Simple Checklist for the Full- Term Healthy Newborn Visit Stan L

Healthy Baby Practical advice for treating newborns and toddlers. Simple Checklist for the Full- Term Healthy Newborn Visit Stan L. Block, MD, FAAP hen I am in the nursery dis- kind of event for which child protective Pacifiers cussing routine newborn services have been known to remove Although controversial, these can ac- Wcare with postpartum moth- babies from households. Also, creating tually be a soothing tool, as most babies ers, I run through a list of pertinent the baby “pillow fortress” is too risky, want more nonnutritive sucking than advice that I have developed over the as I recently explained to my daughters, the typical 7 to 10 minutes they get per years. The clinician may find the entire both of whom were new mothers. Like- feeding. Pacifiers sure make life easier article of my essential tips helpful to use wise, I would advise to never leave a if you have a temperamental baby (per- or distribute in their own practice. baby alone high up on a changing table, sonal experience). Early pacifier use bed, sofa, etc., at any age. may reduce the risk for SIDS and likely TIPS FOR MOMS OF NEWBORNS To help condition your baby, lay her improves rates of breast-feeding.1 ‘Back’ to Sleep/Preventing Crib Death down while she’s still partially awake. A newborn should sleep on his back Breast-feeding only; no side or prone sleeping. Never Breast-feeding is the best for your let your baby sleep in your bed, espe- Bottle-fed and breast-fed baby, but pace yourself — too much too cially during the first 4 months of life babies only require small soon can create unnecessary discomfort. when the risk for sudden infant death By gradually increasing the feeding du- syndrome (SIDS) is many-fold higher. volumes of milk the first 3 ration during the first week, then some- Cosleeping with an older infant/child days of life. what more during the next few weeks, is also fraught with repercussions, such your breasts will have a better chance to as poor sleep for all, and in my clinical acclimate to the increasing vigorousness experience, inevitable marital discord. This will help her learn that being held of nursing. Bottle-fed babies only eat 1 Additionally, as early as 2 weeks, co- is not essential to fall sleep. Rocking the to 1 1/2 ounces per each feeding over sleeping babies are at significant risk for baby completely to sleep will usually the first few days. A breast-fed baby falling out of your bed at night (particu- become a nightly ritual that is traumatic only eats about 1/2 to 3/4 of an ounce larly if you get up to use the bathroom, to break. Sleep comes much easier for per breast per each feeding for the first even for just a few minutes) and fractur- all, if the baby eventually learns to “self- few days.2,3 Thus, both the bottle-fed and ing a major long bone or skull, just the soothe” at night. breast-fed baby only require small vol- Your baby’s crib mattress should be umes of milk the first 3 days of life. Stan L. Block, MD, FAAP, is Professor of Clinical somewhat firm with a touch of cushion- During the first 3 to 5 days of your Pediatrics, University of Louisville, and University of ing. Avoid blankets and pillows inside baby’s life, the milk you are producing Kentucky, Lexington, KY; President, Kentucky Pedi- the basinet or crib, etc., as these may in- is called “colostrum.” The “pins and atric and Adult Research Inc.; and general pediatri- crease the risk for crib death. needles” feeling of the breast “letdown cian, Bardstown, KY. Address correspondence to Typically, the room temperature for a reflex” usually occurs after 3 to 5 days. Stan L. Block, MD, FAAP, via email: [email protected]. sleeping baby should be less than 77°F. Not every mother experiences it, but if Dr. Block has disclosed no relevant financial re- Another way to gauge it is that the room you do, it is a very reassuring sign that lationships. should be comfortable enough for a par- your milk production will be adequate. doi: 10.3928/00904481-20120625-04 ent wearing light-weight clothing. After the fifth day, your full milk sup- 270 | Healio.com/Pediatrics PEDIATRIC ANNALS 41:7 | JULY 2012 Healthy Baby Image courtesy of Stan L. Block, MD. Figure 1. Be aware of the need to increase the bottle nipple size as the baby grows. ply comes in. At each feeding, about close relatives or friends who have suc- as long as you are mostly breast-feeding. 80% of the milk you produce in the first cessfully breast-fed. A recent report has documented that 5 minutes is the “fore milk,” which is Try to avoid all baby bottles until the breast-feeding mothers may safely in- lower in calories than the nutrient- and second week of life at the earliest. Oth- gest some caffeine while nursing, so feel fat-enriched “hind milk” that is deliv- erwise, your baby may refuse to breast- free to enjoy some daily coffee or tea. ered in the next 4 to 5 minutes. Thus, al- feed due to the slower flow of your milk. lowing your baby to nurse for more than Bottle Feeding 8 to 10 minutes on a single breast during Breast Care for Nursing Mothers Boiling or sterilizing bottles for for- the first week is probably unnecessary, Some experts suggest that breast pain mula feeding is unnecessary; wash your since you will not actually produce any caused by nursing may be alleviated by baby’s bottles the same way you would additional milk for the baby, but might applying warm, wet tea bags (due to tea’s your dinner dishes. Mixing tap water cause yourself unnecessary nipple pain.4 tannic acid) to the nipples. Some women with powder or concentrate formula is To avoid this, the most common reason may also find nipple pain relief by using acceptable. But if you instead choose to for breast-feeding discontinuation, try soft silicone nipple shields. Also, try fre- use bottled water products for mixing to limit nursing during the first week to quently changing the angle at which you formula, be sure to specifically purchase feeding intervals of 2.5 to 4 hours for 8 hold your child while he nurses. the “nursery water” formulations, which to 10 minutes on each breast. Routinely apply medical grade lano- have some fluoride supplementation. Be aware that during the first 24 lin cream or emollients to your nipples Introduction of an extra few ounces of hours of life, many babies are so sleepy after every feeding. Do not routinely water alone after the first week is fine. that they may eat very poorly. This com- use soap to clean the nipples; just rinse Be aware of the need to change nipple mon pattern can be extremely stressful, them with warm water. For sore, cracked sizes as the infant grows, as the size of especially for the first-time mother. The nipples, consult your doctor. the nipple controls the amount of formu- mother may think that her breasts are Ensure that the baby is properly la your baby receives with each feeding producing inadequately. However, after latched on to the areola, and that the ba- (See Figure 1). 24 hours, the baby will become more by’s suction is removed by your finger, alert and eat more. So, be patient with before latching off. Growth Spurts the breast-feeding process during the The breast-fed baby needs extra daily Nearly all full-term infants will ex- first few days of life. vitamin D (preferably the much more perience a growth spurt at about 2, 6, During the first few weeks, it may palatable “Just D” formulation available and 12 weeks of life. This can be alarm- also help tremendously to read books at most drug stores or Amazon.com) af- ing because it will seem as though your about breast-feeding or to talk with any ter the first week. Administer 1 cc daily baby’s appetite is almost insatiable, as PEDIATRIC ANNALS 41:7 | JULY 2012 Healio.com/Pediatrics | 271 Healthy Baby Images courtesy of Stan L. Block, MD, FAAP. Figure 2. Newborn with flammeus nevus on the Figure 3. Two-day old infant with milia rubra. nape of the neck. One third of white newborns will have a flammeus nevus (“stork bite”). he demands more quantity and higher Scalp Care sures will usually prevent the wet, putrid frequency of feedings for nearly a full The small “soft spot” on the top of the cord smell. week. The baby is experiencing a tem- head, called the “fontanel,” is where the porary increased need for more calories boney plates of the baby’s head remain Genitalia to grow. No need to start cereal yet. open to allow the large amount of brain Boys growth during the first years of life. This If your male infant is circumcised, Bowel Movements and Urination is a normal feature. The fontanel usually apply petroleum jelly to the wound af- The baby usually has one or two closes after about 9 to 18 months. Do not ter every diaper change. If uncircum- stools per day in the first 2 days. After be afraid to scrub this area gently with cised, leave it alone; do not try to forc- that, the infant typically will produce baby shampoo along with the rest of the ibly retract the foreskin. Circumcision three to eight stools per day, with the scalp several times weekly.

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