheese;tablespoons/day. e.g. yogurt no dirty diaper, the infant is not hungry or uncomfortable.

2420 ~Green vegetables-spinach, green beans and green peas. Begin 29 8-9The months episodes may last from fifteen minutes to several hours and less than 16 oz. of formula supplements per day be given a vitamin D ~Eggusually yolks occur in late afternoon or early evening, often daily, but can supplement. ~Meats-occur at anybegin time with of whitethe day meats or night. (turkey, They chicken); usually then end usewith dark meatsexhaustion (beef, or liver, passage lamb) of stool or gas. Colic is generally not present FORMULA FEEDING ~Realizeuntil a child that is meat about dinners three weeks and meat of age and and vegetable is rarely dinners seen after do notfour Infant formulas are made from cows’ milk that has been havemonths as muchof age. protein as meats alone. The “meat with vegetables” specially treated so that the baby can digest it easily. These formulas dinners Althoughhave more the meat actual that cause the “vegetable is not understood, with meat” it may dinners. be are fortified with vitamins and iron. They come as ready to feed 12associated months with overfeeding or certain environmental factors. It formulas, as a powder or as concentrate. Be sure to read the ~Wholeoccurs frequently milk in first born children. Allergies (to formula or instructions on the label carefully and mix exactly as instructed. The ~Byotherwise) this time rarely your play baby a role. should Fortunately be off a bottle for the and parent on a cup and child, concentrate is cheaper than the ready-to-feed formulas. completely.there are no lasting effects and the problem will gradually disappear Use only the formula that your doctor recommends. with time. Be sure to use clean bottles and nipples. A bottle brush is A number of remedies have been suggested. These include: sometimes necessary to remove all the debris from the rims. Force frequent burping, formula changes and sedation. However, the first hot water through the nipples to be sure they are not clogged. It is BATHINGtwo do not usually THE BABY work and the last is potentially dangerous. better to let the bottles, lids and nipples drain dry than towel dry Recently,Bath there time have can been be an several enjoyable over-the-counter time for both products you and claimingyour them. baby.to be colic Until treatments. the navel is As healed, none onlyof these sponge have bathing had any should testing be or used. If you have well water, boil it for ten minutes prior to using it to Tryregulation, to bathe we the do baby not atrecommend the same time their each use. day. Application The routine of warmth is nice mix the formula. forto the both abdomen of you. andIf your rhythmic baby’s rocking skin is excessivelymay soothe dry, the youchild. may DO not Please read carefully and follow the safety instructions that wantNOT tochange bathe theyour baby’s baby formulamore than or giveevery any 2-3 medication days in order without to avoid accompany your formula. excessiveconsulting drying. your physician. Have all of your supplies together in one place and within easyIf your reach. baby Some has colic, mothers please prefer make to makean appointment a bath tray. to Thebring FEEDING SCHEDULE roomhim in temperature so we can rule during out bathingany physical should causes. be about 75 degrees and the We recommend a flexible feeding schedule in which the baby room should be free of drafts. Fill the tub with about 2-3 inches of eats every 3-5 hours. Crying earlier than 3 hours usually suggests water.DENTAL Check CARE the water temperature with your hand or arm before something other than hunger. Please do not fall into the trap of Care of your child’s teeth is a process that should begin feeding your baby every time he cries! actively soon after birth even before your child has any visible teeth. Breast feeding is best for the development of teeth, facial bones and the muscles of chewing and sucking. If you are bottle feeding, it is best to feed your baby in a semi-upright position and to use a nipple which makes your baby work a little for the formula. Never allow your baby to use the bottle as a pacifier; never give your baby their bottle while in bed. Begin using a cup as soon as your baby can use it (“sippie cup” type); this will occur sometime in the 6-12 month range. Never sweeten your baby’s pacifier with honey, sugar, etc. and don’t put your baby’s pacifier in your own mouth. find you are having trouble breast feeding, we will try to help you Cleansing of your baby’s mouth should be started at overcome the problem. Please call our office if you have questions. approximately 2 months of age by simply wiping both upper and Another excellent source is a lactation specialist. Each hospital has lower gums each day with a damp washcloth or a 2x2 inch piece several nurses who specialize in helping mothers and babies with of damp gauze. By doing this, the gums will be healthier and 1923

30 teething will be much less painful or even painless. This cleansing BREAST CARE process will be continued until the first tooth comes in about 6 Breasts and nipples should be washed at least once a day with months of age. At that time brushing needs to begin, and should warm soapy water. be done twice a day--once after the early morning meal and once You can expect a small amount of milk to leak from the before bedtime. Use non-fluoridated toothpaste until advised by breasts between feedings. Nursing pads will prevent leakage onto your pediatrician or pediatric dentist to use fluoridated. Oral clothing. hygiene involves the parent and the child. Initially, oral hygiene is If your breasts become cracked or dry, moisturize with the responsibility of the parent. As the child develops, home expressed breastmilk and expose them to the air. Avoid using creams care is performed jointly by parent and child. Daily dental flossing and ointments like lanolin as they can cause the baby’s latch to slip. should be added to the routine when your child’s teeth touch each Breasts are usually sore at the beginning of each feeding especially other. Flossing is important to remove plaque from between teeth during the first week. This will decrease over time. Any soreness that where a toothbrush can’t reach. You should floss your child’s teeth persists, or any local area of redness or soreness that is apparent for with floss or another between-the-teeth cleaner that has the ADA more than two feedings in a row should be reported to the doctor. Seal of Acceptance. As your child gets older you and your dentist A supportive bra is essential. It should have good uplift and or hygienist can teach proper brushing and flossing techniques to snaps that allow ready exposure of the breasts. Some babies are quiet and seem to fuss very little. Other babies seem your child. active from the first day of life and demand a lot of attention. The first visit to the dentist should be at about 1-2 years old. PUMPING BREAST MILK Neither Forextreme many means women that who there plan is toanything return towrong work, with pumping your child. is an Fluoride supplementation is essential to the health of your excellentAll infants way cry to and continue should nursingbe expected and providingto do so. Cryingbreast milk is the to baby’s their child’s teeth, and this will be prescribed as needed. If you are using babyfirst form while of they communication. are away. Also, By everycrying, mom he lets needs you a know break, when so an he well water, your child may need some fluoride supplements in his occasionalneeds something. bottle of He breast may milk be hungry, may be thirsty, needed tired, as well. uncomfortable, vitamins; city and school water is usually fluoridated. frustratedIf youor just plan want to pump his position only rarely, to be changed.a simple hand Some pump babies is cry The keys to healthy teeth are: usuallywhen they adequate. have bowel If you movements, will be pumping some babieson a regular cry for basis, no apparent an electricreason. pump Many is babies a worthwhile increase investment.their crying timePump up in to a aquiet, peak calmat about 1. Good hygiene (Brushing, flossing, cleansing) place6 weeks if possible. of age. Make sure you store your pumped milk 2. Small intake of sugar- especially candies, cookies, sugar coated appropriately.Please avoidIt can feedingbe left at your room baby temperature every time for he 6 cries. hours, Often, a cereal, etc. (If these must be eaten a good rule of thumb is to brush refrigeratedchange of diaper, for 6 days a new or sleeping frozen for position, 6 months a pat or onmore the if back stored or ina well after each time; a better idea is to substitute carrots, celery, airtightpacifier containersmay be enough in a deep to satisfy freezer his or needs in the and back quiet of a the regular baby. freezer bell pepper strips, etc., for sugary snacks) (doDuring not leavea crying it in spell, the door).try to handle These yourdiffer baby from in formula a soothing, due to loving natural 3. Limit juices to 4-6 ounces per day and do not allow a child to antibacterialmanner; rock properties him, cuddle of humanhim or milk.speak softlyMilk fromto him. two If or the more crying carry a cup of juice around and sip on it all day. pumpingpersists and sessions does not can respond be combined, to the usualbut should tricks, be check cooled the to baby the samefor 4. No bottles or cups in bed. Wean from bottle by 12 months of temperaturesigns of illness. before doing so. age. When Call your preparing doctor a if bottle the baby from is pumped not consolable, milk, gently extremely swirl— 5. Use of fluoridated water. Use of fluoridated toothpaste or don’tirritable, shake-- has athe fever milk or to refuses loosen to the eat fat normally. layer from the bottle. Heat supplements when directed. under runningIf you feelwater like or you in a are bottle losing warmer your patienceor pan of or warm that water.you may 6. Early intervention and good follow up by your dentist. Neverharm your microwave baby, please any milk ask for yourhelp frombaby. a Dofriend not or rewarm family anmember unfinishedin order to bottle.give yourself a break. If you have no one to call, please call ourVitamin office. D No is matteran essential how frustratedvitamin for you absorption get with yourof calcium baby, and FEAR OF THE DOCTOR boneNEVER development. SHAKE YOUR It’s poorly BABY! represented This can in cause breast serious milk. injury It is or A child is not born afraid of doctors any more than he is born recommendeddeath. that exclusively breast fed babies or babies fed with afraid of anything else. Fear is a learned attitude. For some children, fear of the doctor is due to his association with injections. This is often too greatly emphasized by inappropriate remarks by parents 2218 and others.

31 SPECIALA visit to the TOPICS doctor -should LISTED be regarded ALPHABETICALLY as a matter of fact To help prevent soreness of the nipples, break the suction experience without bribery, threats or false assurances. Preparing the by inserting your finger at the corner of the baby’s mouth. CHILDchild with REARING stories or booksAND aboutDISCIPLINE his visit to the doctor may be very helpful inThere explaining is a verse to inthe the child Bible what which is likely states to that happen “children in the are For best milk production, feed the baby every 2-4 hours. likedoctor’s arrows”; office. the These idea is story that, books just as are an available arrow needs in bookstores to be directed or at to ayour target, local so library. a child needs to be directed to those things which the COLOSTRUM parents Whenbelieve a are child important understands for their that children a stethoscope to attain. is like The a highest During the first few days of breast feeding, the baby will get goaltelephone any parent and that can its have placement for his or on her the child child’s is thatchest the should child notlearn to mostly colostrum. Colostrum is rich in proteins and bother them, they will not be afraid. When they understands that a immunoglobulins which offer the baby additional protection from throughthermometer his Son, is not Jesus a shot Christ. and thatOther an goals otoscope which (ear are light) important is just like a certain illnesses as well as allergies. mightflashlight include (used such for lookingthings as in the the child ears), excelling the fears in of school, uncertainties sports, can There is no need to worry that your baby will starve before music,be removed. etc., and, It is in important general, havingthat you a happypractice and things fulfilling with childhood;your child your milk comes in; babies have good nutritional stores in reserve before you bring them to the doctor. when they are born. Consider the colostrum to be “learning milk”. fulfillingThe and child productive should adulthood.never be threatened with a shot if they are It allows your baby to learn to nurse and your body to have time to naughty or cries, or for any other reason. Likewise, they should never recover from labor and birth before making larger volumes of milk. ofbe thepromised parents, that and they therefore, will not child be given rearing a shot is a orvery that important a procedure area will to The first day, about 3 Tablespoons will be produced—this is consider.not hurt. WeThe try rearing to be ofhonest a child with must children occur in atelling loving them environment; if adequate. The second day, your supply will double and then the thissomething love must is going be as tomuch hurt. as is possible an unselfish love. This love third or fourth day, the true milk will “come in” as your production increases. These small amounts are adequate, so don’t worry! If a child does receive a needed injection, a parent should not laugh at him. A child can be expected to cry after an injection and ENGORGEMENT this should be regarded as a natural response. A little love and When your milk supply begins to increase, you will likely assurance followed by a quick change of the subject after the have 1-2 days of uncomfortable engorgement. This usually occurs 3 injection are better than saying the doctor is mean or the nurse is days after your baby’s birth. You should continue to nurse as you bad. have been, but you may continue to feel full after your baby is parents’Even authority. with the It is best essential of handling, that parents many setchildren realistic object demands to being finished nursing. Effective feeding during the first 3 days will greatly uponexamined their betweenchildren aboutand then 9 months require and that 4 theiryears children of age. live within decrease the risk of breast engorgement. You may still be full – harder these limits. To repeat, discipline is one large aspect of love. A than normal fullness with tight, shiny, hard areola and may have some parentFEVER: who truly loves his child will discipline his child, and will do pain but not engorged. it, not out of anger, but in a loving and firm manner. ThereDEFINITION are several good books on child rearing. We would recommendFever most is defined highly Dareas a rectal to Discipline temperature, by Dr. of 100.4James or Dobson. greater Heand has is one several of the other most books common such problemsas The Strong parents Willed present Child to thewhich woulddoctor. be Fever very usefulis the body’s to you defensebut this mechanismis a good starting against point. infection or Ainflammation. second book that is highly recommended is Shepherding a Child’s Heart byIt Tedd is important Tripp. to know when and how to regulate a sick child’s temperature. Keep a digital thermometer in your home to measure the temperature in a sick child. Guessing at a temperature by feeling or looking is not satisfactory and the unnecessary use of acetaminophen (Tylenol) is not wise. If you are unsure how to take a temperature, one of the office staff will be glad to teach you. 1721

nursingyear of life.and areSometimes available when to you the even baby after cries you these take marks your willbaby become home. COLDSWhen the fever is 102 or greater, it is wise to give carefully Callmore the red-this hospital is normal. where your baby was born for a consult. regulatedColds, amounts or upper of medication. respiratory Usuallyinfections a child (URI) does are notone feel of the bad You will be hungry and should eat a well balanced diet, and frommost fevercommon alone and until contagious his fever reasonsis at least of 102.illness in infants and young

obey your appetite. This is not the time to crash diet. children.As They the child’s are caused temperature by viral goesinfections up, so and does do his not fluid need Daily fluid intake doesn’t necessarily need to increase for requirement.treatment with All antibiotics. children with They fever usually should last be 7-14 given days. increased breastfeeding. You should drink enough fluid so that your urine is amountsIf of your fluids. child Infants has a stoppedcan be given up nose, extra you feedings may want of Pedialyte to use ® or clear to pale yellow. This can vary widely. juices.saline nose Older drops. children You can can take make Pedialyte these by® , juicesadding or ½ Gatorade. teaspoon of Daily calcium requirements do not change while breastfeeding table saltDo to not 1 cup overdress of boiled a childwater. with After fever. the solutionThis will has only come cause to his so you do not need to take extra calcium. There is about 3-9% bone feverroom totemperature, go higher. Heput shouldone drop be inin eachthe very nostril minimum then suck amount with theof 1 loss while breastfeeding but it will be regained once your baby is clothes,ounce rubber e.g. just syringe a diaper. (suction bulb). Do this before each feeding and weaned. at bed time.Never This give will aspirin make to ita easierchild. for the child to breathe. If you breast feed, avoid all medications unless you consult TREATMENTCough and cold medications not recommended. your pediatrician. Acetaminophen or ibuprofen are the recommended drugs of Also avoid excessive use of alcohol, caffeine, caffeine choiceCOLDS--COMPLICATIONS for fever in children and adolescents. NEVER USE ASPIRIN. containing beverages (Coke, tea, coffee). IbuprofenAs discussed should not above, be used the in vast babies majority under of 6 coldsmonths are old. benign Follow and Smoking cigarettes isn’t contraindicated for nursing mothers packagewill go away instructions without for any dosing. difficulties. Rarely, a complication but we strongly advise you to stop smoking. Now is a great time to can arise.Acetaminophen If you see any in of over the followingdosage can signs, be fatal, please so bringplease keep all quit! preparationsyour child in outto be of seen.your child’s reach. •Pneumonia-coughAlternating acetaminophenproducing a lot ofand mucous; ibuprofen pain is onnot breathing; TO GET STARTED recommended.high temperature; shortness of breath; rapid or labored breathing. Find a comfortable position—most mothers prefer to sit in HOW•Ear infection-plugged TO TAKE A RECTAL or painful TEMPERATURE ears or pulling at the ears in young a comfortable chair with a foot stool or lie in the bed on one side. childrenIf with you fever.think your However, infant many is ill, anbabies accurate pull andtemperature play with is their Choose a quiet place that is free of distractions for best results. essential.ears when Usethey a do digital not have thermometer—mercury ear infections. thermometers should Hold the baby in one arm with the baby’s head higher be•Sinusitis-tenderness discarded and ear thermometersand pain above are or notbelow reliable. the eye Our or puffinessstaff will be than the stomach. Turn the baby’s entire body toward your body gladaround to discussthe eyes or in demonstrate infants. the following with you so that his stomach is against yours. Lift the breast with the If your1. child Turn developsthe thermometer a fever several on. days after he has a cold, he will opposite hand, holding, but not squeezing the breast between the probably2. Coat need the to bulbbe checked with petroleum by the doctor. jelly or cold cream. index finger and middle finger. Push the breast to the baby’s 3. Remove the baby’s diaper. cheek; he will turn his mouth toward the nipple. As the baby 4. HoldThe term the babycolic tois ankeep often them from misused wiggling. term to any type presses the nipple, milk will spray into his mouth. This may irritability5. Spread or the crying cheeks in the of theyoung buttocks. infant. Remember, all babies will cause him to gag at first. If so, pull away for a few seconds until of 6. Gentlynormal insert crying the usually end of peaks the thermometer at about 6 weeks into theof age. rectum. the flow decreases and try again. cry and7. TheTypically, baby will colic normally is a combination push against of symptoms it. Wait until whic theyh isquite relax The amount of areola (colored part of the nipple) that goes in continuouscharacteristic.and the Itthermometer usually has awill rather slip suddenin on its onset own. of a loud the mouth is irrelevant. The sizes of mom’s areola differ greatly. The 8. The cry;thermometer the knees shouldare frequently go in about drawn an upinch. to the abdomen most important thing for mom and her support person to look at is and 9.the Holdfists are the clenched thermometer tight. in There place isfor no two apparent to three reason minutes for orthe the corner of the baby’s mouth. It should be a wide angle – like a crying e.g.until no the dirty temperature diaper, the stops infant rising is not and hungry beeps. or Never uncomfortable. let go of rainbow, not a sharp angel. the thermometer. Burp the baby when changing sides of breast and burp again 10. Read the thermometer scale. after the entire feeding. You only need to burp for 1-2 minutes. You Clean the thermometer with alcohol. may find you don’t need to burp this often.

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33 TheFEAR episodes OF FEVER may last from fifteen minutes to several hours and SNEEZING, YAWNING, BELCHING, HICCOUGHING usually occurMany inpeople late afternoon are frightened or early by highevening, fevers often in children. daily, but In can WHATAll babies A sneeze, CUTIE! yawn, belch, hiccough, pass gas and cry. occurgeneral, at anythe heighttime of of the the day fever or doesnight. not They reflect usually seriousness end with of Sneezing and coughing are the baby’s way of clearing his nose and exhaustiondiseases. Many or passage times viralof stool infections or gas. willColic cause is generally much higher not present fever Everythroat baby– it usually is beautiful does notand meanyou will he haswant a tocold. admire Many every babies aspect sound of untilthan morea child severe is about bacterial three weeksinfections. of age Children and is rarely typically seen run after much four thiscongested; new creation. this is normal. Here are Belching some normal and hiccoughing things you mayafter noticea feeding is monthshigher fevers of age. than adults. The two things which most people are aboutnormal your and new should baby. not cause the baby discomfort. concernedAlthough about withthe actual high fevers cause are:is not understood, it may be associated• seizures with overfeeding or certain environmental factors. It HEADBOWEL MOVEMENTS occurs• brain frequently damage in first born children. Allergies (to formula or TheBreast head fed may babies appear normally large have in relation four to to eight the restyellow-greenish, of the body. otherwise)Approximately rarely play a fourrole. percent Fortunately of children for the have parent seizures and child, Itsemi-solid may also to have liquid a peculiar stools a shapeday. Someright after babies, birth. however, This is may called have thereresulting are nofrom lasting fevers effects - called and febrile the problem seizures. will Seeing gradually your childdisappear have a moldingonly one andstool is ordue even to theone skull every bones third overlapping day, and this as may the babybe normal. passes withseizure-even time. a short one-is of course a scary experience. However, throughAs long asthe the birth baby canal. shows This no shoulddiscomfort, return treatment to normal is innot a necessary.few days. these typesA number of seizures of remedies are usually have not been harmful suggested. and do These not lead include: to You mayFormula also be fedable babies to feel usually the sutures-the have pale place yellow, where pasty one stools bone frequentfuture epilepsy. burping, They formula are notchanges preventable. and sedation. However, the first meetsabout onethe next-asto four atimes raised a day.area onAgain, the head. it may be normal for formula two do notFever usually does worknot cause and brainthe last damage is potentially until it dangerous.gets up to at least fed babiesThe to soft have spot one (fontanelle) stool every on other the daytop ofor theevery baby’s third head day. is a Recently,107 or 108. there Many have children been several typically over-the-counter run 104 to 105 products fever with claiming place whereBabies the often bones grunt, have strain, not yet or come turn together.red or purple It is when natural having for a toroutine be colic viral treatments. infections. As Acetaminophen none of these have usually had will any not testing lower or the thebowel soft movement. spot to move This up isand usually down normal, in rhythm and with if the the stool heart is beatsoft, orthis regulation,fever to a normal we do temperaturenot recommend range their but use. should Application lower it to of a warmth102-103 breathing.does not mean This the will baby decrease is constipated. in size and However, disappear if by your about baby 12-18 seems torange. the abdomen and rhythmic rocking may soothe the child. DO months.to have unusually hard stool, call your doctor for advice. NOT changeThe main the baby’s key to formulaa child’s or fever give is any really medication how the childwithout behaves If your baby seems constipated, contact your doctor: DO consultingand acts. Usually your physician. fever itself makes a child feel bad. If the fever EYESNOT give your baby a laxative, suppository or enema. These can be comes downIf your and baby the has child colic, seems please to perk make up, an then appointment you can usually to bring be very dangerous.Babies are occasionally cross-eyed. Eye balance is poor himassured in so that we there can rule is nothing out any seriously physical wrong causes. with your child. during the first few months of life so do not worry if your baby However, if your child becomes more and more lethargic or irritable, sometimesINFANT FEEDING looks at you cross-eyed. If this continues past the third DENTALthen you should CARE call immediately. If the child is given Whether you choose to breast feed or bottle feed your baby, acetaminophen and the temperature does not come down to the 102- this shouldThe color be aof special the baby’s time eyesfor both can changeof you. up It isto one 6 months of the of 103 range after 30 minutes, then you should place them in lukewarm baby’s first pleasant experiences and should be very rewarding and water in the bathtub. They should soak in the lukewarm water for pleasant for both parent and child. approximately ten to fifteen minutes and you should sponge them SKIN from the head down during that time. Do not place them in cold BREASTThe FEEDING skin may vary in color from light pink to lobster red. It water and do not use alcohol to bring the fever down. Do not use an may alsoBreast appear feeding somewhat is the dry most and natural cracked way as ofthe feeding outer layeryour peelsbaby. ice water enema. If your child begins to shiver while in the bathtub, offWe within recommend the first it fewheartily. weeks. In Lotiongeneral, will almost help anybut iswoman not necessary. who remove them from the tub; shivering will cause a fever to go back up. wants toSmall breast white feed dotsher baby may canbe on do the so. baby’s If you face. do desire These to are breast called It is important to realize that sponging in lukewarm water will not be miliafeed and (or “milkare having bumps”) difficulties, and should please disappear DON’T over GIVE several UP. weeks.Call our effective unless the child has had acetaminophen in his system for Smalloffice andred dotswe can on thegive skin you are advice called and miliaria support (or to “prickly continue. heat”) and honey,approximately sugar, etc. forty-five minutes to one hour. Do not place your only requireIt is uncommonthat you do fornot a over mother dress to the have baby. insufficient At approximately milk. If you 1 child in a lukewarm bath if they do not have any acetaminophen in monthfind you of are age, having many troublebabies developbreast feeding, infant acne.we will This try isto normalhelp you and approximatelyhis system. 2 months of age by simply wiping both upper and willovercome go away the in problem. 1-2 weeks Please without call treatment. our office if you have questions. lower gums each day with a damp washcloth or a 2x2 inch piece of AnotherSmooth excellent red source birthmarks is a lactation sometimes specialist. appear Eachin the hospital nape of hasthe damp gauze. By doing this the gums will be healthier and teething neckseveral and nurses over whothe eyes. specialize These in are helping called mothers “stork bites” and babies or “angel with kisses”. These marks over the eyes should fade away over the first 1519

34 POISONINGwill be much less OR painful ACCIDENTAL or even painless. INGESTION This cleansing process SPITTING UP will be continuedFrom the timeuntil yourabout child 12 months begins toof crawlage. When until several the first years tooth HOMECOMINGSpitting up usually occurs shortly after a feeding, and may thereafter,comes in at he about or she 6 monthswill be at of high age, riskthe gumfor ingesting cleansing some may form be of Bringing your new baby home is an exciting and sometimes indicate over-feeding or lack of burping. If your baby spits up after poisonstopped, or but plant. brushing There needs are two to bethings continued that you and can soon do toshould make be this done overwhelming time. Following are some practical suggestions to routine burping, try holding him upright in your arms for about thirty lesstwice possible a day-once or, at after least, the to early minimize morning the effects.meal and once before help in this time of transition. minutes after meals. However, many babies spit up 1-2 tablespoons bedtime. The Unless first, it and is advised most important by your child’sthing, ispediatrician to keep all or pediatric with almost every feeding or between feedings for the first several medications,dentist, do not chemicals use fluoride (such containing as paints, toothpaste varnishes, until cleaning age 2-3material, or NURSERY months; this is normal for infants. furnitureuntil your polish, child isetc.), able and to spit poisonous it out. Byplants age out2, the of childyour child’scan begin reach. Your baby should come home from the hospital to a room of Vigorous spitting – vomiting an entire feeding or vomiting Thesebrushing items himself, should but be you stored will in need a place to follow which him is high with above your yourown his own if possible. This room should be clean, well aired, not drafty over quite a distance of 2-3 feet- should warrant a call to your doctor child’sround ofreach brushing or behind in order locked to assure doors qualityor child-proof and thoroughness. cabinet doors. and about 70-75 degrees. if it happens more than occasionally (more than once a week). Remember,Daily this dental applies flossing to grandparents should be added and other to the homes routine frequently at about

visited.5 years of age. Especially important areas to floss are the areas VISITORS The second item of importance is that you should have the BEHAVIORVisitors & andCRYING the number of people holding the baby should be No two infants are exactly alike, so do not compare your phone number of the Augusta Poison Control Center programmed limited during the first week. This is the best way to protect your baby’s behavior to that of a friend or even to a previous child. When into your telephone. If your child ingests a chemical, medication or baby from contagious diseases. Friends can look but not touch. your baby comes home, he will spend most of his time sleeping; the plant, call immediately for advice. The Poison Control Center is rest of the time, he will be eating or having brief periods of crying. part of a national network of Poison Control Centers and will have SomeSLEEPING babies POSITIONare quiet and seem to fuss very little. Other babies seem the best information available to you. Your newborn baby should be placed on his back to go to active from the first day of life and demand a lot of attention. The number is 1-800-222-1222. sleep. NEVER put your baby on his stomach to go to sleep. Back Neither extreme means that there is anything wrong with your child. In the past, Syrup of Ipecac was recommended in order to sleeping is the best and safest, significantly reducing the risk of SIDS. All infants cry and should be expected to do so. Crying is the baby’s induceThe keys vomiting to healthy in the teeth case are: of an ingestion. Currently, this is NOT As your baby gets older and develops better head control, time on his first form of communication. By crying, he lets you know when he recommended1. Good hygiene(brushing, and should not be flossing,given as cleansing)some substances can be stomach while awake is a good idea because this will help prevent needs something. He may be hungry, thirsty, tired, uncomfortable, harmful2. Smallwhen intakevomited of andsugar it (sucrose)-especiallymay interfere with other candies, needed cookies, flattening of the back of the head and encourage development and frustrated or just want his position to be changed. Some babies cry treatments.sugar Therefore, coated cereal, if you etc. have (If athese supply, must you be shouldeaten a discardgood rule it. is strength. when they have bowel movements, some babies cry for no apparent to brush well after each time; a better idea is to substitute reason. Many babies increase their crying time up to a peak at about SAFETYcarrots, celery, bell pepper strips, etc., for sugary snacks) 6DRESSING weeks of age. YOUR BABY 3.A Limitmajor juices cause to of 4-6 death ounces in young per day children and do and not babies allow isa child to PleaseYou should avoid dress feeding your your baby baby as youevery dress time yourself. he cries. Layer Often, the a accidents.carry Here a cup are of some juice common around andareas sip that on needit all day.to be changebaby’s clothes of diaper, in coola new weather sleeping and position, do not overdressa pat on the the back baby or in a hot addressed4. No to bottles make oryour cups home in bed. safe Weanfor your from children. bottle by 12 months of pacifierweather. may Keeping be enough him tooto satisfy warm hiscan needs be as andharmful quiet as the letting baby. him be age. Duringtoo cold. a crying spell, try to handle your baby in a soothing, loving •Be 5.sure Use that of the fluoridated rails on the water baby’s and crib toothpaste. are close enoughFluoride together vitamins (3- manner;Buy rock flame him, retardantcuddle him items or speak that are softly easy to to him. launder. If the Wash crying 3 1/2 inches)only if so instructed that the baby’sto do so head by yourand body pediatrician can’t slip or or pediatric get stuck. persistsitems before and does the baby not respond wears them. to the Remember usual tricks, that check babies the growbaby for •Alwaysdentist. keep the side rail up on their crib and never leave them alone signsquickly, of illness.so buy items big enough to last a while. on a6. table Early top, intervention bed or chair and to prevent good follow falls. upAlways by your keep dentist. at least one Call your doctor if the baby is not consolable, extremely hand on your baby while changing them; do not take your eyes off of irritable,SCHEDULE has a fever or refuses to eat normally. him.FEAR Babies OF THE roll orDOCTOR flip suddenly. IfDuring you feel the like first you several are losingweeks, your your patience baby will or sleepthat youthe may •Check theA child bath is water not born to make afraid sure of itdoctors will not any scald more them than and he alwaysis born harmmajority your of baby, the time. please Awake ask for times help will from consist a friend of oreating, family periods member of holdafraid them of anything while bathing else. Fear him. is Youa learned should attitude. set your For hot some water children, heater inquiet order wakefulness to give yourself and periods a break. of crying.If you have Each no baby one isto different call, please and lessfear thanof the 120 doctor degrees is due Fahrenheit. to his association with injections. This is callyou ourwill office. quickly No get matter to know how your frustrated baby and you his get or with her schedule.your baby, You •Beoften alert too togreatly any windows emphasized through by inappropriate which or stairs remarks down bywhich parents your can work with your baby over time to develop a schedule that is NEVER SHAKE YOUR BABY! This can cause serious injury or babyand others. could fall. Use appropriate safeguards—childproof gates or death.acceptable to the entire family. window guards. 1814

35 •Buy a safety tested car seat. Children should face the rear of the This5) is not Circumcision unusual unless care –the Your bleeding son’s persistscircumcision for several should days be vehicle until they are at least 2 years of age and weigh at least 20 lb to and/or cleansedincreases within amount. water using a cotton ball or wash cloth to drip decrease the risk of cervical spine injury in the event of a crash. waterFor boys, over the it. circumcisionBe sure to apply need A not & Dbe ointment bandaged. or Vaseline Infants who weigh 20 lb before 2 years of age should ride rear facing in applied toto thethe circumcisionarea for the first site few to prevent days will irritation prevent from the end the ofdiaper. the a convertible seat or infant seat approved for higher weights until at penis fromThis sticking will heal to withinthe diaper. several As days. this area heals, it will normally least 2 years of age. If a car safety seat accommodates children rear appear yellowish then brown. If a plastic bell has been used, this facing to higher weights, for optimal protection, the child should usually6) Pleasefalls off call at aboutthe office one toweek. schedule a 2-3 day weight check and a remain rear facing until reaching the maximum weight for the car 2 week check-up. safety seat, as long as the top of the head is below the top of the seat BELLY BUTTON back. Studies show that children are safest by far in a rear facing car The umbilicus (belly button) will begin drying up and the cord seat until age 2 years. From that point, your child should ride in a will drop off by the seventh to fourteenth day. A small amount of forward facing car seat and progress to a booster. Only when your bleeding normally occurs when the stump falls off and for a few days child is at least 4’ 9” inches tall and able to wear a belt that fits thereafter. Keep the cord exposed to air as much as possible and fold properly over the lap and shoulder should they graduate to a seat belt. the diaper down in toward the skin in order to keep urine off of the Your child should not sit in the front seat until age 13. stump. The stump (navel) should be kept dry at all times. Do not •Be careful not to leave them with a brother or sister because they may bandage, tape, or use a belly band over the belly button. If the area harm the baby without realizing it. continues to drain or show signs of bleeding for more than two days, •It is important that the furniture and toys you buy for the baby be call your doctor for advice. safe. When selecting toys, be sure that the baby cannot break them Sometimes babies have an umbilical hernia (or protrusion of and check to see that small objects such as button eyes cannot fall off. the belly button) due to an opening in the muscles of the abdomen. The baby might swallow them and choke. Most of these go away on their own. Again, do not bandage, tape or •Never use a microwave to heat your baby’s bottle. use a belly band over the hernias since this will only cause irritation •Avoid popcorn and peanuts until the child’s 3rd to 4th birthday. These to the skin and will not make the hernia heal any more quickly. can be sucked into the lungs. •Never let your baby or child sleep in bed with you. This is LEGS dangerous. Occasionally, babies have bowed legs, so their feet may not •Buy safety plugs for electrical outlets when your baby is about six look exactly straight to you. This is usually due to the position the months old. baby was held in the uterus. The legs and feet will slowly straighten •Remember that some house plants are poisonous (for example, but may continue to look abnormal for a few months after the baby poinsettia, Dieffenbachia or dumb cane and philodendron). walks. •Install smoke alarms in your baby’s room and in other strategic places in the house. ______•Always keep firearms locked away and unloaded. •Never use a walker. They can result in severe head injuries from falls down stairs or when babies pull heavy objects from tables. BEHAVIORS:

SIDS BREATHING A fear of most new parents, SIDS (Sudden Infant Death There are many normal variations in a newborn’s breathing Syndrome or Crib Death) is a somewhat preventable disorder. Much patterns. The rate may vary-it may be slow and then become very research has been done to determine the cause of this tragic problem. fast or even have short pauses.

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36 year of life. Sometimes when the baby cries these marks will become No one Whencause hasthe beenfever found,is 102 orbut greater, several it associations is wise to give have carefully been moreNEWBORN red-this DISCHARGEis normal. DAY INSTRUCTIONS maderegulated and amountsyou can decreaseof medication. the chance Usually of SIDS a child by does not feel bad Mongolian spots are dark bluish, bruised looking areas over •alwaysfrom fever put alone your untilbaby histo sleepfever onis at his least or her 102. back-this one the buttocks1) Feedings and back occurring in some infants. These have no interventionAs the has child’s the most temperature dramatic goes effect up, so does his fluid medicala. significance For breast fed and babies will go you away should as the nurse baby your gets baby older. 3 to 5 •dorequirement. not smoke All children with fever should be given increased •doamounts not place of fluids. the baby’s Infants crib can near be airgiven vents extra or draftsfeedings of Pedialyte® or HAIR •dojuices. not Olderput soft children bedding can (pillow take Pedialyte or comforter,® , juices etc) or or Gatorade. stuffed animals to 15A minutes newborn per may side have the fourthlong hair day. or Youno hair should at all. nurse Usually your the in your baby’sDo not crib overdress a child with fever. This will only cause his first hair is lost. Frequently, body hair (lanugo) is present at birth and •usefever a to firm go higher.mattress He in theshould crib be in the very minimum amount of will disappear with time. clothes, e.g. just a diaper. Never give aspirin to a child. hours between feedings occasionally. Do not let your baby go TREATMENTAgain, we are delighted to walk with you through this exciting FINGERNAILSbeyond 5 hours even at night without feeding for these first few stage of Acetaminophenyour lives. We are or ibuprofenhere to help are you the in recommended any way we can.drugs of weeks.Fingernails may be quite long at birth. It is important to keep Pleasechoice don’tfor fever ever in hesitate children to and ask adolescents.any question NEVER or voice USE any concern.ASPIRIN. them clipped or covered to prevent the child from scratching himself. WeIbuprofen want you should to be not a confidentbe used in parent babies and under to know6 months we are old. always Follow DuringYour the firstbaby week should of life,have the 5 tonails 6 wet are diapers usually per attached day and to atthe least skin herepackage when instructions you need us.for dosing.Congratulations… now the fun begins…….! andtwo clipping stools can per cause day; thisthem will to tellbleed. you Afteryour thisbaby time, is getting the nails plenty can of Acetaminophen in over dosage can be fatal, so please keep all be clippedfluid and when calories. the baby is asleep using a small sharp pair of scissors or fingernail clippers. Do not file or bite the nails off. b. If your baby is bottle-fed please use the formula sent home MOUTHwith you from the hospital. Your baby should take approximately 1 to 2Small ounces white per “pearls”feeding initiallymay be butfound should inside rapidly the roof increase of the to 3 mouth.to 4 ounces They are per normal. feeding by the end of ten to fourteen days of age. Your baby should be fed approximately every four hours even at BREASTSnight during the first few weeks. If after five hours or so your baby is stillBreast sleeping enlargement please wake in the him/her newborn to be infant fed. (both Burping boys should and be girls)done is often at least present every for ½ aonce few toweeks. 1 once. This is caused by hormones which stimulated the mother’s breast to produce milk during the latter2) part Your of pregnancy. baby should It always may persist sleep foron hisseveral back. months. Sometimes a white discharge (“witches’ milk”) drains from the nipples.3) If This your is baby normal. looks Do increasingly not try to expressyellow orthe golden milk. afterIf the you breast go turns redhome or appears please inflamed,call us so callthat yourwe may doctor. check a bilirubin.

GENITALIA4) Cord care is accomplished using alcohol wipes three or four Thetimes female per day. infant Make genitalia sure that are youroften baby’senlarged diaper at birth is folded due to hormonesdown passed so it from does the not mother irritate tothe the cord baby or beforeallow thebirth. cord to get Sometimeswet therewith urine.may be The a white cord creamy usually vaginal separates discharge at approximately for a few days. This10 to can 14 be days. wiped After away it haswith fallen cotton off and and warm is well water. healed for two Occasionally,days you a small may amounttub bathe. of bleeding will be present from the vagina. This usually occurs around the seventh to tenth day of life.

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37 Acetaminophen in over dosage can be fatal, so please keep all preparations out of your child’s reach. NORMALAlternating DEVELOPMENT acetaminophen OF CHILDRENand ibuprofen is not recommended.Each child is different and special in his or her own way. You willHOW find TO unique TAKE traits A RECTAL for each of TEMPERATURE your children. There are, however, developmentalIf you think milestones your infant that most is ill, children an accurate follow. temperature Some may is vary,essential. but this Use list a digitalprovides thermometer—mercury estimates of changes andthermometers developments should yoube discarded will likely and see. ear You thermometers can use these are to not prepare reliable. for Ourthe next staff phasewill be of yourglad toadventure discuss orwith demonstrate your child. the following with you 1. Turn the thermometer on. Birth-One2. Coat month the bulb with petroleum jelly or cold cream. 1.3. MoroRemove reflex the (spontaneousbaby’s diaper. startle with arms out quickly & in 4.slowly Place the to midline)baby on hispresent stomach 2.5. VigorousHold the babysucking to keepreflex him present from wiggling. 3.6. LyingSpread prone the cheeks (face down);of the buttocks. lifts head briefly 4.7. LyingGently prone; insert makesthe end crawling of the thermometer movements intowith the legs rectum. 5. HeldThe baby in sitting will normallyposition; pushback isagainst rounded, it. Wait head until held heup relaxes momentarilyand the thermometer will slip in on its own. 6.8. HandsThe thermometer tightly fisted should go in about an inch. 7.9. ReflexHold the grasp thermometer of object with in place palm for two to three minutes or 8. Startleduntil the by temperature sound; quieted stops by rising voice and beeps. Never let go of 9. Ringingthe thermometer. bell produces decrease of activity 10. MayRead follow the thermometer object with scale. eyes to midline 11. Clean the thermometer with alcohol.

Two months 1. Kicks vigorously 2. Energetic arm movements 3. Vigorous head turning 4. Ventral suspension (prone); no head drop 5. Held in sitting position; head erect but bobs 6. Hand goes to mouth 7. Hands often open (not clenched) 8. Head and eyes turn toward sound 9. Listens to bell ringing 10. Cooing 11. Smiles back when talked to 12. Follows object past midline 13. Alert expression

107Three or months108. Many children typically run 104 to 105 fever with routine1. viral Lying infections. prone; holds Acetaminophen head up 90 degrees usually will not lower the BRINGINGWHAT A CUTIE! BABY HOME fever2. to Liftsa normal head temperature when lying onrange back but (supine) should lower it to a 102-103 range.3. Hold hands together Every baby is beautiful and you will want to admire every aspect of 4.The Sucks main fingers, key toinspects a child’s fingers fever is really how the child behaves PREPARATIONSthis new creation. Here FOR are BABY some normal things you may notice and 5.acts. Reaches Usually for fever but itselfmisses makes objects a child feel bad. If the fever aboutGoing your to new the babybaby. store can be an overwhelming, not to mention comes6. down Holds and toy the with child active seems grasp to whenperk up, put then into youhand can usually be expensive, experience. Here are some practical guidelines as to what assured7. Pullsthat there at his is clothes nothing seriously wrong with your child. youHEAD may need for your newest family member. However,8. Rolls if your side childto back becomes more and more lethargic or irritable, The head may appear large in relation to the rest of the body. then9. you Rolls should object call (toy) immediately. side to side If (andthe child 180 degrees)is given CARIt may SEAT also have a peculiar shape right after birth. This is called acetaminophen10. Looks predominantly and the temperature at examiner does not come down to the 102- moldingEvery andbaby is must due to go the home skull in bones an appropriately overlapping sized as the and baby tightly passes 103 11.range Glances after 30 at minutes,toy when then put youinto shouldhand place him in lukewarm installedthrough therear birth facing canal. car seat. This Theshould safest return place to fornormal your inbaby a few is in days. the water12. in Recognizes the bathtub. mother He should and bottle soak in the lukewarm water for centerYou may of the also back be able seat. to If feel this the is notsutures-the possible place as some where cars one do bonenot approximately13. Smiles spontaneouslyten to fifteen minutes and you should sponge him havemeets enough the next-as room a inraised the center,area on the the back head. side is the next alternative. from14. the Cooing, head down chuckling, during squealing,that time. grunting, Do not place especially him in when cold Never putThe a rearsoft spotfacing (fontanelle) seat in the on front the seattop of thea car baby’s or truck head with is a a water andtalked do not to use alcohol to bring the fever down. Do not use an passengerplace where side the air bones bag. have Car seatsnot yet involved come together. in a major It motor is natural vehicle for ice water15. Moro enema. reflex If yourbegins child to disappear begins to shiver while in the bathtub, collisionthe soft spot should to move be replaced up and due down to thein rhythm possibility with of the unseen heart damage beat or remove16. Grasphim from reflex the nearly tub; shivering gone will cause a fever to go back up. orbreathing. stress that This may will not decrease withhold in another size and collision. disappear For by aboutthis reason, 12-18 It is important to realize that sponging in lukewarm water will not be youmonths. should not purchase a used car seat as you do not know if it is effectiveFour months unless the child has had acetaminophen in his system for safe. approximately1. Sits when forty-five well supported minutes to one hour. Do not place your EYES It is very difficult to properly install car seats—80% are child2. in Noa lukewarm head lag whenbath if pulled he does to sittingnot have position any acetaminophen in installedBabies incorrectly. are occasionally Follow all cross-eyed. instructions. Eye If youbalance would is poor like to his system.3. Turns head at sound of voice haveduring your the installationfirst few months checked, of life which so do we not would worry recommend, if your baby call 4. Lifts head (in supine position) in effort to sit 1-866sometimes SEAT-CHECK looks at you or cross-eyed. visit wwwseatcheck.org. If this continues past the third 5. Supports weight on forearms when prone month of life or is persistent ask your doctor about it. 6. Lifts head and chest when prone BEDDINGThe color of the baby’s eyes can change up to 6 months of 7. Held erect; pushes feet against table age.The bed should have a firm mattress—a baby does not care how 8. Grasps rattle fancy it looks or how much it costs. It may be a crib or a bassinet. If 9. Plays with own fingers youSKIN choose a crib, be sure that the rails are close enough together that 10. Reaches for object in front of him with both hands the baby’sThe head skin will may not vary get in caught color (3-3from 1/2 light inches). pink to Therelobster should red. It be 11. Transfers objects from hand to hand sidesmay alsoaround appear the mattresssomewhat to drykeep and him cracked from falling as the off.outer Be layer sure peels that 12. Pulls dress over face theoff withinmattress the fits first snuggly few weeks. inside Lotionso he will will not help slip but between is not necessary. the 13. Smiles at people mattressSmall and the white side dots of the may crib. be on the baby’s face. These are called miliaPillows (or “milk and otherbumps”) fluffy and bedding should such disappear as comforters over several and weeks.stuffed animalsSmall red should dots on not the be skin left inare the called crib. miliaria (or “prickly heat”) and only require that you do not over dress the baby. At approximately 1 month of age, many babies develop infant acne. This is normal and will go away in 1-2 weeks without treatment. Smooth red birthmarks sometimes appear in the nape of the neck and over the eyes. These are called “stork bites” or “angel kisses”. These marks over the eyes should fade away over the first 1511

IMMUNIZATION SCHEDULE FiveThese months items should be stored in a place which is high above your HOMECOMINGBelow is the usual immunization schedule. There are child’s1. reach Moro or reflex behind gone locked doors or child-proof cabinet doors. Bringingseveral combination your new baby injections home availableis an exciting that andmay sometimesbe used to Remember,2. Rolls this supine applies (back to tograndparents front) and other homes frequently overwhelmingreduce the number time. of Following injections arerequired some topractical administer suggestions the needed to visited.3. Rolls side to side helpimmunizations. in this time of transition. 4. NoThe head second lag item when of held importance by hands is and that pulled you should to sitting have the phone numberposition of the Augusta Poison Control Center taped on your NURSERYBirth-2 weeks…………………………………HBV telephone.5. Full If head your control child ingests when sittinga chemical, medication or plant, call 2 months……………………………………….DTaP,Your baby should come home from the hospital Hib,to a roomIPV, HBV,of immediately6. Grasps for dangling advice. objectThe Poison Control Center is part of a his own if possible. This room should be clean, PCV-13, well aired, Rotavirus not drafty national7. Reaches network for of toyPoison with Control both hands Centers and will have the best and4 aboutmonths………………………………………. 70-75 degrees. DTaP, Hib, IPV, HBV, information8. Scratches available on table to you. top The number is 1-800-222-1222. PCV-13, Rotavirus 9. PushesIn the past, chest Syrup off table of Ipecac when pronewas recommended in order to VISITORS6 months………………………………………. DTaP, Hib, IPV, HBV, induce10. vomiting Smiles at inmirror the case image of an ingestion. Currently, this is NOT Visitors and the number of people holding PCV-13, the baby Rotavirus should be recommended11. Jabbers, and squeals should with not high be given voice as some substances can be limited12 months…………………………………… during the first week. This is the best way...MMR, to protect VV, yourHAV harmful12. Regards when vomited toy in hand and it may interfere with other needed baby15 from months…………………………………… contagious diseases. Friends can look...Hib, but notPCV-13 touch. treatments.13. Recognizes Therefore, familiar if you voices have a supply, you should discard it. 18 months………………………………………DTaP, HAV SLEEPING4 years…………………………………………..DTaP, POSITION IPV, MMR, VV SixSAFETY months 11-12Your years………………………………… newborn baby should be placed....TdaP, on his back MCV-4, to go HPVto 1.A Supine; major cause lifts head of death spontaneously in young children and babies is sleep. NEVER put your baby on his stomach to go to sleep. Back accidents.2. Bounces Here areon feetsome when common held standingareas that need to be sleepingPHILOSOPHY is the best OF and USE safest, OF MEDICATIONSsignificantly reducing the risk of SIDS. addressed3. Sits to briefly make (tripodyour home fashion) safe for your children. As yourMedications baby gets older are anduseful develops in the treatmentbetter head of control, an illness time when on his 4. Rolls front to back (6-7 months) stomachthey are usedwhile specifically awake is a and good with idea an because eye toward this willthe benefithelp prevent versus •Be 5.sure Grasps that the foot rails on the baby’s crib are close enough together (3- flatteningthe risk of of that the particular back of the medication. head and encourageViruses, such development as the common and 3 1/26. inches) Grasps so cube that withthe baby’s palm head and body can’t slip or get stuck. strength.cold or vomiting and diarrhea, are not affected by antibiotics and, •Always7. Holds keep theone sidecube rail in eachup on hand his crib and never leave him alone therefore, if your child has what is presumed to be a viral infection, on a8. table Puts top, cube bed in or mouth chair to prevent falls. Always keep at least one DRESSINGthere will be noYOUR antibiotics BABY prescribed. We would ask that you never hand9. on Re-secures your baby droppedwhile changing cube him; do not take your eyes off of begin yourYou child should on antibioticsdress your babyuntil youas you have dress spoken yourself. with orLayer have the him.10. Babies Transfers roll orcube flip from suddenly. hand to hand baby’sbeen seen clothes by our in coolstaff. weather If your childand do is notdiagnosed overdress with the a bacterialbaby in hot •Check11. Shakeshis bath rattle water to make sure it will not scald him and always weather.infection andKeeping is given him an too antibiotic, warm can take be itas exactly harmful as asdirected letting andhim be hold12. him Bangs while spoon bathing on him.table You should set your hot water heater toobe sure cold. to complete the full course prescribed. Cough and cold less 13.than Turns 120 degrees head to Fahrenheit. bell medicationsBuy flameare not retardant recommended. items that are easy to launder. Wash •Be 14.alert Consc to anyious windows of strange through sights which and persons or stairs down which your items before the baby wears them. Remember that babies grow baby15. could Consistent fall. Use regard appropriate of object safeguards—childproof and person gates or quickly, so buy items big enough to last a while. window16. Makes guards. four different sounds 17. Vocalizes at mirror image SCHEDULE 18. Localizes source of sound (bell, voice) During the first several weeks, your baby will sleep the 19. Laughs out loud majority of the time. Awake times will consist of eating, periods of quiet wakefulness and periods of crying. Each baby is different and you will quickly get to know your baby and his or her schedule. You can work with your baby over time to develop a schedule that is acceptable to the entire family. 1410

3UHYQDU 3&9 SURWHFWVDJDLQVWSQHXPRFRFFXVZKLFKPD\ should ride rear facing in a convertible seat or infant seat approved 5) Circumcision care – Your son’s circumcision should be Eight months FDXVHSQHXPRQLDDQGPHQLQJLWLV,WPD\DOVRSURYLGHVRPH for higher1. Sits weights alone until at least 1 year of age. If a car safety seat cleansed with water using a cotton ball or wash cloth to drip SURWHFWLRQDJDLQVWHDULQIHFWLRQV accommodates2. Early stepping children movements rear facing to higher weights, for optimal water over it. Be sure to apply A & D ointment or Vaseline +HSDWLWLV$YDFFLQH +$9 SURWHFWVDJDLQVWDW\SHRIYLUDO protection,3. Tries the to child crawl should remain rear facing until reaching the to the circumcision site to prevent irritation from the diaper. KHSDWLWLV OLYHULQIHFWLRQ maximum4. Leans weight forward for the to carget safetyan object seat, as long as the top of the head This will heal within several days. 0HQDFWUD 0&9 SURWHFWVDJDLQVWEDFWHULDOPHQLQJLWLVDQ is below5. Works the top to of get the toy seat out back. of reach Studies show that children are safest LQIHFWLRQLQWKHIOXLGDURXQGWKHEUDLQ by far6. in Scoops a rear facingpellet car seat until age 2 years. From that point, your 6) Please call the office to schedule a 2-3 day weight check and a +39SURWHFWVDJDLQVWKXPDQSDSLOORPDYLUXVDVH[XDOO\ child7. should Rings ride bell in purposively a forward facing car seat and progress to a 2 week check-up. WUDQVPLWWHGGLVHDVHWKDWFDXVHVFHUYLFDOFDQFHUDQGJHQLWDOZDUWV booster.8. Drinks Only whenfrom cupyour child is at least 4’ 9” inches tall and able to 0RVWRIWKHLPPXQL]DWLRQVFDXVHYHU\IHZVLGHHIIHFWV:HGRQRW wear9. a belt Looks that for fits fallen properly object over the lap and shoulder should he QRUPDOO\UHFRPPHQGJLYLQJ7\OHQROIRUDQ\RIWKHLPPXQL]DWLRQV graduate10. Bites to a andseat chewsbelt. Your toys child should not sit in the front seat XQOHVV\RXUEDE\VHHPVIXVVLHUWKDQXVXDOIROORZLQJWKHVKRWV until11. age Pats 13. mirror image

research has been done to determine the cause of this tragic problem. 139

41 ROUTINE CARE OneNo one year cause has been found, but several associations have been NEWBORNA safeguard DISCHARGE to see that DAY your INSTRUCTIONS child is growing and developing made1. andWalks you whencan decrease lead the chance of SIDS by normally is accomplished by routine check-ups. These are •always2. Stand put your alone baby (or to with sleep support) on his or her back-this one recommended 1) Feedings at the following ages: intervention3. Creeps has on the hands most and dramatic knees effect You should nurse your baby at least eight times per 24 •do 4.not Graspssmoke two cubes in one hand hours (about every three hours on average). You may find your •do 5.not Holdsplace thecup baby’s to drink crib near air vents or drafts baby wanting to feed every two hours occasionally. Do not let •do 6.not Givesput soft toy bedding on request (pillow or comforter, etc) or stuffed animals your baby go beyond 5 hours even at night without feeding for the in your7. Cooperatesbaby’s crib with dressing first two weeks. For additional information see page 19. •use8. a firmPlays mattress with cup, in the spoon, crib saucers 9. Points with index finger Your baby should have 5 to 6 wet diapers per day and at 10. Pokes finger (into stethoscope) to explore least 2 to 4 stools per day; this will tell you your baby is getting 11.Again,Secures we small are delighted object (raisin) to walk with with pincer you graspthrough this exciting plenty of fluid and calories. Stools will begin to lighten in color stage12. ofReleases your lives. to intoWe yourare here hand to help you in any way we can. and should be yellow by day four. Please13. don’tTries everto take hesitate cube toout ask of anya box question or voice any concern. 3HUWXVVLV7HWDQXVDQG'LSKWKHULD We 14.wantUnwraps you to be a cubea confident parent and to know we are always here15. whenHolds you crayon need us. Congratulations… now the fun begins…….! 2) ,39SURWHFWVDJDLQVWSROLR Your baby should always sleep on his back. 16.Tries to imitate scribble 5RWDYLUXVYDFFLQHSURWHFWV\RXUEDE\DJDLQVWRQHRIWKH 17.Reacts to music 3) Ifcommon your baby causes looks of increasingly vomiting and yellow diarrhea or golden causing after you go NORMAL18.Says DEVELOPMENT three words OF CHILDREN homedehydration. please call us so that we may check a bilirubin. 19.EachBabbles child to is self different when aloneand special in his or her own way. You 005SURWHFWVDJDLQVW0HDVOHV0XPSVDQG5XEHOOD will 20.findUnderstands unique traits simple for each commands of your children. There are, however, 4) The umbilical stump should be allowed to dry. Make sure that developmental milestones that most children follow. Some may your baby’s diaper is folded down so it does not irritate the cord or vary, but this list provides estimates of changes and developments allow the cord to get wet with urine. The cord usually separates at Fifteen months you1. will Stand likely alone see. You can use these to prepare for the next phase of approximately 10 to 14 days. After it has fallen off and is well your2. adventure Creeps upstairs with your child. healed for two days you may tub bathe. 3. Walks few steps – starts and stops Birth-One4. Gets month off floor and walks alone 5.1. Uses Moro spoon reflex but(spontaneous spills startle with arms out quickly & in 6. Tiltsslowly cup to tomidline) drink present 7.2. Puts Vigorous pellet sucking in bottle reflex present 8.3. Builds Lying pronetower (faceof two down); cubes lifts head briefly 9.4. Drops Lying prone;cube into makes cup crawling movements with legs 10.5.Helps Held in turn sitting page position; in book, back pats ispicture rounded, head held up 11.Helpsmomentarily pull off clothes 12.6. HandsIndicates tightly wants fisted by pointing 13.7.Shows Reflex graspor offers of objecttoy with palm 14.8.Imitates Startled byscribble sound; quieted by voice 15.9.Speaks Ringing four bell toproduces six words, decrease uses jargon of activity 10. May follow object with eyes to midline

128

42 TwoEighteen months months SIGNS OF ILLNESS IN AN INFANT 1. Kicks:DONVZLWKRXWIDOOLQJ vigorously BRINGINGParents often feel BABY unsure if their HOME infant could be developing 2. Energetic5XQV VWLIIO\ arm movements an illness. Here are some sings to look for when your baby is not 3. Vigorous:DONVXSVWDLUVRQHKDQGKHOG head turning acting like himself: 4. Ventral&OLPEVLQWRFKDLU suspension (prone); no head drop PREPARATIONS )HYHUHTXDOWRRUJUHDWHUWKDQE\UHFWXP,I\RXUEDE\ FOR BABY 5. Held:DONVEDFNZDUG in sitting position; head erect but bobs Going LVOHVVWKDQZHHNVROGZLWKDIHYHURIRUKLJKHUFDOO to the baby store can be an overwhelming, not to mention 6. Hand3XOOVVWULQJWR\ goes to mouth expensive, the experience.office or answering Here are service some immediately.practical guidelines as to what 7. Hands+XUOVEDOO often open (not clenched) you may 9RPLWLQJ QRWMXVWVSLWWLQJXS PRUHWKDQRQHIHHGLQJ need for your newest family member. 8. Head7XUQVSDJHV and eyes turn toward sound in a day. 9. ListensEXLOGVWRZHURIFXEHV to bell ringing CAR SEAT 'LDUUKHD²ORRVHZDWHU\VWRROVWKDWDUHPRUHIUHTXHQW 10. Cooing3XWVWHQFXEHVLQWRFXS Every than baby usual. must go home in an appropriately sized and tightly 11. Smiles3RLQWVWRDQGQDPHVSLFWXUHV back when talked to installed 5HIXVDOWRHDWIRUPRUHWKDQRQHIHHGLQJGHFUHDVHLQWKH rear facing car seat. The safest place for your baby is in the 12. Follows3RLQWVWRLQGLFDWHZKDWKHZDQWV object past midline center of VWURQJTXDOLW\RIWKHVXFNRUIDOOLQJDVOHHSLQWKHPLGGOHRI the back seat. If this is not possible as some cars do not 13. Alert3RLQWVWRQRVHH\HVKDLU expression have enoughsuccessive room feedings. in the center, the back side is the next alternative. )HHGVVHOI ZLWKVSLOOLQJ Never put /HWKDUJ\RUOLVWOHVVQHVVVXGGHQDQGSURORQJHGGHFUHDVHLQ a rear facing seat in the front seat of a car or truck with a Three months&DUULHVRUKXJVDGROO passengeractivity. side air bag. Car seats involved in a major motor vehicle 1. Lying7DNHVRIIVKRHVDQGVRFNV prone; holds head up 90 degrees collision 8QXVXDOVNLQUDVK should be replaced due to the possibility of unseen damage 2. Lifts6FULEEOHVVSRQWDQHRXVO\ head when lying on back (supine) or stress )DVWEUHDWKLQJ RYHUWLPHVSHUPLQXWH RUGLIILFXOW\ that may not withhold another collision. For this reason, 3. Hold,PLWDWHVYHUWLFDOVWURNHRQSDSHU hands together you shouldbreathing. not purchase a used car seat as you do not know if it is 4. Sucks6D\VZRUGV fingers, inspects fingers safe. &RQYXOVLRQV 5. Reaches&DQVD\´KHOORµDQG´WKDQN\RXµ for but misses objects 3HUVLVWHQWLUULWDELOLW\It is very difficult to properly install car seats—80% are 6. HoldsFDUULHVRXWWZRGLUHFWLRQV RQHDWDWLPH IRULQVWDQFH´JHW toy with active grasp when put into hand installed incorrectly. Follow all instructions. If you would like to 7. PullsWKHEDOOIURPWKHWDEOHµ²´JLYHWKHEDOOWRPRPP\µ at his clothes MEDICALhave your installation EXPENSES checked, which we would recommend, call 8. Rolls side to back 1-866 SEAT-CHECKOur policy is that or visitfor scheduled www.seatcheck.org. appointment visits including Twenty-one9. Rolls monthsobject (toy) side to side (and 180 degrees) DQQXDOFKHFNXSVURXWLQHQHZERUQFDUHDQGIROORZXSYLVLWVSD\PHQW 10. Looks-XPSVDQGUXQVZHOO predominantly at examiner LVH[SHFWHGDWWKHWLPHWKHVHUYLFHVDUHUHQGHUHG,WLVSUHIHUDEOHWKDWBEDDING 11. Glances:DONVGRZQVWDLUVRQHKDQGKHOG at toy when put into hand sickThe visits bed and should emergency have a visitsfirm mattress—abe paid for at baby the timedoes servicesnot care arehow 12. Recognizes6TXDWVZKLOHSOD\LQJ mother and bottle UHQGHUHGEXWZHXQGHUVWDQGWKDWWKLVPD\QRWDOZD\VEHSRVVLEOfancy it looks or how much it costs. It may be a crib or a bassinet.H If 13. Smiles.LFNVODUJHEDOO ZKHQGHPRQVWUDWHG spontaneously &KDUJHVIRUDOOVHUYLFHVZLOOEHIUHHO\GLVFXVVHGZLWK\RXyou choose a crib, be sure that the rails are close enough together that 14. Cooing,%XLOGVWRZHURIILYHWRVL[FXEHV chuckling, squealing, grunting, especially when the baby’sHospitalization head will not insurance get caught is (3-3 very 1/2 important inches). for There your should baby be talked8VHVVSRRQZHOO to DQG\RXUIDPLO\,I\RXKDYHQRWQRWLILHG\RXULQVXUDQFHFRPSDQ\RIsides around the mattress to keep him from falling off. Be sure that 15. Moro3RXUVZDWHUIURPRQHFXSLQWRDQRWKHU reflex begins to disappear WKHEDE\·VELUWKSOHDVHGRVRDWWKLVWLPH,I\RXKDYHQRLQVXUDQFHthe mattress fits snuggly inside so he will not slip between the 16. Grasp3XOOVSHUVRQWRVKRZVRPHWKLQJ reflex nearly gone pleasemattress do and all youthe sidecan toof obtainthe crib. some now. )ROGVSDSHURQFHZKHQVKRZQ Pillows and other fluffy bedding such as comforters and stuffed Four months7DNHVWKUHHGLUHFWLRQV RQHDWDWLPH IRULQVWDQFH´WDNHED OO animals should not be left in the crib. 1. SitsIURPWDEOHµ²´JLYHWKHEDOOWRPRPP\µ²´SXWEDOORQIORRUµ when well supported 2. 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43 IMMUNIZATIONEMERGENCIES SCHEDULE Two7. years Held erect; pushes feet against table BelowFor true is emergencies,the usual immunization please call theschedule. office orThere the answeringare 1.8. Says Grasps simple rattle phrases severalservice, combination and we will giveinjections you an available answer immediatelythat may be usedconcerning to 2.9. Uses Plays “I”, with “me”, own fingers“you” reducewhere tothe go number and what of injectionsto do. If there required is no to time administer to call, youthe neededshould 3.10. 5HSHDWVWZRGLJLWV DIWHUIHZWULDOV Reaches for object in front of him with both hands immunizations.bring your child to the office or take him to the nearest emergency 4.11. Distinguishes Transfers objects “in” from and hand“under” to hand room. During times in which the office is closed, you should take 5.12. 5HIHUVWRVHOIE\QDPH Pulls dress over face yourBirth-2 child weeks…………………………………HBVto the nearest emergency room. The emergency room at 6.13. Knows Smiles atfour people body parts the2 Children’s months……………………………………….DTaP, Medical Center at the Medical College of Hib, Georgia IPV, is HBV, 7. Asks for things at table by name preferred in the event that an emergency room PCV-13, visit is necessary. Rotavirus Five8. months 3RLQWVWRSLFWXUHV 4 months……………………………………….One of the most common calls we receive DTaP, is in regard Hib, IPV,to HBV, 9.1. Builds Moro reflex5-6 cube gone tower fever management. (See section on fever) We usuallyPCV-13, recommend Rotavirus 2.Cuts Rolls with supine scissors (back to front) acetaminophen6 months………………………………………. or ibuprofen (if greater than 6 months DTaP, old) Hib, for IPV, HBV, 11.3.5HPRYHVZUDSSLQJIURPFDQG\ Rolls side to side fever management, and as long as fever can be PCV-13, controlled Rotavirus using the 12.4.Claps No head hands lag when held by hands and pulled to sitting recommended12 months…………………………………… dosage and as long as your child...MMR, feels better VV, once HAV the 13.5XQVZLWKRXWIDOOLQJposition medication15 months…………………………………… is given it is fine to wait until morning...Hib, to call PCV-13 the office 14.5.Goes Full head up and control down when stairs sitting alone for18 an months………………………………………DTaP, appointment to be seen. However, if your child is lessHAV than six 15.6.Kicks Grasps large dangling ball object weeks4 years…………………………………………..DTaP, old and has a rectal temperature equal to or greater IPV, than MMR, 100.4 VV 16.7.Imitates Reaches circularfor toy with strokes both hands or less11-12 than years………………………………… 2 years old with a fever of 104 or ....TdaP,greater, you MCV-4, should HPV 17.8.3XOOVRQVLPSOHJDUPHQW Scratches on table top call immediately no matter what the time. Other illnesses should be 18.9.Opens Pushes door chest off table when prone PHILOSOPHYassessed by the parent OF USE on anOF individual MEDICATIONS basis using your own good 19.10.turns Smiles pages at mirror in book, image singly judgment.Medications Do not hesitate are useful to call in inthe the treatment case of anof anemergency illness when or if 11.Throws Jabbers, ballsqueals into witha box high voice theyyou areare unsureused specifically about how and to carewith for an youreye toward child. the benefit versus 12. Regards toy in hand the risk of that particular medication. Viruses, such as the common Two13. and Recognizes One Half familiarYears voices coldPHONE or vomiting CALLS and DURING diarrhea, OFFICE are not affectedHOURS by antibiotics and, 1. 5HIHUVWRVHOIE\SURQRXQ UDWKHUWKDQQDPH therefore,Phone if your calls child for hasappointments what is presumed can be madeto be aduring viral infection,office Six 2.months Walks on tiptoes therehours. will If yoube no have antibiotics questions, prescribed. the office We personnel would askwill that discuss you thenever 3.1. Jumps Supine; with lifts bothhead feet spontaneously beginproblem your with child you. on If antibiotics there is an until emergency, you have you spoken will bewith put or through have 4.2. Tries Bounces standing on feet on when one footheld standing beento the seen doctor by ourimmediately. staff. If your Otherwise, child is diagnosedeither one withof the a officebacterial staff 5.3. 3XVKHVWR\ZLWKJRRGVWHHULQJ Sits briefly (tripod fashion) infectionor the doctor and willis given call anyou antibiotic, later in the take day. it Theexactly doctors as directed review and all 6.4. +HOSVSXWWKLQJVDZD\ Rolls front to back (6-7 months) bemessages, sure to completeand although the full you course may not prescribed. speak to Coughone of themand cold directly 7.5. Can Grasps carry foot breakable objects medicationsevery time you are call, not yourecommended. will receive information by well-trained 8.6. Builds Grasps tower cube withof eight palm cubes personnel who have discussed the problem with the physicians. 9.7. +ROGVFUD\RQE\ILQJHUV Holds one cube in each hand When you call please have the following at hand: 8.Identifies Puts cube 5-7in mouth pictures 1. Your child’s temperature 11.9.Names Re-secures objects dropped (key, cubepenny, watch) 2. Your pharmacy’s phone number 10. Transfers cube from hand to hand 3. Your child’s weight Three11. Years Shakes rattle 4. Pen and paper 1.12. Names Bangs spoon three oron more table objects in a picture If you are calling about over-the-counter medication dosages, please 2.13. 5HSHDWVVL[V\OODEOHV IRULQVWDQFH´,KDYHDOLWWOHG Turns head to bell og”) be very specific about the medication you have as dosages vary 3.14. 5HSHDWVWKUHHGLJLWV VHYHUDOWULDOV Conscious of strange sights and persons greatly between infant’s and children’s formulations. 4.15. Gives Consistent sex (“Are regard you of objecta boy orand a girl?”)person 5.16. Gives Makes full four name different sounds 106

44 17.6. VocalizesKnows a fewat mirror rhymes image OFFICE 3UHYQDU 3&9 SURWHFWVDJDLQVWSQHXPRFRFFXVZKLFKPD\ HOURS and EMERGENCY COVERAGE 18. Localizes*LYHVDSSURSULDWHDQVZHUVWR´:KDWVZLPV²IOLHV²VKRRWV² source of sound (bell, voice) Routine FDXVHSQHXPRQLDDQGPHQLQJLWLV,WPD\DOVRSURYLGHVRPH office hours are Monday through Friday 9AM-5PM. 19. LaughsERLOV²ELWHV²PHOWV"µ out loud We have SURWHFWLRQDJDLQVWHDULQIHFWLRQV emergency hours most Saturdays 10AM-12PM and most 8. &RPSUHKHQGVFRQFHSWVVXFKDV´FROGµ´WLUHGµ´KXQJU\µ Sundays +HSDWLWLV$YDFFLQH +$9 SURWHFWVDJDLQVWDW\SHRIYLUDO 2PM-4PM. Eight9. months8QGHUVWDQGVWDNLQJWXUQV Our KHSDWLWLV OLYHULQIHFWLRQ physicians are in a pediatric call group which provides 1. Sits&RSLHVDFLUFOH alone seven days 0HQDFWUD 0&9 SURWHFWVDJDLQVWEDFWHULDOPHQLQJLWLVDQ per week coverage in the office including Saturdays and 2. Early&DQSXWRQVKRHV stepping movements Sundays. LQIHFWLRQLQWKHIOXLGDURXQGWKHEUDLQ We also provide 24 hour per day coverage for emergencies. 3. TriesAlternates to crawl feet going upstairs We or +39SURWHFWVDJDLQVWKXPDQSDSLOORPDYLUXVDVH[XDOO\the doctor on call for our group may be reached by calling 4. LeansJumps forwardfrom bottom to get stair an object the office WUDQVPLWWHGGLVHDVHWKDWFDXVHVFHUYLFDOFDQFHUDQGJHQLWDOZDUWV at 706-868-0389. If your child is seen urgently or in an 5. Works5LGHVDWULF\FOH to get toy out of reach emergency0RVWRIWKHLPPXQL]DWLRQVFDXVHYHU\IHZVLGHHIIHFWV:HGRQRW by a physician outside of our group, please give us a call 6. ScoopsStands onpellet one foot for a moment theQRUPDOO\UHFRPPHQGJLYLQJ7\OHQROIRUDQ\RIWKHLPPXQL]DWLRQV next morning and let us know how your child is doing. 7. RingsPuts ten bell pellets purposively into bottle in thirty seconds XQOHVV\RXUEDE\VHHPVIXVVLHUWKDQXVXDOIROORZLQJWKHVKRWVIt is important to remember that although your doctor or one 8. Drinks)HHGVVHOIZLWKOLWWOHVSLOOV from cup of

18. Shouts for attention

19. Vocalizes “mama”, “dada”

20. Responds to name

45 ROUTINEDr. LaneCARE graduated from the Medical College of Georgia FiveOne yearsyear and receivedA safeguard his training to see in that pediatrics your child at the is growing Children' and s Hospital developing of 1. CopiesWalks whena square lead normallyGeorgia in is Augusta.accomplished by routine check-ups. These are 2. KnowsStand alone age (“how (or with old support) are you?”) recommended at the following ages: 3. PerformsCreeps on three hands tasks and (with knees one command); for instance: “Put 2 weeks 12 months pen on table – close door – bring me the ball.” All of our physicians are certified by the American Board of 4. Grasps two cubes in one hand 2 months 15 months 4. Knows four colors Pediatrics. 5. Holds cup to drink 4 months 18 months 5. Defines use for: “fork – horse – key – pencil, etc.” All of our physicians are on staff at University Hospital and 6. Gives toy on request 6 months 24 months 6. Skips, using feet alternately Doctor’s Hospital. 7. Cooperates with dressing 9 months 7.8. StandsPlays with on one cup, foot spoon, for seven saucers to eight seconds At age two a physical examination is recommended annually. 8.9. DrawsPoints withman indexwith at finger least six parts ; (for instance: head, arms, 10.legs,Pokes eyes, finger etc.) (into stethoscope) to explore IMMUNIZATIONS 9.11. CountsSecures twelvesmall objectobjects (raisin) correctly with pincer grasp Over the next few months, your baby will have a series of 10.12. CountsReleases number to into ofyour fingers hand correctly shots for protection from certain life threatening diseases. It is very 11.13. NamesTries to nickel, take cube dime, out penny of a box important for you to keep up with your child’s immunizations in 12.14. DressesUnwraps self a cubewithout assistance order to protect him from serious infectious diseases. The Center for 13.15. PrintsHolds fewcrayon letters Disease Control recommended schedule is the most effective way to 14.16. CommentsTries to imitate on pictures scribble protect your baby from these serious and potentially fatal diseases. 15.17. AsksReacts meanings to music of words 16.18. CanSays pronouncethree words correctly; “T –D –N –G –K –Y.” These immunizations are safe and effective. We strongly 17.19. BuildsBabbles six to block self when pyramid alone recommend them to you. The following are the currently 18.20. KnowsUnderstands days of simple week commands recommended immunizations: 19. Transports things in a wagon '7D3SURWHFWVDJDLQVW'LSKWKHULD3HUWXVVLV Fifteen20. Playsmonths with coloring set, construction toys, puzzles, jump rope, (whooping cough) and Tetanus (lock jaw). 1. skatesStand alone 7GDSLVXVHGLQFKLOGUHQZKRDUHROGHUDQGSURWHFWVDJDLQVW 21.2. ParticipatesCreeps upstairs well in group play 3HUWXVVLV7HWDQXVDQG'LSKWKHULD 3. Walks few steps – starts and stops ,39SURWHFWVDJDLQVWSROLR 4. Gets off floor and walks alone 5RWDYLUXVYDFFLQHSURWHFWV\RXUEDE\DJDLQVWRQHRIWKH 5. Uses spoon but spills common causes of vomiting and diarrhea causing 6. Tilts cup to drink

8 4

46 EighteenREFERENCES months INTRODUCTIONSIGNS OF ILLNESS TO OUR IN AN GROUP INFANT :DONVZLWKRXWIDOOLQJ OurParents pediatric often group feel seeks unsure to ifhelp their you infant provide could a goodbe developing and 1. First 5XQV VWLIIO\ Twelve Months of Life, Frank Caplan. This is an healthyan illness. childhood Here forare yoursome children. sings to lookOur forapproach when your is to babytreat isthe not excellent :DONVXSVWDLUVRQHKDQGKHOG pictorial and graphic book on your baby’s growth and wholeacting child: like physical, himself: spiritual, emotional and mental. )HYHUHTXDOWRRUJUHDWHUWKDQE\UHFWXP,I\RXUEDE\ development. &OLPEVLQWRFKDLU It makes growing up with baby a lot of fun. Our practice of pediatrics and adolescent medicine by LVOHVVWKDQZHHNVROGZLWKDIHYHURIRUKLJKHUFDOO :DONVEDFNZDUG definition includes newborns, infants, children and adolescents through age the 21. office Pediatricians or answering are trained service toimmediately. treat these age groups by 2. The Womanly3XOOVVWULQJWR\ Art of Breast Feeding, M.B. Carson. This +XUOVEDOO spending from 9RPLWLQJ QRWMXVWVSLWWLQJXS PRUHWKDQRQHIHHGLQJ three to four years beyond medical school in a is a good 7XUQVSDJHV reference book for those mothers who desire to learn pediatric residency. in a day. A pediatrician is a specialist in the diseases of more aboutEXLOGVWRZHURIFXEHV breast feeding. infants, children 'LDUUKHD²ORRVHZDWHU\VWRROVWKDWDUHPRUHIUHTXHQW and adolescents as well as their normal growth and 3XWVWHQFXEHVLQWRFXS development. than usual. 3. Dare 3RLQWVWRDQGQDPHVSLFWXUHVto Discipline, Dr. James Dobson. Dr. 5HIXVDOWRHDWIRUPRUHWKDQRQHIHHGLQJGHFUHDVHLQWKH Miller graduated from the Medical College of Georgia 3RLQWVWRLQGLFDWHZKDWKHZDQWV and then took VWURQJTXDOLW\RIWKHVXFNRUIDOOLQJDVOHHSLQWKHPLGGOHRI his pediatric training in Houston, Texas, at Hermann 4. Caring3RLQWVWRQRVHH\HVKDLU for Your Baby and Young Child, Birth to age 5, by Hospital andsuccessive M.D. Anderson feedings. Hospital in the Department of Stephen)HHGVVHOI ZLWKVSLOOLQJ Shelov, Boston Press. Pediatrics at /HWKDUJ\RUOLVWOHVVQHVVVXGGHQDQGSURORQJHGGHFUHDVHLQ the University of Texas Medical School at Houston. He &DUULHVRUKXJVDGROO was chief residentactivity. of pediatrics his last year there. 5. Shepherding7DNHVRIIVKRHVDQGVRFNV a Child’s Heart, Tedd Tripp. Shepherd Press, Dr. 8QXVXDOVNLQUDVK Moore graduated from the Medical College of Georgia 1-800-3386FULEEOHVVSRQWDQHRXVO\-1445. and received )DVWEUHDWKLQJ RYHUWLPHVSHUPLQXWH RUGLIILFXOW\ his pediatric training at the Fitzsimmons Army Medical Center in Denver.breathing. ,PLWDWHVYHUWLFDOVWURNHRQSDSHU 6D\VZRUGV Dr. &RQYXOVLRQV Newton graduated from the Medical College of Georgia 6. The Complete Book of Baby and Child Care by Focus on &DQVD\´KHOORµDQG´WKDQN\RXµ and continued 3HUVLVWHQWLUULWDELOLW\ his pediatric training at Vanderbilt University School the Family’sFDUULHVRXWWZRGLUHFWLRQV RQHDWDWLPH IRULQVWDQFH´JHW Physicians Resource Council, obtained at most of Medicine in Nashville, Tennessee. ChristianWKHEDOOIURPWKHWDEOHµ²´JLYHWKHEDOOWRPRPP\µ bookstores or by phoning Focus on the Family at MEDICALDr. Hanna EXPENSES graduated from the Medical College of Georgia 1-800-232-6459. and completedOur hispolicy pediatric is that training for scheduled at Brenner appointment Children’s visits Hospital including of Twenty-one months WakeDQQXDOFKHFNXSVURXWLQHQHZERUQFDUHDQGIROORZXSYLVLWVSD\PHQW Forest University Baptist Medical Center in Winston-Salem, 7. New -XPSVDQGUXQVZHOOMother’s Guide to Breastfeeding This is an excellent NorthLVH[SHFWHGDWWKHWLPHWKHVHUYLFHVDUHUHQGHUHG,WLVSUHIHUDEOHWKDW Carolina. source of:DONVGRZQVWDLUVRQHKDQGKHOG breastfeeding information published by the American sick visitsDr. Threadgill and emergency graduated visits from be paid the Medicalfor at the College time services of Georgia are Academy 6TXDWVZKLOHSOD\LQJ of Pediatrics. andUHQGHUHGEXWZHXQGHUVWDQGWKDWWKLVPD\QRWDOZD\VEHSRVVLEO continued there to complete his pediatric training. H .LFNVODUJHEDOO ZKHQGHPRQVWUDWHG &KDUJHVIRUDOOVHUYLFHVZLOOEHIUHHO\GLVFXVVHGZLWK\RXDr. Leverett received her M.D. from the Medical University of

47 EMERGENCIES NOTESTwo years For true emergencies, please call the office or the answering 1. Says simple phrases service, and we will give you an answer immediately concerning ______2. Uses “I”, “me”, “you” where to go and what to do. If there is no time to call, you should 3. 5HSHDWVWZRGLJLWV DIWHUIHZWULDOV bring your child to the office or take him to the nearest emergency ______4. Distinguishes “in” and “under” room. During times in which the office is closed, you should take ______5. 5HIHUVWRVHOIE\QDPH your child to the nearest emergency room. The emergency room at 6. Knows four body parts the Children’s Medical Center at the Medical College of Georgia is ______7. Asks for things at table by name preferred in the event that an emergency room visit is necessary. 8. 3RLQWVWRSLFWXUHV One of the most common calls we receive is in regard to ______9. Builds 5-6 cube tower fever management. (See section on fever) We usually recommend YOUR NEW BABY ______Cuts with scissors acetaminophen or ibuprofen (if greater than 6 months old) for 11.5HPRYHVZUDSSLQJIURPFDQG\ fever management, and as long as fever can be controlled using the ______12.Claps hands recommendedCONGRATULATIONS!! dosage and as long You as haveyour justchild become feels better new onceparents the and 13.5XQVZLWKRXWIDOOLQJ medicationso many isexciting given it and is fine wonderful to wait untiltimes morning are ahead to of call you the and office your ______14.Goes up and down stairs alone for newan appointment addition. We to arebe seen. honored However, that you if your have child chosen is less our thanpractice six to ______15.Kicks large ball weekswalk old with and you has through a rectal temperaturethe coming season equal toof oryour greater life. thanIt is our100.4 16.Imitates circular strokes or lessprivilege than 2to years care oldfor thewith medical a fever needsof 104 of or your greater, new you baby should and your ______17.3XOOVRQVLPSOHJDUPHQW callother immediately children. no We matter will whatdo all the we time. can to Other give illnessesyou the bestshould medical be 18. Opens door ______ assessedcare and by theto help parent you on to an be individual the excellent basis parents using youyour want own togood be. 19.turns pages in book, singly judgment. Do not hesitate to call in the case of an emergency or if ______Throws ball into a box youThis are unsurebooklet about has been how developed to care for with your you child. and your child in mind. The majority of it is taken from a booklet prepared by the ______Two and One Half Years Ambulatory Pediatric Division of the University of Texas Medical PHONE CALLS DURING OFFICE HOURS ______1. 5HIHUVWRVHOIE\SURQRXQ UDWKHUWKDQQDPH SchoolPhone at Houston, calls for mostappointments of it having can been be made written during by Susan office Cooley, 2. Walks on tiptoes hours.RN, If Pediatric you have Nurse questions, Practitioner. the office There personnel have willbeen discuss many personalthe ______3. Jumps with both feet problemtouches with to you.tailor If the there booklet is an foremergency, our practice you especially will be put in through the areas of 4. Tries standing on one foot to theChild doctor Rearing, immediately. Breastfeeding, Otherwise, Dental either Care one and of Philosophy the office staff of Use of ______5. 3XVKHVWR\ZLWKJRRGVWHHULQJ Medications. This booklet gives the best advice we know of to help or the doctor will call you later in the day. The doctors review all ______6. +HOSVSXWWKLQJVDZD\ messages,in the health and although care and you rearing may ofnot your speak child. to one Your of them child directly is a gift from 7. Can carry breakable objects everyGod time to you.you call, Congratulations you will receive from information all of us! by well-trained ______8. Builds tower of eight cubes personnel who have discussed the problem with the physicians. 9. ______ +ROGVFUD\RQE\ILQJHUV When you call please have the following at hand: Identifies 5-7 pictures 1. Your child’s temperature ______11.Names objects (key, penny, watch) 2. Your pharmacy’s phone number 3. Your child’s weight ______Three Years 4. Pen and paper ______1. Names three or more objects in a picture If you are calling about over-the-counter medication dosages, please 2. 5HSHDWVVL[V\OODEOHV IRULQVWDQFH´,KDYHDOLWWOHGog”) be very specific about the medication you have as dosages vary ______3. 5HSHDWVWKUHHGLJLWV VHYHUDOWULDOV greatly between infant’s and children’s formulations. 4. Gives sex (“Are you a boy or a girl?”) ______5. Gives full name 6 2

48 6. Knows a few rhymes OFFICE HOURS and EMERGENCY COVERAGE *LYHVDSSURSULDWHDQVZHUVWR´:KDWVZLPV²IOLHV²VKRRWV² Routine office hours are Monday through Friday 9AM-5PM. ALLERGICERLOV²ELWHV²PHOWV"µ REACTIONS: We have emergency hours most Saturdays 10AM-12PM and most 8. &RPSUHKHQGVFRQFHSWVVXFKDV´FROGµ´WLUHGµ´KXQJU\µ Sundays 2PM-4PM. 9. 8QGHUVWDQGVWDNLQJWXUQV Our physicians are in a pediatric call group which provides &RSLHVDFLUFOH seven days per week coverage in the office including Saturdays and &DQSXWRQVKRHV Sundays. We also provide 24 hour per day coverage for emergencies. Alternates feet going upstairs We or the doctor on call for our group may be reached by calling Jumps from bottom stair the office at 706-868-0389. If your child is seen urgently or in an 5LGHVDWULF\FOH emergency by a physician outside of our group, please give us a call Stands on one foot for a moment the nextCONGRATULATIONS morning and let us know how your child is doing. Puts ten pellets into bottle in thirty seconds It is important to remember that although your doctor or one )HHGVVHOIZLWKOLWWOHVSLOOV of the other doctorsON is on call YOUR at all times, the doctor who is taking Pours from a pitcher calls is covering for EMERGENCY CALLS and is also covering for &DQXQGRWZREXWWRQV other pediatriciansNEW besides himself. BABY! If you have a true emergency or a Builds three block pyramid significant problem with your child which cannot wait until office hours, then you should call the office number and the nurse triage Four years system will handle your call. If needed, the nurse will then page one &RXQWVIRXUSHQQLHV of us. Please note that there is a fee of $15.00 when you page our &RPSUHKHQGV´:KDWGR\RXGRLI\RXDUHKXQJU\VOHHS\ nurse triage service so please use it only if you have an urgent need. FROG"µ So that we are able to direct our entire attention to patients who truly 5HSHDWVWHQZRUGVHQWHQFHV need immediate care, we ask respectfully that all other calls be made 5HSHDWVIRXUGLJLWV during routine office hours during the week or at the specified times &RXQWVWKUHHREMHFWVSRLQWLQJFRUUHFWO\ mentioned above on Saturdays and Sundays. It is our office policy CHILDHOOD6. &RSLHVDFURVV DISEASES (and dates:) that medications will not be called in after hours. Please call during &RPSDUHVOLQHV´:KLFKLVORQJHU"µ office hourswww.augustapediatrics.com or leave a message for prescriptions and medication 8. &RPSOHWHVWKUHHSLHFHSX]]OHLQVHFRQGV refills. 9. 'UDZVDPDQZLWKWZRSDUWV There is another option for getting a message to us after Stands on one foot for four to eight seconds hours: you may leave a message for the office staff at no charge, we )ROGVSDSHUWKUHHWLPHV will return your call when the office reopens. To leave a message for %UXVKHVWHHWKZDVKHVKDQGVDQGIDFH the office staff press “0” at any time. 'UHVVHVDQGXQGUHVVHVVHOI VXSHUYLVHG Many major insurance companies offer a nurse line as a /DFHVVKRHV free service to their members: that information would be on your &RRSHUDWHVZLWKRWKHUFKLOGUHQLQSOD\ insurance card. Amerigroup members may call 800-600-4441. Knows at least one color Wellcare members may call 800-919-8807. These numbers are on &DQVHOHFWKHDYLHUIURPOLJKWHUREMHFWV your card and you will need it when you call.

49 NOTES REFERENCES INTRODUCTION TO OUR GROUP Our pediatric group seeks to help you provide a good and 1. First Twelve Months of Life, Frank Caplan. This is an healthy childhood for your children. Our approach is to treat the excellent pictorial and graphic book on your baby’s growth and whole child: physical, spiritual, emotional and mental. development. It makes growing up with baby a lot of fun. Our practice of pediatrics and adolescent medicine by definition includes newborns, infants, children and adolescents through age 21. Pediatricians are trained to treat these age groups by 2. The Womanly Art of Breast Feeding, M.B. Carson. This spending from three to four years beyond medical school in a is a good reference book for those mothers who desire to learn pediatric residency. A pediatrician is a specialist in the diseases of more about breast feeding. infants, children and adolescents as well as their normal growth and

Dr. Lazari graduated from the Medical College of Georgia in

Focus on the family website: www.focusonthefamily.com

46 3 10/16 NOTES Dr. Lane graduated from the Medical College of Georgia Five years and received his training in pediatrics at the Children' s Hospital of 1. Copies a square Georgia in Augusta. 2. Knows age (“how old are you?”) 3. Performs three tasks (with one command); for instance: “Put pen on table – close door – bring me the ball.” Dr. Wilson graduated from the Medical College of Georgia at Augusta University and completed his pediatric 4. Knows four colors residency at Children’s Hospital of Georgia in Augusta. He has 5. Defines use for: “fork – horse – key – pencil, etc.” worked for the past eight years in the mission field in Cusco, Peru. 6. Skips, using feet alternately 7. Stands on one foot for seven to eight seconds Dr. Coleman graduated from the Medical College of 8. Draws man with at least six parts ; (for instance: head, arms, Georgia at Augusta University and completed his pediatric legs, eyes, etc.) residency at Children's Hospital of Georgia in Augusta. 9. Counts twelve objects correctly 10. Counts number of fingers correctly Dr. Steven L. Moore retired from APA in 2018 having 11. Names nickel, dime, penny cared for his patients for 30 Years. 12. Dresses self without assistance 13. Prints few letters Dr. Miller, founder of the practice, retired in 2019 after 39 14. Comments on pictures

years of service to his patients. 15. Asks meanings of words 16. Can pronounce correctly; “T –D –N –G –K –Y.” All of our physicians are certified by the American Board of 17. Builds six block pyramid Pediatrics. 18. Knows days of week All of our physicians are on staff at University Hospital and 19. Transports things in a wagon Doctor’s Hospital. 20. Plays with coloring set, construction toys, puzzles, jump rope, skates 21. Participates well in group play

4 45 NOTES NOTES