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Baby Info
(All Newborn Information)

newborn infant

Feeding

Newborns typically lose weight in the first 3 or 4 days of life. A “normal” weight loss is up to 10 percent of birthweight. Most babies reach their lowest weight on day 3 or 4. Breast feeding is best and mothers who can should try to nurse their babies. It is not known how long a mother should nurse her baby, but the American Academy of Pediatrics recommends nursing for the first 12 months. A common mistake is the infant latches on to the tip and not the whole pigmented areola. Babies should be fed every 2 to 3 hours. A new mothers breast milk usually “comes in” between day 3 to 5. Formula fed infants should take 1 to 2 ounces every 2 to 3 hours.

How long can you store breast milk?

How will I know my breast milk is in?

How much milk does a newborn need to drink each day?

Breastfeeding while Sick

Should I stop breastfeeding my 11 day old if I have a stomach bug? This is an important time to continue nursing. Formula will never be able to replicated the immune protection provided by breast milk. (... more on breastfeeding while sick)

 

Vitamin D supplementation

There is an increasing amount of evidence supporting the need for vitamin D supplementation in exclusively breast fed infants. The major source for vitamin D is sunlight. I do not recommend vitamin D routinely to my patients as living in Florida it would be difficult to avoid sunlight. I would consider it for extremely dark skin individuals or those who avoid the sun/cover their bodies when outside.

 

BPA in bottles

BPA or Bisphenol A is a chemical found in some plastics. Bottles had been predominantly made of these plastics. There is some concern that when heated that these plastics may release harmful chemicals. Most baby bottle companies have yielded to public concerns and offer “BPA free” bottles. While there is no hard evidence that BPA containing bottles can harm infants, I think it is best to avoid them.

Two ways to swaddle a baby

 


Umbilical Cord Care

I recommend cleaning your newborn’s umbilical cord area with rubbing alcohol only once a day. I tilt the cord and use a Q-tip to apply a small amount of alcohol at the yellow base of the cord. Typically, the cord falls off in 1 to 4 weeks. If you do not clean the cord site you run the risk of infection. An infected umbilical cord site is a serious infection which requires hospitalization. If you clean the cord site too much the cord will stay on longer than necessary.

 

Umbilical Cord Bleeding

Our 2 week olds umbilical cord fell off 3 days ago.  Since then we find a very small amount of dried blood in her belly button each (... more on Umbilical Cord Bleeding)

 

Newborn Hepatitis B

Todays parents are flooded with information surrounding vaccines. Everyone has heard the horror stories that vaccines cause autism or other problems. This stories persist despite overwhelming medical evidence to the contrary. Vaccines are medications and all medications have risks and benefits. While nothing in life is 100% safe, I believe vaccines as a whole to be safe.

I could not morally offer vaccines if I felt the benefits did not significantly outweigh the risks. All of my children are fully vaccinated and I do not offer vaccines that my own children have not already had. The decision to vaccinate is part personal and part public health.

Your newborn is currently immunosuppressed and will rely on the community’s immunity for protection. If enough individuals choose not to vaccinate then eventually newborns and other immunosuppressed people will needlessly be exposed to potentially lethal diseases.

You are going to be asked during your hospital stay to sign consent for your newborn to get their first hepatitis B immunization. When I was in medical school Hepatitis B was the number one cause of liver disease and liver cancer. Now, thanks to widespread use of a vaccine that was developed in 1982 its incidence has markedly declined in the United States. Side effects are rare and include local reaction and soreness.

Hepatitis B is spread via blood to blood contact (like sexual intercourse, birth or a needle stick). I suspect that most new mothers reading this have had prenatal care. and know that they are hepatitis B negative. Even when mothers are negative there is still a small risk of acquiring hepatitis B infection.

In conclusion, I would recommend you give your newborn the hepatitis B vaccine to protect them against this devastating disease.

 

Pacifiers

I’m okay will minimal pacifier use in the first 2 weeks of life. During the first 2 weeks of breast feeding it is important for the newborn to suck on their mothers breast to stimulate milk production. After breast feeding has been established or if the baby is being bottle fed it is okay to encourage the pacifier. See pacifiers.

 

How to Burp a newborn


Jaundice

All babies are jaundice (yellow), but only a minority will require treatment and close monitoring. In rare cases, extreme jaundice can cause brain damage. Doctors order bilirubin tests as a measure of a newborn’s jaundice level. There are transcutaneous (through the skin) bilirubin meters, but the most accurate measurements of bilirubin done are through blood testing.
Bilirubin is normally present in red blood cells (RBCs). Anything that breaks up RBCs will increase the bilirubin level. It therefore follows, that newborns with different blood types than their mother or with significant bruising are at increase risk for jaundice. Bilirubin molecules are normally cleaned up by the liver and then pooped out in the stool. Bilirubin makes stools darker.
Bilirubin levels naturally peak on day 3 or 4 of life. It is not a coincident that this peak occurs at the same time most newborns are at their lowest weight. Once a child is feeding and stooling well these level typically decrease
If your child is “too jaundiced” your doctor may initiate phototherapy. Phototherapy typically consists of lights above your baby. These lights help reduce the bilirubin level.


Stools

After birth, Infants will have dark, tarry, sticky stools called meconium for 3 to 5 days. As feeding is established, the stools will gradually lighten. Normal infant stools are the color and consistency of guacamole or seedy dijon mustard. In the first two weeks of life, I view stools as a sign the child is well hydrated and getting milk. If the mother of a breast fed newborn calls and reports her child has not stooled in 24 to 48 hours, my immediate concern is that the child is not getting adequate nutrition. On the other hand if a well grown and non-fussy 3 week old has not stooled in 2 to 3 days, I would typically observe them for an additional 48 more hours before taking action.

Baby Cries and Turns Red to Stool

For the past couple of days when my 10 day old has a bowel movement, it seems to hurt.  He scream/cries, turns bright red, kicks his legs & squirms.  His stools are still soft and slightly seedy.  Any ideas on (... more on Baby Cries and Turns Red to Stool)


Urine

Some newborns will have red “brick dust” colored urine. While most often this is a normal finding, it is a sign the child dehydrated. This will often occur when a newborn is 2 to 4 days old before the child is feeding well.

 

Breathing

While adults have regular, predictable respiratory rates infants have periodic breathing. Newborns will have several second runs of quick shallow breaths followed by long pauses. A normal newborn can pause up to 20 seconds before it is considered abnormal. Infants are obligatory nasal breathers and do not learn to breath through their mouths for 3 to 4 months. Many infants will sound “congested” until they learn to breath through their mouth.

 

Wipes

In our hospital, wipes are discouraged and wash clothes are provided. Wash clothes do seem easier to use on the initial black meconium stools. After discharge, baby wipes are fine. In the first few weeks, I would recommend a preventative diaper rash cream as many children do get diaper rashes at this time. We have tried several types but my favorite brand is Desitin (it must work as I can’t seem to get it off my hands).

 

Should we circumcise our son?

Circumcision is a hotly debated topic. Parents often ask if I recommend circumcision. It basically comes down to personal choice. Circumcised males do have a lower incidence of urinary tract infections (UTIs) than uncircumcised males. However, this amounts to a lower risk of a very rare event. It is also true that circumcised males also have a lower risk of acquiring sexually transmitted diseases. It is hard to convince a new mother that this factor would ever benefit her baby boy.

There are more care issues for the circumcised male in the first two years - mostly retraction to allow for proper healing. While uncircumcised males should be taught to clean and retract their foreskin as they get older.

In my experience, most boys tolerate circumcision well. To comfort them, I swaddle their arms, let them suck on a pacifier (often dipped in sugar water) and use local lidocaine.

 

Circumcision care

In the immediate post-operative period, circumcision care consists of placing vaseline on the penis and close observation. It is easier to smear vaseline on the front of the diaper than drip it on the penis. After 5 to 7 days most circumcisions are heeled enough to discontinue use of the vaseline. Typically, the penis is swollen and a yellow scab develops on the head of the penis. Often there is bruising and the base of the penis where lidocaine was injected. The scab, swelling and bruising should be resolved after two weeks. During the first two weeks after circumcision there is no need to retract the foreskin.

 

Baths

Newborns cannot have submersion baths until their umbilical cord falls off and is healed (and a boy’s circumcision site is healed). During these first couple of weeks if you would like to bathe your child you should sponge bathe them. The challenge with sponge bathing is to keep the infant warm and happy.

 

Fever

Fever in the first 3 months of life is an emergency. During this time a rectal temperature of 100.4 degrees or higher should trigger an immediate medical visit. Children less than 2 months old with a single temperature of 100.4 or higher should have a lumbar puncture (spinal tap) with culture, CBC, blood culture and catheterized urine culture. Often these children will require hospitalization or injected antibiotics while awaiting the culture results.

 

Sleeping

While it is your responsibility to wake up and feed your newborn, it is likewise your responsibility to teach them to sleep. Begin by creating a loud, bright stimulating daytime where people talk and full voice, listen to music and watch T.V. In contrast nighttime should be dark and boring, where one parent wakes and calmly feeds the newborn in dim lighting. In the first two weeks of life, parents should feed their newborn every 2 to 3 hours (even at night). After a child has gained back their birthweight let your child wake you at night.

When can we let our baby sleep all night?

Our son is 2 weeks old and seems to be doing well. He was back to his birthweight at his 2 week check up. We are waking him at night to nurse, but he seems tired and wants to sleep. Does he need (... more on When can we let our baby sleep all night?)


Car seats

Children should be placed in 5 point rear facing car seats until they are at least 12 months old and 20 pounds. Most children out grow their infant carrier seat between 6 to 9 months. Car seats should indicate the maximum child size on the side of the seat. These sizes vary by model and manufacturer.

 

Sneezing and hiccups

Sneezing and hiccups are normal infant noises. They do not harm infants or indicate a problem.

 

infant metabolic screen

Every state requires an infant metabolic screen often called a “PKU test”. This amounts to a heel stick drawn after birth to look for rare diseases. The test is done in the hospital 24 hours after the child’s first feeding. Florida’s screen was recently expanded from 5 diseases to 5 categories of diseases.

It screens for PKU, cystic fibrosis, sickle cell disease, hypothyroidism and many others.
Why these diseases? These diseases are screened for because early diagnosis can significantly impact an individual’s lifetime health.

PKU (phenylketonuria) is probably the best example. Have you ever noticed the red letters on a Diet Coke can that states, “this product contains phenylalanine”?. Phenylalanine is an amino acid found in high protein foods like meats, milk and nuts. If people with PKU ingest phenylalanine they will become progressively mentally retarded. If their diet is free of phenylalanine they will have normal intelligence.

The state normally sends the results to your pediatrician about a month later. In general, the state reports abnormal results quickly (usually before 2 weeks of life).

Newborn Peeling Skin

Newborns normally have dry, peeling skin. Babies that are post-dates (more than 40 weeks) often have excess peeling. Newborn skin peeling is usually most apparent at the wrists, ankles and abdomen. This will resolve on its own without lotion or medication. If you would like to apply lotion to help it improve, I would

(... more on newborn peeling skin)

newborn with peeling feet

 

Laundry

For the first year of life, I would recommend a gentle laundry detergent. We use Dreft in our home for the baby’s clothing, sheets and towels. We do not use dryer sheets in the first year. After a year, the baby’s clothes may be washed with the rest of the family’s laundry.

Periodically, I see children who develop skin rashes secondary to detergent or dryer sheets. These usually start as red rashes on the chest.

 

When do Babies Eyes Change Color?

Typically, newborns have lighter colored eyes frequently called “baby blues”. As children age, their eye color often changes. When an individuals eye color changes they go through a “grey” or “muddy” stage where is it hard to determine eye color. By 6 months of age, most (95%) of eyes have established their adult eye color. Sometimes eye color can change up to 2 years old. While parents and grandparents often tell me of people whose eye color changed older, I have yet to see this in my practice.

 

Baby with cold hands and feet

Should I be worried about my infant son having cold clammy hands and feet ? Healthy infants will often have cold/clammy or even purple hands. These findings are thought to be due to an immature peripheral nervous (... more on baby with cold hands and feet)

Baby Ingrown Toenail

My 3 week old daughter’s big toe nail looks like it is ingrown. There is no redness or tenderness. What should we do? Newborns often appear to have ingrown toe nails. Thankfully, these rarely lead to problems. (... more on Baby Ingrown Toenail)

Baby Fingernails

Our newborn has surprisingly long nails. Can we use nail clippers so he doesn’t scratch himself? I do not recommend nail clippers for newborns. In newborns, the tips of their fingers often grows further out underneath their nails. (... more on Baby Fingernails)

Umbilical Hernias

My newborn son has a hernia in his belly button. Our Ped said it should go away on its own. Do you agree? Yes. It is very common for infants to have an umbilical hernia. Most close in the first few months of life. They can (... more on umbilical hernias)

Subconjunctival Hemorrhages (red spots in eyes)

Our newborn son has red spots in the whites of his eyes. Is this normal? When will they go away? These red spots are called subconjunctival hemorrhages. They are common in newborns and typically result (... more on Subconjunctival Hemorrhage)

Baby Acne

My 5 week old has started to get baby acne all over her face.  Do I just let it run its course or is there an ointment I should apply? Neonatal acne peaks around 1 month of age. These red bumps resemble the zits of our teen (... more on baby acne)

How early can you give a baby shots?

We are planning on flying home to introduce our newborn to our families. We would like him to get his first set of vaccinations before traveling. How old does he need to be to get his 2 month old vaccines? (... more on How early can you give a baby shots?)

 

 

 

Updated July 2011 by
Dr. Gordon, Windermere Pediatrician

 

 

 

 

 

 

gregorygordonmd.com is intended to help parents understand the needs and behaviors of children. The information presented in the site is the opinion of Gregory Gordon, M.D.and does not reflect the opinion of his partners. This website is owned exclusively by Doctors insights LLC. The advice in this site does not apply to all children. Always consult your healthcare provider for your individual needs.

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