Newborn Instruction Booklet

by Pediatrician Roger Knapp, M.D., F.A.A.P.

Your baby is resting comfortably and warm in his or her own bassinet. I have given your baby a thorough physical examination. Any abnormalities will be explained to you as soon as they are apparent. If you notice any difficulties or have any questions, please notify the nurse or me.

During the next few days, most of your time will be spent in resting and regaining your strength. You can put this time to good use by getting to know some of the simple things which will help to make your life with baby easy and fuss-free.

You must remember the baby is experiencing a new phase in his life. A short time ago, he was totally dependent on you as his mother. Now, even though he is actually quite helpless, he is to some extent independent in that he can breathe the open air, sleep peacefully, or object strenuously by crying loudly. He is truly an individual and with your help, care and love will grow physically and make rapid strides in his development. Adapt these instructions to your baby. Do not depend on friends and relatives. We will be happy to give you guidance and answer your questions, while you are in the hospital, later by phone and during your visits to the office.

Friends and Relatives: These people are interested in your baby and want to hold and hug him. So long as family and friends are not ill there is not problem in their handling the baby. Stay out of crowds (where you cannot be sure of the health of people present) for the first two weeks. You may take him out after 2 – 4 weeks but be careful not to expose him to anyone who is sick.

Babies Are Babies: All babies sneeze, yawn, belch, have hiccoughs, pass gas, cough and cry. They may occasionally look cross-eyed. Sneezing is the only way in which a baby can clean his nose of mucus, lint or milk. Hiccoughs are little spasms of the diaphragm muscle. They may often be stopped by giving a few swallows of warm water. Coughing is baby’s way of clearing his throat. Crying is his way of saying I’m hungry, I’m wet, I’m thirsty, I want to turn over, I’m too hot, I’m too cold, I have a stomach-ache, or I’m bored, or constipated. You will gradually learn to know what the baby means. Even a well baby will probably cry for an hour or so occasionally.

FEEDING

The baby’s first love for his parents arises primarily from the feeding situation. Both of you should be comfortable.

Breast Feeding: If you choose to breast feed your baby, we want to help you in every way possible. Although the first several days may seem awkward and frustrating to you or the baby, most mothers are successful if they relax and have patience. Introduce as much of the nipple and areola (dark portion around your nipple) as possible into the baby’s mouth to promote adequate sucking and milk flow. The most vigorous sucking occurs at the first breast, so alternate the breast on which you begin feedings.

Nurse the baby 5-10 minutes on each breast every 3-4 hours for the first 24 hours. Your breast milk usually “comes in” on the third day. Your breasts will then feel firm, hard, and tender. At that time you may nurse 10-15 minutes on each breast. Breast feeding a lot on an empty breast will cause cracked and sore nipples. After a feeding, always remove the baby from your nipple by inserting your finger between his/her gums to break suction on your nipple.

Most babies are not hungry the first few days or so. Don’t be alarmed if baby isn’t interested at first. He or she will get hungry. He or she will be content after nursing and will go 2 to 4 hours between feedings. However, most infants go through a growth spurt at 1 to 3 weeks of age. He or she will be hungry every hour or two and appear to be unsatisfied. Stay calm and simply put baby to breast as often as needed. If your breasts get sore, cut back to 5 or 7 minutes. Frequent nursing will increase your milk supply in about a week or so, after which time feedings should be 3 to 4 hours apart and baby will seem more satisfied. If during this time you supplement with infant formula thinking: “baby isn’t getting enough to eat” or “you are drying up,” then the baby will be satisfied with the formula and you may risk depleting your breast milk supply by inactive nursing. So feed the baby “on demand” and ride with the fluctuations in his or her eating habits.

Breast fed infants generally have very watery, yellow and seedy stools. The infant may have a stool after every feeding or can go 4 to 7 days without any stools. Both are normal as long as the stools appear as usual breast stools and the baby is acting normally.

Your diet does not have to change, but we emphasize your eating well balanced meals. Consuming too much of any one thing will determine whether baby gets a reaction, but in essence any food item can affect the baby. For example, one cup of coffee may not bother the baby, but 3 or 5 cups in a morning might. Some foods known to increase gas/colic in newborns are caffeine (chocolate, caffeinated soft drinks, coffee, tea), milk products, dry beans, peas, cabbage, broccoli, and spicy foods. If you feel your diet is causing colic try eliminating some foods from your diet for a short period of time.

Many medications for Mom are permissible while nursing, like acetaminophen(Tylenol), ibuprofen(Advil), allergy pills and antacids. Mineral oil or Metamucil are good for constipation. Always watch the infant for any changes in behavior when you take medication. Call us if you need to take any other medicines, or if you are in doubt. Ask your doctor or us on all prescription medications.

Bottle Feeding: Sit comfortably with your baby in your arms. Relax and let baby feed at his own pace. Do not prop the bottle in his/her mouth because he/she can choke. Hold your baby in your arms with his head raised and resting in the bend of your elbow.

Formula Preparation: Sterilization is not necessary if you prepare each bottle as you give it to the baby. If, however, you choose to make up 20 bottles ahead of time, then you will have to sterilize the water for 6 weeks. You must use these bottles within 48 hours.

The easiest way is to use the concentrated formula. Wash the bottles and nipples in hot water or dishwasher. They should be clean, but do not have to be sterile if you pour the formula into each bottle as you feed baby. Wash the top of the concentrated formula can and open. Either leave it in the can, covered, or pour formula into a covered container and refrigerate. When you are ready to feed a bottle, for example 4 oz., first pour 2 oz. of cold concentrate into the bottle and then add 2 oz. of warm tap water or distilled water. You do not have to boil the water if used right away. Then you are ready to feed the warm bottle. Discard any unused portion.

If you use powdered formula, mix it according to directions with warm water. This is easy to use on trips and camping.

If you use the Ready-To-Use formula, pour it into the bottle and warm it if desired. Warming the formula is usually helpful for several months but not necessary for all infants. Room temperature is adequate.

“Burping”: “Burping” baby helps remove swallowed air. Hold him or her upright over your shoulder, pat or rub his or her back very gently until he or she lets go of the air. Or, place him or her face down over your lap and gently rub his or her back.

The baby can also be “burped” by holding him or her in a sitting position (baby leaning slightly forward) on your lap, with your hand supporting his or her stomach.

It’s not always necessary to interrupt a feeding to burp baby but most need it. Baby will usually burp within 1 or 2 minutes, so don’t try to force him or her. Babies don’t have to burp every time.

A Schedule With Flexibility: Feeding schedules are usually most satisfactory if the hours are set roughly, and the baby is allowed to eat when he or she becomes hungry – for example, any time between two and four hours after the last feeding. It’s better not to wake baby for feeding. If he or she begins crying I hour after feeding, try giving a bottle of water. If crying continues, offer more breast milk or formula.

How Much Formula: Most babies are not hungry the first day and the amount of formula taken will vary with each baby. Some babies will only take 1/2 oz. at first and usually by the third day will take 1 1/2 oz. and yet others will take an entire 4 oz. When putting the nipple into baby’s mouth and is spit back out again this usually indicates he or she is full.

If your baby is taking up to 4 or more oz. of formula every 1 to 2 hours, and is not satisfied by liquid milk, call the office for the next step in feeding.

Liquid concentrate – 1 part formula to 1 pan water or

Powder – 1 scoop to 2 ounces of water.

Also available in 8 ounce and 32 ounce Ready-To-Use cans – Do Not Add Water.

Water: It is not necessary for the baby to drink extra water since there is enough fluids in the formula. You do not have to boil the water unless it is well water. Distilled water is also good.

Test Nipples Regularly: Testing nipples regularly will save time when you are ready to feed your baby.

Nipple holes should be the right size to help baby suck easily. When the nipple holes are the right size, warm milk should drip as rapidly as possible without forming a stream, about one drop per second.

If nipple holes are too small, baby may tire of sucking before he gets all the formula he or she needs. If holes are too large, baby gets too much formula too fast, and may choke or spit up.

To enlarge holes that are too small, push a red-hot needle gently through from the outside. An easy way to prepare the needle is to put the blunt end in a cork and heat it in the flame of a match or cigarette lighter.

If nipple holes are too large, the nipple is worn out and should be thrown away.

Sometimes nipple holes become gummy. Place the nipples in a pan of water, add a pinch of salt, and boil for a few minutes.

BABY CARE

Bathing: Although you will bathe the infant most days, it is not necessary to bathe baby every day. Keep the room warm during the bath. Sponge bathe baby on a dry mat until the cord is healed.

Face: Keep clean and dry. Wash with water or mild soapy water. There are usually white bumps on the nose which is normal and will go away with time. The cheeks will occasionally get red bumps on them from the spitting up of milk and from baby rubbing his/her cheeks when sleeping. Wash and leave face to dry. Do not apply lotion or anything else on the face or the pores will become more irritated and increase the rash. Watch out for your perfume or after shave lotion when you place the baby against your neck. An acne-like rash may occur on the face and upper chest, keep it clean and dry – do not use medications.

Eyes: Clean with soft cloth and clean water. A little matter or mucus once or twice a day is normal. If the eyes tear a lot and are matted closed each morning let us know.

Nose: The nose may be congested from time to time. If there is mucus, aspirate by carefully squeezing the bulb syringe, placing the tip at the entrance of the nostril, and releasing the bulb rapidly. This will extract mucus from the nose into the bulb, which can then be squirted out into a Kleenex. You also help loosen mucous in nostrils by placing salt water nose drops or spray (Ocean or AYR nasal spray) in each nostril, then suction with bulb.

Head: Wash the scalp when needed. There may be dry white flakes at first. Wash with any standard brand of baby shampoo. Cradle cap is thick yellow scales after two months which requires different treatment, and we will recommend these to you as needed.

Body: Wash with baby soap for the time being. Later you may switch to a bar soap after 2 months of age. You can use Ivory or Dove soap. Lotion is permissible but not baby oil. Heat rash is nothing more than small red pinhead size bumps on the chest, neck, arms, etc. This is caused by the pores being clogged by sweat, lotion, milk, or chemicals in the clothes i.e., Downy rinse or deodorant Bounce towels etc. To help clear up the heat rash, wash area clean and let it dry. Talcum baby powder can cause lung damage if inhaled; when using powder, do so sparingly and try to keep baby from inhaling any, or simply do not use it. Corn starch powder is safer.

Diaper Area: Wash with water or mild soapy water. The commercial diaper wipes are very irritating and some infants may develop a rash due to their chemicals. Some brands are made from “all natural ingredients” and are recommended over the others. If rashes appear, discontinue wipe use and return to wash cloth and water. You can protect the diaper area with Vaseline, A&D Ointment or leave skin dry but if a rash occurs, which is normal from time to time, then try Desitin, Dr. Smith’s, or Diaperene creams. If rash continues to worsen, call the office for advice.

Navel: Keep clean and dry. The plastic clamp will be taken off before you go home. Clean with a cotton ball soaked in alcohol. Wipe the base of the cord at each diaper change, or if it gets wet and/or looks moist. The cord usually will fall off in 2 to 3 weeks. The area may smell bad and may also ooze mucous or blood for several days. This is normal. Continue wiping any drainage until the area is dry. When the cord falls off you may wash with soap and water and give baby a tub bath. A sign of infection is when the skin of the abdomen surrounding the naval becomes a bright red. Binders or strapping the naval is not necessary to prevent hernias and can cause irritation.

Circumcision: If you so desire, the obstetrician will perform the circumcision prior to discharge. There are two methods. If your obstetrician uses the “plastic bell”, the penis will have a plastic ring around the end. It will slowly come off in a week. Wash with clean water and wait until it is loose in the diaper. Do not put anything on it. Some times a few spots of blood may appear on the diaper which is normal. If it bleeds excessively, apply pressure and let us know. If it gets infected, the whole shaft of the penis will get red and swell twice its normal size. A little redness at the edge of the ring is normal. The other method of circumcision performed by the obstetrician is with a clamp. The penis will have all the skin taken off with a raw red area present. A generous amount of Vaseline should be applied to the penis in order to prevent it from sticking to the diaper. Apply the Vaseline with each diaper change. Clean off any urine or stool with warm water or soap and water. Continue applying the Vaseline with diaper changes until the area is completely healed (usually about 5-7 days).

Stools: The initial stools are black tarry meconium. After a few days the stools may be yellow or green and are usually seedy. Call for an appointment if there is any blood in the stool. The stools also may be mushy or even watery especially with breast feeding. Constipation is hard pellet-like stools. Treat this by putting one teaspoon of Karo syrup in several bottles of formula a day. Or you may start apple juice, 1 oz. several times a day. However, it is common for babies to go several days without a bowel movement and can be quite normal. In fact, breast fed babies may not go for an entire week, which can be normal, or have a stool after each feeding. Baby needs to be seen by us if there is a lot of colic and/or vomiting.

Diapers: Cloth or disposable diapers are fine and some mothers use both. If you wash the cloth diapers at home, you may use any average detergent but rinse them thoroughly. Dreft or Ivory Snow are also good choices.

COMFORT

Room Temperature: Try to keep an even, comfortable temperature in the baby’s room. On hot days provide ventilation. On cold days check on your baby occasionally to see that he’s covered enough to be warm and comfortable. For the first two weeks, the room temperature should be around 70-75 degrees. If you are comfortable in a short sleeve shirt, it is about right for your baby.

Sleeping: You may expect your new baby to do a lot of sleeping. The Academy of Pediatrics has recommended that infants sleep on their side or back. This new recommendation is based on research which found a 50% lower incidence of SIDS (Sudden Infant Death Syndrome) in these babies. Initially, most babies sleep 16 to 20 hours per day.

Bassinet or Bed: The baby’s mattress should be firm and flat. No pillow should be used. Protect the mattress with a waterproof cover. Next comes a soft baby sheet and one or two cotton blankets. Babies like being swaddled the first one to two weeks. After that they usually kick the cover off.

Clothing: Your baby does not require any more clothing as an adult, so try not to over clothe him. Dress him according to the temperature. Some babies are allergic to certain materials, so watch for rashes in clothing contact areas. It is common to be allergic to the metal snaps on the garments and have small areas of rash where the snaps make contact.

Outdoors: A fairly good rule to follow is to take your baby out whenever the weather is pleasant. Babies may be taken out on a nice day after they are two weeks old. Babies sunburn easily. Early morning or late afternoon reduces the risk of sunburning. Some type of cover overhead is also a good idea. Getting out does not cause babies to get sick. Wind in the ears does not cause ear infections. Keep baby away from people who are sick. Be sure to wrap baby up warmly when it is cold. Babies may fly in airplanes in 2 or 3 weeks. Give baby something to drink if he or she becomes fussy.

Fever: If your child has a fever(100 degrees or more under the arm or in the mouth with the pacifier/thermometer, 101 degrees in the rectum)(I do not recommend the ear thermascan type because of inaccruacy) during the first 2 months of life, your child will need to be seen promptly. If this occurs when the office is closed, bring him into Children’s Medical Center Emergency room.

THINGS THAT ARE NORMAL BUT WORRY YOU:

  • Hiccups are normal and frequent. You can try to stop them by burping or giving a drink of water. Usually they do not upset the infant and you should ignore them.
  • Sneezing a lot is common. This is not a cold or allergy. This is the way they clear the nose.
  • Nasal congestion is frequent during the first week and frequently continues for up to 2 months. If there is a runny nose or a lot of coughing, it could be a cold and we should see the baby. The congestion does not need treatment as long as baby isn’t fussy, and is eating and sleeping well.
  • The stools may be any color or frequency. Sometimes breast babies will go for a week without having a stool. No treatment is necessary unless there is blood in the stools or there is colic and vomiting. Constipation is hard, rocklike stools, but it is normal for them to grunt or strain to produce a normal stool. Other babies may stool after every feeding. Diarrhea is usually watery and several times between feedings.
  • The normal colic occurs in the evenings around 6 to 11 p.m. Usually it is not severe crying and the infant can be rocked, given a drink of water or nursed more often, or put in a wind up swing. It also does not hurt to put baby down and let him or her have a good cry. If the baby is crying all day or all night, we need to check the baby in the office. Milacon for gas usually does not help but is safe. Call the office for Prescription Levsin that helps more.
  • Most babies spit up often. Occasionally, a baby may vomit a large amount. Do not be alarmed. Clean up and watch for recurrence. If this happens 2-3 feedings in a row, bring the baby in for evaluation.
  • Babies may have irregular breathing, startle reflex, chin quiver, or crossing eyes. All of these are normal for newborns.


OFFICE VISITS
Your baby should have his/her first office check-up when he/she is two-three weeks old; unless, of course, he/she needs any attention before then. For your convenience, please call the office for an appointment. The receptionist keeps the appointment book, so please call her several weeks in advance. You also need to get your baby’s newborn screening PKU blood test at the hospital lab.

Both well and sick child care visits to the office are an important part of comprehensive medical care. During a well-child visit we are mainly concerned with observing the growth and development, counseling and teaching of parents, early detection of illness through screening examinations and laboratory tests, immunizations, and getting to know one another. We limit our counseling to the disease at hand during a sick-child visit.

Write down the questions you want answered before coming in for the appointment. Make certain before leaving that your questions are answered fully and that you understand what the doctor has told you.

Well-care and sick-care visits are scheduled separately. When making an appointment, tell the receptionist the reason for the visit plus any other pertinent information which will help her alot the necessary amount of time. If cancellation of an appointment is necessary, please call as far in advance as possible.

Immunizations:
Immunizations are very important and will be started at the 2nd month check-up. Your baby should have immunizations to prevent whooping cough, diphtheria, tetanus, polio, measles, rubella, mumps, HIB meningitis and hepatitis.

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