BOWLING GREEN INTERNAL MEDICINE AND PEDIATRICS, ASSOCIATES

 

 

NEWBORN AND GENERAL INFORMATION BOOKLET

 

 

 

 

 

Baby’s Name: ______________________

 

Date of Birth: ______________________

 

 

AUGUSTA MAYFIELD, MD PAUL KNIERY, MD

KELLY KRIES, MD  KEVIN KELLY, MD

1701 ASHLEY CIRCLE SUITE 200

BOWLING GREEN, KY  42104

(270) 846-4800

 

 

 

 

 

 

 

 

 

TABLE OF CONTENTS

 

 

Welcome to the Practice                                                                                   1

In the Hospital                                                                                                  1

General Tips for Phone Calls                                                                             1

Common Newborn Characteristics                                                                   2

Jaundice                                                                                                           3

Sleeping                                                                                                           3

Feeding Your Baby                                                                                          4

·        Breast Feeding                                                                         4

·        Bottle Feeding                                                                          6

·        Burping                                                                                    6

·        Solids                                                                                       7

·        Vitamins                                                                                   7

Care of the Newborn                                                                                        8

·        Bathing                                                                                     8

·        Nails                                                                                        8

·        Navel Care                                                                               8

·        Diaper Rash                                                                             8

·        Uncircumcised Boy                                                                   8

·        Circumcised Boy                                                                      8

·        The Nursery                                                                             9

·        Clothing                                                                                    9

·        Pacifiers                                                                                   9

When your baby cries                                                                                       9

When to call the Doctor                                                                                    9

Care of the sick child                                                                                        10

·        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

General Office Information                                                                                17

Fees and Payments                                                                                           17

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.

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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.

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General Tips for Phone Calls

  1. Please call during regular office hours for general pediatric questions.  We will return your call the same day.
  2. 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.
  3. 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.
  4. Please take your child’s temperature prior to calling for advice regarding an illness.
  5. 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.
  6. 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.
  7. For life-threatening emergencies when moments count, call 911 or take your child to the closest emergency room for stabilization.  
  8. For poisonings call the Poison Control Center at 1-800-722-5725, and then call your physician.
  9. 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.

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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 7½ 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.

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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.

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Sleeping

The new recommendation of the American Academy of Pediatrics is to let babies sleep on their backs.  Recent studies show a decreased incidence of SIDS (Sudden Infant Death Syndrome or “crib death”) when babies were put to sleep on their backs instead of their stomachs.   If your baby has a tendency to spit up a lot or is premature and has respiratory or breathing problems sleeping on the side may be preferred to sleeping on the back.  Discuss this with your baby’s physician if you have concern.  The risk of SIDS over all is low and decreases after 6 months of age.  It is important for your baby to have regular “tummy time” during awake times.  This helps get your baby used to lying on his stomach and to raise up his head and chest as he develops stronger back and neck muscles.  It also prevents a commonly seen flattening of the head when babies are always kept on their backs.  If you start to notice this flattening of the head on one side or the other you will need to alternate sides for sleeping and increase “tummy time” during wake hours to correct this.  The mattress should be firm and flat and no pillow should be used.  Protect the mattress with a waterproof cover.  Be sure there are no gaps between the mattress and the side of the crib.

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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.

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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.

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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 ½ 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 ½ 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