General Tips on Feeding
Breast Feeding
Formula Feeding
Nipple Holes
Solid Foods
Care of the Cord
Care of Circumcision
Bath
Baby's Room
Baby's Clothing
Smoking and Your Baby
Infant Emergency Problems
Common Newborn Problems

In general, parents know best what’s good for their own children- if only they give their instincts a chance to prevail. Don’t take too seriously all the advice given by well meaning family and friends.

We feel that each baby is an individual who responds differently to new situations. We are hesitant to set down specific guidelines that apply to all babies. The following instructions should be taken as general guidelines and applied by you to your child’s needs.

Parenting is a combined effort in contrast to the concept of it being “mother’s” responsibility. We feel it is father’s right and duty to feed, bathe, change diapers, bring children for check-ups, provide discipline, etc. Realizing this may be contrary to many father’s habits or beliefs, we will be happy to discuss these ideas as well child check-ups proceed.

General Tips on Feeding

Feeding is one of the baby’s first pleasant experiences. The baby’s first love for its mother arises primarily from the feeding situation. At feeding time the baby receives nourishment from his food and nourishment from his mother’s love. The food, correctly taken, helps him to grow healthy and strong. The mother’s love, generously given, helps him to feel secure. Help your baby get both kinds of nourishment.

Both of you should be comfortable. Choose a chair that is comfortable for you. This will help you be calm and relaxed as you feed your baby. Your baby should be warm and dry so that he is comfortable, too.

Hold your baby in your lap, with his head slightly raised, and resting in the bend of your elbow, whether breast-feeding or bottle-feeding, hold your baby comfortably close. Feeding schedules are usually most satisfactory if the hours are set roughly, and the baby is allowed to eat when he becomes hungry… for example anytime between 3-4 hours after the last feeding. New babies usually need to be fed about every 3 hours but may often go 2-4 hours between feedings.

Whether breast or bottle feeding, comfort and relaxation is important for both mother and child. The infant should be burped at least twice; once during and after feeding. Bottles should never be propped for any reason during feedings. The baby should never be allowed to take a bottle in bed.

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Breast Feeding

Breast milk handling and storage (CDC)
Breastfeeding: Hints to help you get off to a good start AAFP

The mother who is breast-feeding should continue her prenatal vitamins along with a well balanced diet and an increased volume of fluids, some of which should probably be milk. Also, we recommend avoiding excessive use of cigarettes, alcohol, and laxatives. If you are using any medications, check with us regarding its excretion into breast milk. If you develop a breast infection, call your obstetrician’s office so they can advise you what to do.

Successful nursing of an infant depends a great deal on the mother’s state of mind. You should be as relaxed, calm, and as happy as possible. You should get ample rest. For the first few days the breast secretions are a deep yellow color called “colostrum”. To help avoid the problem of cracked and sore nipples, gradually increase the time the baby is kept at the breast. Remember that the amount of milk available will be small the first few days.

Most mothers find it best to nurse at both breasts with each feeding, starting on the opposite side each time and not nursing over 30 minutes. The nipples should be washed with a cotton sponge dipped in water before and after each feeding and washed once or twice daily with soap and water. We recommend the use of a nursing bra. If nipples are cracked and sore, various preparatory creams such as Masse are available for nipple care.

The American Academy of Pediatrics recommends breastfed babies receive a vitamin D supplement. This can be given as Trivisol vitamins 1 ml per day.

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Formula Feeding

If your baby is bottle-fed, we suggest Enfamil Lipil or Similac Advance with iron formula. It is available in several forms. The composition of each is the same when used as directed. Vitamins and iron are provided in the formula. The usual full-term baby does not need extra vitamins. The formula is well tolerated at room temperature.

We prefer powder or concentrated liquid since ready-to-feed formula does not supply fluoride. The concentrated liquid comes in 13oz. cans to mix in equal parts tap water and formula (1:1).
If the formula is prepared one bottle at a time and used immediately, sterilization is not necessary, provided the bottles and nipple have been washed thoroughly and sterilized in the dishwasher. A 24-hour supply can be prepared this way provided the bottles are kept adequately refrigerated.

Drinking water may be used directly from the tap without sterilization. Store bottles of formula in refrigerator; remove when ready for use and place in a bottle warmer or pan of hot (not boiling) water for a few minutes. Formula may be set out of the refrigerator before feeding time and given at room temperature. Test the temperature of the formula by shaking a few drops onto the inside of your wrist. It should feel warm but not hot.

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Nipple Holes

Testing nipples regularly will save time when you’re ready to feed your baby. Nipple holes should be the right size to help the baby suck easily. When the nipple holes are the right size, warm milk should drip rapidly as possible without forming a stream. If nipple holes are too small, the baby may tire of sucking before he gets all the formula he needs. If holes are too large, the baby gets too much formula too fast, and may not get enough sucking satisfaction.
If nipple holes are too large, the nipple is worn out and should be thrown away.

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Solid Foods

Any new food should be offered initially once a day in small amounts of one to two teaspoonfuls. Offer the same food daily until the baby becomes accustomed to it. Don’t introduce new foods more often than every week or two. New foods are generally best accepted if fairly thin or diluted. The baby frequently pushes the food out of the mouth because he or she does not yet know how to swallow efficiently. Use a spoon small enough to fit easily in your baby’s mouth.
Most authorities recommend that solid foods not be started until your baby is 4-6 months of age. At that time, we recommend the following order:

  1. Rice Cereal – Rice cereal is excellent to offer the baby who has a large appetite early in life and is not satisfied only with breast milk or formula. It will add significant amounts of iron to the infant’s diet. Other cereals may be introduced after rice in any order.
  2. Vegetables – begin vegetables before fruits because the sweet taste of fruits makes the change to vegetables difficult.
  3. Fruits – especially bananas and applesauce.
  4. Meats
  5. Orange Juice and eggs – not before 9 months of age. If a more structured schedule is desired, consult the office.

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Care of the Cord

The cord falls off at natural lengths of time usually from 1 to 2 weeks. When the cord separates, there is often a small amount of bleeding which is of no consequence. The navel should dry up within a week after the cord falls off.

Care of Circumcision

If a Plastibell has been used, a plastic rim will be attached at the time you take your baby home. This falls off 5 to 6 days after circumcision. If another method is used, there will be slight redness for several days. Squeeze soapy water followed by clear water over the penis to clean it. The nursery staff will instruct you if Vaseline and gauze needs to be applied to the circumcision.

Bath

Do not bathe the baby until the cord is healed and in the case of circumcised boys, the circumcision is healed. Simply sponge bathe your infant with warm water and cloth using a mild soap such as Dove, Mennen, or Johnson’s Baby Soap. Wash the face gently. The scalp should be washed every 2-3 days to prevent cradle cap. Do not be afraid to wash over the soft spot. Baby’s breast enlargement is common for the first few weeks; however, do not rub or squeeze the enlarged breasts.

With baby boys who are circumcised, after the first two weeks, pull the foreskin back as part of the bath. With baby girls, wash and dry from front to back toward the rectum. During the first few weeks a slightly blood tinged vaginal discharge may be present.

Q-tips can be used to cleanse the folds of the genitalia in girls and dry the folds of the ears. Do NOT push Q-tips into ear canal. Nails should be trimmed straight across with cuticle scissors, infant nail clippers or nail files.

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Baby’s Room

Keep the house at a comfortable 75 – 78 for the first few weeks. Then the night temperature may be lowered. If at all possible, the baby should have a separate room and certainly should have a separate bed. Keep the baby’s sheets drawn tight and do not use a pillow.

Baby’s Clothing

Do not overdress your baby, particularly in the summer. The baby needs to be dressed in the same thickness clothing that you wear.

Smoking and Your Baby

Smoking has been demonstrated conclusively to be detrimental to all those exposed and may be especially difficult for infants and young children to tolerate. These children suffer increased risk of sudden infant death, many more upper respiratory infections and may be prone to ear infections. All smoking should be done outside the home and babysitters should be interviewed regarding smoking habits.

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Infant Emergency Problems

Newborn infants respond differently and may have subtle symptoms of serious illness. The following signs or symptoms should be reported to office immediately.

1. Temperature of 101 by rectum during the first two months.
2. Repeated forceful vomiting (not just spitting up).
3. Unusual crying – for example: grunting or whining cry or hoarse cry.
4. Refusal of food several times in a row.
5. Listlessness
6. Frequent watery green stools or bloody stools
7. Redness or pus around navel.

Common Newborn Problems

Bowel Movements
Your baby may have as many as one stool with each feeding or may go 48 hours with no bowel movement. This is normal for the individual baby, providing the stool is not too hard and the baby is relatively comfortable. Breastfed babies have liquid, yellow-colored stools. They may have approximately 6-8 loose stools per day. The stools of formula fed babies may be yellowish-tan color. These babies may have 1-3 per day. Your baby’s stool may change in color, softness, and frequency from time to time. As long as your baby is eating well and there are no signs of illness, there is no need to worry about minor changes in stool. If your baby’s face turns red or he grunts while having a bowel movement, this is normal. Six or more wet diapers a day is your assurance that your baby is getting a minimum amount of fluids per day.

Colic
Colic is crying presumably due to pain or cramping of the stomach and intestines, usually from excessive gas, and harmless but concerning to parents. All babies cry but if your baby cries for 2-3 hours and draws his legs up as though his stomach hurts, this may be colic. If the baby cries only once a day for 1-2 hours in the afternoon or evening, this may be normal for him or her. Babies with colic need to be burped well, at least twice per feeding. If your baby seems to have frequent colic in spite of these precautions, call the office. Careful attention to our feeding instructions, especially relative to being relaxed and comfortable may alleviate or prevent colic.

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Diaper Rash
Prevention through prompt diaper changes and thorough washing and rinsing is the best treatment. A mild detergent such as Dreft or Ivory Snow is recommended for all babies clothing. If a rash does develop, leave off the diaper as much as possible and use a preparation such as Desitin or corn starch to keep the skin dry.

Nasal Congestion
This is often difficult to evaluate as to seriousness. Often symptoms can be relieved with the use of a bulb syringe. If there is difficulty in feeding and breathing or a fever is present, call the office.

Swollen Eyes
Most newborns have swollen eyelids the first week. This will gradually disappear by 7-10 days. If swelling and excessive mucus drainage or redness persists, call for advice.

Thrush
If white spots on the tongue or inside of cheeks persist call the office during office hours.

Positioning for Sleep
The American Academy of Pediatrics recommends that babies be placed on their backs for sleeping. Studies have shown an increased incidence of SIDS (Sudden Infant Death Syndrome) in infants who sleep on their stomachs. This recommendation applies until your infant is one year of age.

Jaundice
Jaundice is a term used to describe the yellowish appearance of the whites of the eyes and of the skin in many newborn babies. This is caused by an excess amount of bilirubin in your baby’s circulation. Bilirubin is the breakdown product of the red blood cells. The bilirubin then is processed in the liver and excreted from the body. However, sometimes the baby’s liver is not fully matured and therefore the bilirubin is not getting metabolized. This results in physiologic jaundice. Physiologic jaundice occurs in more than 50% of babies. This usually appears on day of life 2 or 3 and resolves itself within a week. This type of jaundice is mild and requires no treatment.

Jaundice can also be associated with breastfeeding. It is believed that there is a substance in breast milk which may slow the metabolism of bilirubin. Breast milk jaundice usually requires no treatment. Occasionally high levels of jaundice are treated by interrupting the breast feedings for 24-48 hours. The baby is fed formula for this short time. It is recommended that the mother use a breast pump to keep mild production flowing. However, once the jaundice is under control, the mother is encouraged to resume breastfeeding.

Blood incompatibilities can also be associated with jaundice. This occurs when the mother and the baby have different blood types. The mother may develop antibodies against the baby’s red blood cells. Two conditions are ABO and RH incompatibility. The mechanism is the rapid deconstruction of red blood cells resulting in a sudden overload of bilirubin in the blood.
If your pediatrician suspects jaundice, a blood test will be obtained to measure the bilirubin level in your baby. You may be asked to take the baby to the lab. If the bilirubin level becomes markedly elevated your baby may require phototherapy.

Phototherapy is a process by which lights are used to help lower the bilirubin. The baby may be under lights for a few days. Bilirubin levels will be checked regularly. The lab test and the physical appearance will guide your doctor to the baby’s progress.

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