Newborn Advice

Infant Care | Common Concerns | Potential Problems | Childhood Immunization Schedule

Common Concerns

First time parents are often nervous about their baby. This information is intended to help alleviate your anxiety as well as to inform you about basic infant care.

Feeding

Practically all babies have poor appetites in the first three to four days of life. Thereafter, all babies have a very strong suck reflex, so not all sucking is a signal to feed. Feeding schedules vary from baby to baby and from day to day for an individual baby. You should notice some "routine" develop by the end of the first month. Always feed in an upright or semi–upright position. Your baby may require one or more burps per feeding. It is not a good idea to nurse your baby to sleep regularly, especially leaving the breast in the baby's mouth. As well, do not allow your baby to fall asleep with a bottle in his/her mouth. These routines can cause baby bottle tooth decay as well as promote poor bedtime and sleeping habits.

For the family who is interested, we highly recommended and encourage breast–feeding as the ideal nutrition for the newborn. You will sense your milk "coming in" or "letting down" four to six days after delivery. Guide the nipple into your baby's mouth, keeping the breast from pressing against your baby's nose. Breast–feeding is more nutritionally effective if you nurse your baby on alternate breasts at least once every three hours at first, eventually extending the interval to four hours. Breast–fed babies usually feed more frequently than formula–fed babies (8–12 times over a 24–hour period is typical for a newborn infant.) Care of the breast does not require anything more than washing with plain water before and after nursing. (Of course, wash your hands before each feeding.) You may apply a small amount of cream designed for breast use after nursing. You should have a commercial formula available for use in case of emergency. To ensure continuous, successful breast–feeding, we recommend that you avoid supplementing with formula at least until after your baby's first well–child office visit.

There are several popular infant formulas that are comparable in price and quality. We usually suggest that an infant remain on a milk–based formula fortified with iron and DHA. In certain instances (such as possible allergies, colic, or diarrhea) we may recommend that you change the brand of formula. Bottles and nipples should be thoroughly washed and rinsed; new store–bought bottles and nipples should be sterilized before using. After a quick increase in the first week or two of life to 15–20 ounces of formula per day, gradually increase the formula feedings to 26–32 ounces a day. The amount taken may vary from feeding to feeding and from day to day. Do not heat your baby's milk in a microwave. In addition to possibly sacrificing the milk's nutritional content, microwaving can result in "hot spots" in the bottle that can cause significant burns.

Whether breast or formula fed, babies do not necessarily need other liquids or solid foods until four to six months of age. Nutritionally, other foods are not needed and only rarely does it encourage prolonged night sleeping. Good, progressive weight gain is indicative of adequate nutrition in babies who are exclusively fed by breast or bottle. The need for vitamin and/or fluoride supplementation will be discussed at your baby's first office visit and again at the six–month visit, if appropriate. As you bring your baby in for checkups, discuss your future feeding plans with your doctor. If you have any specific problems or questions regarding feeding, please contact us at the office.

Stools

Never in one's life is "poop" such a major topic of discussion – too much, too little, too hard, too seedy, too soft, too green, too yellow, too dark, too smelly, too much! Bowel movements are as individual as a baby's smile, cry, or disposition. They normally vary in size, color, consistency, frequency, odor, and associated stooling behavior (grunting, straining, turning red, perspiring). These characteristics can change because of fluid intake, activity, the addition of other foods, even colds or – in the case of the breast–fed baby – the mother's diet.

If the stool should become unusually hard (pellet–like) or infrequent (5–7 days without a bowel movement), you can offer one to two ounces of water up to two to three times a day. In the older infant, a few ounces of half–strength prune juice might help alleviate constipation, as does increasing the amount of fruits and other juices. Generally, increasing fluid intake, including water (perhaps adding a couple of extra ounces to your baby's normal formula feeding) will help constipation problems. We do not recommend formula changes. If the problem persists, please contact us at the office.

Diarrhea can be defined as frequent (7–8 or more per day), loose (often watery) stools sometimes accompanied by mucus or blood staining. Breastfeeding and/or formula feeding should be continued. You may choose to offer smaller more frequent feedings. Slowly increase the amount offered every hour (i.e. small and frequent liquid feedings), focusing on liquids. After 12–24 hours, you can introduce solids. Continue with this approach until the diarrhea fails to resolve or if your child appears particularly ill. Infants under three to four months old should be seen in our office if they have persistent diarrhea or any time diarrhea is associated with frequent vomiting, poor liquid intake, very bloody stools, irritability, lethargy, or dehydration.

Washing and Cleaning

It is unnecessary to bathe newborns daily, as this may dry their skin. Newborn babies don't get very dirty, except for the diaper area, which you can clean at each diaper change. Until the umbilical cord stump falls off, only a sponge bath is needed. After that, two or three baths a week are plenty. Wash the baby's face with plain, warm water and a soft cloth. Do not use soap. To clean around the eyes, use cotton dipped in cool water. Wipe from the bridge of the nose toward the ears. Do not try to clean the inside of either the nose or ears, but clean outer areas with a moist washcloth or cotton ball. Wash the infant's head with a mild shampoo. Use a mild soap and warm water to wash the baby's body. Be sure to wash in the folds of skin, rinse well, and pat dry. Powders and lotions are unnecessary. Always check the water temperature before bathing and rinsing; serious burns can occur quickly on a baby's sensitive skin. Set your water heater no higher than 120 F (48.8 C).

Clothing and Environment

The temperature in your baby's room should be kept at a reasonable, comfortable level. Dress your baby the way you are dressed; if it is not hot and you have on very light clothing, dress your baby the same way. Don't overdress your baby in an effort to warm up the feet and hands, most babies have cold feet and hands. Remember to keep a newborn's head covered in cold weather, as heat is lost through the head. Clothing and bedding can be washed in any laundry detergent that is fragrance and softener "free". Avoid using dryer sheets and fabric softeners as they decrease flame resistance and are associated with skin rashes.

Sleeping

Infants should be placed only on their backs while sleeping on a firm crib or bassinet mattress with snug, well–fitted bedding. Do not place stuffed toys, plush comforters, or pillows in the crib or bassinet. Bumpers should be removed when your infant begins rolling around. Mobiles should be hung out of reach and removed when the child can sit up. Take care to keep cribs away from any electrical cords or window blind cords. The family bed is a personal choice, but it can be a significant safety hazard (SIDS, suffocation, entrapment and falls), so several precautions need to be taken. Most adult bedding (pillows and comforters) should be removed. Infants have been injured when they have fallen off a bed or have become trapped between a bed and a wall. Never place your infant in your bed if you have been drinking alcohol or have taken any medications that may cause drowsiness.

Most newborns sleep 14–20 hours per day, though sleep patterns may be quite variable. If your baby is napping many hours in a row (3–4) during the daytime, but sleeping poorly at night, you might consider interrupting those long naps after two to three hours to encourage prolonged sleeping at night. Babies should not fall asleep with a bottle or breast in the mouth. The best way for a good sleeping routine to develop (at least by 3–4 months of age) is to allow your baby to fall asleep on his/her own. If you rock or walk your baby to sleep, or lay next to your baby while he/she falls asleep, your baby may have difficulty falling back to sleep alone at times of normal night–time awakenings. "Crying it out" is a method used by some families, but should not be used before four months of age. Sometimes restlessness or a sudden change in sleeping routine is a symptom of an illness or other problem, such as teething, ear infection, and sore throat. If you have questions about sleeping habits, please contact us at the office.

Habits

All babies sneeze, cough, have a stuffy nose (normal mucus), have hiccups, pass gas, burp, spit up, and cry. Gradually these functional habits will diminish. If your baby is feeding well and comfortably, not coughing incessantly or having difficulty breathing, and has no other signs of illness, then you do not need to be concerned about the sneezing, coughing, or stuffy nose.

Many babies have colic, some worse than others. Colic is defined as prolonged and periodic crying for no apparent reason (wet, hungry, cold, hot, sick). Colic often occurs after feeding and is frequently associated with stiffening and pulling up the legs onto the belly and passing a lot of gas. It is a very common problem in healthy growing babies beginning at two to six weeks, peaking in the second month, and resolving around four months of age, and results in no permanent damage. Colic is also not linked to an individual's future disposition. The cause of colic is unknown. Many babies respond by being side–positioned and/or rocked stomach down across your lap. Feeding more upright with more frequent burping often helps. Sucking, 'shhhh–ing', and swaddling are also of some help to many infants. Some infants do better with different nipple/bottle sets. Using anti–gas (simethicone) drops offers relief to some infants. If this colicky behavior persists or worsens, please call us at the office so we may examine your baby to rule out other possible causes of crying.

This advice is not intended to replace good medical care. If you have a question about your baby or are concerned about your baby's health or welfare, please call our office, contact your physician, or go to your local emergency room.

Sharon E. Barnett, MD; Eric D. Berman, DO; David E. Chasen, MD; Mary Elaine Holmes-Bricker, DO; Kathryn T. Lafferty, MD; Stephen A. Szawlewicz, MD; Kimberly Keane DeNick, MD;
Christina I. DiNicola, MD

Advocare The Farm Pediatrics
975 Tuckerton Road, Suite 100 Marlton, NJ 08053 — (856) 983-6190
1001 Laurel Oak Road, Suite B, Voorhees, NJ 08043 — (856) 782-7400