Infant Care

Congratulations on the birth of your baby! As your pediatric care providers, we are dedicated to providing your newborn infant with outstanding medical care. Our group offers 24-hour telephone coverage, continuity of care, and physician and nurse practitioner accessibility. We have admitting privileges at Beth Israel, Brigham and Women’s, Children’s and Massachusetts General Hospitals.

Caring for your young infant is a full time responsibility and is very rewarding. Common sense, humor, and patience are needed to get you through the occasional rough times. We are available to help during those difficult times. Regularly scheduled well baby check-ups are the time to get your routine questions answered. We offer advice and anticipatory guidance as well as examining your infant’s growth and development. We encourage new parents to call with questions or concerns that can’t wait until the next visit.

We offer the following advice to guide you through the first few weeks with your new baby:

Feedings:
For those who are breast-feeding, we suggest a semi-demand schedule of approximately every 2–4 hours. Wake the baby during the day to feed if the infant has slept more than 4 hours. If the baby has nursed well but wants to suck for prolonged periods, you may offer a pacifier. Use a pacifier judiciously in the first two weeks while your baby is learning to breastfeed. This will help satisfy the baby’s “nonnutritive” sucking urges. Your breasts need time to replenish the amount of milk the infant just drank. On the first day, let the baby nurse for 5 minutes on each breast. Each day increase for 1–2 minutes on each side until nursing is well established. Breast milk usually takes 4-6 days to “come in.” As your milk comes in some babies may have cluster feeding periods where they feed more frequently, every 1 1/2 hours. This is normal but should not necessarily continue the whole day. The American Academy of Pediatrics and the World Health Organization recommend breastfeeding for 6-12 months. We support this recommendation but realize that this is not possible for every family. Centre Pediatrics would like to support every breastfeeding mother. We have developed a list of resources that may be helpful.

If you are feeding with formula, a schedule of every 2–4 hours is usually effective. By two weeks of age, most infants are taking 2–4 ounces per feeding. Wash the bottles and nipples with hot, soapy water. It is not necessary to boil the water. Please do not heat bottles in a microwave oven as it can result in hot spots and burn the baby’s mouth.

Jaundice:
Many babies, especially those who are breast-fed, become jaundiced in the first 5-7 days of life. Jaundice appears as a yellow discoloration of the skin and eyes. If this yellow color is increasing or extends beyond the face to the belly or diaper area, please call the office.

Stools:
Breast-fed infants usually have frequent, loose, yellow-green movements, often following each nursing. Formula fed infants may also have loose, yellow-green movements, but their stools tend to be a little firmer than those of breast-fed infants. The frequency may vary widely. Some infants have bowel movements with every feeding, and others may go for several days without a bowel movement. Additionally, it is normal for a baby to pass gas frequently.

Urine:
You should pay attention to your baby’s urine output. Urination should occur several times a day, should be effortless, and there should be a good stream of urine. The frequency will increase after the first several days and should then be at least every 4 hours.

Cord care:
You don’t need to do anything special to your baby’s umbilical cord; it will fall off on its own between 7 and 21 days of life (the old recommendation was to apply isopropyl alcohol 3-4 times a day until the umbilical cord fell off; the current recommendation is to do nothing). Your baby’s umbilical cord will often ooze small amounts of blood. You only need to call the office if this persists or if the cord oozes large amounts of blood. You should feel free to give your baby a regular bath before the umbilical cord falls off; getting water on the cord is fine.

Bathing:
Mild soaps or liquid baby cleansers are recommended. You may bathe your baby 2–3 times per week or as necessary. Most babies’ skin will dry crack and peel. Lotion is only necessary if the skin is cracked or irritated. Most infants develop several rashes on the face and body during the first few months and those rashes generally do better when left alone.

Boys:
If your baby boy has been circumcised, apply Vaseline or A&D ointment to the area for 5–7 days to prevent adhering to the diaper. If your boy is not circumcised, gentle cleansing of the penis and foreskin is all the care that is necessary. At birth, and for months afterwards, the foreskin is adherent to the head of the penis and cannot be pulled back.

Girls:
Your baby girl has external genitalia that should be gently cleansed with diaper changes. A normal mucousy vaginal discharge mixed with blood often occurs toward the end of the first week due to the withdrawal from the maternal hormones. The bloody discharge is brief, does not recur and should not alarm you.

Diaper rash precautions:
A&D ointment and Vaseline are effective in preventing diaper rash. Peri-anal creams, such as Desitin, Diaperene, and Balmex, contain zinc oxide and are better for healing when a rash is already present. The best prevention, however, is frequent diaper changes and not allowing your baby’s skin to be in contact with urine or stool for prolonged periods. Baby powders are not usually needed. If you do use one, make sure the powder is shaken into your hand and then applied to the baby’s skin. This will prevent the baby from inhaling powder into the lungs where it can be harmful. Persistent diaper rashes warrant a call to the office.

Vitamins:
Breastfed babies need vitamin D supplementation because mothers who live in places like Massachusetts (where the sun doesn’t shine in the wintertime) don’t make enough vitamin D in their skin to secrete enough vitamin D in their breast milk. Vitamin D is important because it works with calcium to build strong bones and teeth. Therefore, all exclusively breastfed babies need to take a liquid vitamin called D-ViSol or PolyViSol; they need to take 1cc (or 1 milliliter) of either of these by mouth every day. There is also a concentrated Vitamin-D formulation, D-Drops or Carlson’s, which is also recommended. Other than one of these, we do not usually recommend vitamins before the age of 4 to 6 months. At that time, we will discuss the use of fluoride and other vitamins with you on an individual basis.

Immunizations:
Vaccinations start at birth and will be discussed at each visit. We strongly believe that a complete immunization program is an essential part of preventive pediatric care.

Sleep:
The American Academy of Pediatrics strongly encourages back sleeping as the preferred position as this position had been shown to decrease the incidence of Sudden Infant Death Syndrome (SIDS). That said, it is important for babies to have time on their stomachs every day. Tummy time allows babies to work on strengthening their necks (so they can lift their heads up) and upper bodies. Tummy time also helps prevent the flat-back-of-the-head scenario (fancy term = plagiocephaly), which has been the only negative sequela of the back-to-sleep campaign. The AAP also strongly discourages allowing your infant to sleep with you in your bed due to the real risk of suffocation.

Fever:
Fever is one of the only ways babies can tell us they may be sick. If your baby feels warm or is not act your baby feels warm or is not acting the way he usually does (i.e. he is not feeding as well or is fussier than usual), you should check your baby’s temperature rectally. Rectal temperatures are the only accurate temperatures in babies. If you baby’s rectal temperature is 100.4 degrees or higher. We want you to call our office immediately. We take fevers in newborns so seriously because babies with rectal temperatures of 100.4 degrees or higher in the first 3 months of life have a 10% chance of having a serious bacterial infection such as a urinary tract infection, bacteria in the blood, pneumonia, or meningitis. If your baby has a rectal temperature of 100.4 degrees or higher, we will send you and your baby to the emergency department for a full evaluation.

Health and Safety Tips:

  • We recommend that healthy, full term babies sleep on their backs
  • When traveling in a car, the baby must be securely strapped into an appropriately sized infant seat in the back seat of the car. Infants should be rear-facing until 12 months of age, regardless of weight.
  • A smoke alarm in the baby’s room is an excellent idea and you should inquire about a “tot finder” sticker for the window.
  • Do not put any jewelry around the baby’s neck.
  • Do not leave an infant unattended with a family dog or cat in the room, and closely supervise toddlers around your newborn baby.
  • Do not feed an infant honey or corn syrup, or use them to sweeten food or water. Infant botulism, a neurological disease, has been associated with the use of honey and corn syrup in infants under one year of age.
  • Do not give your baby any medicines or over-the-counter vitamins or any other products unless you have a specific recommendation from us.

Contact our office if:

  • Your baby has a fever of 100.4 degrees or greater rectally.
  • Your baby has consistent poor feeding, refusing the bottle or breast.
  • Your baby has poor urine output, dry diapers.
  • You find blood in a stool.
  • Your baby has projectile vomiting.
  • Your baby is inconsolable, constantly crying and cannot be calmed for more than 3–4 hours.
  • Your baby is jaundiced, has an increasing yellow discoloration.