Care of the Newborn
Welcome to our Online Newborn Handbook! Jump to a section below or scroll down to browse all topics
Central Arkansas Pediatric Clinic physicians provide inpatient newborn care for infants born at Baptist Medical Center (Little Rock). Please notify the hospital staff at check-in that your baby should be under the care of one of our physicians to ensure that our office is notified when your baby is born. The “on-call” CAPC physician will see you in the hospital and a member of our nursing staff will follow-up with a telephone call after you are discharged to answer questions and be sure you are off to a good start with your baby!
If you deliver at an area hospital other than those listed above, just give a call when you are discharged home with your baby. Often the hospital will ask who you have selected as a pediatrician for your child’s ongoing care. We welcome newborns to our clinic regardless of which hospital you selected for the delivery.
We routinely see healthy newborns in the office within 3-5 days of birth. The focus at this visit is to answer parent questions, evaluate how the baby is eating and sleeping, review car seat and other safety issues. If your baby develops jaundice or has any other problems during these early days, we will see your baby sooner.
After Hours Service
After hours calls are for emergency and urgent medical questions. If after consulting our Online Parent Handbook, you feel your child requires immediate medical attention, please call our After Hours Service at 501-373-8588. Our clinic has arranged for telephone service to be available to you through Arkansas Children’s Hospital Kid’s Care. When you utilize this service, a nurse will provide you with instructions that have been approved by your doctor. If indicated, the nurse will contact the physician on call regarding your child’s condition. Before calling the after hours service, please have available the following information:
- The child’s temperature (a rectal temperature is recommended for infants and toddlers)
- The name and phone number of a pharmacy that is open
- The name and dosage of any medications your child is taking
Care of the Newborn – Common Issues & Symptoms
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.
Books on Child Care
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 (Seborrheic Dermatitis)
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.
We encourage breastfeeding if at all possible. The nutrition and infection fighting capacity of human milk are very important for the baby and will benefit the baby even if the switch to formula is made.
Milk production is based on “supply and demand”. As the baby nurses frequently and “demands” more milk, breast milk production will increase to meet this need. Breastfed infants will need to nurse 8 –12 times in a 24 hour period or about every 2- 3 hours. Early introduction of artificial nipples and formula can interfere with the supply and demand system and may result in decreased milk volume. The American Academy of Pediatrics recommends supplementing all breastfed infants with 400 i.u. of vitamin D daily. (This is available over-the counter.)
All new mothers need lots of rest, a good diet, and plenty of fluids. Taking care of yourself and frequent nursing will help get breastfeeding off to a good start. Some babies and mothers begin breast feeding with little or no difficulty. In other cases it may be difficult to get breast feeding established. In these cases, we want to do all we can to assist you so that you can continue to breastfeed. The Arkansas Breastfeeding Help Line (501-202-7378) is a 24-hour resource line.
Sterilization is not necessary if you have city water and use clean technique in preparing the formula. Prepare all formula following label directions. Prepared formula can be stored in the refrigerator up to 48 hours. Make 3 or 4 oz. bottles at first and then increase as the baby’s appetite increases. Use a fresh bottle at each feeding and give the milk at room temperature. Warm the bottle by placing it in a container of hot water. Use of the microwave oven in not recommended due to the potential of serious burns.
Always hold the bottle and baby for feedings – never prop the bottle. Burp the baby at the middle and at the end of each feeding. Formula fed babies usually eat every 3 o 4 hours. Most babies on city water and bottled water with fluoride, do not need supplemental vitamins with fluoride.
Breast milk or infant formula is recommended for the first full year of your baby’s life. Cow’s milk is a good supplement to the diet of older children, but is does not supply the balanced nutrition your baby needs during the first year. Please contact the office before any formula change.
Spitting up is common in most all babies and should not be thought of as abnormal. Spitting up that is more frequent or forceful probably should have some attention. Frequent burping may help. Babies can spit up because of overfeeding. You should probably not feed your child over four or five ounces at a feeding during the first month or two of life. Call our office during business hours to discuss. Vomiting of green bile is never normal, call our office immediately or proceed to Emergency Room.
Solids are usually introduced between 4 and 6 months of age. Introduction of solids will be discussed at your baby’s 4-month check up. If you have questions prior to this visit, please call the office during regular hours. We do not recommend the use of infant feeders.
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 often strain while having a bowel movement 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 decreases later.
Because of mother’s hormones, occasionally infants, boys and girls, may have breast swelling and occasionally small amounts of milk discharge from nipples. This may last for several weeks and does not require treatment.
Taking a Rectal Temperature
- Get the Thermometer Ready
- If using a glass thermometer, wash with warm, soapy water and rinse
- Shake the thermometer until the silver mercury inside drops below 960 F
- Lubricate the silver bulb end of rectal thermometer with petroleum jelly
- Position Your Baby. Use the position that works best for you. Here are two of the safest positions:
- Put baby on his back on a firm surface. Hold baby’s ankles and lift legs as if you are changing a diaper.
- Or place baby on her stomach and spread buttocks so anus (opening where bowel movements leave baby’s body) is easily seen.
- Taking the Temperature
- Gently slip the tip of thermometer into the anus ½ to 1 inch. The silver tip will no longer be visible.
- Hold thermometer in place for 2-3 minutes or until the mercury stops rising. If using a digital thermometer leave in until you hear a beep.
- Remove thermometer
- Read degree of temperature exactly where the mercury stops.
A rectal temperature above 100.4° in an infant less than 3 months of age should be reported to the physician.
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 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.
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.
Well Child Evaluations & Immunizations
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.
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.
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.
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.
- 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.
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