Newborn Care Guide

South Tulsa Pediatrics

Elizabeth Dunlap D.O.
Jerry Freed D.O.
Dawn Mayberry D.O.
Christine Narrin-Talbot D.O.

Office Hours

8am to 5pm Monday through Friday
Phone 918-728-2000
Fax 918-728-2001 www.southtulsapediatrics.com To the New Parents
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Few things that happen to your baby in the first year are more important than nutrition. As your physician, I would like to share my concerns about feeding your baby.

Breastfeeding is the best feeding for your baby. I recommend it for as long as possible, preferably during the entire first year of life. In addition to giving the proper nutrition, it offers protection from disease, and fosters that special closeness between you and your baby.

However, if you are unable or choose not to breastfeed—or if you are breastfeeding and have decided to switch your baby to infant formula—I have recommended what I believe to be the best infant formula for your baby. My recommendation is based on a number of factors—the nutrition the formula provides, the ingredients and quality of the formula, and how closely the formula is patterned after breast milk. Also, if I feel your baby has any special feeding needs, I’ve taken this into account when coming to my decision.

After careful consideration, I’ve recommended the infant formula that I feel best meets the nutritional needs of your baby for the first full year of life. You can accept my recommendation with complete confidence.

Contents
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❖ Getting Started

❖ Feeding Your Newborn

No Cow’s Milk Feeding Times How Much Is Enough?

Drinking Water Burping Sharing Feeding Times

❖ Breastfeeding

Eat a Balanced Diet Beware of Medications When You Need to Supplement

❖ Infant Formula

Wash and Sterilize Use the Proper Nipple Hole Size Get Comfortable

❖ Solid Foods

The Enfamil® Guide for Introducing Solid Foods Feeding Tips

❖ Food Allergy

❖ Vitamins

❖ Baths

❖ Sleeping

❖ Bowel Movements

❖ Teething

❖ Crying

❖ Diaper Rash

❖ Illness

Fever Vomiting Diarrhea Spitting Up Colds Poisoning

❖ Special Conditions in the Newborn Period

Umbilical Cord Genital and Breast Areas Scalp Eyes Skin

❖ A Final Word

Getting Started
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When babies go home from the hospital nursery, everyone wants to see them. A new baby generally gets lots of callers. For a few weeks, limit your baby’s visitors, especially children. The baby needs a little time to build resistance to common infections. You don’t know who might have a sore throat, cough, or other infectious condition. I also suggest that you keep the baby out of large crowds for a few weeks.

I ask that my newborn patients come for their first check-ups at 2-4 weeks of age. Should a problem arise before then, I’ll see your baby, of course. If the hospital staff does not make an appointment for your baby’s first check-up, please call my office as soon as the baby goes home from the hospital.

The American Academy of Pediatrics has a recommended schedule of well-child visits that I’d like you to follow during your child’s first two years.

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Feeding Your Newborn
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Breast milk is the best food for babies during the first year of life. Breast milk provides just the right balance and amounts of nutrients that babies need for good growth and development. And it contains substances that may help protect babies against certain illnesses and allergies. If you choose not to breastfeed or if you stop nursing before your baby’s first birthday, infant formula provides the best alternative to breast milk. I recommend one of the following:

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Infant Formulas for Baby’s First Year and Beyond

❖ Enfamil® LIPIL® with Iron, Milk-Based Formula with a Unique Blend of DHA and ARA

❖ Enfamil with Iron Milk-Based Formula

❖ Enfamil ProSobee® LIP1L Soy Formula

❖ Enfamil LactoFree® LIPIL Milk-Based, Lactose-Free Formula

❖ Enfamil Nutramigen® Hypoallergenic Formula

❖ Enfamil A.R.® Milk-Based Prethickened Formula with Added Rice Starch

Fat is an important source of energy and nutrition for your baby. In fact, breast milk is about 50% fat. Specific fats have specific roles as your baby’s eyes, brain, and central nervous system develop. The blend of fats in Enfamil LIPIL is very similar to the blend of fats in breast milk. No other formula has a fat blend that’s closer to breast milk.

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No Cow’s Milk

The American Academy of Pediatrics advises that you keep your baby on breast milk or iron-fortified formula until his or her first birthday. Whole cow’s milk should not be given until one year of age (and reduced fat cow’s milk is not recommended until after the 2nd birthday). Cow’s milk doesn’t supply the balanced nutrition your baby needs, and it can be hard on babies’ sensitive digestive systems. When your baby is ready to graduate from infant formula, you may want to consider Enfamil Next Step® and Next Step® Soy Toddler Formulas. Specially designed for toddlers, Next Step can help provide the necessary iron and essential vitamins and minerals that cow’s milk lacks.

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Feeding Times

Babies differ in their feeding needs and preferences, but most breastfed babies need to be fed every 2 to 3 hours and nurse 10 to 20 minutes on each breast. Formula-fed babies usually feed every 3 to 4 hours and finish a bottle in 30 minutes or less. Bottle-fed infants drink about 2 to 4 fluid ounces at first. By the time they’re a few weeks old, their formula consumption has generally doubled.

Your new baby may cry as though asking to be fed as often as every 2 hours. Keep in mind, though, that babies don’t need to be fed every time they cry. When a baby cries for a short time on a regular basis, he may just need more milk at each feeding. Or he may be protesting that his diaper is wet or that he’s too hot. It’s best not to get into the habit of offering frequent small feedings to please a fussy baby. So before you offer the breast or bottle, be sure your baby is not crying for some reason unrelated to hunger.

Let your newborn set his own feeding schedule. Don’t watch the clock for him. He knows how much and how often he needs to eat. And don’t wake him up for a feeding unless it’s been at least 5 hours since the last one.

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How Much Is Enough?

How can you tell whether your baby is getting enough breast milk or formula? The best gauge of good nourishment is growth. This is measured by weight and length. Each time your baby comes in for a check-up, I’ll weigh and measure her. It’s one reason your baby needs regular check-ups during the first two years.

Most new babies weigh between 5 ½ and 10 pounds. The average is about 7 ½ pounds. During the first days of life, infants generally lose 4 to 10 ounces; breastfed babies may lose a little more. This is no cause for concern. It’s all part of your baby’s adjustment to the outside world, and most of the weight loss is water. By 10 days of age, most babies gain back what they lost. Healthy, well-fed babies usually double their birth weight by 4-5 months and triple it by 1 year.

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Drinking Water

Breast milk or formula normally provides all the water needed by healthy infants. In very hot weather, I may suggest giving a small amount of additional water. Please check with me before doing so.

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Burping

Burping your baby helps remove air swallowed during feeding. You can wait until the end of the feeding or burp at intervals during the feeding. You’ll soon be able to tell if your baby needs frequent burping. Here are three good methods:

❖ Hold your baby so her head rests on your shoulder and her chest is against yours. Pat her back or rub it upward with your hand.

❖ Lay your baby face down on your lap. Rub or pat her back.

❖ Hold your baby in a sitting position on your lap, with her side toward you. Support her head and back with one hand, chin and chest with the other. Then gently rock her back and forth as if helping her “take a bow” or pat her back.

Your baby may spit up small amounts of formula or breast milk, too. No cause for alarm. It happens to all babies. You may be able to reduce the spitting up by burping your baby more often or longer during and after feedings.

If your baby is formula-fed and spitting up a lot, I may recommend Enfamil A.R. ®, a milk-based nutritionally complete infant formula that’s prethickened with added rice starch. Doctors often suggest a thickened formula to help reduce spit up. Traditionally, formula has been thickened by adding rice cereal to it. But adding rice cereal throws off the nutritional balance provided by formula alone (and it can really be inconvenient and messy for you). There’s a better alternative—Enfamil A.R. Clinically proven effective to reduce spit up (regurgitation) in babies who spit up frequently, Enfamil A.R. will still provide the complete, balanced nutrition your baby needs. And although it’s thicker than other formulas, Enfamil A.R. flows freely through a standard nipple.

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Sharing Feeding Times

Feeding time is more than an opportunity to get nutrients into your baby. It’s a time for closeness and sharing. Your baby’s meals are as much for his emotional pleasure as his physical well-being. So, maintain eye contact with your baby while you feed him. Hold him comfortably close to you, seating him in your lap with his head resting in the bend of your elbow and slightly raised. Talk to him softly during the feeding.

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Breastfeeding
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The first few days of nursing will be a time of learning for you and your baby. Neither of you may accomplish a lot on your first few tries, but that’s all right. A clear or yellowish fluid called colostrum that’s extra rich in nutrients will come from your breasts. Although the amount will be small, it’s close to what your newborn’s stomach can hold. At first, your new baby will nurse often—eight or more times in 24 hours.

Rinse your nipples with plain water before a feeding; then dry them gently. Nurse from both breasts at each feeding. As long as you’re holding your baby in the correct position and nursing is comfortable, there’s no need to limit the time your baby nurses at each breast.

At the next feeding, begin at the breast where the last feeding was completed. Some breastfeeding mothers pin a safety pin to their bra on the side last used to remind themselves where to start the next time.

If you have trouble with sore nipples, make sure your baby has “latched on” correctly. Also, start nursing on the side that bothers you the least. If you need to skip any feedings due to sore breasts, express your milk by hand or with a pump at the baby’s regular feeding times so you’ll maintain your milk supply.

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Eat a Balanced Diet

As a nursing mother, you’ll need to eat a balanced diet that contains about 500 Calories more per day than the diet you needed before pregnancy. Your daily food intake should contain about one quart of milk to provide you with the recommended amount of calcium.

Be sure to drink lots of fluids—at least 8 glasses of water a day. You will need the fluids to replace what you’ll lose through your breast milk.

Foods in mothers’ diets rarely have a disturbing effect on their babies. It may happen, though, with certain foods such as tomatoes, onions, cabbage, chocolate, and spicy foods. If your baby has loose stools, colic, or excess gas for no reason that you can think of, review your diet for the previous 24 hours. Try eliminating foods on the above list and see if it helps.

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Beware of Medications

Medications taken by a mother can pass into her breast milk. This applies to both prescription and over-the-counter drugs. Examples are sedatives taken for sleep, tranquilizing agents, other mood-altering drugs, laxatives, and antibiotics. If you’re breastfeeding, please check with me before taking any medication—even seemingly harmless nonprescription drugs. I will want to discuss with you whether a medication will reach your baby through your milk.

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When You Need to Supplement

Sometimes breastfeeding mothers need or choose to give their babies some bottle-feedings of infant formula. It’s quite possible to balance breastfeedings and bottle-feedings, but I advise new mothers against the practice until their breast milk supply is established, usually a matter of several weeks. And if you do supplement with formula, you should continue to express your breast milk in order to maintain your milk supply. Generally, breastfeeding babies shouldn’t even be given water during this period.

If you decide to supplement, the formula that I recommend for your baby is:

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Infant Formulas for Baby’s First Year and Beyond

❖ Enfamil® LIPIL® with Iron, Milk-Based Formula with a Unique Blend of DHA and ARA

❖ Enfamil Milk-Based, Low Iron Formula

❖ Enfamil with Iron Milk-Based Formula

❖ Enfamil ProSobee® LIP1L Soy Formula

❖ Enfamil LactoFree® LIPIL Milk-Based, Lactose-Free Formula

❖ Enfamil Nutramigen® Hypoallergenic Formula

❖ Enfamil A.R.® Milk-Based Prethickened Formula with Added Rice Starch

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Infant Formula

If you’re not breastfeeding your baby, infant formula should be the only form of milk your baby gets during the first year of life. Enfamil LIPIL with Iron, LactoFree LIPIL, Nutramigen, Enfamil A.R., or ProSobee LIPIL are the formulas I typically recommend, and are available in three forms. Ready-To-Use is fed without adding water. Concentrate is a liquid that’s been condensed and must be diluted with equal amounts of water. Powder must be dissolved in water. The colors of the cans are the same; be sure you are buying the form you want by the container size and the written description of Ready-To-Use, Concentrate or Powder.

When your baby comes home from the hospital, he’ll probably take 2 to 4 ounces of prepared formula at each feeding. When he’s able to empty the bottle, start adding another ounce.

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Wash and Sterilize

Cleanliness is important for small babies, especially when it comes to things that go in their mouths. So you’ll need to be careful about keeping formula containers, bottles, nipples and utensils clean. Everything must be washed thoroughly in hot, soapy water and rinsed with plain, hot water. Utensils must be kept off unclean surfaces. You should wash your hands well with soap and water before beginning formula preparation.

You can prepare enough formula for one feeding or for a whole day. If you prepare powder or concentrated liquid formula, it may be advisable to sterilize the water by bringing it to a rolling boil, then cooling before use. Check with me if you have questions about this.

After each feeding, rinse the bottle and nipple with cool water. If you rinse the milk away before it can form a film, washing will be easier later.

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Use the Proper Nipple Hole Size

The size of the nipple hole should be large enough to let milk flow freely, one drop at a time. If the milk doesn’t form separate drops or flows too fast, throw the nipple away. If the formula flows too slowly, carefully enlarge the nipple hole with a needle or toothpick. If you use cross-cut nipples, throw them away when openings become too soft.

As you feed your baby, keep the bottle tilted so formula fills the nipple and the baby can’t suck any air through. Too much swallowed air will give her a false feeling of being full. She could also get uncomfortable from gas later.

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Get Comfortable

Before you start a feeding, make sure your baby is ready. He should be wide awake, hungry, warm, and dry. And you should sit in a chair with him where you’re comfortable and relaxed. Hold him close to you in the nursing position, his head slightly higher than his tummy and resting in the bend of your elbow. Keeping your baby’s head higher may help prevent ear infections.

Never prop your baby’s bottle or let him feed by himself. Not only does it deprive your baby of needed contact with you, but small, unattended babies may choke when left with a propped bottle, and propping the bottle can lead to ear infections.

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Solid Foods
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Many parents are proud of the day their baby begins to take solid foods, including cereals. They view it as an accomplishment. However, if a baby is given solid foods too early, food allergies may be triggered, the extra calories may make your baby overweight, and the baby may choke or gag. Most babies aren’t able to swallow foods easily in the first few months of life. From a nutritional standpoint, solid foods are not necessary during the first 4 to 6 months of life. The American Academy of Pediatrics recommends that no solid foods be given before 4 months of age. Breast milk or full-year formula provides all the nutrients a baby needs. In fact, the earlier any food is introduced, the greater the chances are that the baby will have problems with it.

For your baby’s first solid food, I recommend an iron-fortified rice cereal. Single grain cereals such as barley or oatmeal may be introduced next. By about 6 to 8 months, you can offer 100% fruit juices (up to 4 oz per day) and single ingredient fruits and vegetables that have been pureed to a smooth texture.

New foods should be introduced one at a time. When a new food is introduced, no other new foods should be given over the next week. Unless instructed by me, you should not change formulas at the same time that you are introducing solid foods. If the food causes diarrhea, constipation, or a rash, you should stop giving it. By introducing new foods slowly, you give your baby’s system a chance to adjust, and it’s easier to trace problems back to the source. If a food doesn’t agree with your baby, I may recommend that you try it again when the baby is older.

Later on, when your baby is a toddler and is able to chew well and eat more foods, you can offer nutritious snacks. Always be sure your baby/toddler is seated and supervised while eating.

THE ENFAMIL® GUIDE FOR INTRODUCING SOLID FOODS

AGE |CEREALS AND BREADS |FRUIT JUICES |VEGETABLES |FRUITS |PROTEIN FOODS | |0-4 months |none |none |none |none |none | |4-6 months |Rice cereal, then oatmeal or other single grain baby cereals (with iron) |none |none |none |none | |6-8 months |Single-grain baby cereals (with iron), cereal/fruit baby cereals, oven-dried toast or teething biscuits |Infant 100% fruit juices by cup (up to 4 oz per day) |Strained or mashed , without the peels (up to ½ cup per day) |Strained or mashed, without the peels (up to ½ cup per day) |none | |8-10 months |Baby cereals with iron, toast, plain bagel, crackers, teething biscuits, bread |100% fruit juice by cup (up to 4 oz per day) |Cooked, mashed vegetables |Soft fruit or canned fruits packed in water, peeled, seeded and finely chopped |Ground or finely chopped lean meats, egg yolk, small amounts of plain yogurt, cottage cheese, cheese | |10-12 months |Baby or Toddler cereals with iron, unsweetened cereals, mashed potatoes, rice, noodles, spaghetti |100% fruit juice by cup (up to 4 oz per day) |Cooked vegetables, chopped |Soft fruit or canned fruits in water, peeled, seeded and chopped |Smaller tender pieces of lean meats, cooked beans | |Back to Contents
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Feeding Tips

❖ Avoid overfeeding. Stop feeding when baby turns away from food or shows disinterest.

❖ Use a baby spoon to feed cereal and other foods. Do not put cereal in bottle.

❖ Use breast milk or iron-fortified formula, not cow’s milk, until baby’s first birthday—thereafter, whole milk is recommended until 2 years of age.

❖ Don’t add any sugar or salt to baby’s food. Check labels of packaged foods and avoid added sugar and salt.

❖ Introduce one new food a week once baby is ready for vegetables and fruits.

❖ Feed baby food from a bowl, not the jar.

❖ Don’t offer baby sweet desserts, candy, soft drinks, fruit-flavored drinks, sweetened or sugar-coated cereal.

❖ Buy plain vegetable, fruit, and meat baby food. Combination dinners may contain fewer nutrients than single food items.

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Food Allergy
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A true allergy to a food is not very common in infants, and can be controlled by changing the formula or diet. The best way to help your baby avoid allergies is to breastfeed. Occasionally a formula-fed baby may develop symptoms that might indicate an allergy, such as colic, severe rash, eczema, or diarrhea that won’t clear up. If there is a history of allergy in your family, these symptoms are even more likely to indicate an allergy. That’s why you should tell me if allergies run in your family.

If I suspect that these symptoms are due to an allergy to milk protein, I may switch your baby to Enfamil® Nutramigen®. All of the ingredients in Nutramigen have been carefully selected to almost eliminate the possibility of an allergic reaction, and the protein has been broken down (extensively hydrolyzed) into tiny pieces. If your baby has cow’s milk protein allergy, he or she is reacting to large pieces of a formula’s protein. But even babies with very sensitive digestive systems usually won’t react to the smaller protein pieces in Nutramigen.

Sometimes colic is caused by milk protein allergy. If this is the case, your baby’s colic symptoms should be reduced or may even disappear completely within 48 hours after starting Nutramigen.

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Vitamins
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Sometimes I recommend a vitamin and mineral supplement for babies to help meet special needs, such as during periods of rapid growth, to compensate for an inadequate diet or finicky eating, or in case of illness. Vitamin supplementation can help ensure that your baby still receives all the vitamins and minerals recommended for healthy growth and development, even during times of illness or reduced dietary intake.

If you’re breastfeeding your baby, I may suggest you give your baby a daily supplement of Vitamin D—important for bone formation during your baby’s rapid growth in the first year. Enfamil” Tri-Vi-Sol® is convenient for vitamin supplementation during the first 6 months of life and provides an excellent source of vitamins A, D, and C.

Both formula-fed and breastfed babies should receive iron supplementation by 4 months, so if you’re breastfeeding, I may recommend iron supplement drops. For formula-fed babies, I usually recommend an iron-fortified formula such as Enfamil® LIPIL® with Iron.

And if your local water supply doesn’t contain adequate fluoride, I may prescribe a fluoride supplement.

All of the supplements listed below provide your baby with essential nutrients for proper growth and development. If I advise any of these for your baby, be sure to read the instructions on the box to ensure proper dosage.

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Available Without Prescription

❖ Enfamil® Tri-Vi-Sol® Drops (A, D, and C Vitamins)

❖ Enfamil Tri-Vi-Sol® with Iron Drops (A, D, and C Vitamins)

❖ Enfamil Poly-Vi-Sol® Drops and Chewables (Multivitamins)

❖ Enfamil Poly-Vi-Sol® with Iron Drops and Chewables (Multivitamins)

❖ Enfamil Fer-In-Sol® Drops (Iron)

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Prescription Necessary

❖ Enfamil Tri-Vi-Flor® 0.25 mg Drops (A, D, and C Vitamins with Fluoride)

❖ Enfamil Tri-Vi-Flor® 0.25 mg with Iron Drops (A, D, and C Vitamins with Fluoride)

❖ Enfamil Poly-Vi-Flor® 0.25 mg Drops and Chewables (Multivitamins with Fluoride)

❖ Enfamil Poly-Vi-Flor® 0.25 mg with Iron Drops and Chewables (Multivitamins with Fluoride)

❖ Enfamil Poly-Vi-Flor® 0.50 mg Drops and Chewables (Multivitamins with Fluoride)

❖ Enfamil Poly-Vi-Flor® 0.50 mg with Iron Chewables (Multivitamins with Fluoride)

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Baths
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For the first few days after your baby comes home, bath time can consist of a gentle once-over with a soft, damp wash cloth—warm, of course—and a mild soap. Regular baths should wait until what’s left of the umbilical cord has come off—and, in the case of boys, until the circumcision heals. Once your baby is ready for full-fledged baths, be sure the room is warm, with no drafts, and the water is about 85°F. When you stick your elbow in the water, it should feel warmer than your skin but not actually hot.

Your baby will find bath time a highlight of his day if you take a few precautions to keep soap out of his eyes and mouth and make him comfortable. Wash your baby’s face with plain water, a soft cloth and mild soap. Wash your baby’s head gently, working from front to back to keep the soap out of his eyes.

To clean the area around the eyes, use cotton dipped in cool, clear water. Clean the outer areas of the nose and ear only, using a moist washcloth or cotton ball dipped in water. With a cotton ball, wipe away any yellow-orange earwax that’s collected in the visible part of his ear. It’s important not to poke inside the ear: it’s risky for your baby, painful, and unnecessary.

You can clean erupting teeth with a clean, damp cloth.

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Sleeping
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Newborn babies sleep a lot, usually waking up every 2 to 4 hours for feedings. At about 1 to 2 months of age, they generally start sleeping through the night, although a few cooperative babies start sooner. You may have heard that starting solid food will make a baby sleep through the night: there’s no evidence that this is true.

Between 5 and 7 months of age, your baby may disappoint you by starting to wake once again during the night. This isn’t backsliding. It’s a normal developmental phase. Let her stay in her bed, comfort her, pat her on the back, and change her if needed. The pattern of nighttime sleeping will soon return.

The American Academy of Pediatrics recommends that babies be positioned on their backs when sleeping. Babies who are placed on their sides may roll onto their stomachs.

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Bowel Movements
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Your baby’s stools will probably change in color, softness, and frequency from time to time. Also, different babies have different bowel habits. Some have a stool with every feeding; others may have one stool every 36 to 48 hours. The consistency and color varies from day to day. Usually, breastfed infants have liquid, yellow, or mustard-colored stools. If you’re breastfeeding your baby, don’t take runny stools as a sign of diarrhea. The stools of formula-fed infants are yellowish-tan. All babies sometimes have green or brown colored stools. However, if the stool is green, runny, and frequent, it may be a sign of diarrhea.

As long as your baby seems happy and content, is eating normally, and has no signs of illness, don’t worry about minor changes in the stools. And if he strains, grunts or turns red in the face while having a bowel movement, that’s normal, too.

If your baby’s stools are small and pebble-like, he may have constipation. Constipation has nothing to do with frequency of stools. Don’t give him an enema, suppository, or laxative until you’ve talked to me.

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Teething
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Most babies start teething at 6 to 7 months. A few early birds begin at 3 to 4 months. While the majority of babies aren’t troubled by the teething process, some get irritable, eat poorly, and have trouble sleeping when teeth begin to arrive.

If your baby seems uncomfortable, you may want to give her acetaminophen or you can apply a mild topical anesthetic to the area of the gums where new teeth are coming in. Talk to me about how to use such products. Some babies are helped by teething toys and teething biscuits.

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Crying
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Ways that tiny babies can communicate are limited. Crying is one of them. Crying is how your baby makes his needs known and his displeasure felt. As you’ll soon find out if this is your first baby, most parents quickly learn to identify whether their baby is crying from hunger, restlessness, pain, anger, or some other reason. Many babies go through unexplainable fussy periods each day as they adjust to living in the world. Don’t worry about spoiling a tiny baby by pampering him. He needs to know you’re there to meet his needs.

There are a number of things you can do to help comfort your baby:

❖ Give the baby something to suck, such as a pacifier.

❖ Give the baby more physical contact and movement. Walk, rock, or pat him.

❖ Take the baby for a stroller ride or car ride.

❖ “Bundle” the baby (wrap him snugly in a blanket) or raise the temperature in his room a little if you think it’s too cool.

❖ Change his position. For example, move him from his back to his side or vice versa.

If all else fails, just let him cry. He may need to let off steam. Often babies fall asleep after a good cry—so allow him up to 20 minutes on his own.

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Diaper Rash
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Some babies are more prone to diaper rash than others, but almost all of them get it at some time. Babies who wear disposable diapers are more likely to get diaper rash than those who wear cloth diapers, which allow the skin to breathe. Plastic pants worsen diaper rash.

To treat your baby’s diaper rash:

❖ Change her diapers often. Keeping the area clean and dry allows it to heal.

❖ Expose her bottom to air several times a day.

❖ Avoid plastic pants for a while. At night, use disposable diapers that pull moisture into the diaper and away from the skin.

❖ Wash your baby’s bottom with warm tap water if diapers contained only urine. Use a mild soap if there was a stool. Rinse thoroughly and pat dry.

❖ If your baby’s bottom is very raw, have her soak in a tub of lukewarm water for 15 minutes three times daily.

❖ Don’t use special creams or ointments unless I prescribe them.

❖ If you use cloth diapers and launder them at home, use a regular detergent during the wash cycle. Then run a second wash cycle with warm water and 1 cup of bleach added. (Vinegar does not kill germs.) Follow with the normal rinse cycle.

If your baby’s diaper rash lasts more than 3 days, call my office. You should also call if the rash spreads beyond the diaper area or if any blisters, pimples, boils, pus, or yellow crusts form on the baby’s buttocks.

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Illness
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I’d like you to be familiar with a few warning signs of severe illness. Just because your child has one or more of these signs doesn’t necessarily mean a severe illness is present. But it could be. So call me if you note any of the following danger signs:

❖ Temperature of 101’F or higher

❖ Vomiting, not just spitting up

❖ Refusal to take feedings

❖ No energy

❖ Diarrhea, especially if there’s mucus, blood, or an unusually bad smell

❖ Hard crying with no obvious cause

❖ Inability to see or hear normally

❖ Unusual rash

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Fever

If your new baby develops a fever (temperature of 101°F or higher), call my office. In babies, the rectal temperature is simplest and most accurate to take. First, lubricate the bulb of the thermometer with petroleum jelly (Vaseline®). Then place the baby on his tummy. With your thumb and index finger, spread the baby’s buttocks and insert the tip of the thermometer with your free hand. Remove the thermometer after 1 minute.

To lower his temperature, give him acetaminophen. If the fever is very high, I may suggest that you sponge the baby off with water that’s at room temperature (about 78°F). Or give him a bath in water of this temperature for 20 to 30 minutes. Don’t make the water too cold. And don’t use plain alcohol; it could chill your child. Ice baths should never be used at home.

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Vomiting
If your baby has forceful, persistent vomiting any time in the first 6 months, report it to me. Persistent vomiting with fever or abdominal pain needs prompt attention. Also, if your baby bumps her head hard, falls headfirst, or is struck in the head and later starts vomiting, call me.

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Diarrhea

A baby has diarrhea when she passes frequent, loose, or watery stools. Usually diarrhea isn’t a medical emergency, but it can lead to dehydration which is a serious complication. Dehydration is caused when minerals and fluids are lost in diarrhea. Dehydration can be prevented by giving your baby the right liquids when she gets diarrhea. Not every clear liquid has the right amount of minerals, salts, or carbohydrates your baby needs when she has diarrhea. That is why a commercial oral electrolyte solution is recommended. It has the proper balance of minerals, salts, and carbohydrates. These solutions can be found in most drug stores and some grocery stores.

When your baby has diarrhea, you should call my office if you notice any of the following:

❖ Mild diarrhea that lasts more than 24 hours

❖ Severe diarrhea

❖ Fever above 100°F for 2-3 days

❖ Vomiting 2-3 times in a two-to-three hour period

❖ Blood in the stool

❖ Infrequently wet diapers (further apart than every 2-3 hours)

❖ Deeply colored urine

❖ Lethargy or excessive sleepiness

❖ Acting very sick

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FOLLOW THESE STEPS TO PREVENT DEHYDRATION CAUSED BY DIARRHEA.

❖ • Have an oral electrolyte maintenance solution stocked at home so you can begin giving it as soon as diarrhea starts.

❖ Toddlers 1 year old or older should be given as much oral electrolyte as they will drink every 3-4 hours. If your baby is less than 1 year old, call me for dosing instructions.

❖ Don’t hesitate to give your baby more oral electrolyte solution if she vomits or spits up. It may be necessary to give smaller amounts (by the teaspoon) more frequently.

❖ If you are breastfeeding and your baby gets diarrhea, continue to nurse your baby between feedings of the oral electrolyte solution.

❖ Continue feeding regular foods or formula. Your child is growing fast and needs continued nutrition, especially when she is sick.

If you’re not breastfeeding and your baby has diarrhea, gas, or is fussy, I may switch your baby’s formula to Enfamil® LactoFree® LIPIL. These symptoms can sometimes be signs that your baby is having difficulty digesting the lactose (milk-sugar) in milk-based formulas. LactoFree LIPIL is a nutritionally complete milk-based formula that will keep real milk protein in your baby’s diet while eliminating the lactose that can cause these problems.

Lactose malabsorption results from a shortage of an enzyme called lactase. This enzyme digests or “breaks down” the lactose in breast milk and milk-based formulas into simpler sugars your baby can absorb and use for growth and energy.

A shortage of lactase most often occurs after an intestinal virus. Such viruses can reduce the body’s ability to produce this enzyme and it can take some time for the enzyme to return to normal levels. If your baby’s diarrhea and other symptoms are due to lactose, a switch to LactoFree will resolve them. In some cases I may recommend Enfamil ProSobee® LIPIL, a soy formula which has neither lactose nor milk protein.

If I suspect your baby’s symptoms are due to a milk protein allergy, I may recommend Enfamil Nutramigen®, a hypoallergenic formula with carefully selected ingredients that have been chosen to almost eliminate the possibility of an allergic reaction. You should see improvement within 48 hours after starting Nutramigen® if your baby’s symptoms are due to a milk protein allergy.

If the skin of your baby’s buttocks gets red or sore from the diarrhea, especially the area around the anus, wash it after each bowel movement. Then apply a thick layer of petroleum jelly (Vaseline®). Also, change diapers quickly after each bowel movement.

Most diarrhea is caused by intestinal viruses and is very contagious. So, you should wash your hands well after diaper-changing or using the toilet to prevent the viruses from spreading to other family members.

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Spitting Up

If your baby spits up (regurgitates) frequently, you may worry that she’s reacting to her formula. Don’t worry—spit up is common in babies, and it isn’t usually a cause for concern. One way to reduce spit up is with Enfamil A.R.®, a milk-based nutritionally balanced infant formula that’s prethickened with added rice starch. Clinically proven effective to reduce spit up (regurgitation) in babies who spit up frequently, Enfamil A.R. is more nutritionally balanced and convenient than adding rice cereal to infant formula.

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Colds

Occasional colds are unavoidable in babies and children. Usually colds involving no more than a runny or stopped-up nose and mild cough can be handled at home. If your baby has vomiting or a high fever, however, I’d like for you to call me.

During the first month or two of life, most newborn babies have some nasal mucus that can cause sneezing and noisy breathing. To lessen this, use the nasal bulb you were given at the hospital. A vaporizer of the cool mist type in your baby’s room might also help.

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Poisoning

All of your family’s medications should have child-proof caps. They should be kept in locked or out-of-reach cabinets. You should also store soaps, cleaning agents, and painting supplies in a secure place. It’s surprising how quickly little fingers become nimble enough to open drawers and doors and pry the lids off things.

If you’ve seen your child swallow a medicine or poison, call me or your poison control emergency number at once! Even if you only suspect it, call!

If your child has swallowed an acid-type chemical or kerosene, gasoline, or other petroleum product, you will be instructed not to induce vomiting.

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Special Conditions in the Newborn Period
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When a baby enters the world, it’s an adjustment. A few mild symptoms may occur, and if this is your first baby, they may worry you. Some normal conditions of the newborn period are described below.

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Umbilical Cord

Your baby’s umbilical cord will fall off by itself in 1 to 4 weeks. Until it does, apply alcohol on a cotton swab to the cord three times a day. If the navel oozes spots of blood or a clear moist fluid for a while after the cord drops off, don’t worry. This is natural. But if the oozing persists more than 2 days, if the discharge smells particularly bad, if the skin around the cord gets red, or if your baby gets a fever, notify me.

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Genital and Breast Areas

If your little boy has had a circumcision, each time you change his diaper apply Vaseline® to the circumcised area. Call me if you see any swelling or bleeding. If your baby hasn’t been circumcised, don’t pull the foreskin of the penis back until after his first office visit with me. The tip of the penis (glans) of newborn boys is generally red at first and sometimes has thin yellow crusts in spots. The skin looks more normal in 2 to 3 weeks.

Many newborn girls have a whitish discharge from the vagina. This is normal and no cause for worry. Just clean the area with a cotton ball soaked in sterile water.

A thin discharge from the nipples is seen in some babies, both male and female. They may have enlarged or swollen breasts. No treatment is necessary, since the condition will go away by itself. However, if you notice any redness of the swollen areas, notify me.

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Scalp

It’s normal for newborn babies to have white dandruff-like flakes on their scalps. The flakes are old skin being shed and not a dry scalp condition. So, don’t use oils, lotions, or Vaseline®. They “paste” these flakes on the scalp and make the condition worse.

Thick yellowish scales are called cradle cap, a very common condition in infants. It, too, is associated with old, dead skin, and is only made worse by oils, lotions, and so on. Washing may not help much. You can treat cradle cap by removing the scales with a soft brush.

The soft spot on your baby’s head (fontanelle) is an area where the skull bones haven’t yet joined. The soft spot is covered by thick, tough tissue that protects the brain tissue underneath, so you needn’t worry about hurting it. If you sometimes notice pulsating of the soft spot, this is normal. You may also see small lumps, bumps, and irregularities. These are normal too.

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Eyes

Many babies look slightly cross-eyed at birth. Usually, this is caused by muscles that are temporarily out of balance. Also, the wide skin area that babies have across the nose can make the eyes look crossed when they’re not. Crossed eyes generally correct themselves by the end of the first year.

Some babies have yellow drainage and perhaps redness or swelling of the eyes in the first week of life. Usually, this is caused by silver nitrate, a compound that’s put in all infants’ eyes at birth as a health precaution. The condition clears up without treatment.

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Skin

Some babies have little white dots on their noses. They’re called milia and go away without treatment. One of the most common newborn rashes is newborn acne, which disappears in 6 to 8 weeks. It’s helpful to wash the area with a mild soap once or twice daily. Don’t apply oils, lotions, or creams; they only worsen the problem.

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A Final Word

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This information guide won’t answer every question you have about the first weeks and months of your baby’s life. But I hope that it’s given you some useful guidelines for baby care and outlined some precautions you must take to safeguard your baby’s health.

My small patients are of the utmost concern to me, and I welcome any questions you may have about your baby’s growth, development, and well-being.

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Thank You for choosing South Tulsa Pediatrics to care for your child. We hope this information is helpful. If this newborn care guide does not answer your questions, we will be happy to answer any questions you have. Just call our office during 8 am to 5 pm Monday through Friday to discuss these items with our very knowledgeable Nurses (if your child’s condition is urgent and cannot wait until normal office hours, you may call our office number 918-728-2000 and the physician on call will be paged). We want to answer your questions, but appreciate if you refer to this Newborn Care Guide or the rest of our patient education section on our website, www.southtulsapediatrics.com.

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Recommended Office Visits
Age Reason for Visit
2-4 days Early check-up if discharged within 48 hours
2-4 weeks Check-up
2 months Check-up, vaccines
4 months Check-up, vaccines
6 months Check-up, vaccines
9 months Check-up
1 year Check-up, vaccines
15 months Check-up, vaccines
18 months Check-up, vaccines
2 years Check-up, (sometimes vaccines)

Signs of a Well-Fed Baby ❖ Looks and acts satisfied after feedings ❖ Wets six or more diapers daily (after 4-5 days of age) ❖ Has yellow stools or greenish stools (after 4-5 days of age)

Forms What to Do

Ready-To-Use Pour in clean bottle

[pic] Concentrate Mix equal parts of water and formula in a clean bottle

[pic] Powder Mix I scoop with 2 oz water in a clean bottle®

[pic] Note: Always follow specific label directions for mixing and serving exactly. * When mixing powder formula in a bottle, do not make more than 6 fl oz to allow room for proper agitation.