Owings Mills Pediatrics

1. Feed your baby 8 times in 24 hours (about once every 3 hours). If your baby sleeps longer than 3-hour intervals at night, you may have to give an extra day-time feeding.
2. Do not skip daytime feedings. Do not wake your baby at night after the 11 pm – 12 am feeding.
3. If breastfeeding, offer each breast for no longer than 15 minutes. If formula feeding, offer 2 oz at each feeding.
4. If breastfeeding, you may substitute one bottle beginning at age 3 wks.
5. If breastfeeding, baby should receive 1 ml ( 1 dropper) of vitamin D or a multivitamin once a day.
6. If breastfeeding, baby should receive fluoride drops after 6 months of age until the baby is weaned or at least half of his/her fluids are from formula.
7. Bathing: sponge bathe your baby with water and a mild soap until the umbilical cord falls off, then give a full bath every 3 days.
8. Diaper care: Clean the diaper area with unscented wipes or water on a wash cloth. Air dry the baby’s bottom, then apply cream (e.g. Triple Paste, Desitin, A&D ointment, or Butt Paste) as needed.
9. Trim your baby’s fingernails with an emery board.
10. Schedule your baby’s first visit for 3-5 days following discharge from the hospital.

Every infant born in the State of Maryland has a blood test done in the nursery and again at the three-week-old office visit. A few drops of your baby’s blood are tested for abnormal hemoglobin (such as sickle cell disease), hypothyroidism, and several other very rare diseases (such as PKU disease). This newborn blood test is important because it reveals these rare diseases before babies become sick and allows the doctor to prescribe treatments to prevent symptoms from developing.

All babies sneeze, yawn, belch, have hiccups, pass gas, cough, and cry. They may occasionally look cross-eyed. Sneezing is how babies keep the nasal passages clear of mucous and milk. Hiccups are little spasms of the diaphragm, the muscle that helps us breathe. Hiccups often stop after giving your baby a few swallows of water. Coughing is how a newborn clears the throat. Most of the gas a baby passes is just air that has been swallowed during feeding.

Crying is a baby’s way of communicating. It almost never indicates pain. When your baby cries, check him/her out for the obvious: wet, soiled, hungry, too hot, too cold. Many well babies have daily fussy periods. These become longer and louder until about age 6 weeks. They gradually disappear by age 2-3 months. The fussiest babies who cry hard with knees against their chests for hours at a time are said to have colic. Here are some tips to minimize the fussy periods: Keep the baby in an upright position while feeding and burp the baby frequently. Gently rock the baby, bounce with the baby on an exercise ball, or take the baby for a ride in the car. During sleep times, swaddle the baby and play white noise in the nursery (vacuum cleaner or a white noise CD). If these suggestions fail to help after two nights, call the doctor.

Most babies sleep from feeding to feeding during the first week of life. They generally require about 14 hours of sleep during each 24-hour period for the next several months. Some babies sleep for long stretches, while others take frequent catnaps. You should aim to get your baby to sleep for at least 3-hour stretches at night during the first four months. Thereafter, expect your baby to sleep for at least 6 hours at a time each night.

To get your baby to sleep more at night and less during the day, try the following: After daytime feedings, burp your baby and try to keep him/her awake for one-half hour before putting them to sleep. After evening and nighttime feedings, burp your baby and put him/her to sleep immediately. Try to put your baby to sleep at least slightly awake, so they learn to settle themselves.

Spitting up and occasional vomiting frequently occurs in newborns. If your baby seems well otherwise, nothing needs to be done. Spitting up should stop as your baby grows older. If your baby vomits after or between all feedings, please inform your doctor.

Babies can be breast or bottle fed. If you have not yet decided which method to use, we will be happy to discuss the pros and cons of each one. Remember, although formula fed babies will grow and develop normally, human breast milk is the perfect food for babies. Feed your baby every 2-4 hours for a total of eight feedings in twenty-four hours. Do not wake your baby at night if he/she is sleeping. If your baby cries before 2 hours have passed since the last feeding, offer a pacifier or rock your baby. Do not mistake your baby’s strong urge to suck for hunger. Babies have a need to suck above and beyond their need to eat. Most babies will sleep for a 3-hour stretch between feedings at night after age one month and will sleep for at least a 6-hour stretch between feedings at night beginning at age four months.

Many mothers find the following schedule useful:

1. Feed your baby 5-minutes on each breast during the 1st feeding. Increase the length of time feeding on each breast by 1-minute every day. If your breasts are uncomfortably engorged, feed the baby longer. For the first few days expect your nipples to be sore but not painful.
2. Burp your baby for five minutes after feeding from each breast. Do not continue to burp your baby if they are crying as your baby will swallow more air than he/she can expel by burping.
3. Begin each feeding on the breast last offered.
4. Gradually work up to a maximum feeding time of 15-20 minutes on each breast. Your baby will remove 85% of your breast milk after only five minutes of steady, hard sucking. Try to empty at least one breast completely during each feeding, even if your baby does not appear to need to nurse at all from the 2nd breast. The milk that comes from your breast at the end (hind milk) has a higher fat and calorie count than the first milk (fore milk) and is needed for your baby to grow well.
5. At first, you may use a clock or watch to time the feedings.
6. Hold the baby whichever way is most comfortable for you.
7. After feedings you may apply a lanolin cream to your areolas but not to your nipples.
8. Wear a nursing bra. For comfort, you may wish to wear the bra even while sleeping.
9. If you are concerned that your baby is not feeding properly, please call our office.

Cow’s milk formulas are available as ready-to-use, concentrate, or powder. Most mothers use the concentrated form and dilute with unboiled tap water. Ready-to-use Nursettes are expensive but require neither preparation nor refrigeration. Prepare 26 oz. of concentrate or powder formula as indicated by the manufacturer, divide into 4 oz. bottles, and then refrigerate. Formula may be refrigerated for up to 24 hours. Unsterilized tap water is suitable for concentrated and powdered preparations unless you use well water. Well water must be tested to make sure that it is appropriate for feeding babies. Well water is safe to use if it is checked yearly for bacteria, nitrites, and acidity – none of these should be present. Clean bottles in the dishwasher or with hot tap water and dish soap. Sterilization of bottles and formula is not necessary. Nipples may be cleaned in the dishwasher or with hot water and then air dried on a drainboard, using a toothpick through each nipple hole.

Babies who are exclusively breast fed should receive Trivisol or Polyvisol vitamin drops daily (1 ml per day) until solids are begun or until at least 3 feedings a day are from formula. Babies who are exclusively breast fed, use well water or live in an area where water does not contain fluoride may need a fluoride supplement after age 6 months.

The circumcision requires little in the way of special care and heals within a week. Apply a thin layer of Vaseline after each diaper change to prevent irritated skin from adhering to the diaper.

As the umbilical cord separates, usually when your baby is age 2-3 weeks old, a small amount of bleeding may occur. Likewise, the base of the cord may have a foul smell and produce a small amount of pus. This is normal and part of the normal healing process – no special care is needed. Let us know if there is redness on the skin surrounding the umbilical cord.

Most babies pass soft, seedy bowel movements. Bowel movement frequency ranges from 11 per day to only one every 2-3 days. Breast fed infants after 6 weeks of age may actually have a bowel movement as infrequently as once a week. Bowel movements are often golden yellow but commonly may change to green. Babies often cry and turn red as they try to pass a bowel movement, even when bowel movements are soft. This does not indicate pain or “gas”. It is just a common response to feeling the bowel contract in a newborn. Wash your hands after changing your baby. Please call us if bowel movements are hard or your baby appears to be in significant pain when passing a bowel movement.

Most, but not all babies, remain well during the first three months of life. Call the doctor if your baby:

1. suddenly appears yellow all over.
2. vomits three consecutive feedings.
3. has more than six explosive, watery bowel movements in 24 hours.
4. fails to urinate in 12 hours.
5. takes less than 2 ounces at three consecutive feedings.
6. feels limp.
7. has a rectal temperature greater than 100 degrees F.
8. appears less active than usual.
9. whimpers and cries despite everything you do.
10. “just doesn’t seem to be right.”