By now, you should start feeling a little more comfortable with your baby. You are starting to realize when your baby cries for hunger, cries for attention, or cries when in pain. Your baby is also becoming comfortable in his new world. He is learning patterns related to eating and sleeping. He is learning how to interact with his environment and he is gathering information which affects his emotions and actions. This, in turn, helps him to feel content, safe, and secure.
Breast milk or formula continues to be your child's basic source of nutrition for the first 12 months of his life. Your baby will not require any solid foods until 4-6 months of life. Babies tend to know how much they want to feed and when they want to feed. Learn your baby's feeding cues.
Bottle Feeding - Typically, a bottle-fed baby will feed every 3 to 4 hours, taking 2 to 4 ounces each feeding (about 3 ounces per pound over 24 hours).
Breast-Feeding - Breastfed babies will typically nurse for 5 to 20 minutes per breast, every 2 to 3 hours. Because of the nature of breast milk, breastfed babies will feed more often, have a more active digestive system, and have more frequent bowel movements than formula fed babies. Bowel movements will be looser, and in some cases, be no more than a release of gas. Moms of breastfed babies should continue to take prenatal vitamins. Breastfed babies should be given vitamin D (sold as "D-vi-sol" or "Just D") once a day until they turn 1 or are no longer fed breast milk.
Hygiene and Safety
Umbilical Cord - There is no need to clean the umbilical cord. The cord usually dries and falls off between 14-21 days. Sometimes there is a small amount of blood; this is normal. Give only sponge baths until the cord completely comes off.
Bathing - Daily baths are not necessary; every 2 — 3 days is satisfactory. Use only lukewarm water on the baby's face and a mild soap without added scents or dyes) for the rest of the body. Make sure your water heater is kept to less than 120° F.
Nails - Keep your baby's nails short. Do not use mittens because they will prevent your baby from exploring his environment with his fingers.
Diapers - Change diapers frequently to prevent rashes. Rashes are due to prolonged exposure to urine and/or stool. The new absorbent diapers may feel a lot drier than they actually are. Try to provide a good barrier between the diaper and your baby's bottom (Vaseline, diaper creams). Avoid talc.
Circumcision - We suggest that your baby is circumcised only if you choose. There is no increased risk of infection for those uncircumcised males who maintain good hygiene techniques. Most decisions to circumcise are made according to social and cultural factors - a family decision.
Vaginal Discharge - Girls often have a slight clear discharge from the vagina; that is normal. Also normal is slight vaginal bleeding that starts around the seventh day and lasts 2 or 3 days.
Dressing - Babies are usually comfortable in one more layer than what you are wearing.
SIDS - We recommend that babies sleep on their backs, in their own bed, in order to decrease the incidence of Sudden Infant Death Syndrome (SIDS). There is a 75% decrease in SIDS for those infants sleeping on their backs. You can further decrease the risk by breastfeeding, using a pacifier during sleep, running a fan in the baby's room, having the baby's bed in your room, and by having no smoking in the home. We recommend swaddling the baby. Sleeping on the back may cause some flattening of the back of the head. You may want to have your baby's head facing one direction for a few nights, then the other direction for a few nights. This will help keep your baby's head rounded instead of flat.
Infection - Babies have immature immune systems. Going outside is NOT dangerous, but exposure to large numbers of people should be avoided. Other than siblings, exposure to children and ill adults should be limited. It is best to limit exposure until your baby is 2 months old. The best way to prevent illness is through thorough hand washing either with soap and water, or a hand sanitizer like Purell. Call the office immediately for temperatures greater than 100.4° rectally. Do not give any medicines without speaking with our office first.
Smoking - Smoking around the baby, or smelling like cigarette smoke, can increase your baby's risk of asthma, sinus infections, ear infections, SIDS, and other respiratory illnesses. One of the best "gifts" you can give your baby is to stop smoking.
Chairs/Cribs - Never leave your baby unattended on a table, couch, bed, or other elevated surfaces. Make sure that crib slats are no more than 2-3/8" apart on your crib. To decrease the risk of suffocation, do not put pillows, stuffed animals, bumper pads, or extra blankets in the crib. When traveling in a car, never have the baby in your lap. Use only an approved rear-facing infant car seat that is placed in the middle of the rear seat.
Illness Warning Signs - You should call us if you think your baby is sick. Some warning signs in the first month are:
- A temperature of over 100.5° when taken rectally (THIS IS SERIOUS IN ANY BABY YOUNGER THAN 2 MONTHS, so call the office immediately)
- Refusal to nurse or take a bottle
- Repeated vomiting
- Not urinating at least every 8 hours
- Being very restless and irritable or difficult to wake up at feeding time
- Looking sick, or "just not right"
Advance Preparation - You may find it convenient to purchase in advance from your drug store: a rectal thermometer, liquid acetaminophen (Tylenol), a cool mist vaporizer, an infant nasal aspirator. Check with us before administering any medication.
Never leave your baby unattended on any elevated surfaces. Keep the crib free of loose bedding, bumpers, and/or stuffed animals. Test smoke detectors monthly. Do not attach pacifiers or any other object, to your baby. Do not place strings or necklaces around your baby's neck.
Development and Behavior
Motor Skills - Your baby's movements will start as quivering and jerking, but by the end of the first month, the movements will be more fluid. Your baby may start to push up on his arms when lying on his stomach. By the end of this month, your baby may bring his hands to his mouth and eyes, keep his hands in a tight fist and have an increase in neck control.
Vision - By the end of the first month, your baby may start to focus on objects as far away as three feet. Your baby may start to track and follow objects and faces. Newborn eyes are still weak and may occasionally become cross-eyed. Eventually, this will disappear and your baby will be able to recognize more complex patterns and shapes. Babies will always prefer to look at a human face.
Hearing - Your baby will pay close attention to the human voice. A baby will turn to the direction from which the sound is coming. An annoying and loud sound will eventually be ignored by babies. This is their way of protecting themselves. By the end of the first month, your baby's hearing will be fully mature, and he will be able to recognize sounds and voices. It is never too early to read to your baby!
Fussiness - Many babies have a crying or fussy period lasting from 10 minutes to 4 hours each day. Occasionally, babies will have more than one fussy period a day. Most fussy periods tend to occur late in the afternoon and early evening. Crying is your baby's way of communicating. It does not always mean that your baby is hungry. Your baby will cry to be fed, to be held, to go to sleep, and to play. Babies who are responded to, tend to eventually cry for shorter periods of time. Carrying your baby helps to establish trust, prevents SIDS, and helps to prevent flat heads. The time not to respond to your baby is that time when you are feeling frustrated and angry. Let someone else take a turn at meeting your baby's needs. NEVER SHAKE YOUR BABY.
Sucking - Some babies require more sucking in the first few months than others. Sucking does not necessarily mean that your baby is hungry. Thumb sucking and pacifiers are not harmful, but they do have their advantages and disadvantages. In general, look for a one-piece, solid pacifier with a large mouth guard. Do not tie a pacifier around your baby's neck. It is best to wait until 3 to 4 weeks of age to introduce a pacifier to a breastfed baby (to avoid nipple confusion).
Spitting-Up - Some spitting-up is normal. It always looks worse than it actually is. Apart from being messy, there is usually no cause for concern unless your baby has poor weight gain or is overly irritable. Spitting-up does not indicate a need to change formulas. To minimize spitting-up, feed your baby in an upright position, burp your baby frequently, and try to keep your baby upright for 15 to 20 minutes after each feeding.
Bowel Movements - Many infants appear to have difficulty passing even soft stools. Straining, turning "red in the face", and infrequent stools are all part of normal intestinal development. All babies have their own bowel patterns, ranging from one with every feeding to one every several days. By definition, constipation refers to the "hardness" of the stool, not the frequency. Straining with bowel movements does not indicate the need for a formula change.
Sleep - The amount of sleep each infant requires varies a great deal. Typically, a newborn will sleep a total of 14-20 hours a day. This total amount of sleep may randomly be divided into anywhere from eight 2-hour periods to four 4-hour periods. You can help a baby realize that it is sleep time by keeping your baby in a quiet room with minimal activity at night, and in a more active area of the house during the day.
Toys - During the first month, your baby will enjoy mobiles with contrasting colors and patterns, looking at mirrors securely attached to the crib, soft music, and toys with colors and patterns. But remember, babies will always prefer interacting with another human instead of a toy.
Interaction - Try to figure out what your baby is saying to you. Respond to your baby. This will build a positive sense of self and a desire to communicate. Talk and sing to your baby. Offer your baby many lots of different objects to look at, touch, and even grip. Play "tracking" games by moving yourself and interesting objects back and forth. Babies are most stimulated by big, bold patterns; and the colors black, white, red, and yellow. Your baby will first only move his eyes, but eventually, he will move his head.
One of the important roles of a pediatrician is to prevent illness. This is why we like to perform well-child visits so that we have time to examine your child and observe potential problems, to provide anticipatory guidance, and to provide vaccinations to prevent devastating diseases. The vaccination is one of the most important tools to prevent illnesses and diseases.
Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine - Whooping cough (pertussis) is a very dangerous disease, especially for infants. The risk of suffering and death caused by whooping cough is far greater than the possible side effects of the vaccine. A child who has not been immunized against pertussis has a chance of 1:3000 of getting whooping cough. In contrast, a child who got the vaccine is estimated to have a chance of 1:2,000,000 of having neurological damage with the vaccine. The risk of children getting pertussis increases if fewer children are immunized. Parents should make sure they have had their Pertussis (Tdap) booster shot.
Haemophilus influenza type b (Hib) Vaccine - Contrary to the way the name sounds, the Hib vaccine does not protect against the flu. Haemophilus influenza is a type of bacteria that can cause several life-threatening diseases in young children such as meningitis, epiglottitis, and pneumonia. Before the vaccine was available, over 10,000 children in the U.S. developed Haemophilus meningitis each year. About 500 of them died and 3,800 became mentally retarded, blind, deaf, or got cerebral palsy as a result of the disease. Because of the vaccine, Haemophilus influenza type B is now uncommon in the U.S.
Hepatitis B Vaccine - Vaccination against hepatitis B prevents this type of hepatitis and the severe liver damage that can occur 20 to 30 years after a person is first infected. More than 5000 adults die each year in the U.S. from hepatitis-related liver cancer or cirrhosis. The younger the age when the infection occurs, the greater the risk of serious problems. Adolescents and adults are at the greatest risk of contracting hepatitis B, but we are immunizing all children in order to have "herd" immunity. If all children in the U.S. are vaccinated, there will be no more hepatitis B when these children become adults.
Polio Vaccine - The polio vaccine protects children from this crippling disease. The inactivated vaccine (IPV) is now recommended for all polio doses.
Pneumococcal Vaccine - Pneumococcal infections are serious infections that may cause pneumonia, bloodstream infections, meningitis, and ear infections. There are many types of Pneumococcal bacteria, and this vaccine protects against the most common types in the U.S. Like all vaccines, the risk of suffering and potential death is far greater than any possible side effect of the vaccine.
Rotavirus Oral Vaccine - This vaccine prevents a stomach infection called Rotavirus. Although most infants will do well when they have this infection, a few may have such severe diarrhea that they must be hospitalized due to dehydration. The intention of this vaccine is to prevent the risk of hospitalization and in some cases, death, resulting from dehydration secondarily to Rotavirus infection.
Measles, Mumps, and Rubella Vaccine - These diseases are nearly gone from the U.S.; however, they will come back if children are not fully immunized. There have been several outbreaks of Measles in communities with under-immunized children. There has been a lot of recent controversy surrounding this combination vaccine, but all of the research has been unable to support any connection between this vaccine and developmental disorders. As with other vaccines, the risk of suffering and potential death is far greater than any possible side effect of the vaccine.
Chickenpox (Varicella) Vaccine - The chickenpox vaccine is recommended in order to prevent the complications associated with the disease. Although many people remember "suffering" through chickenpox without any major difficulties, before the vaccine, more than 5000 children a year had been hospitalized and more than 500 children had died due to complications from chickenpox. The vaccine may not prevent chickenpox in all individuals, but it will decrease the duration of the illness and the chance of complications like pneumonia, meningitis, or lifetime balance problems.
Influenza Vaccine - It is recommended that all children 6 months and older get the influenza vaccine yearly, in order to prevent any chance of becoming severely ill or becoming hospitalized because of the flu.
Very small infants often accept the first injection easily, since they are not expecting it. The vaccinations become more difficult, however, with every succeeding shot. Simply providing love and warmth helps children of all ages accept immunizations. We prefer to administer as many vaccines as possible during a single visit because it is better for your child to get over the discomfort on a single day than draw out the fear of the doctor visit from month-to-month.
No one should lie and tell a child that a shot will be painless. Some health providers suggest telling them that it "stings" a little and to count to five while it is being administered. One study reported very good results with a breathing technique - the child is told to inhale very deeply right before the shot and blow out very hard as the injection is given.
Giving a sweet fluid before the shot and a little reward, such as nursing or feeding the baby immediately after the shot is very helpful. Sugar has actual mild pain relieving properties for infants. Likewise, you can give some Acetaminophen (Tylenol) if you think your child is in pain or has a fever due to the vaccine. It may reduce your baby's immune response to vaccines if given routinely after vaccines, so we recommend giving Acetaminophen only if the baby is uncomfortable or has a fever.
Unwarranted Reasons Not To Vaccinate - Many children in the U.S. have not received all of the recommended immunizations. Unnecessary precautions have led parents to postpone or cancel scheduled immunizations. The following list of conditions are NOT routine reasons for postponing or canceling immunizations. That is, a child can still be immunized even if one or more of the following conditions is true:
- Your child had soreness, redness, or swelling at the injection site after a previous vaccine injection
- Your child had a fever of less than 105° F after a previous vaccine injection
- Your child has either had or currently has a mild illness such as a cold, cough, or diarrhea without significant fever
- Your child has been exposed to an infectious disease
- Your child is taking antibiotics
- Your child was born prematurely
- You are pregnant or currently breastfeeding
- Your child has an allergy (except egg allergy in some instances)
- Your family has a history of seizures or Sudden Infant Death Syndrome (SIDS)
Symptoms of Severe Reactions to Vaccinations - Call the office immediately if a child has any of the following symptoms:
- Extremely high fever. A rectal temperature of 105° F or higher. (Temperatures taken under the arm, or in the mouth, may tend to be lower)
- Inconsolable crying. Your child has been crying for over 3 hours without stopping or has a cry which does not sound normal (high-pitched), despite using a pain medication.
- Seizures. This is usually secondary to fever. Febrile seizures are not dangerous, but you should notify our office regardless.
- Shock. Your child collapses and turns pale or unresponsive. (call 911 first)
- Severe Allergic Reaction. Swelling of the mouth and throat, wheezing, breathing difficulties, and dizziness. (call 911 first)
Call the office within 24 hours if your child has any of the following symptoms:
- Injection site is still red and swollen
- Fever does not improve or if he is still fussy
Your next visit is your 2 Month Checkup
At your baby's 2 Month visit, look forward to receiving more information on Breastfeeding, Developmental Expectations, and advice on ensuring a continuing healthy baby. Contact us if you would like information sooner.