As parents of a new baby, you are about to embark on one of the most exciting and challenging of life’s journeys. We have prepared this information to help you through the next few weeks. Remember, you will in fact see eight consecutive hours of sleep again, although not for awhile.
One of our doctors will come visit you and your new baby in the hospital if you are delivering at California Pacific Medical Center. If you are delivering at another hospital, the house staff will care for you while still in the hospital. Once you know your discharge date, either the hospital staff or yourself should call our office to schedule your first appointment in the office.
The first well baby appointment is usually scheduled for two to four days after your discharge from the hospital. At that office visit you should bring with you your completed First Visit Form that can be downloaded from here or otherwise you will be asked to fill them out at that visit. Please bring any relevant insurance information with you to your first visit. Most people do not have the baby’s insurance card by the time of your first office visit, so please have the card of the parent whose plan the baby will be on. It is your responsibility to notify your insurance carrier of your baby’s birth. The baby is automatically covered under the mother's insurance for the first 30 days of life, but the baby has to be added by day 31 for there to be no interruption of coverage. Even if the insurance carrier receives bills from the hospital, they do not initiate coverage until called by the parent. If you are interested in having a visiting nurse come to your home after your discharge from the hospital, please let the discharging pediatrician know so that the order can be recorded.
The usual well baby schedule for the first two years includes visits at 3 to 5 days, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and two years. There are recommended immunizations at each of these visits
If your baby appears to be turning a yellow or orange color, this is jaundice. Please call the office for instructions; your doctor may want to do a blood test to determine the amount of jaundice present. Treatment for jaundice includes adequate feeding, getting the bowel movements going, and sunlight. Occasionally bilirubin lights are needed.
Newborn babies may be very sleepy for the first two to four days. Take advantage of this time and get as much rest as you can. We recommend getting most babies to feed every two to three hours or approximately 11 to 14 times a day. Most newborn babies need about fifteen minutes on a side per feeding, although some babies are done in less than ten minutes. It is best not to let your breasts be the pacifier especially in the early days, as this can lead to problems with cracked nipples and engorged breasts. Ideally, we like to see babies regain their birth weight by fourteen days. Bottle fed babies will drink one to two ounces of formula per feed in the early days, rapidly getting to four ounces on average by the end of the first month. As babies get more to eat, there will be an increase in the number of bowel movements and urine output. Babies need to be burped frequently to get the air up. Most babies will spit-up on occasion, but if your baby is throwing up large volumes (especially if they project away from the baby) with each feeding, please call the office.
If formula is used, you doctor will help you choose the type (soy vs. cow’s milk based). Iron rich formula can be used from the beginning, but must be used after four months of age. Concentrated or powder formula is cheaper than the ready-to-feed, and can be made with tap water which has the advantage of containing fluoride. If bottle water is used, check your brand to see if it contains fluoride. If not, your doctor may want to start fluoride supplements. Water for formula does NOT need to be boiled, nor do bottles and nipples need to be sterilized. Cleaning bottles with soap and water or in the dishwasher is more than adequate. Formula not finished can usually be used at the next feeding. Formula should be at room temperature or heated slightly. It is not recommended that milk be microwaved.
Breast milk can be pumped and saved; fresh breast milk can be kept in the refrigerator for up to three days. To keep milk in the refrigerator make sure the temperature is cold enough to keep ice cream brick hard. Milk can be left on the counter for three hours and be stored in the freezer for up to three months. Breast milk can be defrosted in the refrigerator, and warmed just before use.
For most breast fed babies, it is a good idea to introduce a bottle by three to four weeks. This bottle can contain breast milk or formula, and should be given at least once every three to four days. This will help ease the transition to the bottle later if the mother needs to return to work.
If there are questions or problems with nursing, the office can be called or Newborn Connections can be consulted at (415)600-BABY.
Stools / Urine
Once the baby has eliminated all of the meconium, there may be a little lag period of a couple of days until the next bowel movement. Transition stools tend to be thinner and greener. Normal breast fed stools are extremely liquid, bright yellow with little curds, and explosive. The colors though can range from green to brown to yellow. Baby’s tend to be garden hoses, in one end and out the other, so they may have eight to ten bowel movements a day. It may be hard to see a lot of urine in the beginning, especially with some of the super absorbent diapers. A few diapers may have some urine with a reddish, orange color. This is not a cause for alarm, these are normal crystals in the urine. Some girls may also have a little bit of vaginal bleeding from the hormones of the pregnancy. The number of bowel movements in a day often slows down after the first month; some “infrequent stoolers” may go as long as seven days without a bowel movement. Water is the best way to clean the diaper area after a bowel movement; wipes can be used unless your baby develops a rash in response to the wipe.
Toward the end of the first month, babies begin to have gassy/colicky periods especially in the early evening. These are usually normal; if the crying seems excessive, it is wise to talk to your doctor about tricks that might help get all of you through this period. Fortunately, almost all colic is gone by three months of age.
The American Academy of Pediatrics recommends that all babies sleep on their backs until they are able to turn themselves over themselves. The evidence that sleeping position influences the number of SIDS events is indisputable. This is true whether babies sleep by themselves or with their parents.
Babies are well able to regulate their body temperatures within hours of birth. The house temperature should be comfortable for the family, usually 68-72 degrees. The general rule of thumb is that babies be dressed in similar pattern to their parents. Young infants should not be put in hot tubs.
It is not necessary to take a baby’s temperature regularly. If a baby appears to be sick, the best temperature to take is a rectal one. Any infant less than six weeks of age with a rectal temperture more than 100.5 F or 38 C needs to be seen by a doctor. Axillary(armpit) or ear temperatures are less accurate. The office should be called if there is any doubt as to the meaning of a reading.
Babies are not dirty. They do not need to have daily baths. A sponge bath once or twice a week is sufficient until the cord has fallen off (and the circumcision has healed for boys). Immersion baths are fine after the cord is off; always check the temperature of the water before putting the baby in the water. If soap is used, it should be a mild one. When bathing the baby’s head, let some of the water go into the ear. This allows for natural removal of ear wax. Q-tips should never be used to clean inside the ear canal.
Naval and Circumcision
Keep the navel as dry as possible. Most umbilical cords will fall off in one to two weeks. After it has fallen off there may be some bloody or yellowish discharge. This is normal and can be cleaned with alcohol. If there is ever a lot of redness, a particularly bad smell, or anything that looks like pus, your doctor should be notified.
If you child is circumcised, a little bit of vaseline can be applied to the raw skin. Circumcisions normally heal in about a week. There may be a yellowish film on some parts of the glans (tip) and this is not of any concern. If there appears to be lot of bleeding, or your son has problems urinating, your doctor should be called right away.
Infants can have a variety of normal blotches and pimples. The first week of life, the skin may have a wandering pattern of red blotches some with yellowish centers. The skin will also begin to appear dry. These are both normal and need no treatment. If you had been in a hot tub for nine months, your skin would be dry too. By the end of the first month, a number of babies will get “newborn acne” in response to crying or getting over-heated. A cool wash cloth helps make the rash look less angry. Diaper rash is common especially in the early days as the baby’s skin gets used to stool and urine. If truly irritated, a mild barrier cream such as Aquaphor can be used. If a rash is not going away, it is best to call your doctor.
Visitors / Going Outside
Weather permitting, fresh air is good for babies and their parents. It is best to avoid large crowds, and to keep visitors to the house to a minimum. You need to rest as much as possible. Young children especially when they have colds are the biggest vectors of illness; they are often not able to control their own secretions (drool, etc.) and therefore can infect your baby.
Newborn babies tend to be very noisy breathers. Their nasal passages are small, and it does not take much mucous to make the whole system get plugged. Nothing need be done if the baby is able to nurse well and sleep well. If feeding or sleeping is interfered with, the simplest thing is to drop a drop of saline solution into the nostril one side at a time, and either suck the nostril out using a bulb syringe, or use a Q-tip gently inserted into the nostril to remove the mucous. Babies also are periodic breathers, so there can be spurts of rapid breathing separated by slower deeper breaths. At any time if your baby appears to be in distress breathing, the office should be called.
Blocked tear ducts are a very common occurrence in newborns. Infants do not usually have tears until three to four months of age. If your baby has tears, the nasal end of the tear duct is blocked or plugged, causing a back flow of tears. Anytime there is plugging, an infection can occur causing a yellowish accumulation of pus in the corner of the baby’s eye. Pus can be wiped away with a damp wash cloth; if the discharge continues, antibiotic ointment may be necessary and your doctor should be called. If the whites of the baby’s eye are ever pink or red, this is “pink eye” or conjuctivitis and the doctor should be called.
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