|Newborn CareTwo-Month ExamFour-Month Exam|
Diet: Breast milk or formula.
Separate information on nursing and infant feeding is available from the office.
Take the suction bulb in the bassinet home with you. If it’s not much use for stuffy noses, it will make a good squirt gun or ear wax cleaner later. (see “snuffles”)
Acne: Pimples and blackheads often appear about three weeks after birth and last about two months. (Keep this in mind for scheduling photographs.) Wash face, as you do the body, with soap and water, about every three days.
Activity: You may take the baby out at any time after the first week. His natural resistance levels are very high during the two months. Use common sense, however. Avoid family gatherings, crowds and people with snivelly noses.
Your baby may sleep in his own room from the day he comes home.
Bathing: After the cord has fallen off, you may tub-bathe your baby. Daily bathing can dry out a child’s skin but the drying is minimized if you use a thick moisturizing cream after each bath (below). Usually, a bath every third day is plenty for newborns. Use mild soap, such as Dove® or Basis®. Use baby shampoo for the head and scrub up scales with a washcloth or toothbrush. You may use either soap or shampoo on the face. After the bath, while the skin is still soaking wet, apply a cream such as Aquaphor®, or Eucerin® cream, to hold in the moisture and minimize peeling.
Babies can be bathed in a sink with a hand towel on the bottom. Be careful to avoid hot spigots and scalding water. If possible, adjust your domestic hot water heater down to 125° F to minimize accidental scalding risk (and save fuel).
Portable “tubbies” are very useful. There is an urn shaped plastic tubby on the market that holds babies very securely. The most fun and secure way to bathe your baby is to take him into the tub with mother or father. Babies like very warm bathwater. Adjust the temperature to a level that would be comfortable for you.
Bottles, sterilizing: If you are using bottles, your baby will do well with standard “milk” nipples or contoured “Nuk”® nipples. Playtex® nurser kits offer no real advantages. In this geographical area it is not necessary to sterilize bottles or nipples. Dishwasher, or scrupulous hand-washing and rinsing is all that is needed.
Bottles, heating: the chill of refrigerated milk and formula bottles can quickly be taken off by sitting the bottle in a container of hot water for a few minutes. Then, swirl the milk to distribute heat and eliminate hot spots and test a few drops on the inside of your wrist. Microwaves can be used but be very careful- it’s easy for microwaves to leave scalding spots- mix the milk carefully and test the milk against your wrist carefully before giving the bottle to your baby. Some babies will drink cold milk. But why should they?
Burping: It is natural for infants, whether bottle or breastfed, to swallow air with nursing. During the first month, it is often hard for baby to get this air up, which may contribute to cramping. It often takes experimenting to figure out the best way to burp your baby. For starters, try this: let him nurse or feed until he stops- this means he’s full of milk and air. Try burping, then let him go back for seconds.
Car seats: Massachusetts has strict infant car seat regulations: rear-facing car seat until age 1; forward facing car seat after age one until child weighs 40 lbs.
Booster seats until age 9 or height of 4’9. Sit in the rear until age 12 away from the front airbag.
Car seats are very confining and your baby, like everyone else, needs pit-stops during a long trip to get out and stretch.
Circumcision: We are glad to discuss the pros and cons of routine circumcision with you.
Circumcision Care: Put a glob of Vaseline® on the tip of the penis to reduce chafing. Minor bleeding or oozing can be stopped with light pressure with a clean cloth.
Colic: Screaming, cramping, gassy spells. Colic occurs occasionally in all newborns, frequently in some, who may show a consistent “crying time”. Colic is often made worse with solid foods. Do not confuse colic with hunger pains. Colic is treated best by soothing holding, walking, and tight swaddling with a receiving blanket or infant swaddler. The Ultimate Treatments, are the expensive but durable front infant carriers, which may be worn on the chest of any adult. Cinch it high to save your back.
Some nursing infants are colicky because they are intolerant to something their mother’s diet, most commonly cows’ milk. Ask us about this and we can work out a diet plan to test for this possibility.
Constipation: Babies’ stool will vary tremendously in consistency and frequency, regardless of feeding regimen. At this age, your baby hasn’t been around long enough to have a “regular” anything. Nursing babies will normally stool anywhere from six to seven times a day to once every three to seven days, and patterns may change daily, all other factors being the same. The color may be green, yellow, or brown. Consistency may be runny, gooey or semi-formed. Some children never have formed stools.
If your bottle-fed baby has not pooped for three days and appears uncomfortable, you can often stimulate a bowel movement by inserting an infant-size glycerin suppository into his rectum. If the problem persists, try diluting each four ounces of formula with an extra ounce of water. Next, try adding 1/2 teaspoon of Dark Karo® syrup to a bottle twice daily. Call if these remedies do not help.
Cradle Cap: Cradle cap, or seborrhea, is a common and normal scalp rash. Cradle cap looks like yellowish, sometimes greasy scales on a baby’s scalp, face and ears. You may scrub this rash with a washcloth or toothbrush and baby shampoo twice weekly. Don’t be afraid of the soft-spot.
Diapers: We recommend paper diapers for their convenience. In terms of rashes, there is little difference between paper and cloth diapers. You might save a great deal by buying diapers by asking the store manager if you can buy by the case.
Diaper Rashes: It is not necessary to use a diaper cream with each changing. Should a rash begin, use a heavy application of Desitin® ointment, which forms a second skin and protects the skin from further urine contact. The rule with diaper rashes is to keep the skin protected and dry and avoid over-bathing, which can further break down the skin. “Wet wipes” are convenient to keep in your diaper bag, but they may irritate your baby’s skin if used a great deal. At home, just wipe off your baby’s bottom quickly with a damp washcloth.
Dress: Stretch sleepers or sacks are very handy. Wrap the child snugly in a receiving blanket and, depending on weather, a blanket. Babies are fairly resistant to slight temperature changes. Set the thermostat at your usual setting. During the summer, your baby may sleep in an air-conditioned room. The baby is covered appropriately when his hands and feet are slightly cool, and his body is warm. Infants generally lie slightly flexed when they are comfortable. If your baby is completely stretched out, or tightly bunched up, he is likely too warm or cold.
Ear wax: When you bathe your baby, gently bathe his ears with soapy water, then wipe away any ear discharge and blot his ears dry. Getting bath water into your baby’s ears will not cause ear infections. Keeping his ears clear of wax, however, will make our job of examining his ears much easier when he does get sick. Q-tips tend to pack wax into the ear, even when used carefully.
Eye discharge: Common for the first two weeks. Dab it away with tap water and cotton balls. If thick and yellow or green, call for advice.
Feeding: Should you start cereal? Generally a bad idea. Your baby will grow more quickly on breast milk or formula than on cereal which is just a starch filler. His digestive tract is still immature does best on a liquid diet.
Hiccoughs are very common and often start prenatally- that’s what a lot of those “kicks” were. They will go away on their own. Occasionally a sip of tapwater will help break them up.
Safety: Use a car seat at all times! (This recommendation is important and also is state law.) Massachusetts law requires than an infant face to the rear in his car seat until age one.
Sleeping accommodations: Your baby’s crib should have a firm mattress. Sheets and other mattress covers should be taut and secure. Do not allow your baby to sleep on a water bed, or a regular bed covered with a soft surface such as a sheepskin. Crib bumpers aren’t needed.
Sleeping position: Because of the possibility that a baby’s sleep position can increase the possibility of sudden infant death syndrome, the AmericanAcademy of Pediatrics recommends that all infants sleep on their backs for the first few months. In practice, we find that some babies can’t settle down in this position. If this is the case with your baby, give us a call so we can talk it over.
During the day when your baby is awake and you are with him, encourage your baby to spend some time on his tummy.
Change your baby’s sleeping position frequently so he doesn’t always sleep on one side of the back of his head. If he continually sleeps on one side, his head will get flat on one side. The flattening improves with time, but in the short run the flat head can look very strange.
Snuffles: Commonly appear about one month. Mucous that you can see in the baby’s nose can be suctioned out with an “ear syringe” if it seems to interfere with his feeding. Rattling mucous in the back of the throat sounds worrisome, but is harmless, even though you can sometimes “feel it” in the chest. Salt water drops, (1/2 teaspoon salt in 1 cup of warm water) 1 – 2 drops to each nostril can help congested babies breathe a little easier. You can also buy a commercial salt water preparation like “Ocean” drops at the pharmacy.
Umbilical Cord care: The cord usually falls off between 1 – 2 weeks of age. If it looks “soupy” swab it with rubbing alcohol twice a day. The cord is insensitive and can be pushed back and forth to clean around the base well. If there is some bleeding around the cord, simply apply mild pressure with a clean cloth.
Visitors / Help: The first month is a period of recovery, physical and social readjustment. The mother will undergo a dramatic physical, hormonal and fluid readjustment which may produce sharp mood swings, night sweats, hot and cold flashes. The result of these changes and lack of sleep, is extreme fatigue. We encourage fathers to stay home the first week or longer, if possible.
Household help, as distinguished from visitors, can be a tremendous relief. Friends and relatives can make the first few weeks more enjoyable if they help with household work or caring for other children. However, don’t fall into the common trap of playing host and hostess.
Post a sign on the door to turn away well-intentioned, but uninvited guests. If you are fortunate and can afford to hire help, we suggest you hire a housekeeper, not a nurse. Let others take care of you, or let housework go undone, so that you can have time for the baby.