SouthpointePediatrics established in 1990

Gregory L. Smith, MD Steven R. Asdell, MD

Margaret D. Workman MD Allison M. Koepke, MD

A Guide for New Southpointe 8851 Southpointe Drive Suite C-1 Indianapolis, IN 46227 317-887-3344 www.southpointepeds.com facebook.com/southpointepeds

Production by Meurer Graphics, www.meurergraphics.com Cover by Aaron Meurer Interior design by Veronika Grebennikova

This Book cannot be reproduced without the consent of the doctors. Copyright © 2017, Southpointe Pediatrics. All rights reserved. Revised July 2017 Table of Contents

For New Parents...... 1

Our Pediatricians...... 2 Appointment/Office Hours ...... 3 Telephone Calls...... 3 In Case of an Emergency After office hours ...... 3

What is Normal for a Newborn?...... 5 Activity...... 5 Breathing ...... 5 Crying ...... 5 Colic...... 6 Skin and Birthmarks ...... 6 Head ...... 7 Eyes ...... 7 Nose...... 8 Ears ...... 8 Mouth ...... 8 Heart Murmurs ...... 8 ...... 8 Umbilical Cord...... 9 Genitals ...... 9 Circumcision...... 9 Bowed Legs and Curved Feet ...... 9

Newborn Care...... 10 Guidance ...... 10 Baby Needs ...... 10 Room Temperature ...... 10 Clothing ...... 10 Cribs ...... 10 Sleeping ...... 11 Bathing...... 11 Nail Care ...... 12 Lotions and Powders...... 12 ...... 12 Heat Rash ...... 13 Other Rashes & Newborn Acne...... 13

Table of Contents | iii Teething and Teeth ...... 13 Visitors and Visiting ...... 13 Sun Exposure ...... 14 Travel ...... 14

Feeding ...... 15 Breast Feeding ...... 15 Bottle Feeding...... 19 Solid Foods...... 20 Bowel Movements...... 21 Vitamins...... 21 Fluoride ...... 22

Your Baby Has a Personality Too ...... 23

Sibling Rivalry ...... 24

Mothers and Fathers ...... 25 For Fathers...... 25 For ...... 25

Well ...... 26 Philosophy of Modern Pediatrics ...... 26 Early Vaccines & ...... 27

Illnesses ...... 32 Fever...... 32 Colds ...... 33 Coughs ...... 34 Antibiotics ...... 34 Vomiting and Diarrhea ...... 35 Chickenpox...... 36

Accidents...... 37 Prevention ...... 37 Car Seats ...... 38 Poisoning ...... 38 Plants...... 39 Minor Injury Management ...... 39 The Choking Child...... 40 For More Information ...... 41

iv | Table of Contents For New Parents You are now starting a marvelous new adventure with your baby. - hood is a full-time job devoted to the education, love and care of your child. It is challenging but very fulfilling.

If this is your first time to be a parent, you outside sources such as relatives and neigh- may realize that you had more training to bors. Do not take too seriously what others drive a car than in being a or a fa- say. If you learn to rely upon your own com- ther! It is normal for parents to have feel- mon sense and follow our advice bringing ings of anxiety about their new responsibil- up your baby will be much more enjoyable. ity. The purpose of this booklet is to outline The baby requires time to adjust it- some guidelines to assist us in providing self to our complex way of life. Many years the best possible care for your baby and were required for us to become adjusted. child. If you become concerned about a Why should we expect this new , who particular problem, let us know. Most prob- is using its respiratory (breathing) system, lems, however, have a way of taking care of intestinal (stomach) and other vital organs themselves. So, relax and enjoy watching for the very first time to adjust to this new your new baby grow and develop. All your environment in a very few days or weeks. baby needs from you is a generous portion We must give the infant the time he or she of tender loving care to learn what they will requires to level off into a contented, happy need to thrive in life. baby. The first 2 to 3 months of a new ba- You are a husband and wife as well by’s life are very difficult and trying times as parents. After several weeks, plan oc- for both the new infant and the parents. casional evenings out. You may also take a Complete readjustment of the parent’s day away from the baby to see friends and routine has to be made. If the mother ever pursue your own personal interests outside seems depressed this is not unusual. This is the home. The change of scene will help sometimes referred to as the mother hav- you and your baby. ing “baby blues.” If this occurs discuss this Your baby is a very special person. with the pediatrician or obstetrician. There Don’t feel that your baby should be like any is considerable emotional pressure from other baby. No two ever are.

For New Parents | 1 Our Pediatricians Gregory L. Smith, Margaret D. Work- M.D. is a native of the man, M.D. is a na- south side of India- tive of Columbus, In- napolis. He graduated diana. She graduated from Perry Meridian from Columbus East High School before High School before earning his undergraduate in pharmacy earning her undergraduate degree in biolo- from Purdue University. He obtained his gy from Xavier University in Cincinnati. She medical degree from Indiana University obtained her medical degree at Indiana School of Medicine and completed his University School of Medicine and complet- post-graduate training at James Whitcomb ed her post graduate training at Riley Hos- Riley Hospital for Children. Dr. Smith is pital for Children. She is married and has married and has three daughters. He three sons. She has practiced in this office founded this office practice in 1990. since 2002.

Steven R. Asdell, Allison M. Koepke, M.D. is a native of M.D. was born in Cal- southern Indiana. He ifornia but considers graduated from Loo- herself a native of gootee High School southern Indiana. She before earning his un- graduated from Cas- dergraduate degree in chemistry/biology tle High School before earning her BA in from Indiana University. He obtained his mathematics from Depauw University. She medical degree from Indiana University obtained her medical degree at Indiana School of Medicine and completed his University School of Medicine, where she post-graduate training at Children’s Hospi- also completed her residency at Riley Hos- tal of Michigan. Dr. Asdell is married to Dr. pital for Children and then stayed on one Tessa Asdell, formerly Tessa Antolin, who is more year to be a pediatric Chief Resident. an OB/GYN. They have one daughter and Dr. Koepke has been married since 2002 one son. He has practiced in this office since and has two sons. Dr. Koepke has practiced 1995. in this office since 2008.

2 | Our Pediatricians Appointment/Office Hours

We work by appointment, please remem- in the past 24 hours, and what is concern- ber, children become ill daily and may cause ing you the most about your child. This us to fall behind schedule. We will make will help us provide the best care for your every effort to be punctual. Your patience child. Sick visits and well child visits are with this matter is greatly appreciated. scheduled at different times of the day, but When calling to schedule routine appoint- if your child happens to be sick on the day ments call in the morning, but avoid Mon- they are scheduled for a well visit they can day mornings when we are busy seeing sick still be seen for the well visit and the illness patients. can be addressed at that time. Also, if you Before any well child visit you want more than one child seen, please let us should write down any questions you have know when you call so we can schedule time about your child so that you will not forget for all of your children. Please note that to ask them. We will write down your child’s antibiotics will not be phoned in for weight and length so that you will have a patients without being seen first. Our permanent record of his growth. hours of operation are 8:30 A.M.-5:00 P.M., Before any sick child visit or on Monday, Tuesday, Thursday, Friday and phone call be sure to know and write 8:30 A.M.-6:00P.M. on Wednesday. If you down the following: when the illness be- must cancel an appointment, please call us gan, what the symptoms are, if vomiting at least 24 hours in advance. Our phone or diarrhea the number that have occurred number is (317) 887-3344. Telephone Calls

Telephone calls for routine questions, ap- convenience. If your child is ill and needs pointments, and prescription refills should to be seen, please call the office early in the be made during office hours only. As you day. We will always make every effort to see might imagine, we receive many phone your child as soon as possible. The office an- calls during the day. In fairness to the pa- swers the phones until 4:30 P.M. and after tients in the office, the physician cannot that time phone calls are forwarded to the interrupt their visits to personally answer answering service. Additionally the phones each call. Our nurses will usually be able are forwarded to the answering service for to answer your questions. If not, the phy- an hour over lunch. sician will return your call at their earliest In Case of an Emergency After office hours

Telephone calls after hours should ever, if you have an emergency that cannot be limited to true emergencies only. wait until morning then call the office and To provide the best pediatric care for your find out how to reach the pediatrician who child the pediatricians need to be alert and is on call. This pediatrician may not be your therefore they need their sleep too. If you regular pediatrician and they will most have a simple medical question that can likely be at home and asleep if it is during wait until morning, please let it wait. How- the evening or the night. (Therefore being

Our Pediatricians | 3 on-call does NOT mean the physician is you are not called back in 30 minutes call at the hospital at all times.) Do not make the office to have the answering service calls after the office is closed to schedule page the physician on call again. If your appointments or to ask for prescription child has a life threatening emergency refills. If you have the physician paged and then call 911.

4 | Our Pediatricians What is Normal for a Newborn?

Activity

Newborn babies can breathe, eat, sleep, All babies sneeze (to clear their nos- taste, smell, dirty their , and call you es), cough (to clear their throat), yawn, by crying. They depend on you for feeding, burp, hiccup, spit up, and pass gas. You’ll bathing, love, and attention. notice that when your baby is wrapped in Usually the first few days after com- a light blanket, he will lie quietly, except for ing home from the hospital are the most his mouth, which is seldom still for more difficult. However, this is a time to finally than a few seconds, but when you remove settle down and get acquainted with your the blanket and his , he moves his new baby. You will find that your baby likes arms, and legs. Many newborn cry to be handled and is comforted by gentle with dressing and undressing. This is nor- but firm handling. Your baby will respond to mal. As you continue to look your baby sudden movements, bumps, or noises with over you may find that his head seems too startle reflexes, which are jerky movements large for his body, that he hasn’t much of of throwing his arms and legs out widely a neck and that his barrel-shaped chest and then trying to encircle something to looks huge above his flat belly and small hold. He may also draw up his legs and give hips. His hands and feet may appear enor- a sharp cry. However, as he grows older and mous compared to the thin arms and legs you manage him with more confidence, day to which they are attached, and their color by day he will overreact less often. Babies may be darker than that of the body. That’s also often will jerk or twitch for no apparent all normal. reason, even while asleep. This is all normal. Breathing

Newborn babies often have a rather irreg- and strong. This is normal. Often parents ular breathing pattern while sleeping. You are concerned with “rattles in the chest”. may notice his breathing may vary over 10 This is usually due to nasal congestion and to 20 seconds from being very shallow and should be treated as described in the sec- quiet increasing in intensity to being deep tion about the nose. Crying

In addition, all babies cry. They cry more telling you, “I’m tired, I’m hungry, I want than you expect and more than you think to turn over, I’m thirsty, I’m hot, I’m cold, is necessary. Crying is your baby’s way of I want to be held, or I’m bored”. Unfortu-

What is Normal for a Newborn? | 5 nately, most of us aren’t always going to three fourths of the day, most also have a know exactly what each cry means. Some time of the day when they are awake and parents are concerned that responding too fussy. Periods of excessive crying are not quickly to crying will spoil the baby but this unusual in the first three months and these is not the case in the first 4 months of life. At usually occur in the late afternoon or eve- this age your quick response will give your ning. At times crying can be very stressful newborn confidence that there is someone to a family. If you feel upset by the crying do there to care for them. If you are reason- not be afraid to place your baby in his room ably sure your baby has been fed, doesn’t and close the door for a few minutes. Nev- have a dirty diaper, and is not in pain, then er shake a baby. If crying is excessive ask it is perfectly safe to allow him to cry for a about written information which has other short period of time. Crying does not harm suggestions. your baby. Although most babies sleep over Colic

Colic is a common condition usually begin- hand smoke during pregnancy or ning at 2 to 4 weeks of age and normally while breast-feeding are twice as ends by 3 months. Characteristically, a likely to suffer from colic. baby will fall asleep, and then wake up Sometimes a pacifier, rocking, cud- crying with his knees drawn up. It is usual- dling, or baby swings will help. Usually if ly associated with excessive activity, hard you spend more time holding a baby crying, passage of much gas. A mother’s with colic when it is not crying it will inexperience is not the cause of colic. It help decrease the crying. In infants less may be aggravated by changes in routine, than 4 months of age you can hold introduction of solid food at too early of an them as much as is necessary and it age, overfeeding, or by some foods ingest- will not spoil them. Often nothing you ed by breast feeding mothers (particularly do will help. There is no cure for colic, and caffeine, cow’s milk, nicotine, broccoli, and it does not harm your baby. Don’t blame cabbage). Even though there is no known yourself and make time to be away from cause for colic, infants of women who your baby during these periods. smoke or were exposed to second Skin and Birthmarks

If you are like most parents, you will perform neck (stork bites) are normal and may fade frequent and very complete physical exam- with age. Dark areas on the back and bot- inations on your baby. You may be alarmed tom of some babies are caused by normal by certain things you find, but most of what skin pigment and are not bruises. you see will be entirely normal. Your baby may have a few small white Baby skin is thin and is usually a live- spots or blisters across his nose or fore- ly pink color. Dry or scaly skin is frequently head. These are temporarily plugged sweat seen during the first week of life. Pink to and oil glands that will open naturally with reddish colored birthmarks on eyelids (an- time. gel kisses), nasal bridge, and back of the

6 | What is Normal for a Newborn? Many babies develop some degree A term baby who is jaundiced and has of a yellow tint to their skin. This is called behavioral changes like not being able to jaundice and normally is a natural process be awakened to feed for 8 hours straight that is not a concern. Jaundice can occur during the newborn period will sometimes secondary to a newborn breathing on its need phototherapy as a treatment. If you own outside its mother and therefore need- have questions about your child being jaun- ing to change its red blood cells. Initially diced call the office. this change leads to excessive red blood Your baby’s skin often will appear cell breakdown products known as biliru- splotchy with cooling. Hands and feet may bin. This bilirubin is temporarily deposited remain bluish for a few weeks, and often re- into fatty tissue like the skin until the liver main cold most of infancy. All of the above can further process it. is due to immature circulation and is of no significance. “Bootie socks” are easiest to Jaundice can be a problem in situations keep on the feet, but are not necessary. like: All newborns have skin that peels off 1) It develops in the first few days of life. their hands, feet, and stomach sometimes 2) the newborn is premature 2 or 3 times in the first month of life. This is 3) the newborn has an infection, has a normal and lotions are not needed. blood disorder or other problems. Head

Many babies’ heads undergo some “mold- All babies have “soft spots” where the ing” during the birth process. The head skull bones come together. The biggest one may look a little lopsided and have some is on top of the head near his forehead. This bruising. The skull bones may also overlap area may even pulsate. This area is not very slightly. This is all normal and gradually vulnerable to injury and may be thoroughly goes away in a few days to month depend- washed. ing on the child. Eyes

At birth medicine is placed in your baby’s objects and cannot follow moving objects eyes to prevent infection. This may cause at birth. However, they can see you and like some eyelid swelling and discharge for 4 bright colors. Over the first 2 months they or 5 days. This can be rinsed away with wa- will gradually be able to focus better and ter and a clean washcloth. If the discharge be able to follow moving objects. They may does not clear in this time, we should check occasionally look cross-eyed, and this is not it. Red spots in the white part of the eyes cause for concern unless it persists longer can occur and it is caused by the breaking than 6 months. of tiny blood vessels during birth. It will re- Some newborns have eyes that water solve in days to weeks. or tear excessively and may become mat- After a few days your baby will begin ted. This usually is not due to infection, but to open his eyes more and more and look rather secondary to a blocked tear duct. around. Babies cannot focus well at distant Blocked ducts usually clear by six months

What is Normal for a Newborn? | 7 but sometimes last past 12 months of age. child has a blocked tear duct contact the Massaging the area usually unblocks the office. tear duct. If you have a concern that your Nose

Many babies develop stuffiness due to the tip in the nostril. Then slowly release mucus in the nose and upper airway. This the bulb and let the suction draw out the makes for noisy breathing and difficulty in mucous. This simple maneuver is safe and sucking. This is alleviated by using a vapor- very effective. Sometimes normal saline izer in the room and a bulb syringe to clear nose drops are helpful along with the bulb the nose. Squeeze the bulb before placing syringe. Ears

Your baby can hear and will not only re- be placed in the ear canal for clean- spond to loud noises with a startle, but will ing. The ears clean themselves. Although also be comforted by your smooth and re- some children produce more wax than assuring voice. Talk to your baby--they’re others which occasionally needs removal good listeners. Under no circumst