Expecting Parents

• We offer free prenatal visits. This will give you the opportunity to visit our clinic and talk with one of our physicians about any questions that you have about us.
• When you deliver at the hospital, tell them that your child will be going to Vestavia Pediatrics.  The hospital will then inform us of your child’s delivery.
• Currently, our pediatricians make rounds at the newborn nurseries at Brookwood Hospital and St. Vincent’s Birmingham (formerly St. Vincent’s Hospital). If you have a baby at one of these hospitals, one of our physicians will come to the hospital to examine your newborn and answer any questions you may have every morning while you are in the hospital.
• If your child is in the Neonatal Intensive Care Unit (NICU) at these hospitals, the neonatologist at the hospital will be taking care of your newborn while he/she is in the hospital.
• If your child is born at a hospital where our physicians do not round another physician (usually a neonatologist or pediatrician), we will see your child while you are in the hospital.
• We usually like to see your child in our clinic 2-3 weeks after being discharged from the hospital. The doctor that discharges you will make the determination on when you should bring your child to the office.

Feedings

Feeding is just about the most important experience your baby will have during the early months. Actually, there is nothing especially difficult or technical about figuring out what to feed the baby. With breastfeeding it is predetermined, and with most currently used formulas preparation could hardly be simpler. Feeding means more to the baby than just satisfying hunger or gratifying the desire. It is the first social and emotional experience as well. The close contact with mother and the feeling of love, warmth and security, which the baby acquires from this closeness, are just as important to emotion growth and development as the nutritional elements of milk to physical growth and development. The feeding contact gives the baby the first pleasant and satisfying relationship with another person, in effect with the outside world.

Besides love, the baby learns other things during the early feedings. Usually, your baby has to wait at least a few minutes after awakening and beginning to feel hungry before you can be ready with the feeding. So, feeding time becomes the first experience in adjusting baby’s needs and behavior to that of others. This, of course, is the essential basis of all social relationships. Furthermore, as you meet baby’s needs in a consistent and reasonably satisfying way, your baby learns to feel trust and confidence in you. This sort of trust is an important part of healthy personality development.

Your baby will feel or sense your love in the way you hold him/her, and the tenderness with which you care for him/her needs. This is true no matter how inept or inexperienced you may feel. By the same token, your baby will sense if you are tense, anxious, upset or impatient. Your confidence in yourself and our enjoyment of feedings in a relaxed and understanding way are more crucial than what you feed or how often.

BREAST OR BOTTLE

If done in the proper way and with the proper attitude, each are perfectly satisfactory ways of feeding the baby, both physiologically and psychologically. A close relationship with mother is inherent in breastfeeding and perhaps is its major advantage. However, bottlefeeding can offer the same opportunity for close relationship if the mother takes advantage of it.

FEEDING SCHEDULE

When deciding on a schedule for feeding your baby, there are two considerations. The baby will be happier if fed when he’s hungry and the parents will be happier if this is not every 1-2 hours. What we suggest is that you try to find a schedule that meets both of these needs.

Ideally, feeding the baby every 3-4 hours during the day can accomplish this well. Babies that eat well during the day tend to sleep better at night and go longer periods between feeding at night. We might best refer to this as flexible scheduling.

Strict schedule feedings make no allowance for variations the baby’s needs for food and sleep. Strict demand feedings make no allowance for your needs or convenience. Flexible feeding implies a give-and-take approach. You want to try to satisfy the baby’s hunger as promptly as possible and keep him/her reasonably satisfied most of the time. But also want to avoid letting him/her become a tyrant, whose every whim and whimper dictates the actions of the entire household. It will not hurt your baby to wait a little longer if you are occupied. When baby begins to cry, a little delay in feeding will allow baby to become wide awake and definitely hungrier.

BREASTFEEDING

1. You do not need a large breast to successfully breastfeed. Size has no relationship to quality of milk produced.
2. Regaining your figure after delivery is primarily a matter of proper diet and exercise-before as well as after.
3. Breast milk does not “come in” as a rule until the third or fourth day.
   1. Babies will not “starve” during this waiting period. The baby will receive colostrums from the breast when nursing. This is a thick, sticky, yellowish material protein, minerals, and vitamins.
   2. You should nurse during this time because both you and the baby will benefit by the practice and the baby will benefit from the colostrums
4. Breast milk does not look like cow’s milk – pasteurized, homogenized or otherwise. After all, why should it? It is thin, floury looking, and bluish in color. Do not take this to mean that it is not rich enough or strong enough.
   
5. Breastfeeding is not entirely a comfortable experience in the first week or so.
   1. You will have some discomfort initially just because of the fullness and engorgement of your breasts when your milk comes in.
      1. Wearing a nursing bra, which provides good support, helps alleviate this.
         
      2. Manual expression of enough milk to soften the breasts and relieve some of the pressure may help. If baby is hungry and can make good contact with the nipple, he/she may accomplish this for you.
   2. Your nipples may hurt when the baby first begins to suck. This discomfort can be minimized by:
      1. Advance care of nipples during the last 4-6 weeks of pregnancy.
      2. Proper nursing technique.
6. All newborn infants lose weight, even prematures, during the first few days-regardless of how they are fed. This is due to loss of excess tissue fluid and not of body substance. Newborns are saturated with fluid like a sponge soaked in water; the bigger they are, the more they hold, so to speak. They may lose as much as 10% of their birth weight before starting to gain again. The bottle-fed baby may start his weight again a day or two sooner but the fast start has no apparent advantage, and it does not take the breast-fed baby long to catch up.

1. The hospital experience is never a fair trial for breastfeeding.
   1. It will take a little while for the baby to learn to “latch on.”
   2. Your milk supply will not be established.
   3. Your milk supply will gradually increase as the baby nurses over the first ten days to two weeks. It will take this long for you to be producing “high octane” milk in full volume.
      
2. Your milk supply will also be affected by fatigue, the excitement of going home, increased activity and the anxiety by frequent waking and feeding. Do not decide or let anyone convince you that you do not have enough milk to continue to breastfeed during this time.
3. Always remember that you can contact or visit our office if you have questions, concerns or wish to have the baby weighed and examined. The best way to improve the situation is to relax and be patient. You may even have to “work at it” to some extent (not too hard or you’ll defeat your purpose). Your success will come and once you are “over the hump” it will be a uniquely gratifying experience for you.
   

HOW TO NURSE

1. First and foremost, get comfortable before you begin. Lying on your side at first, probably. Later, sitting in a well-cushioned chair.
2. Touch nipple to baby’s chest. The baby will turn toward the nipple because of the built in “rooting” reflex. Do not try to force the baby to turn. If you do, the baby will turn instead toward your hand on the cheek.
3. Place index finger above and third finger below the nipple, both behind the dark circular area or areola. Help your baby take the entire nipple into mouth and as much as possible of areola. Sucking will be easier and more effective for baby this way and less hard on your nipples.
4. Hold back breast from baby’s nose with fingers so that easy breathing will continue while nursing.
5. When finished, press down gently on part of breast next to corner of baby’s mouth. This lets air into the mouth and breaks suction, allowing easy removal of nipple.

CARE OF NIPPLES

1. Wash hands thoroughly with soap and water before touching breasts
2. Wipe nipples with clean, fresh water prior to and after nursing.
3. Apply nipple cream as directed.

HOW LONG TO NURSE

1. Most babies need to nurse at least 10-15 minutes at each breast each feeding at first.
2. Nurse the baby 10-15 minutes on one breast, then try to burp the baby and move to the other side and allow the baby to nurse until he/she is content, which should be about 15-20 minutes.
3. As the baby gets older, he/she may nurse a shorter period of time on each breast or nurse for a slightly longer time on one breast only.

ONE BREAST OR BOTH

1. Until milk comes in, plan to nurse 10-15 minutes at each breast each feeding.
2. After you have milk, find by trial and error which way is most satisfactory. You want to keep your breasts comfortably empty, the baby comfortably full, and your nipples as comfortable as possible in the meantime.
   1. Alternate breasts at alternate feedings.
   2. Nurse 10-15 minutes on each breast each feeding.
   3. Let baby empty one breast, and if not then completely satisfied, finish at other side. Next time, start with the incompletely emptied side.

HOW OFTEN TO NURSE

1. See discussion of flexible demand schedule.
2. Often with first feedings, your baby is not very wide awake, hungry or interested. Do not be discouraged by this slow start.
3. By the third or fourth day, your baby will have worked up an appetite and be ready to go. Almost certainly, your baby will want to nurse more often than four hour intervals, very probably at 2- to 3-hour intervals.
4. Since the only real stimulus to milk production is emptying of breasts, frequent nursing helps build up full supply of milk. You can, however, get to point of diminishing returns if baby is nursing every hour on the hour since fatigue, tender nipples, and shortened filling time may well reduce the quantify of milk.
5. If you see that the baby is nursing for a short period and then failing asleep and waking up an hour or two later wanting to nurse again, it would be better to put the baby off by offering some sugar water. Prepare sugar watery by using 1 teaspoon of light Karo syrup in about 4 ounces of water. This will allow you to go longer between feedings at the breast. When the baby comes back to the breast for nursing, baby will be hungry enough to take good feeding and tend to go longer between feedings

MANUAL EXPRESSION OF MILK

May be necessary if-

1. Baby drops off to sleep before emptying breast and leaves breast uncomfortably full.
2. Baby can’t make good contact with nipple because breast is so tense and full of milk.
3. You have to skip one of more nursings for any reason.

HOW TO DO IT:

1. Wash hands with soap and water.
2. Place thumb just above upper edge of areola and second finger just below lower edge.
3. Press hand inward until you can feel ribs. At same time, raise breast with palm of hand.
4. Press fingers against breast and open and close in scissors motion.
5. To empty entire breast, use same hand position but start with fingers at outer edge of breast and gently massage down toward nipple.

A breast pump can be used but usually is no more efficient and often is more uncomfortable.


FREEDOM BOTTLE

You may pump and store breast milk or formula bottle may be given occasionally in place of nursing if for any reason you need to be away from the baby at nursing time. This practice is a matter of convenience, not a matter of necessity.


WHEN TO STOP NURSING

This is up to you. You can nurse as long as you have ample milk and both you and the baby are enjoying nursing. Don’t make the decision now.

MOTHER’S DIET WHILE NURSING

1. Eat what you please and be observant. If some particular food seems to upset baby each time you eat it, omit it from your diet. No list of things to eat and things not to eat will apply to every mother or baby. Do not ordinarily expect trouble from common, “garden variety” items or diet such as roast beef, mashed potatoes, and green peas, etc. Highly seasoned foods, shellfish, berries, chocolate, etc. are more likely to be offenders.
2. During nursing you will need all the foods which are necessary in any healthy individual’s diet. Include at least one serving daily of lean meat, poultry or fish, egg, fruit, vegetable, and whole grain cereal or bread. Drink a quart of whole milk each day. If you do not like milk, take an equivalent amount of calcium and liquid in some other form. Adequate fluid intake is important. Use supplemental vitamins as prescribed by your obstetrician.
3. Many drugs are excreted in small quantities in breast milk when taken by nursing mother. Although the drug in the breast milk may not have any bad effects on the baby, let us know if you have to be on medication over a period of time so that we can determine whether or not this drug will affect the baby adversely.

BOTTLE FEEDING

TYPE OF FORMULA

Once having decided to bottle-feed your baby, you will then have a choice of several possible formulas to use. The very multiplicity of it makes it apparent that there is no single one, which is perfect for every situation for every baby. We will discuss with you the various types and guide you in your selection. Generally speaking, we prefer the commercially prepared formulas, which have been modified in chemical composition and physical properties to simulate breast milk. The baby will be given in the hospital the same formula you are to use at home.


PREPARATION OF FORMULA

The formula can be purchased in several different forms which as ready-to-serve, formula concentrate, or formula powder. As long as you follow the instructions on the package when adding water, the resulting formulas are identical. If you live in the greater Birmingham area and use city water in your home it is not necessary to boil the water before using. Some areas surrounding Jefferson Country have high mineral content in their water, and in these situations, it might be best to use ready-to-serve formula rather than adding your local water to the formula.

Some mothers prefer to make up a day’s worth of bottles each morning and keep them in the refrigerator until needed for feedings. The bottles are filled with approximate amount of formula that the baby is currently taking at each feeding. At feeding time the bottle is removed from the refrigerator and brought to body temperature to be used for feeding. A bottle warmer can be used, or one may hold the bottle under a warm tap water briefly to bring it to feeding temperature. Shake the bottle and test a few drops on the back of your wrist to make sure that the temperature is about the same as body temperature before feeding the baby. You will find that as time goes on the baby will soon tolerate taking formula at room temperature and eventually right out of the refrigerator without much warming having to be done. If a significant amount of formula is left in the bottle after a feeding, it can be re-refrigerated and used at the next feeding. Do not keep partially used formula longer than from one feeding to the next before discarding.

Some mothers have found that they prefer to make up each formula bottle just before feeding. When formula concentrate or formula powder is used, warm tap water can be added to make the proper dilution and bring the formula to the proper temperature for feeding.


FEEDING FORMULA

1. Wash hands thoroughly with soap and water.
2. Sit in a comfortable chair, cradling baby in arms. Always hold baby. Never prop bottle in bed or leave baby unattended.
3. Keep bottle tipped up so that milk fills neck and nipple to prevent baby from swallowing air.
4. When baby seems well satisfied and has burped, put him/her back to bed.

SPECIAL CONSIDERATIONS

1. Check nipple holes periodically (you can do this when you check formula temperature). Adjust size of hole to suit baby.
   1. If holes are too large, gagging, sputtering and vomiting may result.
   2. If holes are too small, this may result in undue fatigue and excessive air swallowing around the nipple.

For most babies, when the bottle is turned upside dose with contents at feeding temperature, milk should flow, without shaking, in a slow steady drip. If it gushes, discard nipple. If it trickles out only with vigorous shaking, enlarge hole by heating small needle (blunt end stuck in cork) in flame until red, then passing quickly into hole and out again. Do not crosscut nipples unless so advised. As soon as feeding is completed, clean nipple by turning inside out and washing with brush and detergent. Rinse thoroughly. Squirting cold water through it does not clog hole. Rinse used bottle and fill with cold water until ready to scrub with brush and detergent. If you have an automatic dishwasher, it would be fine to use it to cleanse your baby bottles.

WATER

The baby may or may not be interested in water. Too much water can be harmful to a newborn. The baby should be getting all the fluid that is needed from the breast milk or formula (a significant portion of each is water.) The milk feedings will usually be preferred since they satisfy hunger and thirst.

BURPING

1. Why
   Burping, or if you prefer bubbling, is necessary to help the baby expel swallowed air from the stomach. Air swallowing occurs during crying and feedings. Accumulated air not only makes the baby fretful and uncomfortable but also makes the stomach feel full when it is actually not.
2. When
   You will learn by experience how often you need to burp your baby. Usually, when the baby stops nursing, pulls away from the nipple, and begins to squirm about, you’re being given a cue. If the baby does not do this, interrupt after each ounce or so and give the baby a chance to bubble. You are more apt to bubble too seldom than too often, especially in the early weeks. It’s not a bad idea even to burp the baby before you start a feeding, because the baby very likely has been crying to let you know it is feeding time and will have swallowed some air in the process.
3. How
   The best burping position is with the baby held upright against your shoulder or in a sitting position on your lap (or beside you on the bed). Pat baby on the back to help get up the air bubble, or rock gently back and forth. Support the head and back with your hand. After about five or six months the baby probably will be able to burp without assistance.

HICCUPS

Almost all babies occasionally have hiccups during or after feedings. Some have hiccups even before they are born. Hiccups have no significance, except their nuisance value, and are not harmful to the baby. If a good burp or a few swallows of water will stop them, well done. Otherwise, just wait for them to stop spontaneously.

SPITTING UP

The term spitting up is popularly used when only small amounts of stomach contents are regurgitated. The term vomiting is reserved for large amounts, especially when they gush out with some force. We do not think such a distinction of much practical value primarily because the amount of regurgitated material is often hard to estimate.

Most vomiting, even when it seems excessive, is due to feeding procedure rather than something being wrong with the baby or the formula. It may be that the nipple holes are of improper size (either too big or too little) or that the baby is gulping down the milk too fast even from properly sized nipple holes. In the beginning, spitting up may occur because of inadequate coordination of the swallowing and sucking. This will improve with experience and maturing. Sometimes spitting up can result from a tense and over anxious atmosphere during feedings. Too infrequent burping during feedings or too much bouncing around on a full tummy may result in spitting up.

Remember that as long as your baby is healthy and thriving in other respects, and as long as weight gain is satisfactory, spitting up remains more an annoyance than a catastrophe.

Incidentally, whether or not regurgitated milk smells sour and looks curdled has no importance. The first step in the digestive process in the stomach is the action of hydrochloric acid on the milk protein, resulting in souring and curdling. The same thing would happen to milk in a glass if you added acid – you can make buttermilk this way. If the milk comes back looking exactly as it did when it went down, it just means it hasn’t stayed down long enough for this to take place.

BOWEL MOVEMENTS

1. General Considerations
   1. For the most part, you will evaluate bowel movements (BM) more intelligently and accurately if you’ll watch them rather than just count them. There is no law about how many BMs a baby can have or can’t have – or even that baby has to have one each day.
   2. Each baby has a unique schedule or pattern for BMs. This pattern may change from one time to another. Every BM is not necessarily going to look like every other. Variability is expected and permissible, even with the same feedings meal after meal and day after day.
   3. It is absolutely not necessary to good health or happiness to have one or more BMs each day.
   4. There is no advantage in trying to make an irregular baby regular. Potentially such an effort might even be harmful.
2. Constipation by definition means hard, dry bowel movements. There is no inherent relationship to frequency. Your baby might have several BMs a day in the form of little hard, dry pellets and be constipated. On the other hand, he/she might skip a day or two and then produce – somewhat spontaneously and without discomfort – a perfectly normal, soft BM – in which case he/she would hardly qualify for constipation If you baby literally gets constipated, let us know and we will advise you what to do.
3. Diarrhea, the opposite of constipation, is a much more urgent problem, especially in the young infant. If this occurs, BMs will not only increase in number but also become progressively looser in consistency and greener in color, contain increasing amounts of mucous, and perhaps smell more and more offensive. One inevitable characteristic of real diarrhea is that it always gets worse before it gets better. If you are suspicious at any time of one or two BMs because they seem extra in number, looser or greener than usual, watch closely for a progressive trend in this direction with the next several BMs. You will then know whether it is real diarrhea or just accidental.
4. Breast-Fed Baby
   1. Rarely constipated.
   2. BMs quite variable in number. From 6-8 or more a day especially at first (often one with each feeding) to 1-2 a day or even every 2nd or 3rd day.
   3. Color usually pale yellow but often may contain traces of green.
   4. Consistency soft to loose, maybe granular.
5. Bottle-Fed Baby
   1. May have frequent BMs like breast-fed baby in beginning. Later usually 1 to 3-4 daily.
   2. Color yellow to yellow-orange.
   3. Consistency usually pasty to firm. May contain curds or lumps.
   4. Odor not so strong.

BATHING

1. Type
   Use a sponge bath until the cord has become detached and the navel is well healed and dry. Thereafter, you may tub bathe the baby if desired. Often babies do not enjoy being placed in a tub in the early weeks of life because they are startled by the insecurity of it. A little later baby enjoys being in the water, splashing and responding in a positive way to this liquid environment.>
2. Equipment (Have these items ready before you begin.)
   1. Basin, tub or bathinette. Regular bathtub if unhandy.
   2. Cake of Ivory or Dove, one of the baby soaps or any pure brand soap.
   3. One or two soft washcloths.
   4. Towel for wrapping and towel for drying.
   5. Cotton balls.
   6. Cotton-tipped swabs (Q-tips).
   7. Change of diapers and clothes and diaper pins.
   8. Baby lotion. We suggest baby lotion in preference to oil or powder.
3. Where
   Warm room, free of drafts, with convenient working area and working surface, usually bathroom or kitchen.
4. When
   At your convenience. It makes little difference to the baby as long as the bath does not disturb the eating or sleeping pattern. It is preferable to bathe before, rather then after, a feeding. Bathing at the same time every day helps mother and baby get used to a routine.
5. How
   
   1. Check temperature of water with wrist or elbow. The water temperature should be comfortably warm to your skin.
   2. With a soft wash cloth moistened slightly in water, gently cleanse opening of the nostrils and around the eyes.
   3. Wash face with soap and water, include outer ears and creases behind ears but avoiding spilling excessive water into the ear canals. The wax at the outer opening of the ear canal may be removed with a cotton tip or soft cloth. Do not probe inside the canal. Dry face and ears.
   4. Apply soap to the scalp, being careful to avoid soap getting into the baby’s eyes. Hold baby’s head over the tub and rinse thoroughly. You may use baby shampoo rather than soap if desired. Dry scalp and hair thoroughly.
   5. Apply soap to neck, chest, arms, hands, back, abdomen, legs, buttocks and genitalia. Do not miss the skin folds and creases in such areas as the neck, underarms, groin, genitalia, etc. These deep creases are easy to forget and take a little special effort to clean thoroughly. If the creases are not carefully cleaned, it is easy to get rash development in these areas. The baby will be slippery and you can hold more safely with a clean diaper or small towel. A towel in the bottom of the tub may help too. Support head and shoulders with one arm, fingers of that hand securely gripping baby in armpit with thumb on arm. Hold legs with other hand with forefinger between ankles. Lower into tub and release legs, continuing to support head as before. Rinse thoroughly. Lift out of tub (or raise hammock sling if you are using bathinette). Pat or blot with dry towel, do not rub hard.
   6. Apply lotion lightly if desired.
   7. Dress.
6. Comments
   1. Do not avoid the soft spot when washing the scalp. It is actually a very tough area and you need not be afraid of injuring it.
   2. In female infants, be sure to spread apart the labia of the genitalia and clean between them, both during baths and when changing diapers, especially after BMs. Always wipe front to back.
   3. Never leave baby alone during baths. Telephones and doorbells can wait.

CARE OF NAVEL

The umbilical cord usually comes off after about 7 to 10 days. It may come off as early as 4 or 5 days or not until as late as 2 weeks or more. Separation occurs by softening. The cord is just a tube of rather unusual jelly with some blood vessels coursing through it. This gelatinous material simply “melts” away from its attachment at the navel. You will see, as separation occurs, a “gooey” appearing material in the navel and some will probably spill to the outside. You may also see a spotting of blood. This may persist for up to a week until the navel looks dry and healing is completed.

Care entails two things:

1. Keeping navel as dry as possible. The drier it stays, the sooner it will heal and the less likely it is to get infected.
   1. Avoid getting wet with soap, water, lotion, etc., during baths. Never apply oil or powder to navel.
   2. Do not use binders, bands, adhesive tape or dressings of any sort. They can do nothing but harm.
   3. Keep the diaper edge folded down to avoid constant rubbing, or pin the diaper loosely to minimize chafing.
2. Clean navel with antiseptic for further insurance against infection. The antiseptic of choice is ordinary rubbing alcohol because it evaporates quickly after application.
   1. Moisten cotton tip with alcohol and wipe around the base of the cord and into the navel fold. Continue to cleanse inside the navel fold with a cotton tip swab with alcohol for several days after the cord comes off.
   2. Caring for the navel at bath time once a day is usually often enough. If there is excessive oozing of mucous material from the navel, be sure to cleanse several times a day. The navel is not painful unless the surrounding tissues become inflamed or irritated.

CARE OF CIRCUMCISION

The circumcision of the foreskin seldom bothers the baby except for a few hours after the procedure. The penis heals quite rapidly after circumcision and these tissues are back to normal in 3 to 4 days.

Wash the penis and circumcision area with a soft washcloth when changing diapers. Apply a liberal amount of Vaseline to the penis to prevent the healing tissues from sticking to the diaper. It is not necessary to bandage or wrap the penis or circumcision area with gauze.

DIAPERS

There are several brands of disposable diapers on the market. Most parents prefer these because they are so convenient. However, you may elect to use cloth diapers.

If you elect to use cloth diapers, the following factors are important to know:

1. You may fold any diaper in either rectangle (oblong) or triangle shaped or you may use contour of fitted diapers that require no folding.
   1. Rectangle diapers are usually more absorbent.
   2. Triangle diapers are more comfortable for the baby because it avoids bunching of the diaper between the legs.
   3. To provide for maximum absorption of urine, fold any diaper excess in front for boys and in back for girls.
2. Soak soiled diapers in a large-sized diaper pan half full with cold water until ready to wash. Wash in hot water and rinse once or twice. Initially, it is best to use a non-detergent soap such as Ivory Snow. As time goes on and the baby seems to have no unusual skin sensitivities, you can use regular detergents in the wash.

DIAPER RASH

1. Appearance
   Patches of rough, red skin; clusters of small red pimples, which may develop a white top; small to large blisters or bleb, which may rupture and form shallow ulcers.
2. Causes
   1. Often caused by ammonia produced as urine decomposes on skin or diaper.
   2. May be caused by irritation of skin by bowel movements.
   3. May be result of skin sensitivity to soap used for bathing, detergent used for washing diapers or cosmetics used after bathing and diaper changes.
   4. May be result from yeast infection called Monilia.
   5. Rarely may be related to feeding or particular foods or juices.
3. Treatment
   
   1. Use special soap or rinse or both, as instructed.
   2. Change diapers as soon as wet or soiled, even during sleep unless this disturbs baby so much he cannot get back to sleep afterwards.
   3. Leave plastic pants off.
   4. Clean diaper area with extra care when changing diapers.
   5. Apply zinc oxide, Desitin, Vaseline or other prescribed ointment for skin protection and enhanced healing.
   6. Expose skin of diaper area to warm, dry air several times a day for one-half hour. Usually do this when baby is asleep. Place several diapers and/or an absorbent pad under bottom.
   7. Prevention, when possible, is equally as important as treatment. Treatment is tedious and you may wonder if it is worth it. Your extra effort, however, will usually be rewarded by clear skin and a more comfortable baby.

OTHER RASHES AND SKIN CONDITIONS

Mild face rashes are common in the early months. You may see little shiny white or yellowish pimples, clusters of little red spots and pimples or small rough red patches. Do not worry about these. They almost inevitably disappear in due course, leaving no remaining blemishes. If they become unusually thick or widespread, we will try to help you control them. Do not be misled by the external “peaches-and-cream” complexions of the magazine ad babies into thinking this actually is the usual situation.

Prickly heat is one of the most common types of infant rashes and its occurrence is not confined to hot weather. It can appear at any time that the baby is overheated, either by too hot environment temperature or by overdressing and over-blanketing.

Cradle cap is a common disorder of the scalp which appears as flakes or scales which may form a rather dirty- and greasy-looking crust. It, too, is more easily prevented than cured.

Prevent it by good, vigorous daily scrubbing of the scalp with soap or shampoo and water, using a washcloth or a soft brush. Other special agents are available if needed.

Thrush is a yeast infection of the mouth. It looks like patches of milk scum stuck to the cheeks, tongue and palate. Unlike milk, if you rub off the underlying mucous membrane, it looks inflamed and bleeds a little. Specific medications are available for treating this problem. There may be an accompanying diaper rash, for which specific ointment is used.

Birthmarks occur in many newborn infants, especially on the back of the neck, between the eyebrows, and on the upper eyelids. Most of these appear as irregularly shaped, flat, mottled areas of redness, which fade under pressure of the fingers and then flush again when pressure is released. On other parts of the body, birthmarks may be raised and lumpy, with a surface appearance like that of a fresh strawberry. These may not necessarily be present at birth but may appear anytime during the first 4 to 6 weeks. They often enlarge for awhile. Still another type is located more deeply in the skin and presents a combined bluish and reddish appearance. These birthmarks are collections of blood vessels in the skin, and the blood flowing through the vessels produces the color. Flat ones look more red and conspicuous when baby is crying, exercising or hot because blood flow is increased under these circumstances.

The great majority of the birthmarks disappear slowly within the first 2 to 3 years of life, even though they may have enlarged initially. Cosmetic results are better when the vascular marks are allowed to regress spontaneously. We usually do not recommend surgery unless the mark is in a particularly objectionable area cosmetically or is located in an area subject to trauma.

JAUNDICE

It is common for newborn infants to exhibit some yellowish discoloration of the skin and eyes during the first week of life, beginning on the second or third day. This yellow color is called jaundice of the newborn. The yellowish coloration is caused by the excess amount of bilirubin in the baby’s skin. Bilirubin is one of the waste products of the body that is normally eliminated by the liver. Before birth, mother’s liver was handling the job of eliminating the waste products for the baby. After birth, the baby’s liver is, for the first time, presented with the problem of eliminating these waste products. During the first few days, the baby’s liver often is a bit immature and not ready to do its full job of eliminating waste products. Consequently, we see a buildup of bilirubin in the baby’s body. As this waste product builds up, it tends to show up on the skin as a yellow color.

There are certain situations that put an extra burden on the baby’s liver such that the jaundice becomes more of a problem and it becomes important to use some treatments to help the baby handle this waste product. Premature babies almost always have more jaundice than mature babies do because the liver is more immature and consequently slower handling waste products. A reaction between the mother’s blood and the baby’s blood may cause an increased breakdown of the red cells and, consequently, more waste products for the baby to handle. Sometimes, extra bruising at the time of birth will cause an increase breakdown of red cells and waste products.

The jaundice that occurs in the first few days in a normal mature baby is called physiological jaundice because it is caused by a natural process of the breaking down of red cells and the initial liver inability to handle the waste products. Blood tests are done if it appears that the baby is becoming unusually jaundiced. If the jaundice does not increase quickly or go to an unusually high level, treatment will not be necessary. The jaundice resolves as the liver starts functioning in a mature way over the first week or two. If for some reason the jaundice does become unusually elevated, it is important to help the baby through this initial period. The common treatment for uncomplicated jaundice is to use phototherapy lights. If this treatment becomes necessary for your baby, we will discuss this in more detail.

INSIDE AND OUTSIDE

For the first few weeks of life, the best place for your baby is in a well-ventilated room, free of drafts. The ideal room temperature is 65-75 degrees.

Once the baby has regained birth weight, assuming the baby was not born prematurely, you can take him/her outdoors on pleasant days. Short intervals are best at first; longer intervals can be tolerated as the baby grows older.

• In summer – early morning and late afternoon are the best times.
• In winter – middle of the day is preferable.

Avoid direct, hot sunlight. Protect eyes from direct, bright glare.

Dress the baby appropriately for the weather when taken outdoors. Avoid unnecessary exposure to extreme heat or cold and rainy or windy conditions.

Use your own comfort – and your common sense – as a guide to dressing. It is much easier to overdress than to underdress. If kept too warm, the baby loses the ability to adjust to changes in temperature and actually becomes more susceptible to chilling.

The older and heavier the baby gets, the better the heat regulating mechanism and fat insulation will become. Consequently, the baby will need less clothing and less protection from temperature variations. In hot weather, a diaper alone or a shirt and diaper are enough clothing. A nightgown should be used at night over a shirt if the room is cold. Wrapping the baby snugly in a blanket adds extra security and warmth. An effective blanket wrap technique is as follows: Spread a blanket on the bed or table in a diamond shape. Put the baby on the blanket with the head position near the upper point. Fold the lower point up over the feet, legs and lower abdomen. Fold the side points over the upper abdomen and chest. Another blanket can be placed over the baby as needed, depending on the temperature.

Do not feel the hands or feet to judge whether the baby is warm or cold. Feel the trunk or neck. The exposed extremities usually have a lower temperature than the general body temperature. This is normal and of no concern.

BREATHING

In the early weeks of life, your baby’s breathing may seem quite irregular to you. It may be shallow and rapid at one minute and deep and slow at the next. At times, the baby may seem to stop breathing completely for several seconds, then start up again. Very seldom will the baby consistently breathe in the steady, even, rhythmical fashion of an adult. This is entirely normal and no cause for alarm.

Babies are often noisy breathers while awake and asleep. They snort and gurgle, huff and puff, sneeze and cough and even snore at times. Most of these sounds are related to the normal mucous babies have and do not represent a true cold illness. You can help your baby handle the nasal and throat mucous by using the bulb syringe.

NERVOUSNESS

People often refer to babies as being nervous because they are rather jumpy, shaky, tremulous and easily startled. Babies behave this way because their nervous systems are not fully developed and their reactions are mostly reflexive in nature rather than purposefully controlled. Purposeful controlled movements develop gradually with maturation. Do not decide you are going to have a nervous child because you have a so-called normal “nervous” newborn.

The most dramatic example of newborn jumpiness is the startle response or reflex. When bright light, loud noise or an abrupt change in position startles the baby, the baby will throw out both arms, open the hand and spread the fingers, bring both arms forward as if to hug, draw up the legs and perhaps begin to cry. We are very happy to see them do this because it is one of the very best indications we have in the newborn period that the baby has a normal functioning nervous system. If your baby did not do this we would be rather concerned.

Your baby will often wiggle, squirm, jerk, twitch and perhaps even cry out while asleep. Other sleep movements include smiles, frowns, grins and grimaces. The baby may sleep sometimes with the eyes partly open and deviated upward. Your baby does not have the strength or coordination of eye muscles to make the eyes more together all the time.

BREAST ENLARGEMENT

Almost all full-term infants, male and female, show some enlargement of the breasts under the influence of maternal hormones during pregnancy. You may be able to see some swelling or feel a thick little button of breast tissue under the nipples. Sooner or later, there may be a few drops of whitish secretion from the nipples – sometimes called “witches milk.” This is a perfectly normal occurrence and you need do nothing about it. Avoid squeezing and rubbing the breasts. This could potentially create a distinctly abnormal situation in the form of infection or abscess formation.

VAGINAL DISCHARGE

You may see within the first ten days to two weeks in female infants a thin, gelatinous secretion from the vagina. At times, this may be blood-tinged. Do not be distressed. This, too, is a perfectly normal occurrence resulting from maternal hormone influences. All you need to do is clean it away and forget it. It represents, in a sense, the first and last menstruation for many years to come.

VISITORS

1. Take advantage of waking hours to “show off” baby. Nobody enjoys being disturbed during sleep.
2. Avoid exposure to individuals with colds or other infections, especially children. Remind relatives, if necessary, that baby is just as susceptible to their “germs” as to anyone else’s.
3. Limit handling by all visitors to a minimum.

OLDER CHILD AND NEW BABY

1. Anticipate at least some expression of jealousy. We all resent competition for the attention of others.
2. Prepare your older child for the new arrival by explaining about the baby in language appropriate to the child’s age and understanding. Stress how your child can enjoy the new baby and how much you need his help to care for the baby. Let your child be a real helper by doing simple errands, like fetching a diaper or towel for the baby at bath time.
3. Take advantage of opportunities to spend some time alone with your child and give reassurance of continued importance and love. Accept the simple fact that you cannot be at two places or do two things at once.
4. Do not punish your older child for minor acts of jealousy. Emphasize cooperation and “good” behavior.

SLEEP

The amount of sleep required by a newborn varies. Babies do not all follow patterns. Some babies will require as much as 18 hours of sleep in a 24-hour period, while others will require as much as is needed during the first year.

Where your baby sleeps is a personal decision. You may be more comfortable with the baby in your room in the first few weeks and thereafter in baby’s own room, but do not wait too long to make this move. Never allow the baby to sleep in the bed with mother.

When putting the baby down, the safest position is propped on the side or flat on the back. The right side position after feeding enhances movement of the stomach contents into the bowel.

When selecting the baby’s bed or crib, you should consider the following thing:

1. Use a firm mattress, no pillows.
2. Be sure the slats of the crib are close enough together so there is no possibility of the baby getting his head between the slats.

Your baby may begin to have wakeful periods as early as the second week of life. They will tend to occur at the same time each day, most commonly in the late afternoon or evening. These wakeful periods may initially be restful times, and then later become more contented play periods.

Tips:

1. Allow the baby, from the start, to get accustomed to ordinary household noises.
2. It is fine to allow the baby to sleep after feedings, preferably without company.
3. Picking up the wakeful baby, walking the floor, rocking and so on may be a temporarily soothing but not necessarily an effective way to actually encouraging baby to sleep. Furthermore, the more often you do this, the more the baby depends on it and demands it.
4. Every time you go back for a second look, you are setting a precedent you may well regret later on.
5. Sleeping, like feeding, should be a given and take proposition. Do not make the mistake of sacrificing too much of your own comfort and need for sleep to keep the baby quiet 24 hours a day. It will not help the baby establish good sleeping habits in the first place, and you will find yourself soon exhausted.

ACCIDENT PREVENTION

1. Accidents cause more deaths in childhood than any single disease. They are among the leading causes of death in children of all ages. Infants are by no means immune.
2. Almost all such accidental deaths should be preventable by proper protection, education and discipline.
3. We will give you materials from time to time cautioning about the types of accidents most common at different ages and suggesting appropriate precautionary measures. Keep these handy and take them seriously. You may save your own youngster’s life.

CAR SEATS

A very important consideration when preparing for the arrival of your little one is the selection of a car seat.

More children are killed or injured in car crashes than from any other type of injury. Many of these injuries could be prevented by the correct use of a car safety seats.

Using a car seat correctly does make a difference. Just a little mistake in the way a seat is installed or in the way a child is buckled into the seat could cause serious injury to your child. There is no one brand that everyone agrees is the safest or the best. The best and the safest car seat for your baby is one that fits his/her size and weight, fits in your car and you will use correctly on every ride. Choose a car seat that meets Federal Vehicle Safety Standard 213.

Infant car sets can be used from birth to at least 20 lbs. or at least 1 year of age. The advantage of an infant car seat is that they are small, portable and fit newborns best. The disadvantage is that a convertible seat must replace them when a baby outgrows the seat. Remember that infant seats are always used rear-facing and should not be placed in the front seat of the car.

Convertible car seats can be used from birth to about 40 lbs. These are seats that are used rear-facing for infants and forward-facing for toddlers. Infants should ride rear-facing until they weigh at least 20 lbs. The advantage of convertible car seats is that they can be used longer.

Special Considerations:

1. For small infants or low-birth weight babies, a car seat without a shield is recommended for the first few months. Shields are often too high or too far from the body to fit correctly. A five-point harness fits small infants best because it can be adjusted to fit snugly.
2. Look for a seat with harnesses that are easy to adjust when the seat is in your car.
3. When convertible seats are reclined and rear-facing, they may not fit in the back seat of many smaller cars. Since the back seat is the preferred position (and must be used for the rear-facing seat in a car with a passenger-side air bag) make sure you first try the car seat in your vehicle before you buy it.
4. The rear seat is the safest place for a child of any age to ride. However, if you must put your older child in the front seat, slide the vehicle seat back as far as it will go and make sure he is properly buckled up and disable the air bag.

NORMAL DEVELOPMENT

Probably the most fascinating aspect of parenthood is the opportunity it affords to observe the tiny, helpless creature, we call a baby, grow and develop into a mature, effective human being. Some development depends on the very fact that the baby has parents who provide a genetic makeup or heredity. Much of it, on the other hand, depends upon the environment and upon the baby’s impression and reactions to the environment – the persons, the feelings, the ideas, the customs and the things which surround the baby.

There is another influence, perhaps the most fundamental of all. This is what we might call the “biologic factor.” It implies those all-human infants – wherever they may be born and of whatever parents – go through certain characteristics and invariable steps in their development as human beings. These steps have been very carefully studied, and we know, as a result, what general behavior to expect of babies at any given age. It is as if there was a kind of predetermined map and timetable for each of the different steps of development along the road to maturity. Most children reach each step at a particular time, or age, and all – inevitably – must take the same steps in the same sequence.

There are wide variations among children in the rate at which they progress along the road to maturity. A given child may run over some stretches and crawl along others – yet still follow the same course and arrive at the same end, usually “on time.” There may also be wide variations between different aspects of a particular child’s development. A child may be slow to walk but fast to talk in terms of average, but still wind up entirely normal in total development.

This concept of individual variability within the range of normal is a tremendously important one. To say it another way, it is essential both parents and physician understand the difference between “average” and “normal.” Fortunately, most of us are not perfectly average individuals, thinking and behaving in exactly the same, average way. What a dull and unimaginative bunch we would be if this were the case. The average individual – infant, child, teenager or adult – is more a useful statistical concept for purposes of comparison than a reality. One can certainly be normal without being average.

The point is that most parents make the mistake of comparing their baby’s progress with the accomplishments of their friends’ and neighbors’ babies or with the so-called average baby’s progress, outlined in a great variety of reference materials on the subject of child development. Sometimes this comparison is with delight and sometimes with disappointment. It is always a mistake in the sense of expecting any two babies to be and to behave exactly alike. Even a mother with six children will tell you that no two of them develop exactly alike or had exactly the same personality, despite the fact that they all were completely healthy, intelligent, and capable individuals. This is not a race and certainly sameness is not the ultimate goal. Relax and enjoy your baby as a unique individual.

DISCIPLINE

Discipline is an essential aspect of parental guidance from the very beginning. It is also one of the most complex functions which parents have to exercise and, often times, a seemingly thankless one. It requires much in the way of patient and persistence. Yet, it remains a necessity.

It is necessary, on one hand, to protect the child from danger. You must, for the simple sake of self-preservation, set limits on his/her behavior in specific situations. There is another purpose in discipline that is to teach the child to respect the rights and needs of others. This is something the child must learn to be an acceptable and effective member of our society. Even as an infant, the baby should begin to learn that life is giving and taking. The baby does not have the right to command your constant time and attention regardless of all else.

Acceptance of your baby does not mean indulgence of every whim and fancy. The baby’s hunger needs to be satisfied regularly but the baby does not need your anxious concern over every bite of food that is eaten. The baby needs to be reassured of your continuing affection, but does not need your constant presence. The baby needs your understanding of a temper as a normal aspect of an enlarging individuality, but does not need your bowing before tantrums as if they were commandments of king to slave. The baby requires your assistance in many things, but does not require it every time a whining bid is made.

Limits are important in encouraging the development of self-esteem and self-confidence. Impulsiveness is natural when a child is young. Young children need to know that they need not be at the mercy of every impulse that comes along. If no one cares enough to set restraints, the child is buffeted about without any sense of direction or purpose at all. Whether you are strict or lenient with your child will depend primarily upon what kind of person you are and upon the way you were brought up. The more important factor is that you be consistent. If children know what is expected of them, it can usually be accomplished without confusion. If “no” really means “no” and always means “no,” the child will not waste time trying to change your mind. But if “no” can be changed to “yes” by a temper tantrum or a two-hour crying spree, the child will certainly take advantage of this fact. It may be easier for you to give in than to stand your ground, but keep in mind that any ground you lose now may be hard to regain later. Obviously, a child’s age and stage of development must determine what sort of behavior you can reasonably expect and what limitations you should establish for behavior. With a little understanding or normal growth and development, this is not very complicated. In fact, much of it is just a matter of common sense. You would not, for example, expect a 6-month-old baby to be toilet trained any more than you would expect the baby to walk or talk at this age. You would not spank an 8-month-old the first time something was broken. At this age, the child neither understands what has been done wrong nor what you mean by the punishment. If you take a 2-year-old to the supermarket with you, you either hold the child firmly by the hand or confine him in the grocery cart, otherwise you know that the child will try to touch and pull down every product that can be reached. This is not because the child is naughty but just because of a healthy curiosity.

Children are not naturally and automatically obedient. They have to learn from you setting limits even before they are able to understand explanations for such limits. As they mature, and as their understanding and ability to comply increase, the limits can be modified. Crossing the street is a good example of this: the baby is carried; the toddler walks with the parent holding the hand; the 5-year-old walks alongside the parent; the 6-year-old, with the rules that have been learned for safe crossing, crosses alone.

The feeling of security and self-confidence which you foster in the child by setting limits makes it possible for the child to progress more easily from one stage of development to another. It helps the child to realistically and successfully meet such new experiences as playing with other children and going to school. Setting limits helps the child to create satisfying relationships with others. This is really the entire point of discipline.