BOWLING GREEN INTERNAL MEDICINE AND PEDIATRICS,
ASSOCIATES
NEWBORN AND
GENERAL INFORMATION BOOKLET
Baby’s Name:
______________________
Date of Birth:
______________________
KELLY KRIES, MD KEVIN KELLY, MD
(270)
846-4800
TABLE OF CONTENTS
General Tips for Phone Calls 1
Common Newborn Characteristics 2
Jaundice 3
Sleeping 3
·
Breast Feeding 4
·
Bottle Feeding 6
·
Burping 6
·
Solids 7
·
Vitamins 7
·
Bathing 8
·
Nails 8
·
Navel Care 8
·
Diaper Rash 8
·
Circumcised Boy 8
·
The Nursery 9
·
Clothing 9
·
Pacifiers 9
·
Fever 10
·
Common Cold 11
·
Ear Infection 12
·
Sore Throat 13
·
Vomiting/Diarrhea 13
·
Teething 14
·
Head injuries 14
Well child Visits and Vaccinations 15
Notice of Privacy Practices 17
Welcome to the Practice
Congratulations on the birth of your new baby! We appreciate you asking us to be your
child’s pediatrician. We are committed
to providing the best possible care available for your child and our wish is
that your child enjoys a long and healthy life.
Questions that parents frequently ask about their babies are answered in
this booklet. We hope it will be helpful
to you and that you will read it carefully, even if this is not your first
baby.
Sometimes new parents are a little unsure of themselves, at first. As long as your baby is well-fed.,
well-loved, and comfortable, he does not mind a bit that you are less than
expert. These few simple infant care
instructions should help you to relax and enjoy your baby. The most valuable thing parents can do for
their children is to enjoy them.
In the Hospital
While you and your baby are in the hospital we will see you daily. We will thoroughly examine your baby on our
first visit, and again upon discharge, and attend to any medical needs that
arise in between. Any problems that
arise concerning your baby will be discussed openly and completely with
you. We hope you will take advantage of
our visits to ask questions about your baby so that your arrival at home will
be as smooth as possible.
Routine blood tests for PKU and thyroid disorders will be done on all
infants. Other blood tests and x-rays
will be done only as the need arises.
General Tips for Phone Calls
- Please
call during regular office hours for general pediatric questions. We will return your call the same day.
- For
children that are ill or need attention the same day- Please call between
8:00 am and 10:30 am for an appointment.
Please try not to wait until late afternoon to call about a child
that has been sick all day.
- Calls
after office hours- If you feel your child is ill and you need advice at
night, one of our physicians will be available to answer your
questions. However, if your
questions can wait until morning, we would appreciate your calling when
the office is open.
- Please take
your child’s temperature prior to calling for advice regarding an illness.
- Have a
pencil and paper ready in case we need to give instructions. If calling after hours, try not to leave
your phone after calling the doctor if possible. If you must leave home, please notify
the office where you may be reached or when you will return home.
- Have your
favorite daytime and nighttime pharmacy numbers ready should we need to
call in a medication. If you wish
to refill medications, you can generally call the pharmacy and ask them to
fax a refill request to our office.
You shouldn’t need to call our office directly. We will not refill medications on the
weekends and after hours.
- For
life-threatening emergencies when moments count, call 911 or take your
child to the closest emergency room for stabilization.
- For
poisonings call the
- Should we
fail to return your call after office hours within a reasonable amount of
time, call again as a safeguard against telephone trouble, wrong numbers
and human error.
Common
Characteristics of Newborn Babies That May Concern Parents
(Normal
Newborn Variations)
1. Noisy
Breathing- Most babies will have a rattle sound when they breathe, and parents may
think that the baby is always keeping a cold.
If the child is exhibiting no other signs of illness, do not be too
concerned. Little babies (like all human
beings) normally have mucous in their noses, but sometimes have trouble
expelling it. Infants breathe through
their noses during the first few months.
Excess mucous may be removed with a nasal suction bulb and saline solution
2. Sneezing-All babies
sneeze repeatedly. This does not mean
they are catching cold. They are just cleaning their noses.
3. Hiccoughs- Babies will
frequently have hiccoughs, and they usually bother the parents more than the
baby! Do not be alarmed.
4. Spitting up- Many parents
become unduly worried because their baby spits up during the first few
days. Fluids which the baby has in his
stomach after birth may cause it to be upset. Also, it is not unusual for your
baby to bring up food during the first few months whenever he burps or after he
has been active. Although spitting up is
an inconvenience, it seldom is a serious problem in a child who is growing and
developing normally. Time and
acceptance on your part usually handles this problem best.
5. Fretting,
Red in the face, Straining with bowel movements or infrequent bowel movements- Just as our
baby develops their own feeding patterns, they will develop their own schedule
for moving the bowels. Normal stool
patterns can include a movement after each feeding or one every second or third
day. Initially, the stool is a tar-like
black sticky material. With the onset of
milk feedings the stools become yellow, and can be pasty, semi-formed or
loose. Formula-fed babies will have
curds or seeds in their stools; while breast feed babies will have a thin,
smoother loose stool. The consistency
varies daily with each bowel movement.
You may have noticed that the baby’s muscles are generally weak - that
is why he doesn’t sit up or control his head well. The same applies to the abdominal muscles,
which, in older children and adults, provide the force to move the bowels with
control. Your baby has to work harder and longer to have his movement. It is not unusual for a baby to grunt, fuss,
and turn red when he is preparing to move his bowels. Instead of becoming anxious, keep him secure
and comfortable. Two problems concerning
bowel movements should be brought to our attention:
·
Crying or screaming with the passage of the stool.
·
Recurring small hard, bead-like stools.
(Constipation means hard pellet like stools, not infrequent ones.)
6. Swollen
Breasts and Vaginal Bleeding- Both male and female babies frequently have
swelling of breast tissue, and female babies often have some bloody discharge
from the vagina during the first week of life.
These are related to stimulation of the tissue by the mother’s hormones
during the pregnancy and gradually go away after birth.
7. Blue
feet/Hands- Often a baby’s hands and feet will look blue in color. This is a common occurrence and need not
cause alarm.
8. Dry Skin- Dry, flaky skin
is perfectly normal for several weeks after delivery and usually requires no
treatment.
9. Birthmarks- Most babies
have a collection of red, mottled spots on the backs of their necks and between
their eyebrows. These spots generally
fade with time. It is very common for
dark skinned infants to have a dark spot at the base of their spine. This, too, will fade with time.
10. Puffy eyes- Many infants
will have puffy eyes for several days after birth. This swelling is transient and is nothing to
worry about.
11. Facial
rashes- These are common in the first few months of life and are due most often
to maternal hormonal influences or irritations to the infant’s skin. These rashes will upset you, but they will
soon fade. The best treatment is simply
to help keep the area dry and clean.
Rashes may appear like minute shiny, white pimples without any redness
around them or collections of a few small red spots or smooth pimples on the
cheeks. At times they fade, and then get
red again.
12. Bowed Legs- The legs of
the newborn are normally bowed from the curled up position in the uterus for
the nine months of pregnancy. Until the
child starts to walk well, the legs will probably remain bowed because nothing
has stimulated them to change. Likewise,
the feet may turn slightly inward or outward, but this is usually normal. If you have questions concerning the walking
pattern of your child, please ask us at the next well child checkup visit.
13. Newborn
Jitters- Most infants startle easily and may jerk violently when disturbed. This is normal reflex. It may involve the arms, legs, chin, and at
times, be vigorous.
14. Weight
Loss- Your baby is born with an excess of calories and water from which he
is self-nourished for the first few days.
For this reason the baby will want very little of the first feedings
offered him, and may lose up to 10% of his weight. For example, a 7˝ lb baby can lose up to 12
ounces before he starts to gain. Most of this weight loss occurs in the 24
hours. By the 4th or 5th
day your baby will begin to show an increased appetite and then a slow but
steady weight gain.
15. Umbilical
Hernia or “Outie” button belly -
It is typical for a baby to have an umbilical hernia. In utero, there was a small opening in the
abdominal muscle wall that would let blood vessels pass from the cord to the
deep organs of the body. This served as
the baby’s lifeline. Once the cord is
off, the muscle slowly grows together and the hernia disappears. For many infants this process is completed by
one year of age. Most others are closed
by 4 years of age.
16. Intestinal
Gas- Babies pass gas freely without control from the gastrointestinal
tract. This gas comes from a
combination of swallowed air and fermentation of food in the digestive process.
It is normal and it is not necessarily the cause of colic.
17. Head molding- The head
shows the stress of labor. The head
will return to its normal shape within 5-7 days after birth.
Jaundice
Jaundice is a yellow or orange color to the skin. It is part of the transition babies make from
living inside mom to living on their own.
On or about the second or third day, two out of three normal full-term
babies become yellow tinted, or jaundice.
This coloring of the skin results from a combination of two normal
processes which involve the immaturity of the infant’s liver and the breakdown
of red blood cells. Bruising of the skin
and the presence of a cephalhematoma makes the occurrence of jaundice more
likely. A small percentage of
jaundiced babies require treatment under the bilirubin lights. This photo therapy increases the baby’s
ability to eliminate the bilirubin. We
will alert you if there is any reason for worry.
Sleeping
The new recommendation of the
Feeding Your Baby
Feeding provides the infant with nutrition, oral gratification, and
emotional fulfillment. Your baby’s early
feeding efforts may be frustrating and appear inadequate. Babies like mothers go through a lot during
the birth process and tend to rest and recover the first 3 or 4 days. They feed better after this initial period.
Breastfeeding
Breastfeeding is a satisfying and fulfilling experience that requires a
minimum of equipment and is no doubt the most inexpensive form of infant
feeding. Breast milk is nature’s formula
for the best nutrition available for your infant. There may be an initial period of learning
when mother and baby are both inexperienced.
It usually takes about 4 to 5 days after the baby is delivered before
milk production begins. Your infant’s sucking stimulates the hormones involved
with milk production. Initially, the
breasts produce a thick, yellow secretion called colostrum which is rich in
antibodies. Colostrum is thicker than
mature milk and may require the infant to suck more aggressively. Unless specified by your pediatrician, early
on the infant does not need additional water or formula. Remember
weight loss is expected during this period.
Feedings are usually started on a demand-type schedule (feeding when the
infant is awake and hungry). Eventually
a pattern will develop and the feedings will be at 2 –3 hour intervals. During the first few days the time spent at
each feeding is short-about 5-7 minutes.
Gradually you will be able to tolerate 15-20 minute periods of
sucking. As you progress you will have
at least one breast emptied per feeding, alternating sides each time (if the
infant seems hungrier both breasts are offered at each feeding). In this way, supply meets demand since the
more you are emptied the more you produce.
If the infant seems sleepy while at the breast, try stroking underneath
his chin towards his neck. This will
stimulate him to suck. With some sleepy
infants it helps to change their diaper before or during feeding. Some nipple discomfort is normal early in
each feeding. However, as the feeding
progresses the pain should subside. If
the pain continues beyond the first minute of the feeding, this is a sign of an improper latching. Unlatch the infant by sliding your finger
between the baby’s mouth and your breast.
Then re-latch the infant ensuring proper positioning. The nipple must go
into the infant’s mouth and rest between the tongue and roof of the mouth. (The gums and lips should cover almost all of
the dark area of the breast.) It may
help to pull his chin down gently with your index finger when his mouth is open
wide, quickly pull him to you and place his open mouth on your breast so that
his nose, cheeks, and chin all touch the breast. Very little air is swallowed at the breast
so breast fed babies require little burping.
Success at breastfeeding involves many factors. Most important is your physical and
emotional health. As a nursing mother,
it is important that you eat well and drink plenty of fluids. Rest is vital since fatigue is the most
frequent cause of failure at breastfeeding.
Emotional stress will further depress milk production. Success, therefore, requires family support
and tranquility. An occasional bottle
feeding of breast milk or prepared formula given by father (especially during
the night) will help keep mother from being over worked and under rested and
allow the father to take part in nurturing his child. We suggest, however, that any bottle
supplements be delayed until about the 2nd or 3rd week
after delivery
We usually do not restrict the mother’s diet if the baby’s behavior is
normal. However, we do recommend that
you avoid caffeine (in excess) and nicotine (cigarettes). Both may cause the infant to be irritable and
restless. Medications you take may pass
into the breast milk and affect the baby, so get a clearance from us before you
take prescription drugs. It is safe to
take Tylenol, mild laxatives and mild cold medicines such as Sudafed or
Robitussin.
Week one Healthy Growth Indicators (from “On Becoming Baby Wise, Szso
and Buckman 1998)
1.
Baby is nursing a minimum of eight times in a 24
hour period.
2.
Baby passes tarry stool, then transitions from
brown to yellow stool by the fourth or fifth day. Number of stools a day 5-15.
3.
By the third or fourth day the baby is producing at
least six wet diapers in a 24 hour period.
4.
The baby is achieving at least 15 minutes of
sucking time at each nursing session.
Storage of Breast
Milk
Breast milk storage recommendations vary according to source. These are conservative estimates.
Freshly expressed
milk storage time:
- Four
hours at 77 degrees room temperature.
- 24 hours
at 59 degrees room temperature.
- 48 hours
in the refrigerator.
- 2 weeks
in freezer compartment inside refrigerator.
- 3 months
in freezer compartment of refrigerator with separate door.
- 6-12
months in deep freezer (0 degrees or lower)
Previously
frozen milk storage time:
·
4 hours or less at room temperature.
·
24 hours in refrigerator.
·
Do not refreeze.
Storing breast
milk:
- If not
used for immediate feeding, refrigerate or freeze milk after expressing.
- Store
breast milk in glass or rigid plastic containers, or in easily, sealed,
sturdy plastic bags. Consider
“double bagging” if using the thin plastic bags used for bottle-feeding.
- Put the
date on the container at the time of collection.
- Store
only two to four ounces in each container, the amount your baby is likely
to take in a single feeding. Smaller quantities are easier to thaw and
avoid waste.
- Do not
fill container to the top. Leave 1
inch of space for milk to expand as it freezes.
- Refrigerated
breast milk not used within 48 hours should be discarded.
- Previously
frozen milk can be kept in the refrigerator for up to 24 hours.
- Previously
frozen and thawed milk should not refrozen.
Cooling and
warming breast milk:
·
Breast milk should be thawed and heated slowly and
carefully. High temperatures can affect
some of the beneficial properties.
·
Tighten container lid as needed to avoid
contamination when warming in water.
·
Thaw frozen breast milk under cool running
water. Gradually increase the
temperature of the water to bring the milk to feeding temperature. Or immerse the container in a pan of water
that has been warmed. Breast milk itself
should not be heated directly on the stove.
·
To bring refrigerated milk up to feeding
temperature, hold the container under warm running water for several
minutes. Or immerse the container in a
pan of water that has been warmed.
·
Do not use a microwave oven to heat human
milk. If the milk gets too hot, many of
its beneficial properties will be destroyed.
Because microwave ovens heat liquids unevenly, there may be hot spots in
the container of milk that can be dangerous for your baby.
Feeding
expressed breast milk:
- Use fresh milk whenever possible.
- When using refrigerated or frozen milk, use
the oldest dated milk first.
- Breast milk may separate into a cream layer
when stored. Shake gently before
feeding to redistribute the cream.
Bottle Feeding
The baby-feeding formulas on the market
such as Similac with iron are based on cow’s milk with modifications to make
them more like human breast milk, thereby more digestible and nutritious. An occasional infant will be intolerant of
cow’s milk and require a milk free substitute such as soybean formula. In some highly allergic families, we may even
start the infant on soy such as Isomil.
The nutritional values of all formulas are essentially equal. They are available as powders, concentrated
liquids, ready to use liquids, and even ready to use bottles.
Formula
Preparation:
If proper precautions are used, sterilization of bottles, nipples, milk
and city water is no longer thought necessary.
Be certain, however that all parts of the bottle and nipple are
carefully washed and rinsed and that no dry milk remains. Carefully, wash bottles and nipples in hot
soapy water and rinse with hot water or run them through a dishwasher. If you have well, spring or cistern water, it
would be advisable to boil the water to sterilize it. As stated above, city water can be used
without boiling. Do not use a microwave
for warming as the milk heats unevenly and may burn the baby.
How much
formula?
Most newborns feed for 15 to 20 minutes and initially take approximately
˝ ounce per feeding in the first 24 hours.
Each day the feeding amount will increase. As your baby grows and gains weight, he will
need more formula. When your baby takes
all of his bottle easily and cries for more, it is time to increase the
amount. Do this adding ˝ to 1 ounce until
satisfied. By 4-5days of age most normal
newborns will take about 3 ounces of formula per feeding. Let the baby tell you how much formula he
wants. Over feeding will lead to an
obese infant.
Feeding with a
bottle
Seated comfortably and holding your baby, hold the bottle so that the
neck of the bottle and the nipple are always filled with formula. This helps your baby to get the formula
instead of sucking air. Air in his
stomach may give him a false since of being full and may also make him most uncomfortable.
Do not prop the bottle and leave the baby to feed himself. The bottle can easily slip into the wrong
position so that he sucks air or he may choke.
Remember, too, that your infant needs the security and pleasure of being
held at feeding time. Do not get into
the habit of putting the baby to bed with a bottle. This habit can cause serious tooth decay in
later months.
Burping
“Burping” your baby helps remove swallowed air. Even if fed properly, bottle and some breast
babies usually swallow some air. Hold
him upright over the shoulder and pat or rub his back gently until he lets go
of the air, or place him face down over your lap and gently rub his back. The baby can also be “burped” by holding him
in a sitting position. (baby leaning slightly forward) on our lap, with your
hand supporting his chest and neck. It’s usually not necessary to interrupt a
feeding to “burp” baby but do it after each feeding. Of course, sometimes baby may not “burp”
because he does not need to, so don’t try to force him. A delayed burp up to 30 minutes later is
normal. The infant may also spit up with
each feeding. Do not be alarmed unless the vomiting is continuous or very
forceful in nature.
Solids
The Council on Nutrition recommends delay in the introduction of solid
feedings until the age of 4-6 months.
All of your baby’s nutritional needs are met by the milk. Delaying the introduction of solids decreases
the risk of developing allergies and digestive problems.
Vitamins
Most babies on formula with iron do not require
extra vitamins. Breast milk contains all
the necessary vitamins and minerals except vitamin D and Fluoride. Breast fed babies need an extra 200IU of
vitamin D per day. This can be started
at the 2 week check up. Fluoride will be
given as a supplement starting at 6 months old if your water is severally
deficient in fluoride.
(<0.3ppm).
CARING FOR YOUR NEWBORN
Bathing
Most infants need a bath only 2-3 times a week. Clean the face, chin, neck, and diaper area
daily. Withhold regular tub baths until
the cord is healed. Use mainly water for
the first weeks. Soaps are drying to the
newborn’s already dry skin. Mild soaps
(Dove, Tone or baby soaps) are used in small amounts. To clean the eyes use a
clean cloth or cotton ball dipped in water.
You may shampoo the baby’s hair with baby shampoos or liquid baby soaps.
Use a soft brush to scrub the scalp.
Never leave your baby unattended in the bath.
Nails
Keep them clean and short. Cut
them squarely across using clippers or scissors. Have someone help you. One of you should hold the baby and the hand
or foot while the other clips the nail.
Navel Care
Care of the navel is especially important since this can be the source
of a serious skin infection. Do not use
a band-aid or other covering over the umbilical stump. The hospital may put on an antiseptic called
“triple dye” which is deep purple. At
home, however, simply clean it four times a day with a cotton ball or Q-tip
soaked in rubbing alcohol. A small
amount of bleeding before and after the cord drops off is normal. Remember, the navel cord is not really a part
of your infant. It is part of the
discarded placenta. There are no nerve
endings there so the alcohol will not burn or sting your infant. He may cry a bit because the alcohol is cold
on his abdomen. Most cords fall off in
two-three weeks.
Diaper Rash
Because babies have sensitive skin, they are prone to have rashes and
irritations, especially in the diaper area.
Usually, irritation is due to prolonged periods of wetness or contact
with fecal material. Prevention and
treatment both require frequent diaper changes.
Exposures of the rash to air for several hours a day, avoidance of
plastic or rubber pants, and thorough cleansing of the area will heal most
rashes. If there is no improvement after
a few days of such treatment, a diaper rash cream such as Desitin or A & D
Ointment, may be used. If these remedies
bring no improvement, we should be consulted.
Uncircumcised Boy
Clean the outside of the uncircumcised penis as you would any other part
of the baby’s body. The foreskin of the
uncircumcised penis is normally attached to the glans of the tip of the penis
in layers of tissue. As the baby grows,
the skin will eventually separate and allow the foreskin to slide back
naturally. You should never try to force
the skin back as this could cause bleeding and possible infections. In some boys, the skin retracts by one year of
age. In others, full foreskin retraction
may occur as late as adolescence. As
long as your baby can urinate normally, you should no be too concerned about
whether the foreskin retracts yet.
Circumcised Boy
If your baby has been circumcised, your doctor will give specific instructions
on how to care for it depending on what type of circumcision is done. If a small plastic ring is attached, simply
clean with solution of 1/2 water and ˝ hydrogen peroxide every diaper change
until the plastic ring falls off (usually about 3-8 days later). If the foreskin is removed completely, you
may be instructed to apply Vaseline on a gauze dressing after cleaning until
the exposed area of the penis is no longer moist.
The Nursery
Your baby should have his or her own room if possible. Furnishings should be of a type that is
easily cleaned so they will not collect dust.
All painted items should be lead free.
The baby may sleep in a bassinet, or you may use a crib from the
start. The mattress should be firm and
flat and protected with a waterproof cover.
No pillow should be used. The
mattress should fit snugly and there should be no more than two fingers width
between the crib and the sides of the mattress.
Bumpers may be used to keep head, arms, and legs form getting caught
between the bars of the crib. Try to
keep the temperature between 68 and 72 degrees.
Provide adequate ventilation, but avoid drafts. Usually, a single baby blanket will be enough
covering even in cold weather.
Clothing
Your baby requires no more clothing than an adult and perhaps less. Make an effort to dress the baby according to
the temperature without overheating him.
If the baby perspires, then he is too warm. Clothing should be loose fitting,
lightweight, and soft textured.
The Pacifier
All babies have an instinctive need to suck. This need goes beyond the sucking that
accompanies feedings and is often confused with a need for more food. If your baby has been fed, but is busily
chewing its thumb or fingers, you may wish to substitute a pacifier.
When your baby cries
All normal newborn babies cry a certain amount of the time, just as they
sleep and suck. During the first few
weeks, crying is about the only way they have of expressing themselves and of
telling you their needs. A baby may cry
when he is hungry, too cold, too warm, has an “unburped” burp, has a wet or
soiled diaper, wants to be held, or just because they feel out of sorts. It is very common for a baby to cry or fuss
at about the same time each day, often in the evening, and they may go on for
quite a while for no apparent reason.
This period of fussiness often causes concern for new parents because
they usually think that their baby is still hungry. It’s tempting to keep offering more milk, but
this seldom really helps for more than a short time. Sometimes, a buggy ride or a warm bath at the
fussy period helps relax the baby.
Holding the baby doesn’t hurt, either.
A reassuring fact about crying is that this causes no physical harm to
the infant, so you need not worry if your baby cries or fusses for a while
before you attend to his needs. In fact,
many new babies fuss for fifteen or twenty minutes after each feeding or before
going to sleep. It is really pretty good
exercise. The amount of time a baby
spends crying peaks at about 8 weeks (3 hours average). By 12 weeks the crying time decreases to
approximately one hour a day on average.
Hopefully this will give you a light at the end of the tunnel!
When to call the Doctor
Sometimes it is very difficult to tell when a newborn is really
ill. It is advisable to call your
Physician if you are concerned. The
following signs should be reported as soon as possible in any infant less than 3 months of age:
- Fever
100.4 or more rectally.
- Listlessness. (Persistent lethargy or inactivity).
- An
unusual amount of diarrhea.
(Remember: stools are normally very loose.)
- Refusal
of food several times in a row.
- Repeated
vomiting (not just spitting up.)
- In a
newborn, jaundice that reaches the abdomen. (Yellow coloring)
SICK CHILD VISITS
Fever
Fever is one of the many symptoms of an illness. It often accompanies many colds and
viruses. Calling the office for a fever depends
on what you think is causing the fever and how ill the child appears. Under
three months, call your doctor for any fever 100.4 or more rectally. For older infants and children, if the
symptoms are mild and the child does not appear to be in distress, treat the
fever with Tylenol or Motrin/Advil to make him/her more comfortable. The fever itself does not cause any problems.
(i.e. brain damage) or will not continue to climb if you do not treat it. Again, we try and reduce the fever only to
make the child feel better. You may have
your child checked by the doctor if there is any change or the fever persists
especially more than three days. If your
child appears acutely ill or is having more discomfort, call us. Look for specific sources of the fever: Does
he hit his ears or complain of earache, is he vomiting, does he have diarrhea,
is he coughing, does he have a headache.
Do not use aspirin to
control your child’s fever due to the link to Reyes Syndrome during viral
illness.
Taking Baby’s Temperature
The rectal thermometer is the gold standard of infant temperature
taking. It is recommended for children
under 3 months of age when it’s important to know the exact temperature so your
doctor can determine the proper course of action. For older babies, there are more
options. When you speak with your
doctor, let him know which method you used.
Rectal
Thermometer
·
Apply petroleum jelly to the thermometer tip.
·
Lay your baby on his belly and hold him steady with
on hand on his back.
·
Gently slide the thermometer about a half inch into
the rectum, then hold it in place between your second and third fingers for two
minutes, or until the thermometer signals that it is done.
Underarm Thermometer
·
Place the tip of the thermometer in the center of
your child’s armpit. Hold his arm
against his chest for two to four minutes.
·
Do not use an arm thermometer in children less than
3 months old because they are not accurate for this age group.
Acetaminophen
(Tylenol) Dosage Chart
|
|
|
Infants |
Children’s |
Children’s |
Junior |
|
|
|
Concentrated Drops |
Susp. Liquid |
Chewable |
Chewable |
|
|
|
80mg/0.8 ml |
160mg/5ml |
80mg each |
160 mg each |
|
Dose |
|
Dropperful |
Teaspoon (TSP) |
Tablet |
Tablet |
|
|
|
Use only the |
Use only the |
|
|
|
Weight |
Age |
dropper provided |
dosing cap provided |
|
|
|
6-11 lbs |
0-3 mths |
Call your Doctor for fever |
|
|
|
|
12-17 lbs |
4-11 mths |
1=(0.8 ml) |
1/2 TSP |
|
|
|
18-23 lbs |
12-23 mo |
1 1/2= (0.8+0.4ml) |
3/4 TSP |
|
|
|
24-35 lbs |
2-3 yrs |
2= (0.8+0.8ml) |
1 TSP |
2 |
|
|
36-47 lbs |
4-5 yrs |
|
1/ 1/2 TSP |
3 |
|
|
48-59 lbs |
6-8 yrs |
|
2 TSP |
4 |
2 |
|
60-71 lbs |
9-10 yrs |
|
2 1/2 TSP |
5 |
2 1/2 |
|
72-95 lbs |
11 yrs |
|
3 TSP |
6 |
3 |
Dosing Schedule-Children’s Motrin
|
|
|
Infants |
Children’s |
Children’s |
Junior |
|
|
|
Concentrated Drops |
Susp. Liquid |
Chewable |
Chewable |
|
|
|
50mg/0.5 ml |
100/5ml |
50mg each |
100 mg each |
|
Dose |
|
Dropperful |
Teaspoon (TSP) |
Tablet |
Tablet |
|
|
|
Use only the |
Use only the |
|
|
|
Weight |
Age |
dropper provided |
dosing cap provided |
|
|
|
6-11 lbs |
<3mths |
Call your Doctor for fever |
|
|
|
|
12-17 lbs |
4-11 mo |
1=(1.25 ml) |
|
|
|
|
18-23 lbs |
12-23 mo |
1 1/2= (1.875ml) |
|
|
|
|
24-35 lbs |
2-3 yrs |
|
1 TSP |
2 |
|
|
36-47 lbs |
4-5 yrs |
|
1 1/2 TSP |
3 |
|
|
48-59 lbs |
6-8 yrs |
|
2 TSP |
4 |
2 |
|
60-71 lbs |
9-10 yrs |
|
2 1/2 TSP |
5 |
2 1/2 |
|
72-95 lbs |
11 yrs |
|
3 TSP |
6 |
3 |
|
|
|
One dose
lasts 6-8 hours |
|
|
|
The Common Cold
A “cold” is the word we use to describe congestion
in the nose and sinus areas caused by virus.
There are many viruses that cause a “cold” and they are all
contagious. Most colds occur in the
winter because people are in closer contact indoors and can spread the virus
more easily. Colds have nothing to do
with how cold it is outside. Many
parents notice their children getting viral upper respiratory infections (a
more specific term for “cold”) as soon as they are around other children, such
as day care or nursery school. The
average preschool child will get 6-10 viruses each year!
Signs and
Symptoms
·
Fever that lasts 24 to 48 hours.
·
Runny nose that lasts about a week or two. At first the drainage will be clear. After a few days, it will change from clear
to yellowish-green and sometimes back to clear.
This is because the constant drainage irritates the lining of the nose
and causes microscopic bleeding. The
tiny blood cells break down and turn yellow and green, just as a bruise turns
color. Do not let this normal color
change worry you. Sometimes this
irritation of the nose will cause a regular nosebleed too.
·
Coughing.
Many parents worry about their child’s cough because it sounds like it
is “coming from the chest”; however, the cough is good because it prevents
mucus in the throat from going into the lung.
Because your child’s chest wall is thin, the large airways (windpipe and
bronchi) project the sound of the cough like a megaphone, so that it sounds and
feels loud and like it is coming from the lungs.
·
Postnasal drainage down the throat. This often causes a sore throat.
·
Achy and tired.
Children often get cranky.
·
Your child may not sleep well at night because the
congestion will wake him/her up. Others may sleep a lot.
·
Your child often does not feel like eating because
he/she either feels too bad or it hurts to swallow.
·
Some children have diarrhea. Others have
constipation because they don’t eat their normal food.
Treatment
·
The cold is a virus. There are no medicines that can cure these
viruses yet. We can only treat the symptoms of the virus. So even if you do nothing, the cold will go
away.
·
If your child is comfortable, we recommend no
treatment.
·
To loosen and /or decrease mucus drainage, you can
use a suction bulb just before eating and sleeping. You can use normal saline nose drops if the
mucus is thick. The drops will loosen
the mucus and make suctioning easier.
You can use these drops as often as necessary since they are
non-medicated. You can also use a
humidifier at night to moisten the air.
This helps keep breathing airways open and reduce coughing.
·
There are some over the counter medications for
children that can help decrease mucus.
The ones we recommend include Sudafed, Triaminic, Dimetapp or
Pediacare. Please read the instructions
on the label for dosage.
·
For children who wake up a lot due to a stopped up
nose, Neosynephrine Pediatric nose drops (1/8% strength) can be used at bedtime
to help dry up the nose. We do not
recommend using this in the daytime or for more than 3 days because using these
drops repeatedly can actually make the nose more stopped up.
·
To help decrease coughing at night, raise the head
in the bed or crib by putting large stable blocks under the front legs of the
bed. Raising the head helps decrease the
postnasal drip pooling in the back of the throat. Older children can usually raise their heads
by using an extra pillow.
·
You may use an expectorant or mild cough
suppressant such as Robitussin DM with your decongestant for coughing. Many over the counter medicines are for
congestion and cough, such as Triaminic DM, Novahistine DMX, Sudafed cough
syrup, and Robitussin CF.
·
Give your child extra liquids to drink, such as
water, juice, Gatorade, flat 7 up. Give
your infant extra Pedialyte. Some
mothers notice that milk seems to make their child’s congestions worse when
they have a cold: other children do fine with milk. Do not be concerned if your child does not
eat very much when he/she has a cold.
His/her appetite will come back later.
·
Use acetaminophen (Tylenol, Tempra, or Liquiprim)
for fever of general discomfort.
When to Call the Doctor
·
If the fever is not gone in 48 hours.
·
If the fever goes away and comes back again a few
days later.
·
If your child’s symptoms get worse instead of
gradually getting better.
·
If your child is under 2 months old (even with a
mild cold).
·
If your child has minor symptoms or seems very ill.
·
Anytime you are anxious about your child, please
call your doctors office.
Ear Infections
Earache is a common complaint in children. If a middle ear infection is present the
pressure change in the middle ear space is causing the earache. Usually the child will also have a fever and
may be quite irritable or complaining of decreased hearing ability. Keep in mind, however, that small children
sometimes have difficulty localizing pain, and thus not all earaches are due to
middle ear infections.
Earaches do not represent an emergency situation, but usually should be
evaluated within 24-48 hours, during our regular office hours. The pain can cause great discomfort and there
are several steps that can help this problem.
Tylenol or Motrin can be given in appropriate amounts. A warm towel or
heating blanket can be applied to the affected ear. Warm oily drops (baby oil, sweet oil) can be
put into the ear canal to help relieve the pain. Do not use the oil if your child has ear
tubes.
If we find a middle ear infection is present, then antibiotics will be
given to your child. Unfortunately these
medications do not cause a dramatic resolution of the earache or fever. It may take 24-48 hours before the child
begins to improve. In general, we will
need to see your child during our regular office hours before prescribing such
a medication.
The complications of ear infections can cause serious handicaps to your
child. We will ask to examine your child
again in 2-3 weeks after an ear infection is found. This visit is to make sure that the infection
responded to the antibiotic and the fluid behind the ear drum is resolving.
Sore Throat
Most sore throats are caused by viruses as is the common cold and are
not treated with antibiotics. Some sore
throats, however, are caused by a bacterium called streptococcus. This typically causes swollen tonsils with
white patches on them, fever and swollen glands under the jaw. All the symptoms, however, can occur with a
viral sore throat as well, so that the exact diagnosis of strep is made by a
throat culture. When strep is suspected or proven, treatment with oral or injected
antibiotics is needed. It is
extremely important to complete a FULL COURSE of antibiotics to clear up the
strep infection and prevent complications.
Stopping the medicine after the symptoms are gone does not kill all the
strep and can allow complications such as, rheumatic heart disease and kidney
disease. Occasionally, a red sand-papery
rash associated with strep throat can be seen.
This is scarlet fever or scarletina. It is not more serous than simple
“strep throat” and the treatment is the same.
Vomiting/Diarrhea
By definition, diarrhea is more frequent or more watery bowel movements.
In some infants it may be hard to distinguish this condition from their normal
stool pattern. It can be caused by a
number of conditions such as: overeating, food allergies, too much juice,
antibiotic usage, but it is usually caused by viruses. Vomiting is the forceful emptying of the
stomach through the mouth. It is usually
caused by viruses as well. If your child
has vomiting and/or diarrhea we will usually advise you to follow the following
regimen:
- Stop all
milk and solid feeding for 24-48 hours except if the infant is
breastfed. For breast fed infants
provide breast milk in smaller amounts than usual, if vomiting continues
put on clear liquids until four hours of no vomiting has elapsed.
- Allow
nothing by mouth for 2 hours to allow the stomach to rest.
- Give only
clear liquids for the first 24-48 hours.
Start with 1-2 teaspoons every 10-15 minutes and gradually increase
to 1-2 ounces every hour if possible.
For children one year and older, clear liquids may include flat,
diluted coke or 7 UP, popsicles, Kool-Aid, Jell-O, or Jell-O water,
Gatorade at ˝ strength or Pedialyte.
For children under one year, the preferred liquid is Pedialyte. Do not use only water because it does not
replenish electrolytes that are lost.
- Once the
vomiting subsides (usually 24-48 hours), then infants may be restarted on
their regular formula. If the
diarrhea is still persistent (it may last up to 1-2 weeks), the infant may
be placed on Isomil DF (or soy formula)
or LactoFree for 1-2
weeks. If the infant is taking
solid foods, he may slowly begin taking such things as bananas, rice cereal,
applesauce, and dry toast. (BRAT
Diet.). Older children may be
started on a bland diet once the vomiting resolves.
- Watch out
for signs of dehydration. We find
that a sensitive indicator of dehydration is how frequently your child is
urinating. In most cases if the
child is urinating every 8 hours or so, he is not yet seriously
dehydrated. A moist mouth is another
indicator of hydration.
- The above
instructions are only guidelines for treating this common problem in
children. If you have any
questions, or feel that our child is becoming dehydrated, please give us a
call. Your child needs to be seen
if:
- He has
no urine output for 12 or more hours.
- No tear
with crying and mouth is dry.
- Blood in
diarrhea or vomiting.
- Severe
abdominal cramps.
- Fever
for more than 72 hours.
- Repeated
forceful projectile vomiting especially if under eight weeks old.
Teething
A baby may begin to erupt teeth as early as 2 ˝ or 3 months of age or as
late as 18 months.
It can cause a baby to be fussy at times as early as 2 months of
age. Your can try one of the
over-the-counter teething preparations to rub on his gums. Sometimes chewing on a hard/cold object may
alleviate some of the discomfort. If
your child appears to be very ill, it is not due to teething, and you should
give us a call. Teething does not cause
significant diarrhea or high fever.
Head Injuries
Notify your doctor if:
- There is
loss of consciousness at the time of the injury or anytime thereafter.
- You are
unable to arouse the child from sleep.
You may allow the child to sleep after the injury but check
frequently to see whether the child can be aroused. Check at least every one to two hours
during the day and two to three times during the night.
- There is
persistent vomiting. Many children
vomit immediately from fright but the vomiting should not persist.
- There is
inability to move a limb.
- There is
an oozing of blood or watery fluid from the ears or persistent oozing of
blood from the nose.
- There is
persistent headache that lasts over one hour. The headache will be severe enough to
interfere with activity and normal sleep.
- Persistent
dizziness is present for one hour after the injury.
- There are
unequal pupils. Be sure your light
is not shining brighter in one eye or that pupil will normally be
constricted. Unequal pupils are
obvious when they are significant.
A small difference in pupil size is normal.
- A pallid
color is noticed that does not return to normal in a short time.
- Slurred
speech develops.
- If your
child has a personality change.
Well Child Visits
We will see your child at the following intervals:
·
Two Weeks
·
Two Months
·
Four Months
·
Six Months
·
Nine Months
·
Twelve Months
·
Fifteen Months
·
24 Months
From this point on we will need to see your child every year until their
6th birthday and every two years after that until they are 18years
of age.
We will also see exclusively breast fed infants at 4-5 days for weight
checks.
Your
Childs Growth Log
|
|
WELL CHILD
GROWTH LOG |
|
|
||||
|
(Use this form to track your child’s growth) |
|
|
|||||
|
Age |
Weight |
% |
Length |
% |
HC |
% |
|
|
Birth |
|
|
|
|
|
|
|
|
2Weeks |
|
|
|
|
|
|
|
|
2Months |
|
|
|
|
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|
4Months |
|
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|
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|
6Months |
|
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|
9Months |
|
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|
12Months |
|
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|
15Months |
|
|
|
|
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|
18Months |
|
|
|
|
|
|
|
|
24Months |
|
|
|
|
|
|
|
Recommended Childhood Immunizations
Schedule
Vaccines are listed under routinely recommended
ages. Bars indicated range of
recommended ages for immunizations. Any dose
not given at the recommended age should be given as a “catch-up” immunization
at any subsequent visit when indicated and feasible. Shaded areas indicate vaccines to be given if
previously recommended doses were missing or given earlier than the recommended
minimum age.