Care of the Newborn

Give sponge baths until the cord falls off and circumcision is healed.  Use a mild soap and warm water (for safety we recommend reducing the temperature of your hot water heater to no more than 120° F).

Shampoo the head once or twice a week.  Wash the baby’s face in plain water to avoid getting soap in the eyes.  We do not recommend the use of baby lotion, oils or powder.  A dry appearance to the skin is often normal in the first 2-3 weeks of life and requires no treatment.

Caring of Your Baby and Young Child:  Birth to Age 5, Published by the American Academy of Pediatrics.

How to Parent, by Dr. Fitzhugh Dodson

The First Twelve Mondths of Life, by Frank Kaplan

How to Solve Your Child’s Sleep Problems by Dr. Richard Ferber

There are variations in normal bowel patterns in newborns.  Some babies have a small bowel movement after each feeding, while others may have only one every other day. Babies tend to strain at their stools, but unless the stool is hard and pellet-like, no treatment is needed. 

Breast-fed babies tend to have more frequent stools in the first few weeks of life which are usually yellow and soft or watery.  The frequency of these stools decrease later.

Apply petroleum jelly (Vaseline) to the circumcision until it is well healed to prevent sticking to the diaper.  Call your doctor if there is any bleeding.

Colic is a poorly understood condition of young infants associated with crying spells usually in the evening.  Typically, an infant with colic has periods of extreme fussiness characterized by crying, sucking on fist, wanting to eat often, passing gas, flailing the arms and legs, turning red in the face and pulling the knees to the abdomen as if in severe pain.  The following approaches may be helpful:

• Check your baby carefully to make sure there is no other reason for crying.  This should be done with the baby completely undressed.  If there is nothing obviously wrong, make sure you baby is well fed, adequately burped and appropriately dressed, including a clean, dry diaper. 
• Swaddle the baby snugly in a blanket, hold close to you with baby’s head near your voice box as you hum quietly.
• Rock baby gently or use an automatic swing.  Some babies are comforted by a ride in the car.
• Burp the infant after every one to two ounces of formula and several times during breastfeeding.  Mylicon drops (simethicone) (0.3ml every 2 hours) may help decrease gas and is available without prescription.
• If you are breastfeeding you may want to consider recent changes in your diet that might be affecting the infant.
• If your baby is bottle fed, try changing the type of bottle and/or nipple.  We recommend that you call the office before changing formulas.

If the above measures are not helpful and your baby continues to scream, it is possible that your child has another problem besides colic.  Unusual screaming which is inconsolable and persists for more than two hours should prompt a call to our office.

Cradle cap is a scaly rash on the scalp of newborns and infants.  It is caused by excessively oily skin and can be made worse by baby oils.  It is treated by keeping the scalp clean and dry and removing the scales with a soft baby brush. Stubborn scales may require an anti-dandruff shampoo such as Sebulex or Selson Blue. This can be rubbed gently on the scalp twice weekly with a soft baby brush.  Use caution to avoid getting in the baby’s eyes.

Many times the newborn’s eyes are mildly swollen or irritated in the first few days of life due to medicine used in the nursery. Usually, the swelling and irritation will resolve without treatment within a week. Occasionally one or both eyes may be slightly mattered from time to time during the day. This is usually due to a blocked tear duct.

The treatment for this is massaging the tear duct with the index finger at the inner corner of the eye applying pressure in a downward direction. This massage will help open the tear duct and no additional treatment is needed in most cases. If there is significant drainage from the eyes or if they seem excessively swollen the child should be checked.

The umbilical cord usually falls off within two weeks.  (1) There is no need to routinely cleanse the umbilical cord with alcohol.  (2) Do not use a bandage or binder on the cord.  Occasionally when the cord falls off there will be a few drops of blood, but this will stop on its own and requires no treatment. After the cord falls off, the area can be bathed with soap and water. (3) Notify your physician for any signs such as redness or drainage.

Diaper Rash:

Diaper rashes are usually due to either irritation from a wet diaper or to yeast which grows on the skin in moist areas.  The following treatments are recommended:

• Change wet or soiled diapers frequently
• Use a washcloth with water only; avoid wipes and soaps
• Apply zinc oxide (Desitin) or other diaper ointment (A&D; Diager Goop)
• Allow exposure to air by leaving diaper off; this is most convenient during naps when the child can be laid on a towel.

Newborn Rash:

Many newborns have a migrating red rash over their bodies which remains for a few days.  Newborns may also have many small white bumps on the nose called milia.  Newborns can also develop acne in the first one to two months.  All of these rashes go away without treatment.  Do not squeeze the bumps.

If the rash is red and bumpy and fails to respond to the above measures, try an over-the-counter yeast cream such as Monistat, Gyne-Lotrimin applied to diaper area three or four times per day.

In the U.S., SIDS (Sudden Infant Death Syndrome) is the major cause of death in infants between one month and 1 year of age.  It is recommended that babies sleep on their back on a firm mattress with NO pillows, toys, bumper pads or anything in the crib.  Remind all caregivers to always place your baby on his back to sleep.  Try to keep the room at a comfortable temperature (about 72° degrees). 

Every parent wants to create a safe environment for their children. www.healthychildren.org provides detailed, age-specific safety information.  Sleep related infant deaths are of particular concern.  Ways to reduce these risks are:

• position infant wholly on their backs for all sleep  
• use firm sleep surface  
• room share for first 6 months, but do not bed-share
• avoid soft bedding 
• dress baby appropriate for sleep, avoid over-heating

Thrush is very common in babies.  White patches from on the inside of the mouth.  They look like milk, but do not wipe off.  Thrush is caused by a yeast and is not dangerous.  It can sometimes cause mild discomfort. 

An over-the-counter product called Gentian Violet is available for this condition.  Just paint Gentian Violet inside the mouth thoroughly with a Q-tip.  One application is usually all that is required.  IF not effective, call the clinic during regular hours for a prescription.

Because of mother’s hormones, occasionally infant girls may have slight bleeding from the vagina in the first few days of life.  Once again, this will stop spontaneously and does not require treatment.  

First Visit:

Your baby’s first visit to our office will be scheduled by 1 week of age.  This important visit allows us to identify and manage any problems which may have developed after the baby’s hospital stay.  We will evaluate your baby’s weight gain, answer questions, and plan for future visits.

Check-ups:

The American Academy of Pediatrics recommends routine health maintenance visits (“check-ups”) at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, and then annually.  These visits assure that your child’s growth and development are monitored appropriately.  A complete physical exam is performed rather than the more focused exam of a “sick visit.”  Therefore, well-child check-ups are scheduled separate from sick visits.  Well-child visits provide parents an opportunity to ask about issues such as nutrition, behavior, and development.  It is recommended that you schedule regular check-ups even if your child’s immunizations are obtained at the Health Department.  Well-child evaluations must be up-to-date for specialty referrals and for refills of some medications.

Immunizations:

Today, most children in the United States lead healthier lives and parents live with less anxiety and worry over infections during childhood.  Immunizations are one of the success stories of modern medicine. The recommended schedule of immunizations can change.  Your child’s immunization status will be evaluated with each well child evaluation visit.  If you have questions regarding the latest immunization recommendations, we recommend visiting one of the following websites for up-to-date and reliable vaccine information.

• www.immunize.org
• www.cdc.gov/vaccines
• www.healthychildren.org.  

The American Academy of Pediatrics, and its 67,000 members, urges parents to make the decision to immunize. CAPC Pediatricians strongly recommend timely vaccinations because of what we know to be true: Vaccines are simply the best way to protect our children from these viruses and bacteria that can cause real and devastating harm. 

Car Seat Safety:

All infants and toddlers should ride in rear-facing seat until they are at least 2 years of age, or, preferably, until they reach the highest weight or height allowed by the manufacturer of the car seat you use.

Signs of Serious Illness in the Newborn:

While most illnesses suffered by newborn infants are caused by common viruses, newborns can also have much more serious bacterial illnesses.  Early in the course of the illness it is difficult to differentiate between the two.  Thus there are certain “worry signs” which are very important in newborns.

These are:

• Fever (rectal temperature above 100.4°)
• Significant decrease in feeding
• Significant change in activity (increased sleeping or lethargy)
• Protracted vomiting which is different from the usual spitting up

If you child is under 3 months of age and any of these signs occur, call the physician immediately.