Health & Wellness




Newborn

As new parents watching your baby grow and develop, you will experience many new things, most exciting and rewarding. There will be, however, many problems and questions which will arise. As long as your baby is well-loved, well-fed, warm and comfortable, he/she will do well. Remember, we are available to help with these issues, no matter how trivial they may seem. Loving your child, common sense, and the ability to adapt to particular situations are the keys to successful parenting.


Babies are Babies


All babies sneeze, yawn, burp, have hiccoughs, pass gas, cough, grunt and strain at stools. They may occasionally look cross-eyed. Sneezing is the only way a baby can clean his/her nose of mucous or milk. Hiccoughs are little spasms of the diapragm muscle and are harmless. Coughing is the baby's way of clearing the throat. Nasal congestion, causing a "snuffling" sound, is common. This is not usually a cold unless accompanied by nasal discharge. Crying is his/her way of saying "I'm hungry, I'm wet, I'm thirsty, I want to turn over, I'm too hot, I'm too cold, I have a stomach ache," or "I'm bored." You wll gradually learn to know what your baby means. The baby just may need to suck, or be cuddled, or may just be expressing him/herself.


Feeding


The choice of whether to breast or bottle feed is up to you. Whichever you choose, we will try to help support you in maintaining the best possible care of your infant.

Vitamin supplements are not needed for formula fed infants. Exclusively breastfed infants may need to take a daily vitamin - your doctor will make the recommendation.

Click here for feeding handout.


Breast Feeding


We strongly encourage breast feeding. Even if the mother is returning to work and can breast feed for only a few weeks, it is still well worthwhile. While adequate milk supply will take a few days to become established, you should start nursing soon after birth to encourage milk production. Find a comfortable place to sit with good back support so you can relax. Nurse the baby on a demand feeding schedule. In general, let your baby nurse until satisfied, starting with approximately 5 minutes on each side and gradually increasing the duration of the feeding to approximately 30 minutes of nursing per feeding. Begin each feeding with the breast used last in the previous feeding. Newborn babies should generally eat every 2-3 hours, to equal 8-12 feedings a day.


Formula Feeding


Always hold the baby. Never prop the bottle in bed or leave the baby unattended while feeding. Burp the baby during and after each feeding. Spitting up is common and should be of no concern.

Infant formula offers a good alternative to breast milk and provides all the nutrients that most babies need the first 4-6 months of life.

As the baby's milk needs grow, the amount offered is increased so that the bottle is just barely emptied or only a little is left.

All formulas may be given to babies as cool as room temperature, depending on the infant's preference, unless otherwise stated by the doctor. The baby may drink from a bottle over a one hour period of time; after one hour the remaining formula should be discarded and a new bottle prepared for the next feeding.


Formula Preparation


Ready Mixed - The individual bottles are opened, any standard sized ring and nipple attached, and the baby is fed. Any milk remaining in the bottle should be discarded. The bottles may be cleaned and reused if you make up a formula, or they may be used for water.

Quart Sized Ready Mixed - The top is cleaned with hot water and soap, then opened with a clean punch can opener. The amount needed is estimated and poured into a clean bottle. The opened can is kept covered in the refrigerator until empty. Discard unused formula after 48 hours. Any formula left in the bottle is discarded, and the nipple and bottle thoroughly cleaned before reuse.

Powdered - Each can of powder contains a small plastic measure. For each level measure 2 oz. of warm tap water is added in a clean bottle. Put the water in the bottle first, then add the powder. The mixture is shaken and is then ready to use.

Concentrated Liquid - The top of the can is cleaned with hot water and soap, rinsed well, and opened with a clean punch can opener. The formula is poured into a clean bottle; an equal amount of tap water is added, the nipple put on, and thebaby fed. The opened can is kept covered in the refrigerator until empty. Discard unused formula after 48 hours. Any formula left in the bottle is discarded, and the nipple and bottle thoroughly cleaned before reuse.


Schedule


Feeding schedules should remain flexible, and the baby allowed to eat when hungry. Breast fed babies commonly feed every 2-3 hours, while formula fed babies go 2 1/2 - 4 hours between bottles. It takes at least two hours for the infant's stomach to empty after eating, so crying less than two hours after the last feeding is seldom due to hunger. If the baby sleeps more than 4 hours between feedings during the day, he/she should be awakened to feed. After the parents have gone to bed, the infant should be allowed to waken you for feeding.


Skin/Cord/Circumcision


The navel should be kept dry until the cord falls off, usually in 10-14 days. This means not washing the navel with water, and keeping the diaper down low enough so that the wet diaper does not cover the navel. Sponge-bathe your baby with mild soap and water until the cord has fallen off and healed. Some oozing and bleeding from the stump is normal. The cord can be cleaned with an alcohol swab 1-2 times per day. Once the navel has healed, your baby may be put in water for bathing.


If your baby has been circumcised, put some Vaseline on the sore area and cover with a gauze pad at each diaper change. Continue this until the area has healed, usually 7-10 days.


If a diaper rash develops, apply Desitin or Zinc Oxide ointment to the inflamed area at each diaper change and do not use plastic or rubber pants until the rash has healed. Dry skin rashes will be helped by baby lotion applications. Do not use oil or powder on the baby's skin.


Bowel Movements


Bowel movements may vary from as often as following every feeding to as infrequently as every 3-4 days. Even though the baby may strain, unless the stool is hard and pellet-like, he/she is not constipated. It is perfectly normal for a baby to pull his/her legs up, grunt and cry while having a bowel movement. This helps to push the stool out.


Vaginal Discharges


Occasionally a light grey, bloody vaginal discharge may be seen in the newborn female. This is a normal occurence. Likewise, the baby's breasts may be swollen for a few weeks, even in males. Massaging the swollen breasts is unnecessary and may be harmful.


Comfort


The temperature of the nursery is right if it feels comfortable to an adult. A baby needs as much clothes or cover as an adult - do not overdress your baby. Your baby's mattress should be firm and level, and no pillow should be used. Fresh air is fine for a new baby. An infant may go out at any age, but exposing the baby to direct sun rays is not advisable.


Safety


To reduce the risk of SIDS, it is recommended that an infant be placed on his/her back to sleep. When your baby rides in the car, he/she should be placed in an approved car seat that is properly strapped into the car. Rear-facing infant seats should be used from birth until the child is 20 pounds and one year old. A rear-facing car seat should not be used in the front seat of car. Foward-facing seats may be used for children from 20-40 pounds. Until 57" or 4 feet 9 in., a booster seat is recommended. At around 8-9 years old and 4'9", most children are big enough to use an adult seatbelt. Without proper restraint, a seemingly minor accident can lead to tragedy.



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Common Childhood Illnesses



Fever


Most of the time, fever indicates that some type of infection has started. In many cases, the fever is gone in a day or so and the child becomes better. This is usually a short-lived viral infection. Temperatures of 100.5° F rectal or below are considered normal. If the child is under 2 months of age and the temperature is above 100.5° F rectal, please call us.

Rectal temperature of 103-104° F is common in ordinary childhood illness and is not necessarily a reason for great concern. Most high fevers seem to occur at night. To lower the temperature, give Tylenol or another Acetaminophen product, using the following dosage guidelines:

AGE WEIGHT (lbs) DOSAGE -
Concentrated Infant Tylenol Drops 		DOSAGE -
Tylenol Children's Suspension
8 Wk - 3 Months 8-11 0.4 cc every 4-6 hours --
4-11 Months 12-17 0.8 cc every 4-6 hours 1/2 tsp
12-23 Months 18-23 1.2 cc every 4-6 hours 3/4 tsp
2-3 Years 24-35 1.6 cc every 4-6 hours 1 tsp
4-5 Years 36-47 2.4 cc every 4-6 hours 1 1/2 tsp

The rule of thumb for Tylenol drops is 0.8 cc per 10 pounds of weight, every 4-6 hours. Aspirin should not be used in children unless specifically directed by your physician. In some cases, Ibuprofen (Advil, Motrin, etc.) may be effective in reducing fever.

Tub bathing your baby with fever is generally not necessary unless the fever is over 104° and is not coming down with treatment. Bathe with room temperature water. Do not use alcohol. Dress the child in light, comfortable clothing. Call us if the fever does not respond to medication or your child is very lethargic or has persistent vomiting.


Click here for our handout on childhood fevers.


Vomiting and Diarrhea


Vomiting and diarrhea are common in infants and children. The most significant problem that can develop is dehydration. If your child has good urine production, tears in the eyes, or saliva in the mouth, he/she is not dehydrated. For vomiting, nothing should be offered by mouth for 2 hours. Then offer 1/2 ounce of clear liquid (Pedialyte) for infants under 12 months (Gatorade for older children) every 1/2 hour for 2 hours, then 1 ounce an hour for 2 hours.

When symptoms have subsided, you may gradually resume a normal diet. For diarrhea, the child can take liquids. Milk or fruit juice should be avoided. At this point, you may gradually resume a normal diet, restricting only milk for the next 1-2 days. If the symptoms of either vomiting or diarrhea persist more than 2 days, or the child seems ill, please call us.



Poisoning


If your child has swallowed a poison, call the office or Poison Control Center (404-616-9000) immediately. Most poisonings can be prevented by the proper storage of drugs and household cleaners and chemicals. Request that all your prescriptions be dispensed in child-proof containers.


Office Visits


One of the purposes of routine visits is to assess your child's growth and development at key intervals. In thefirst few months, these visits are more frequent because infants grow and change rapidly. At certain visits, tests will be done to check for anermia, hearing, vision and cholesterol. The schedule of office visits may change periodically due to changing recommendations for immunizations. Our current schedule of routine visits is linked below.



Vaccines


Our practice strongly believes in adherence to the American Academy of Pediatrics (AAP) and Center for Disease Control (CDC) guidelines for childhood immunizations. It is the policy of our practice to immunize all children as recommended within the guidelines set forth by these organizations.

Flu Vaccine


This year, in addition to flu shots, we will offer FluMist (an intranasal vaccine) to our patients. FluMist is an option for children 5 and older who don't have certain health problems. Please read the attached vaccine consent form to see if your child is a candidate for FluMist.

We tentatively expect to offer FluMist and flu shots beginning sometime in September or early October, depending on the vaccine availability and shipment. As always, we are available to answer your questions about these and all other vaccines.

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Copyright 2006 Peachtree Park Pediatrics LLP, All Rights Reserved
3193 Howell Mill Rd NW, Suite 250 - Atlanta, GA 30327-2100 - ph:404-351-1131 - fax:404-351-3515