On behalf of Glendale Pediatrics, congratulations on the birth of your baby. The first two weeks are a time of getting to know one another, and you may feel overwhelmed by the new responsibilities. You may find that you will hear a lot of advice from friends and family as well as from books. Our goal is to help you to navigate through all of this advice and simplify the care of your child. Child care is more art than science. We have included home care information for your newborn as well as a discussion of commonly asked questions. For any other questions or concerns, please feel free to call our office during our regular office hours.
Are you expecting a new baby?
For new, expecting parents, once a month, we host a "Meet and Greet" session to introduce you to our office. Come by, see our office, meet one of our doctors, and have your questions answered. Call our office at 818-246-7260 to find out when our next "Meet and Greet" is scheduled. Spaces fill up quickly. Reservations required.
Will my doctor see me in the hospital?
If you are delivering at one of the hospitals that we have privileges at (Glendale Adventist Medical Center and Huntington Memorial Hospital), one of our physicians will see you and examine your baby every day while you are in the hospital. Simply state the name of one of our pediatricians when you arrive to the hospital, and they will inform us. If you are delivering at a different hospital, your baby will be seen by one of the hospital staff pediatricians. Once you are told that you are being discharged home, the pediatrician will let you know when you need a follow up appointment with us (usually one or two days after discharge). Please call us on the day of discharge to schedule your newborn's first appointment with us.
IMPORTANT REMINDER TO THE PARENTS OF OUR NEWBORNS
Please remember to add your new baby to your insurance plan within the first 30 days after birth. If this deadline is missed, many insurance carriers may exclude coverage of what they consider to be pre-existing conditions that developed during the first month of your baby’s life.
Babies feed very irregularly in the first few days. They may not easily waken for feedings for the first two days. You need to wake your baby to offer to feed him/her at least every two to three hours in the daytime by unwrapping the blanket, sponge-bathing the baby, or changing the diaper. At night wake your baby every three to four hours for feeds. If your baby refuses feeding or falls asleep while feeding, try undressing and stimulating him/her. Feeding “skin to skin” may stimulate more feeding. If your baby still refuses, this is OK. Try again in another hour or two. As long as your baby is otherwise healthy and urinating at least once in the first 24 hours and twice in the second 24 hours, do not worry. Also, try to feed more often in the day, so that your baby gets used to awakening more during the daytime.
After the first three days, your baby should be feeding vigorously at least every two to three hours and urinating four to five times per day. If this is not occurring, call the office. Feed your baby on demand, which may mean that he/she eats as frequently as every hour. After the baby has regained all of his/her birth weight, we do not usually recommend waking the baby for feedings at night.
Breastfed babies will tend to feed more frequently. Aim for 8-12 feeds in 24 hours. Alternate the breast with which you start nursing and burp the baby between breasts. Initially nurse for five to ten minutes per breast. Gradually increase feeding time to ten to fifteen minutes per breast. Be sure that the baby’s gums are behind the nipple on the areola (the dark skin around the nipple).
All babies lose weight within the first few days until mom’s milk comes in (usually by the 3rd to 5th day). Unless there is a medical reason, there is no need to supplement with formula. Babies who receive frequent bottles in the first weeks often start refusing the breast. However, if your milk has not come in by 80-90 hours of life, some supplementation may be necessary. If you are having nursing problems, we have a very experienced lactation consult, Miranda Johnson-Haddad, in our office. We also have Medela breastfeeding supplies available for purchase and rent.
At 2 1/2 to 3 weeks of age, breastfeeding is usually well-established, and we recommend that you start introducing a bottle of either your expressed milk or formula at least every other day. This is to prevent bottle refusal, allowing you to both nurse and bottle-feed your child. Most babies who are not already taking a bottle by one month of age, will refuse all bottles.
We generally recommend that you start with a standard milk-based formula, such as Enfamil Newborn, Similac Advance, or Good Start with DHA & ARA. Offer one-and-a-half to three ounces every two to three hours. Burp the baby after one ounce.
Newborn babies sleep an average of 16 to 22 hours per day. The safest position for your baby to sleep is on his/her back for the first six months (until he/she can roll over by him/herself). The sleep space should be sparse, with no pillows, heavy blankets, sleep positioners, stuffed animals or hats. Wake and stimulate your baby more and respond more quickly during the day. At night, respond more slowly and feed the baby in dim light with little noise to encourage day-night recognition. Swaddled babies often sleep longer.
In the first few days the baby may have an orange-pink spot in the urine. This is from uric acid crystals in the urine and is normal. Babies should urinate at least once during the first 24 hours and at least every eight hours in the first few days until the feedings increase or the milk comes in. If this is not occurring, recheck the baby’s diaper. Disposable diapers will only feel heavier, but often not wet. If there is no sign of urine, try giving some extra feedings or supplement with a little formula. If no urine is forthcoming, call the office. You may find it helpful to keep a chart of feedings, urination, and stool for the first week.
After four to five days of life, the urine should increase to five to six times a day or more.
Babies usually stool at least once in the first 24 hours. Initially, the stools will be thick, sticky, and very dark green, almost black; this is called meconium. You may find that keeping a coating of Vaseline on the baby’s bottom will help you to clean off the very sticky meconium stools. Over the next few days, the stools will change color to light green, yellow, or orange. They may be soft, mushy, liquid, or seedy. This is all normal. Bottle-fed babies may initially have two to seven stools per day. Breastfed babies may have a stool after each feeding (up to twelve or more per day). Babies may pass three to four small stools in several minutes (one bowel movement). After one month of age, many breastfed babies start stooling much less frequently, sometimes as infrequently as every seven days. If she is not bloated or uncomfortable and the stools are not formed, this is normal.
Cord Care and Diaper Changes
Over the first two days the cord will become dark and hard. If the clamp is not ready to be removed by the time you leave the hospital, we will remove it in the office. The cord will fall off on its own between one to four weeks of life. Keep the cord dry to facilitate its falling off. Fold the front of the diaper under so that the diaper is well below the cord and the stump is exposed to air. Check the cord every time you change a diaper. If it is moist or a little bloody, you can clean it with alcohol. Sponge-bathe the baby (every two to three days) until the cord falls off. Call immediately if there is any foul-smelling discharge, actively dripping blood, or redness extending beyond the umbilical stump onto the abdomen.
Avoid using commercial wipes for diaper changes in the first month or so. Newborn skin is often very sensitive and can develop rash with exposure to wipes. Instead, use a soft cloth or Viva paper towels and warm water to clean your baby’s bottom. You may also wish to use a barrier cream to prevent diaper rash. Examples of barrier creams include Desitin, Balmex, Aveeno, A+D, and Vaseline.
Congestion, Sneezing, and Hiccups
Most babies will sound congested and sneeze considerably over the first few days. The congestion may persist for more than a month. You do not need to worry unless the baby is having difficulty feeding because of blocked nasal passages. In that case, you may use nasal saline irrigation solution and a bulb syringe to help clear the nasal passages. Be careful not to overuse the bulb syringe and thus cause more swelling of the nasal passages.
Babies hiccup frequently in the first months. This will bother you more than it bothers the baby. Burping may help.
Crossing Eyes, Irregular Breathing, and Tremors
Many babies will periodically have crossing or wandering eyes. This is normal and decreases over the first two months of life. Let us know at your appointment if this is still occurring beyond two months of age or is continuous. Infants can initially see about the distance of the crook of your arm to your face.
Babies also tend to have irregular breathing patterns, called periodic breathing. Parents often notice that their infant will breathe very fast for a few seconds, and then pause for a few more seconds before breathing again. This is normal as long as your child does not have any color changes or consistently fast breathing.
Babies often have tremors (shaking of their arms and legs) over the first month. This is a normal startle reflex which will cause them to suddenly throw their arms open, draw them near, and cry. Swaddling your baby can help her to startle or tremble less frequently, and thus cry less.
Females may have a creamy-white vaginal discharge for the first week or two. There may be some blood in the discharge. This is normal and will resolve in a few weeks.
After the circumcision, we will place gauze with antibiotic ointment on the penis to help protect the penis from sticking to the diaper. For five days, continue to reapply gauze with Polysporin with every diaper change. It often takes about one week for the penis to fully heal. As the site heals, you may notice a yellow tissue covering the head of the penis. This is likely normal healing (granulation) tissue. If you are worried about an infection, give us a call.
We perform circumcisions both in the hospital after birth and in our office (until two weeks of life).
Most babies will have a yellow discoloration of their skin between one to five days of age called jaundice. The discoloration starts at the face and eyes and spreads downward. If the jaundice is at the face and shoulder level, this is not concerning. If it progresses to below the umbilical cord or if your baby looks very jaundiced and you are unsure, call the office. Frequent feedings and indirect sunlight to your baby (in just a diaper) lessen the degree of jaundice.
Normal baby rectal temperature is 98.5 to 100.3. Do not feel you need to take your baby’s temperature regularly, but if your baby is excessively fussy or sleepy, we recommend you take a rectal temperature. Fever in a baby under six weeks of age is concerning. If your baby is in a warm room or is over-wrapped, she may have an elevated temperature. If your baby has a fever of 100.4 or higher rectally that does not resolve with unwrapping, please call our office or the doctor on call immediately.
Rest and take as many naps as you can. Nap when the baby sleeps. You should not be burdened with entertaining guests for the first few weeks. Avoid any visitors who are sick, including those with minor colds. Try to limit visitors and phone calls to a specific time of the day. Allow friends and family the opportunity to help you when they offer.
"Baby blues" and post-partum depression are very common are the birth of a baby. We have resources for post-partum psychologists, so please call our office if you are concerned that mom may be showing signs of post-partum depression.
Babies cry for any number of reasons. This is the only way that your baby has to communicate his/her needs. He may only need a diaper change, less coverings, or some cuddling. Try to evaluate what your baby needs. When babies cry, they swallow large amounts of air and therefore need to burp or pass wind more.
Many babies begin to have a fussy time around two to four weeks of age. This usually occurs in the evening and lasts two to six hours (usually three to four hours). This fussy time gets worse for a few weeks and wanes by three to four months. This is a time when babies are more awake and sensitive to their surroundings. They are easily sensory-overloaded. Generally, some sort of rhythmic motion helps calm them. Massages, stroller rides, swaddling, swinging, and dancing are among things that can help. A car ride usually helps if all else fails.
If your baby is fussy during and/or after feeding (when most babies are calm), he/she may have gastro-esophageal reflux or colic. Call the office during office hours so that we can help you sort this out.
If your baby is excessively irritable and cannot be consoled, or if your baby is excessively sleepy and will not arouse for two or more feedings, call our office or the doctor on call immediately.
Erythema Toxicum (a migrating red rash that often looks like flea bites) and Milia (white dots typically over the nose) are common rashes in newborns and no need for worry. Peeling skin (especially over hands and feet) is also normal. Lotion is not recommended for newborns.
What to Expect in the First Year. A. Eisenberg.
Nursing Mother’s Companion. K. Huggins.
Infants and Mothers. Brazelton.
The Happiest Baby on the Block. H. Karp.
Care of Your Baby and Young Child: Birth to Age Five. AAP, S. Sheldon.