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Infant Care

The following information will help you care for your infant. Remember, these are just general guidelines. If you have any questions or concerns, please don't hesitate to call us or come in.

Antibiotics

  • antibiotics are drugs designed to kill bacteria
  • colds, the flu, croup, and most “stomach bugs” are due to viruses, thus antibiotics do nothing to treat them
  • when antibiotics are needlessly given, either there will be no change in the symptoms or the child gets better because the virus ran its course, not because of the antibiotic
  • overusing antibiotics is a concern because it leads to resistance
  • bacteria become resistant to commonly used antibiotics, leading to the need to use stronger, more expensive drugs to treat what are often simple infections
  • a recent example is MRSA, which stands for “methicillin-resistant Staph aureus,” which means drugs that used to treat this type of Staph infection (like penicillin) no longer work
  • infections where antibiotics are needed include: Strep throat, some ear infections, some pneumonias, and skin infections



Baths

General Precautions

  • give your baby warm water sponge baths until the umbilical cord falls off
  • make sure the water is not too hot by setting your water heater to a maximum of 120°
  • never leave your child alone in the bath tub -> a baby can drown in 1 inch of water in < 1 minute
  • try to avoid oils and use soap sparingly as even baby soaps may dry the skin
  • do not use baby powder -> inhaling the powder dust can damage the lungs

Boys

  • if he has not been circumcised, you only need to clean the outside of the foreskin
  • if he has been circumcised, there is no special care needed once the circumcision has healed

Girls

  • make sure to wash front to back to prevent contaminating the vaginal area with stool


Bottle Feeding

Types

  • cow milk formula is the standard type of formula
  • soy formula is a consideration if there is a strong family history of milk allergy
  • both of the above types are iron-fortified to prevent anemia
  • there is no good evidence that iron in formulas leads to constipation
  • we do not recommend giving regular milk (in the first year of life) or goat's milk as they do not provide sufficient nutrition and can lead to anemia

Schedule

  • having a schedule allows time for you to rest, but you will find that you may have to be flexible with feeding times
  • a good initial goal is 2-3 ounces every 2-3 hours (from start-to-start) by 2 weeks of age
  • by 6-8 weeks of age, you should have a goal of 3-4 ounces every 3-4 hours
  • as your baby begins eating solid food, the amount of milk he drinks will decrease, but you want to keep a minimum goal of 18-24 ounces a day for the first year of life



Bowel Movements

What's Normal?

  • the first stools after birth are normally dark green and tarry
  • soon the color will change to brown for a very short time -> these are called transitional stools
  • breastfed babies will then have small seedy yellow stools 4-6 times a day, while formula-fed babies will have less frequent stools that are a little firmer and a little darker
  • after about 6-8 weeks, the number of stools may drop down to 1-2 a day (or less)
  • having soft stools only once every 4-5 days is normal
  • occasional straining is normal
  • new foods may change the odor, consistency, and frequency of the stools

Constipation

  • constipation is having infrequent, hard stools
  • iron in formula does not cause constipation
  • if your baby frequently strains, you can help by gently pushing his knees up to his tummy
  • if positioning does not help, put some petroleum jelly on the tip of a thermometer and insert it into the baby's rectum to stimulate him to go
  • if all else fails, sparingly use a sliver of a glycerin suppository
  • do not give your baby an enema or a laxative without discussing it with your doctor first
  • if the stools are frequently hard and your baby is <4 months, try giving 1-2 ounces of sugar water (made with 1 tsp of sugar for every ounce of water) twice a day
  • if your baby is >4 months, try giving 1-2 ounces of prune or apple juice once or twice a day

Diarrhea

  • diarrhea is >6-8 loose or watery stools a day
  • you do not have to stop breastfeeding when your baby has diarrhea
  • if your baby takes formula, it is okay to switch to Pedialyte for 6-12 hours, but then go back to regular formula
  • do not substitute formula with tea, water, soft drinks, or sports drinks
  • if your baby has decreased wet diapers (none for >8 hours), is refusing to eat, or is vomiting and cannot keep any food down, then your baby needs to be evaluated for possible dehydration
  • your baby may develop a diaper rash due to diarrhea -> use a zinc oxide cream (like Desitin, Boudreaux's, or Dr. Smith's) with every diaper change to help control the rash, but realize that it likely will not completely go away until the diarrhea stops



Breastfeeding

General Information

  • the initial watery yellow milk is called "colostrum" -> even though it does not seem like a lot of volume, it is very high in key nutrients your baby needs
  • your infant may initially feed inconsistently -> as your milk comes in, she will feed more consistently and more effectively
  • the best way to make sure your infant is getting enough is by following her weight, which the doctor will do in the hospital and in the office

Schedule

  • frequent feeding during the first few days is important for you to get your milk in and for your baby to working on sucking effectively
  • a good goal is 10-20 minutes per feed, though some babies will finish faster and others may take a little longer
  • since breast milk is digested quickly, your baby will probably be hungry again in about 2 hours (which ends up as 10-12 feeds a day) -> by 2-3 months, this will spread out to every 3-4 hours
  • at 3-4 weeks of life, you may find your baby is hungry more frequently and harder to satisfy -> this is due to a growth spurt and your milk will increase to meet your baby's demands

Supplementing

  • there is no need to give water as a fluid supplement because breast milk (and formula) provide more than enough water for your baby
  • water has no calories, thus does not provide any additional nutrition
  • there may be instances where your doctor recommends supplementing with formula, such as poor weight gain or jaundice



Colds

  • colds (or “upper respiratory infections”) are caused by viruses, so antibiotics do not help
  • the color of the mucus does not mean an infection needs antibiotics (you can have yellow or green nasal discharge with a cold)
  • you can have fever with a cold
  • sneezing is normal in infants and does not mean they have a cold
  • some babies can catch a new cold every 1-2 months
  • In infants, over-the-counter cold medications generally do not help and have the potential for serious side effects. As such, they are not recommended.

Things that can help relieve cold symptoms:

  • suction your baby's nose with a bulb syringe and saline drops, especially before feedings
  • use a humidifier in the room where your baby is sleeping
  • elevate your baby's head when she is sleeping by raising the head of the mattress or having her sleep strapped in her car seat



Crying

Reasons

  • hungry
  • sleepy
  • needs to be changed
  • wants to be held
  • not hungry, but wants to suck
  • fever

Solutions

  • check to see if the cause is one of the items above
  • if not, it is okay to let your baby cry for awhile without you holding her -> this will not hurt her
  • check every 10-15 minutes -> if the crying lasts more than 30 minutes or is getting worse, then hold her
  • if you feel uncomfortable waiting, then hold her -> you won't spoil her

Colic

  • persistent intense crying in a baby < 3 months that usually occurs in the evening
  • you may see him clench his fists, stiffen his legs, and turn red
  • there is no known cause or cure for colic
  • it is not harmful, does not affect development, and will usually resolve by 3 months of age

Things that may help include:

  • less stimulation (i.e. gentle rocking in a quiet darkened room)
  • if you are breastfeeding, cut down on caffeine, chocolate, spicy foods, and dairy products
  • burp during and after feeds
  • infant gas drops (we do not recommend any other medicines to treat colic)



Fever

General Information

  • fever is considered to be a temperature =100.4° rectally
  • a “low-grade” fever is a temperature between 100.4°-102.1°
  • fever in of itself is not bad, but rather a sign that your body is fighting an illness
  • fever due to infection does not cause brain damage
  • in infants <3 months, it is especially hard to know if a fever is due to a mild or a serious illness, so please call us

Treatment

  • the first thing to do is use a thermometer to see if your baby actually has a fever
  • you can feel warm & have a normal temperature or feel cold (due to chills) & have a fever
  • a cool rag on the forehead or a lukewarm bath can help with the fussiness
  • do not give a cold bath as it will make your baby feel more uncomfortable and may actually increase the fever (due to shivering)
  • medicine should bring down a fever at least 2-3°, but not necessarily to 98°-99°
  • acetaminophen (Tylenol) can be given every 4-6 hours
  • ibuprofen (Motrin, Advil) can be given every 6-8 hours in infants > 6 months of age
  • never give your baby (or even your older children) aspirin as it can have serious side effects (including liver and brain damage)



Foods

General Information

  • your baby can grow well on just formula or breast milk for the first year of life, so do not feel pressured to start baby foods early
  • you do not want to introduce any solids until at least 4 months of age -> before this time, your baby does not have enough head, tongue, or neck control to safely swallow
  • starting foods too early also can lead to intolerance and food allergy, which can present as vomiting, diarrhea, constipation, or even bloody stools
  • there is no evidence that giving solids at an early age helps a baby sleep through the night

Types

  • start with the most easily digestible food => rice cereal, which should be mixed with formula (or breast milk) and fed with a spoon (not in the bottle)
  • after 1-2 weeks on cereal, start introducing a different food every several days, but wait at least 4-5 days between each new food to see if your baby is allergic to it
  • avoid meats until 7-9 months of age and eggs until 8 months
  • avoid strawberries and citrus fruits until 1 year of age
  • peanuts are one of the most allergenic foods, so you should avoid peanut products (including peanut butter) until after 2 years of age
  • avoid foods such as hot dog pieces, peanuts, popcorn, chips, and hard candies as they are choking hazards

Liquids

  • try to avoid juice in the first year of life as the excess sugar is not as nutritional as the proteins and fats in breast milk or formula and can lead to early cavities
  • we do not recommend switching to regular milk until after 1 year of age as cow milk has insufficient iron and zinc for proper growth for a young infant
  • we do not recommend switching to low-fat or skim milk until after 2 years of age as your child needs the fats in whole milk for growth and brain development
  • while you want to ensure your child gets 20-24 ounces of milk daily while starting solids, you want to limit him to 16-20 ounces a day after 1 year of age so that he gets a broad diet and adequate nutrition from iron-rich foods

Vitamins

  • while breast milk is very rich in essential vitamins (as well as iron), there is a growing consensus that exclusively breast-fed babies are not getting enough vitamin D. As such, we recommend a vitamin D supplement (i.e. D-Vi-Sol or Tri-Vi-Sol) for all exclusively breastfed infants
  • we routinely do a blood test to screen for iron-deficiency anemia at 9 months (and again at 4 years)



Hiccups

  • normal and very common, especially in the first 3 weeks of life
  • resolve without any treatment
  • giving water, scaring your baby, having her hold her breath, and other home remedies do not work and may be unsafe



Jaundice

  • occurs because of the normal breakdown of fetal blood when your baby is born
  • bilirubin is the breakdown product that causes a yellow tint to the skin
  • usually peaks on day 4-5 of life, then slowly goes away over the next week
  • if there is a concern, we may do a blood test to check your baby's bilirubin level -> if the number is high, your baby may need to stay under special blue lights (phototherapy) to reduce the bilirubin level
  • making sure your baby is feeding well will usually help minimize the degree of jaundice



Safety

Car Seats

  • you should have your car seat ready to go before your baby is born
  • an infant car seat should be rear-facing and in the middle of the back seat
  • once your child is >24 months, the seat may be switched to facing forward
  • once your child is >40 pounds and >4 years of age, the seat should be switched to a booster seat
  • use the car seat every time your child is in the car
  • never take your child out of the seat when the car is moving

Cribs

  • use a firm snug mattress with properly fitted sheets
  • we do not recommend using a blanket in the crib
  • no pillows or stuffed animals until after 1 year of age
  • there should be no posts or other items that can possibly catch onto your baby's clothes and suffocate him

Falls

  • most falls are preventable
  • even young infants can roll over uneven surfaces, so never leave your child unattended on a changing table, couch, or bed
  • we do not recommend infant walkers as they can lead to severe injuries from falls and may also delay normal walking

Smoking

  • smoking in the house significantly increases the risk of accidental injury to your baby (i.e. fire, burns)
  • living with smokers increases the number, length, and severity of respiratory infections in children
  • passive smoke is a risk factor for ear infections, sinus infections, pneumonia, and SIDS
  • children with asthma who are exposed to smoke are at greater risk for more frequent & more severe attacks and they are less likely to outgrow their asthma
  • even when someone smokes outside, once they come back in, the smoke clings onto clothing, furniture and rugs
  • pregnant mothers who smoke are at much higher risk of having complications including premature labor
  • breastfeeding mothers who smoke can pass harmful chemicals to the baby via the breast milk

Other Tips

  • keep all electrical outlets covered
  • keep medicines, cleaning solutions, and other hazardous materials out of reach
  • if you have a pool, make sure it has a safety fence that covers all sides of the pool
  • we do not recommend four-wheelers or trampolines as they can be potentially very dangerous



Sleep

Position

  • sleeping on their backs has significantly cut down the incidence of SIDS (“crib death”)
  • even the side position has been associated with a higher incidence of SIDS
  • your baby is not at risk of choking from spit-up while on her back
  • as she begins to roll over, your baby will decide which way she wants to sleep

Flat Head

  • result of babies sleeping on their backs
  • almost always temporary -> resolves by 9-15 months (when the soft spots close up)
  • it is very uncommon to need a special helmet to correct the flattening

You can minimize flattening by:

  • doing “tummy time” when your baby is awake
  • placing your baby's head at the head of the crib on some nights, then at the foot of the crib on other nights

Time

  • some newborns may sleep 18-20 hours of the day, waking up twice a night to eat -> this will usually decrease to once a night by 1 month, then not at all by 4-6 months
  • keep daytime naps to a maximum of 3 hours at a time so that your baby will sleep longer at night
  • place your baby in the crib while he is drowsy, but still awake -> he will feel more secure in his crib when he wakes up in the middle of the night
  • do not feel you have to feed your baby each time he wakes up crying -> try swaddling or a pacifier first -> if that does not work, then attempt a feed
  • keep the room quiet when feeding at night -> talk softly (if at all) and keep the lights off
  • giving cereal at bedtime does not help babies sleep through the night (it may actually make them hungrier as the starch in the cereal is digested a lot faster than the fat in breast milk and formula)
  • do not leave your baby in the crib with a bottle -> this can lead to ear infections, cavities, and can increase crying if he wakes up and cannot find his bottle
  • let your baby sleep in his own bed -> by 2-3 months, try to have him sleep in a separate room



Spitting Up

  • babies have looser stomach muscles so that they can burp easier -> because of this, up to 50% also have mild reflux (“spitting up”)
  • though it often seems like a lot, usually spit-up is no more than 1 teaspoon -> your baby can spit up that much many times a day and be fine
  • propping your baby up and burping frequently during feeds can help cut down the spitting up
  • spitting up is a problem if: your baby is not gaining weight, the reflux is hurting him, or he develops associated problems breathing
  • projectile vomiting (shooting out > 1 foot away) with 2 or more feeds, dark green vomit, or blood in the vomit is different from spitting up and needs to be addressed immediately



Twitching

  • little jerking movements, eye twitching, or weird facial movements that are seen especially during sleep
  • common, normal, and are not seizures
  • due to the immaturity of babies' brains -> as the nervous system develops, they will go away

 

Hometown Pediatrics, PA | 1595 Lake Front Circle | The Woodlands, TX 77380 | (281) 292-8980 T | (281) 292-8070 F

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