Caring for Your New Baby

169 Minebrook Road Bernardsville, NJ 07924 908-766-0034 advocaresinatrapengpediatrics.com Advocare Sinatra & Peng

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Getting to Know Your Baby Sometimes new mothers are a little unsure of themselves at first. As long as your baby is well fed, well loved, warm and comfortable, she doesn’t mind a bit that you are not an expert. The few basic -care instructions that follow should help you to relax and enjoy your baby. The most valuable thing parents can do for their children is to enjoy them. Your baby is an individual from the day she is born. As the baby’s mother, the person most intimately involved in her care, you will come to know her best. Trust yourself and do not take all of the advice of well-meaning friends and relatives too seriously. If you have questions or need advice, call our office. Your baby will do some things all babies do. For example, all babies sneeze, yawn, belch, have hiccups, pass gas, cough, and cry. They may occasionally look cross-eyed. Sneezing is the only way in which a baby can clean his or her nose. Hiccups are little spasms of the baby’s abdominal muscles. Hiccups often may be stopped by giving a few swallows of warm water. Coughing is your baby’s way of clearing her throat. Crying is the baby’s way of saying, “I’m wet, I’m thirsty, I want to turn over, I’m too hot, I’m too cold, I have a stomachache, I’m bored, or I’m hungry.” You will gradually learn what your baby means. Almost all have a fussy period. This may occur regularly, perhaps in the late afternoon or evening but hopefully not at night. This is not colic, but a normal response for which there is no explanation. Even well babies cry!

Your Baby’s Safety The types of injuries a baby may sustain change with age, thus, you will con- tinually need to consider and adjust your safety efforts. No one can protect a baby from all hazards, but you can take some specific actions, starting the day your baby comes home from the hospital. The crib for your baby must have slats no more than 2 3/8 inches apart, no unsafe design features, and a snug–fitting mattress. To avoid blocking your baby’s breathing, do not place pillows, large and floppy toys, or loose plastic sheeting in the crib. Stay close by when your baby is on a flat surface above the floor to avoid injury from falls. Car Seats – A car seat will be necessary to transport the baby home from the hospital and should be used with utmost concern and diligence. Closely follow product and safety guidelines and be sure to use equipment meeting federal safety standards. Car seats are a must!

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Pacifier and Jewelry –Pacifiers should never be worn around the in- fant’s neck. Suitable pacifier attachments are available which can be clipped onto the infant’s . Equally important in preventing strangulation, is not placing jewelry of any kind around the child’s neck. Wrist and ankle bracelets are acceptable if properly fitted and refitted (i.e. not too loose so that they won’t accidently come off and not too snug to allow good circulation). Infants Seats – Never place an infant in an infant seat and leave it on an elevated surface, like a table. An active infant can easily maneuver the infant seat to the table edge and fall. Also, curious toddlers have been known to pull infant seats on top of themselves in an effort to obtain a closer look. Walkers – Walkers will not misalign healthy normal legs, but can be the cause of serious accidents, as they allow the infant to move faster than she should. Therefore, we do not recommend the use of walkers. Use a stationary exersau- cer instead. Toys – Early in life, babies prefer simple black-and-white shapes but soon become attracted to colorful and shiny objects. Keep small objects such as and pins out of the baby’s reach so she cannot pick them up and swallow them. Skin – A baby’s delicate skin can be burned easily. When you take the baby outside, shade your baby from the hot rays of the sun. Always use a hat when outside to protect baby’s head and eyes. Set your water heater to lower than 130°F (54.4C). Always test the temperature of the water before your baby’s bath to be sure it’s not too hot. Smoking cigarettes while feeding or playing with the baby is harmful to the baby’s lungs and dangerous because hot ashes could fall on the baby. Also, don’t hold the baby while cooking. Hot food could splatter on the baby, or she could touch hot pans or their contents.

For Your Baby’s Comfort Room Temperature – Try to keep an even, comfortable temperature (68◦-70°) in your baby’s room. Windows may be opened in warm weather, provided the baby is not in a draft and the room temperature does not fall below 68°F. Crib – Cover the mattress with a waterproof cover, quilted pad, and soft baby sheet. Clothing – A baby does not require any more clothing than an adult. Dress your baby according to the temperature. Some babies are allergic to certain materials, so keep an eye out for rashes in areas where clothing touches the skin.

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Outdoors – You can take your baby outside whenever the weather is pleasant. Babies born during warm weather may be taken outside after they are about two weeks old. If you use a carriage or stroller, be sure the wind blows over the top and not into it, or directly on your baby. Avoid taking your baby to crowded places in the first two months of life due to the increased potential for infection.

Jaundice Jaundice frequently occurs in newborns. The baby’s red blood cells break down to form a pigment called bilirubin. The bilirubin undergoes further changes in the liver until it is excreted in the stools. Most newborns have an immature liver; hence bilirubin tends to accumulate in the skin, giving the baby a yellow color. As the baby’s liver matures and as the baby feeds more, the bilirubin is handled more efficiently and excreted. In a full term baby this maturation occurs about the third or fifth day of life. This normal process may be exagger- ated if there is an incompatibility between the mother and baby’s blood type. Breastfed babies also tend to have more jaundice than bottle fed babies. If your baby is jaundiced a blood test will be done to check the bilirubin level.

Newborn Supplies Shampoo Rectal thermometer Ointment (A&D, Triple Paste, Desitin, etc.) Bottles Baby Oil (for dry scalp) Nipples Pacifier (one piece) Cotton balls (disposable or cloth) Mattress pads Detergent (Dreft, Ivory, All clear) Crib sheets Nasal aspirator Wipes (unscented) Salt water nose drops (Nasal, Ocean, Ayr) Measuring spoons, syringe Baby bath and lotion (unscented)

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Breast Feeding Nursing is the most convenient and natural way to feed your baby and has numerous benefits such as the transfer of protective antibodies and a signifi- cantly decreased risk of developing food allergies. Additionally, is at the perfect drinking temperature and over time adapts to the baby’s changing energy needs. Once established, a mother’s supply of breast milk will usually meet her baby’s needs and the quality of her milk will remain fairly constant. At first, breast feeding requires patience as the milk does not really begin to flow until about three to four days after delivery. During this period the baby receives small amounts of a very nutritious substance called colostrum. Because of the limited amounts, babies will feed more frequently in the first few days of life until the breast milk begins to flow. You may be tempted to offer your baby formula for fear that she is not receiving enough. We encourage you to be patient as frequent nursing in the initial days will stimulate your body to produce more milk. Occasionally, a baby may lose significant weight in the first few days of life and we may recommend supplementation with formula. Should this become necessary, it is important to still continue nursing and offer your baby formula after each nursing session so that the supplementation can be discontinued once your milk starts flowing. Before nursing, wash your hands with soap and water, and then wash your breast with clear water. When you nurse you should be relaxed and comfort- able. Numerous nursing positions work well, i.e. lying on your side, or sitting in a rocking or low arm chair. Commercially available “u”-shaped nursing pillows work well and are highly recommended. Cradle your baby’s head in your arm so that the infant’s head is higher than his or her stomach. Gently stroke his or her cheek nearest the breast—she will then turn his or her head and open his or her mouth searching for the nipple. Use one of your hands to hold your breast and the other to gently push your baby’s head towards your nipple. Be certain that the whole nipple and as much of the surrounding areola (the flat brown part of your nipple) as possible enter the baby’s mouth. It is important your baby grasps as much of the areola as possible to prevent nipple soreness. When latched on correctly, the baby’s jaws should clamp down on the areola with his or her chin resting against the breast and his or her nose unobstructed. Sometimes it may be necessary to hold part of the breast to keep it from press- ing against the baby’s nose and interfering with her breathing.

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If your breast is engorged, it may be difficult for your baby to on cor- rectly. In this case, hand express a little milk before nursing. Hand expression is performed by surrounding the nipple with your thumb and index finger, then pressing back until you can feel your ribs under the breast and then squeez- ing gently down towards the nipple. At first you will only get a few drops of milk but later on the milk will come out in a stream. Alternatively, you may use a (either hand or electric) for this purpose. Once the breast has softened, it should then be possible for your baby to latch on. Allow your baby to feed for 15-20 minutes at each breast. Avoid having your baby feed for prolonged periods (e.g. over 50 minutes) as you and your body will not have a chance to rest prior to the next feeding. Each baby’s feeding needs will vary. Some babies are very efficient feeders and will be done after 5-10 minutes, other babies will take longer. For the first five minutes the baby should be sucking vigorously; after that, the baby may take short breaks be- tween periods of sucking. After 15-20 minutes sucking usually does no longer serve to satisfy nutritional needs but simply sucking needs. After the milk supply is established, nursing from one breast may be sufficient. If both breasts are used, alternate the breast you start with and if one breast is adequate give the other breast a rest period and use it for the next feeding. After nursing, let nipples dry in the air before putting your bra flaps up. If you encounter difficulty or pain with please call your physician. To es- tablish a sufficient milk supply, it is important to feed regularly and drink plenty of fluids. Your baby will usually dictate the feeding interval, but in general, you can expect to be feeding your baby approximately every two to three hours. It is important to get plenty of rest and try to take a nap yourself while your baby is sleeping. If you are very tired or need a rest, a formula feeding may be substituted. Any commercially available infant formula may be used. However, until breastfeeding is well-established, try to feed frequently and not replace too many feedings with formula as your milk supply may otherwise decrease. Remember to drink plenty of fluids and call our office before taking any medi- cations other than medication prescribed by your obstetrician. Breast feeding mothers should avoid alcohol, smoking and drugs. It is advisable to avoid gassy foods as anything you eat is passed to the baby. If you are breast feeding exclusively, we recommend starting your baby on Tri-Vi-Sol infant drops as breast milk can be deficient in Vitamin D. These can be purchased over the counter at most pharmacies and supermarkets. If you choose not to breastfeed we will advise you on what formula to use.

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Burping Infants swallow some air during both breast and bottle feedings and it is usu- ally necessary to burp your baby during and after each feeding. This is done by holding her upright with his head over your shoulder and patting her lightly on the back. Alternatively, you can hold her in a sitting position on your lap and pat her back. Some babies do not require burping.

Schedule Rather than adhere to a rigid schedule of feeding, it is better to feed your baby when she becomes hungry. This may vary from 2 ½ to 4 hours. Smaller infants will eat more often than larger babies because of their smaller stomachs. As your baby grows, she will take larger quantities and eat less often. Babies who are breast feeding will eat more often than babies who are formula feeding, usually every 2 ½ to 3 hours. It is usually advisable not to wake a sleeping baby to feed as sleepy babies are often fussy and not interested in feeding. Infants will eat better if they become fully awake for 10 to 15 minutes before feeding. If your baby sleeps longer than five hours, however, she should be awakened and fed as she needs the nutrition. Changing the usually works very well in waking up a sleeping baby. If your baby seems excessively sleepy or not in- terested in feeding please call us immediately as this can be a sign of a serious problem.

Vomiting Many infants regurgitate or “spit up” part of their feedings during the first few months. To a certain degree this may be normal. Excessive regurgitation may be due to: • Inadequate “burping” • Taking excessive amounts of milk • The milk flow is too rapid • Lying on back after feeding.

Jostling or rough handling after feeding. Most infants will continue to gain weight even though spitting up some of their feeding. However, if you believe your baby is regurgitating more than normal please call the office.

Bowel Movements The stools vary considerably from one day to another in appearance and consis- tency. Some infants will have a stool after every feeding and some will have one every few days. Normal stools may be yellow, brown, or green and may vary in consistency from soft to mushy to well formed. Straining with bowel move- ments is normal in infants.

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Bathing and Skin Care In order to maintain healthy, clear skin, it’s essential to keep your baby as dry as possible and free of irritating substances. Sponge baths should be given until the umbilicus is well healed. Thereafter, you may partially immerse your baby in warm water for her bath. A daily bath is not a necessity. Using a soft wash cloth and a mild soap, bathe the entire body including the scalp and face. Do not be afraid to wash over the “soft spot”. Your baby’s skin is naturally supplied with the necessary ingredients and for the most part oils, creams, lotions, and ointment are unnecessary. If the skin becomes red or is very dry use a moisturizing cream made for infants or sensitive skin. Baby powders are not to be used. Many skin rashes are due to overdressing, one layer of soft loose clothing is usually sufficient during the day. It is best to avoid garments which may come in contact with the skin. Scalp – The scalp should be cleaned 1-2 times a week with a mild soap. No special shampoo is needed. Rinse soap out thoroughly, dry the scalp with a towel, and brush hair with a baby brush or use a fine comb. If the scalp is dry, put a few drops of lotion on and massage generously. Do not be afraid of the “soft spot”. The following morning, remove the crusts with a fine comb, and shampoo the hair. Follow this procedure two or three times, and if not success- ful, call our office. Eyes – The baby has no tears until she is about one to two months old. For the first two months, was your baby’s eyes with sterile cotton and warm water to remove the mucus that accumulates. Nose – The baby’s nose does not ordinarily require attention. All babies breathe noisily for the first month due to the large amount of adenoid tissue. Only salt water nose drops may be used. Prepare nose drops by adding ½ teaspoon of salt to 8 ounces of water. Boil and place in a dropper bottle. Discard the excess. Use as directed by physician. Saline nose drops are also available at your drug store. Do not use any non-saline nose drops unless prescribed by your physician.

Sun Newborns should not be exposed to direct sunlight. Sunscreens are not recom- mended for babies under 6 months of age. Always protect your baby’s head with a hat when outside in the sun.

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Diaper Rash and Diaper Care The most common cause of diaper rash is wet diapers in contact with the skin for a long period of time. There is no substitute for frequent diaper changes. The diaper area should be cleaned with each diaper change. If a diaper rash appears, ointments, such as, Destin, Balmex, Triplepaste, etc., may be effective in clearing the rash. If there is no response after 72 hours, call us. Exposure of the diaper area to the air is also helpful in clearing a diaper rash. If the rash is severe or unresponsive to treatment, your baby should be examined for other possible causes. Baby’s clothes should be washed separately from the families clothes for the first 6 months. Bounce should be avoided. Ivory, Dreft, and Tide are least irritating to the skin.

Umbilicus After discharge from the nursery, the cord is usually still attached to the navel. A small amount of bleeding from the area is common and clears as the navel heals. If inflammation occurs, call our office. Do not immerse your baby in the tub until the cord falls off.

Visitors and Relatives Newborn infants are susceptible to colds and other infections. You should discourage handling or intimate contact with friends or relatives even though they may mean well. Anyone who is ill should not handle your baby. Always stress good hand washing habits to anyone who handles your infant.

Crying You cannot spoil a very young infant. Paying close attention to your baby’s cries will help you decipher and respond to her needs. Crying is her sole form of communication. Soon you will become an expert at interpreting the different cries. One will mean hunger, another restlessness, and another pain. Even if your infant cries to be held, this should not be viewed as a premeditated form of manipulation. Rather her cry to be held stems from her basic needs for secu- rity, love, and warmth. Almost all babies have “fussy periods”, which usually occur in the late after- noon or evening. Dinner hour, bath times for siblings or people coming home from work, are times of the day which can be mildly stressful relative to other parts of the day. Perhaps your infant picks up on the tension and wants extra nurturing or reassurance. Fortunately, these “fussy periods” will be less frequent after the first few months of life.

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Colic can be defined as excessive crying as a result of spasms of abdominal pain. This abdominal pain or cramping is thought to be related to an immature gastrointestinal system and the presence of gas. Breastfed, as well as bottle fed infants, can have colic. Usually comforting is all that is required. If your baby has long crying periods when nothing seems to calm her down, call our office to discuss whether your infant has colic and what can be done to provide relief. There are many old-time remedies that may prove helpful. Try some of these suggested methods: swinging, rocking, use of a pacifier, rhythmic patting on the back, “infant massage”, music, a ride in the car, gentle rubbing of the stomach, use of a “snuggly” or infant carrier, or swaddling the baby in a blanket. If you are using formula, we may consider the possibility of an allergy to the pro- teins in cow’s milk. A formula change may be indicated. A protein hydrolysate, such as Alimentum or Nutramigen, may also be considered. Always check with our office prior to changing formula. If you’re breastfeeding, we may suggest eliminating or cutting back on the amount of milk, dairy products, chocolate, fruit, certain vegetables, eggs, caffeine, onions or supplements you consume. These diet modifications are done gradually and incorporate a trial-and-error approach. Getting through colic is not easy and requires patience on your part, as well as ours. Happily, this is a self-timed condition and is usually resolved by three months of age. Some parents report relief of symptoms magically at ninety days while others feel the problem vanishes gradually until it is nonexistent. Don’t be afraid to ask for advice or look to us for support. Medication can be helpful in extreme instances but mostly we are interested in providing “care for the care-giver.” Try to arrange for some time away from the baby, especially if you are distressed about the crying. Ask a trusted friend or relative to care for the baby for a short while so you can get some rest.

Pacifiers Newborns have a tremendous sucking need which cannot be met by feeding alone. This additional time spent sucking is called “non-nutritive sucking” and will occur with or without the use of a pacifier. For example, some infants will suck on fingers, hands, or demand to breastfeed or bottle-feed even when they aren’t hungry For this reason, we recommend using a one-piece pacifier until the age of four or five months, when the sucking need diminishes. Removing it at this age prevents a pacifier habit.

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Thermometer Buy a rectal thermometer and learn how to use it. Call our office with any temperature over 100.4°F in an infant less than 8 weeks of age.

“Normalcy” In Infancy 1. All newborn babies have an immature nervous system which is responsible for the so-called startle reflex. Sudden jarring, even loud noise will result in a sudden outward jerking of the arms.

2. Because of an immature circulatory system, many babies are apt to develop a mottled or blotchy appearance when undressed or have “blue hands or feet”.

3. It is normal for many newborn babies to have irregular respiration. 4. Crossing of the eyes are common, especially after a few weeks, when baby is gazing at any object a few inches away. 5. Due to the presence of various hormones passed into the baby from the mother, many full-term babies show transient swelling of breast tissues. Female newborns often show a whitish vaginal discharge, and may even bleed.

6. Other normal manifestations may include frequent sneezing, coughing, hiccups, and quivering of the chin when crying.

Sleep Typically, newborns alternate between sleeping and feeding with greater alert periods as they get older. Time spent sleeping is also very individual and will range from fourteen to twenty hours per day. On average, babies do not usu- ally sleep through the night until 4-6 months of ages. While newborn babies often drift randomly in and out of sleep, babies around six weeks of age are more definite about the difference between an awake state and a sleep state. Three- to four-week-olds wake up because they are hungry and go to sleep because they are full. By the second month, the relationship between feeding and sleeping begins to slacken a little. By the time the baby reaches three to four months, she is likely to have two or even three wakeful periods in the day with usually one morning and one afternoon nap. Most babies have “set” times during which they will appear sleepy and will be ready to nap. To establish good sleep patterns, it is often helpful to plan your day (e.g. running errands) around your baby’s routine sleep periods. Babies who are used to a routine usually sleep better and find it easier to self-soothe. This is not to say that you cannot occasionally change your routine. However, for the most part it is advis- able for the first year of life to stick to your baby’s schedule. Babies are to sleep on their back.

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Child Proofing During your well-child visits we will discuss your child’s level of development and offer anticipatory guidance in eliminating hazards and providing a safe, child-proof environment. Written and illustrated information sheets are avail- able through our practice. Keep in mind, however, that a home that is thought to be child-proof does not always prove to be “fool-proof”. For this reason you should have emergency numbers (including Poison Control 1-800-222-1222) near the phone. We will be happy to provide written instructions on handling other emergencies (i.e. choking, etc.) and answer any questions you may have.

Guidelines for Obtaining Assistance Learn to trust your instincts. You are the best judge of your baby’s state of health and you will sense when your child does not seem right or is having dif- ficulty. If you are concerned, call our office.

Signs of Illness During the first few weeks of life you should be alert for changes in your baby’s daily routine and/or physical findings. The following are reasons for potential concern during the first few weeks. Call the office if your baby develops:

1. Fever over 100.4° rectal 2. Projectile vomiting (not just spit up) 3. Any unusual rash 4. Listlessness 5. Yellow skin 6. Green or yellow eye drainage 7. Rapid or labored breathing 8. Marked jitteriness 9. No urine in 12 hours 10. Baby’s very irritable and inconsolable 11. Any other notable change or concerns you may have

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Telephone and Emergencies Our nurses have been thoroughly trained with our plans to handle most of the routine problems of child care. All telephone messages are written down and transmitted to a physician. If you feel the need to talk with a physician, tell the nurse. In cases of emergency, a doctor can be reached within minutes. In case of life-threatening emergencies, please go to the nearest emergency room or call 911.

Suggested Reading 1. Caring for Your Baby and Young Child Birth to Age 1, American Academy of Pediatrics 2. Baby and Child Care, Benjamin Spock, M.D. 3. Toddlers and Parents, T. Brazelton, M.D. 4. Infants and Mothers, T. Brazelton, M.D. 5. Dr. Mom, a Guide to Baby and Child Care, M. Neifert, M.D. 6. The First Twelve Months of Life, F. and T. Caplan 7. Crying Baby, Sleepless Nights, Sandy Jones 8. The Womanly Act of Breastfeeding, LaLeche League International 9. Nursing Your Baby, Karen Pryor 10. Caring for Your Baby and Young Child, Steven P. Shelov, M.D.

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Notes

15 169 Minebrook Road Bernardsville, NJ 07924 908-766-0034 advocaresinatrapengpediatrics.com