AUSTIN REGIONAL CLINIC

Name: Length Weight Head Circumference Health Screens/:

WELCOME to your baby’s first check-up. During the first two weeks your baby will go through many changes. By three days of age most babies have lost six to eight ounces of weight. By two weeks most babies will return to or exceed .

Length, Weight, and Head Circumference: our newborn book if you want to see the Your baby is carefully measured to assess current recommendations. Also if you proper nutrition and growth. would like to read about your baby’s immunizations prior to the well check, ▪▪ Nutrition: A discussion of feeding, or read the information on the CDC web- diet is an important part of each well site, www.cdc.gov/nip. baby or well child visit. ▪▪ Frequency: There are many well baby ▪▪ Development: Various developmental visits over the first two years. The rec- AustinRegionalClinic.com has a milestones are reviewed to make sure ommended well child schedule is in our number of educational resources that that your is developing appro- newborn book. Also each visit’s newslet- are helpful for . Please take a priately. ter will have a reminder of when the next little time to become familiar with the ▪▪ Physical Exam: Your infant receives a visit will be. pediatric education section of our web- head to toe physical exam by his or her site and feel free to download informa- provider. tion and handouts. ▪▪ Health Screens/Immunizations: At Online features that may interest you some visits health screens such as blood include: tests are needed. Most visits during the first two years also include immuniza- 1. McKesson Pediatric Advisor: tions. You can check the schedule in Online index of close to 1000 pe- diatric topics including illnesses, injuries and behavior problems. 2. Well Check Newsletters: Breast Feeding handouts given at well checks During the first 3-5 days of your baby’s life, 3. General Pediatric Resources: nursing will notice many changes. A collection of pediatric health resources for parents, includ- ▪▪ Breasts become fuller as milk supply increases. ing information about vaccines, asthma management, nutrition ▪▪ Wet increase from 1-3 a day to and more. 5-7 or more a day. 4. Up to Date: A patient-friendly ▪▪ Stools change from the dark and tarlike version of a popular web-based meconium to looser transition stools of resource for physicians. variable color. By 7 days the stools are usu- ally yellow, seedy, and fairly loose. Babies 5. Natural Standard: High quality initially average 3 or more stools a day. information about complimen- Some breast-fed stool with almost tary and alternative therapies. every feeding. (continued on pg. 2)

17.0814CS 1 11042009 ▪▪ Most breast-fed infants are nursing 8-12 ▪▪ If you feel that your infant is not satis- add 3, that is the number of ounces that times a day and many will settle fied and “always at the breast,” you most infants will take per feeding. For into about 8 feedings a day by 2 weeks need to see his/her provider or lactation example a 1 month old will usually take of age. Rigid feeding schedules are not consultant to check that your baby is about 4 ounces per bottle feeding. recommended for breast-fed infants. growing properly. ▪▪ If your baby is growing at a normal ▪▪ Some infants cluster feed. A cluster Do not limit the number of feedings. rate, then your baby is getting enough feeding infant will nurse 5-10 times in a formula. 2-3 hour period and will then sleep 4-6 Bottle Feeding ▪▪ Do not microwave formula. hours. This is normal. ▪▪ Baby will set the pace. ▪▪ Do not prop bottle, this can cause ear ▪▪ By 7-10 days of age many infants have infections. a growth spurt. These are fussy periods ▪▪ Some babies require 2-3 ounces. By two of several days when your infant may weeks most are up to 3 to 3 ½ ounces ▪▪ If baby has trouble sucking, make sure want to feed every one to one and a half per feeding. A helpful rule of thumb for nipple hole is big enough. hours. Be patient, try to get some rest, infants up to about 4 months of age is this will pass. that if you take the age in months and

Sleep Cradle Cap Heat Rash Newborns are often This harmless often appears Heat rash occurs usually on the back, drowsy for the first by a month or two of age as a scaly area neck, or chest and is caused by overheat- day or two. By three on the top of the scalp, behind the ears, ing. The rash looks like tiny pink bumps to five days of age and sometimes on the eyebrows. To treat and is best treated by measures that cool most parents notice cradle cap, loosen the scaly areas with a your infant’s skin: Dress your baby with that their babies have soft brush. Brush scales away. If the scalp fewer clothes, use tepid or cool baths, more alert periods. is very crusty you can put some baby oil or make sure that your house is not too Unfortunately, these olive oil on the scalp an hour before wash- warm, don’t use ointments on your baby’s wide-awake periods ing your baby’s hair. skin. Ointments block sweat glands and are often during the middle of the night. can make the rash worse. Day-night reversal during the first week or Infant Acne so is very common. You may try to keep the lights low and stimulation to a mini- Red pimples on the face, neck and chest mum, but at this age patience is the key. can appear sometime during the first few Take a nap in the afternoon while your months of life. The rash will disappear baby is sleeping. on its own. If blisters develop, your baby should see his provider. Infant acne is Most newborns sleep at least 16-17 hours a caused by hormone changes during the day. Babies can see clearly from the mo- first few months. ment of birth, but they are very near sighted. He or she can see at best eight to 10 inches Milia away. Objects further away are fuzzy. These are tiny white bumps that occur on Rash Jaundice in Newborns the face of newborns. They are blocked skin Frequent changing, rinsing, and drying pores which will open up and usually dis- Jaundice is the word to describe the yellow of the diaper area reduces the number of appear by 2 months of age. No treatment is skin color and yellowish sclera (whites of diaper rashes. The best treatment is to let necessary. eyes) that is often seen in newborns. the diaper area air out when possible, either Jaundice occurs in a newborn because by keeping the diaper loosely attached or “Newborn Rash” your baby’s liver is not able to process a leaving it off altogether. Clean with water (Erythema Toxicum) red blood cell product called bilirubin (the rather than commercial diaper wipes. Treat Many babies get a rash called erythema yellow pigment that causes the jaundiced area of diaper rash with mild diaper oint- toxicum by the third day of life. The rash appearance). Sixty percent of all newborns ment. Some diaper rashes are caused by looks like multiple ant bites, red spots with develop jaundice and the peak of jaundice yeast infections. Yeast infections look moist, white pimples in the center. It can occur is generally from three to five days of age. red and sore, and may have bumps on the anywhere on the body. Although the cause edges. (Lotrimin AF) is an Within a week a newborn’s liver should is unknown, this rash is harmless and usu- over-the-counter medication that works well be able to break down the bilirubin more ally goes away by 4 weeks of age. on diaper rashes caused by yeast. effectively.

17.0814CS 2 11042009 Reducing the Risk

SIDS is the leading cause of death in infants older than one month of age. SIDS frequency Newborn screening peaks in babies two to three months of age and is less common after six months of age. for early detec- While the causes of SIDS are not known, researchers are beginning to understand the tion of medical risk factors for SIDS. The following are highlights from the November 2005 Academy of disorders began Policy Statement on SIDS. The entire statement is available in the Health Topics in the early 1960’s section of the AAP website, www.aap.org. and has gradually 1. Back to Sleep: Placing your baby to sleep on his back is the most effective way to pre- been expanded and vent SIDS. Since the “Back to Sleep” campaign began in 1992, the incidence of SIDS has perfected. Today dropped by more than 50 percent in the U.S. Babies placed on their sides tend to roll onto these simple blood their stomachs while they are sleeping; the side position is not safe. Babies who sleep on tests identify about their backs are less likely to vomit and choke than babies who sleep on their stomachs. 3000 newborns nationwide each 2. Keep your baby’s face and head uncovered during sleep. Tuck covers in so that your year with seri- baby does not wriggle under the covers, or else dress her warmly and put her down ous underlying without any covers. Keep fluffy toys and pillows out of your baby’s bed. Do not use a medical conditions. Most of these infants bean bag or water bed for your baby. are diagnosed before symptoms occur and 3. Keep baby in your room but NOT in your bed. This is probably the most controversial have improved outcomes because of early of the AAP recommendations. A baby who sleeps in his parents’ room is less likely to diagnosis and treatment. In addition to die from SIDS but sharing a bed with your baby is not safe. Sleeping in the same bed as blood tests, most states also screen hearing. parents is thought to increase the risk of SIDS by increasing the chance of covering the Nationwide at least 6000 newborns a year baby’s face with soft bedding and/or increasing the chance of overheating the baby. The are diagnosed with hearing impairments safest place for a young baby to sleep is in a bassinet or crib next to their parents’ bed. by these screens. 4. Don’t let your baby get overheated. Overheating increases the risk of SIDS. Do not over- dress your baby for sleep nor use too many blankets. Do not keep the room too warm. Required Blood Screen 5. Avoid cigarette smoke. Infants whose mothers smoked during pregnancy have a higher The state of Texas screens for close to 30 incidence of SIDS. Smoking also increases the chance of SIDS after your baby is born. No medical disorders. Prior to being sent home one should smoke in a house where a baby lives or visits. No smoking in the car either. from the hospital, newborns have blood drawn, placed on a special filter paper and 6. Offer a pacifier at naptime and bedtime. The reduced risk of SIDS is compelling, and the sent to a central state lab for testing. A sec- evidence that pacifier use inhibits or causes later dental problems is not. ond newborn screen will be done in your The AAP recommends use of a pacifier throughout the first year of life, when placing doctor’s office at the two week check-up. the infant down to sleep. The pacifier does not need to be reinserted when the infant falls asleep and the pacifier falls out of the mouth. If the infant refuses the pacifier, he should Newborn Hearing Screen not be forced to take it. For breast-fed infants, you may delay pacifier use until a month Texas has a state-wide program of univer- of age to ensure breast-feeding is established. sal newborn hearing screening, tracking and intervention. Your newborn should have had his or her Most infants need a bath only 2-3 times a hearing tested before being discharged week. Clean the face, chin, neck, and diaper from the hospital. Two babies a day in area daily. Withhold regular tub baths until Texas are diagnosed with hearing loss by the cord is healed. Sponge bathe and keep these newborn hearing screens. Interven- the cord dry. tion during the first six months of life sig- Use mainly water for the first weeks. Soaps nificantly improves language development are drying to the newborn’s already dry in these infants. skin. Mild soaps (Dove or baby soaps) are Without newborn hearing screening, hear- used in small amounts. ing loss is not generally diagnosed until the Do use soap daily to clean the diaper skin. second year of life. The newborn hearing Take care to wash and dry the skin folds at test is covered by all insurance plans, and the neck, arms, groin, vagina or scrotum. is exempt from a deductible or dollar limit. Keep the skin clean and dry. If you have any questions about insurance coverage, call the Texas Department of To clean the eyes use a clean cloth or cotton Insurance at 1-800-252-3439. balls dipped in water. You may the baby’s hair with baby or liquid baby soaps. Use a soft brush to scrub the scalp. Never leave your baby unattend- ed in the bath.

17.0814CS 3 11042009 Car Seat Safety Smoking Use an approved infant car safety seat. ▪▪ Place infant seat in the center of back If you or another Information on approved safety seats and seat for maximum safety. family member is a local programs to check you car safety seat ▪▪ The American Academy of Pediatrics smoker, one of the placement can be obtained by calling the (AAP) recommends that infants less than best ways to protect Safe Riders Program at 1-800-252-8255 or a year of age and less than 20 pounds your newborn’s 1-866-SEAT-CHECK (www.seatcheck.org). remain in a rear facing safety seat. health is to quit smoking. Smoking ▪▪ Install car safety seat according to direc- ▪▪ In addition child safety experts are now in the household tions. Not all infant seats are installed recommending that infants and toddlers the same way. remain in a rear facing safety seat until increases respira- tory illnesses, frequency of ear infections, ▪▪ Always secure baby inside the safety two years of age. Serious injuries are five and increases your child’s long-term cancer seat-even for short trips. A When your times more likely to occur if your 12 to risk. Household smoking also increases the baby is small you might need to roll up 24 month old child is in a forward facing risk for Sudden Infant Death Syndrome a baby blanket or small towel to place at rather than a rear facing safety seat. each side of your infant’s body to make (SIDS). We encourage you to discuss smok- your baby more comfortable. ing cessation with your family doctor.

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All parents should have a copy of the Your Baby and Child: From Birth to Age 5, www.fabermazlish.com, Austin Regional Clinic Newborn Booklet. Penelope Leach. website In addition, we encourage all parents to Baby 411: Clear Answers and Smart Ad- www.cdc.gov/nip, National Immuniza- invest in one or more reference book on vice for Your Baby’s First Year, Ari Brown, tion Program. Federal government spon- and child development. Below Denise Fields. sored online information about vaccines. are a few that we recommend. We do not recommend the On Becoming Babywise Infants and Mothers: Differences in De- www.vaccine.chop.edu, Information book series. A trip to the public library or velopment, Terry Brazelton. about vaccines from the Children’s Hos- favorite bookstore can be helpful in decid- Siblings without Rivalry, Adele Faber and pital of Philadelphia ing what book is best for you. Selected Elaine Mazlish, Avon Books. www.AustinRegionalClinic.com, web sites are also included. The Happiest Baby on the Block: The The ARC website contains The following are a few that we can New Way to Calm Crying and Help Your a number of edu- recommend: Newborn Baby Sleep Longer, by Harvey cational resources. Karp, MD. See the front section New Mothers Guide to Breast-feeding, of this handout for The AAP, Bantam. In addition here are selected websites that more details. we recommend: Caring for Your Baby and Young Child: Birth to Age 5, The American Academy www.aap.org, The American Academy of of Pediatrics. Pediatrics

17.0814CS 4 11042009