All About Your Baby
Infants generally double their birth weight by 5 months of age and triple their birth weight by 1 year. A loss of up to 10 percent of birth weight by 3-4 days of age is normal. This loss is usually regained by 2 weeks of age.
The American Academy of Pediatrics (AAP) and The Pediatric Center recommend breast feeding for your newborn. Breast-feeding provides nutritional, immunologic and developmental advantages for your baby. Babies should initially be nursed on demand, not on a schedule. Most newborns will nurse every 1-2 hours initially. It is helpful to have formula and bottles available for emergencies.
Wash your breast with plain water. Do not use any soap, powders, or any lotions other than petroleum jelly. It may be helpful to wear a nursing bra at all times for support and comfort. Nursing bras for sleep are also available. Disposable or cotton nursing pads may be used to guard against leaks. Cotton nursing pads should be washed in water that is 140 degrees to kill bacteria.
Breast milk may be pumped and stored in the refrigerator for 24 hours, the freezer for 3 months, and the deep freezer for 6 months. It is best not to store breast milk in glass containers. Never heat breast milk in the microwave! This destroys many of the immunologic benefits and promotes the formations of hot spots in the milk.
Iron fortified formula is the best substitute for breast milk. Sterilized water (rolling boil for 2-3 minutes, then cooled) is recommended for the first 4 months of life. Bottles and nipples should be sterilized initially by boiling in water for 5 minutes. Afterwards, they may be adequately cleaned in the dishwasher. Although feeding schedules vary greatly, a feeding of 2-3 ounces every 2 ½ to 3 hours is average for newborns. It is helpful to hold the baby slightly upright while feeding and burp him intermittently.
Your pediatrician will prescribe a fluoride supplement at 6 months of age if your baby is exclusively breast fed or if you are on well water.
NO solids, juice or water should be offered for the first 4 months without your doctor’s advice.
Solid foods may be started at approximately 4-6 months of age. Your doctor will give you specific guidelines.
Whole cow’s milk, shellfish and nuts/peanut butter should be avoided in the first year of life. Eggs may be started around 9 months of age.
Umbilical Cord Care
To clean the umbilical cord, use alcohol on a swab or a cotton ball after each diaper change. Gently move the cord to clean completely around the base. The umbilical cord usually falls off in the first 2 weeks. A small amount of blood as the cord separates is normal. Any signs of infection, such as foul odor, discharge or bleeding after separation should be reported to the doctor. Cleaning the area does not bother the baby; the cord has no feeling. Your baby may cry because the alcohol feels cold.
Stool patterns vary greatly. Initially, the stool is a thick, black, tarry substance called meconium. This changes to a green, then yellow color with a pudding-like consistency in the first week of life. Some infants stool with every feeding, while others stool every two or three days. You will be able to determine what is normal for your child very quickly after birth.
Jaundice is a yellow discoloration of the skin resulting from the breakdown of excess red blood cells. Jaundice usually appears 1-4 days after birth. Call your pediatrician if you suspect your newborn may be jaundiced.
Infants should be dressed, as you would sensibly dress yourself plus one extra layer. In the winter moths, keep rooms at least 67-68 degrees. In the summer, keep clothing lightweight.
Hiccuping and sneezing are normal, coughing is not. Sneezing naturally clears nasal passages. Although an occasional cough is fine, persistent coughing is abnormal and should be discussed with your doctor.
All visitors should be illness free and asked to thoroughly wash their hands before handling the newborn. The first two weeks are a period of adjustment for any family. Try to make this time as relaxing and calm as possible. Feel free to take walks with a stroller on seasonably warm days but avoid direct sun exposure. Public outings in the first six weeks are acceptable, but over-handling of the infant should be avoided.
Accidents are inevitable with children. Here are a few tips to help decrease these risks.
Law requires car/booster seats for children less than 8 years of age, unless taller than 4 ft 9in or greater than 65 pounds. Infants must be rear facing until they are over 20 lbs. AND one year of age. Children should ride in the back seat at all times. Be sure all passengers buckle up every time! For more information call Maryland Kids In Safety Seats (KISS) at 1-800-370-SEAT or go to www.carseat.org.
Use electrical outlet covers; keep chemicals, medicines and alcohol out of reach.
A CPR or first aid class for infants and children is helpful. CPR is available through the American Heart Association, at many local community colleges and hospitals, and the American Red Cross.
Use gates for stairwells, and avoid those with V-shaped slats.
NEVER leave your baby unattended on a bed, even with pillows around. Infants should be placed on their back to sleep.
Cigarette smoke is dangerous to developing lungs and respiratory passages. Infants of smokers are at increased risk for Sudden Infant Death Syndrome (SIDS). Children of smokers are at increased risk for respiratory and ear infections.
Keep the number for Poison Control (1-800-222-1222) handy. Poison Control does not recommend keeping syrup of ipecac in the home.
Do not use walker for your infant. Exersaucers are acceptable.
Set your water heater to 120 degrees. Be sure to always test bath water and formula temperatures.
If you choose to heat formula, do NOT heat it in the microwave. This creates hot spots in the formula, which may scald your child.
Cribs, pack and plays, and high chairs should not be placed within reach of heating units, stoves, appliance or dangling cords.
Buy toys that are age appropriate as designated on the packaging. Be sure they are washable, unbreakable and have no small parts.
A rectal temperature should be taken for all infants less than 1 year of age. Ear thermometers are sometimes inaccurate and generally unreliable, especially in younger infants. A more accurate means of measuring temperature is the temporal artery thermometer. A normal rectal/oral temperature in from 98 degrees to 100.4 degrees. Notify the office of any elevated temperature in an infant younger than 6 months old. For infants less than 2 months old, a fever is considered a medical emergency and should be treated as such. Notify the office immediately. Use acetaminophen, e.g. Tylenol or Tempra (not Aspirin) for temperatures of 101 degrees (rectal/oral) or higher. Acetaminophen should NOT be given to an infant under 2 moths of age for any reason without your doctor’s permission. You can also use cold compresses on the forehead or back of the neck, and increase fluids in older infants with fever. Please do NOT give your child aspirin. Ibuprofen should also be avoided in infants less than 6 months old.
The following are the recommended doses for Acetaminophen (e.g. Tylenol) in children 6 months or older. For infants younger than 6 months, contact our office for the correct dose.
Weight Infants Concentrated Tylenol Drops (80mg/0.8ml)
12-17 lbs. 0.4ml (1/2 dropper)
18-23 lbs. 0.8ml (1 dropper)
24-35 lbs. 1.2ml (1-1/2 droppers)
Vomiting and Diarrhea
If you have an infant younger than 12 months of age, contact your doctor for persistent vomiting or diarrhea. For older children vomiting not associated with blood or bile (a green-colored material), severe abdominal pain, or a swollen abdomen, the child should be off solid food for 12-24 hours. Encourage water, electrolyte solution (e.g. pedialyte), popsicles or dilute white grape juice. Offer 1-2 swallows of liquid 30 minutes after a vomiting episode. Continue this every 20 minutes for 2 hours. If this is tolerated, slowly offer increasing amounts of these clear liquids. In most cases, children can be expected to return to a normal diet in 12 – 24 hours. Please contact your Pediatrician for specific guidelines if your child continues to vomit or shows any symptoms of dehydration. Signs of dehydration include: a decrease in urine output, dry mouth, sunken fontanel (“soft spot”) , and lack of tears when crying.
Breast fed infants with diarrhea should be fed on their regular schedule. Infants who are on cow-milk based formulas (e.g. Enfamil or Similac) should be placed on soy-based formula (e.g. Prosobee or Isomil) while they have diarrhea. For mild diarrhea in older children continue a regular diet. Starchy foods such as cereals, potatoes, applesauce, bananas, rice and toast are recommended. Juices may aggravate diarrhea, so large quantities should be avoided. Very diluted juices may be used as needed. Most of the time mild diarrhea can be expected to resolve after 3 to 6 days. As long as the child is acting well and taking adequate amount of fluids loose stools are not a great concern. If you suspect dehydration, at any time, call your pediatrician immediately.
There is still no cure for the common cold. As they are caused by viruses, colds are not treatable with antibiotics. Frequent hand washing and avoiding kissing your infant on the face (especially around the eyes, nose and mouth) are two ways to limit exposure to germs that may precipitate a cold.
Supportive therapy is often recommended in infants for a simple cold. This includes elevating the head of the bed, using saline drops, suctioning the nose, and running a cool mist humidifier in your baby’s room.
Persistent colds (lasting longer than 7-10 days) without improvement may become complicated by an ear or sinus infection. If your child’s symptoms do not improve, please contact our office so we can evaluate your child.
For babies under 9 months, we generally do not recommend the use of over the counter medications to relieve cold symptoms. Many times, these products do not relieve the symptoms, and can have adverse side effects for your child.
We recommend a physical exam every 1 to 2 years for children older than 5. These exams help us to identify any problems (i.e. physical, emotional, or mental) early so appropriate intervention can be initiated. In addition, most schools/camps request physicals every 1 to 2 years. Sports physicals often need to be done annually in older adolescents.
Chronic medical problems, such as Asthma or Reactive Airway Disease (RAD) and many others are a part of the lives of a fair number of our patients. We encourage you to let us help in the management of your child’s chronic disease before there is a problem, in addition to when there is an exacerbation of the illness.