Specific Care

The Cord

Upon discharge from the hospital, cleanse the navel area with soap/water or alcohol 4 times daily or with each diaper change. This keeps it dry and clean. Be sure to clean well in the creases where it is attached. The cord usually falls off between 7-14 days after birth. Florida’s moist warm climate can sometimes delay this up to 1 month. You may notice a few drops of blood from this area when the cord detaches. This is normal. If you feel there is a large amount of blood, we wish to see the baby. Similarly if the skin surrounding the navel is red, swollen and tender, or there are red streaks in the skin over the abdomen around the cord, we want to see the baby. Diapering slightly beneath the cord will assist in drying and healing.

Circumcision

Vaseline applied to the head of the penis with diaper changes for 24-48 hours is usually all the care necessary. It is important that parents observe the nature of the urine stream. It should be forceful. The urine should shoot out, especially when the baby begins to urinate. If your baby dribbles his urine, please notify us.

Breast Enlargement and Menses

Male and female babies may have an enlargement of one or both breasts. There may even be a thin milk- like secretion. Do not massage or manipulate the breast. If they seem to be extremely painful, apply cool applications. Some female infants will have a thin bloody vaginal discharge. Both conditions are due to hormonal influences from the mother and will clear up in time.

Nose

Sneezing is the baby’s way of clearing the nasal mucus and is normal. If this is not sufficient and the nose remains stuffed, instill several drops of saltwater nose drops (1/4 teaspoon of salt in 4 ounces of water) into one nostril. Wait 30 seconds, then aspirate with a rubber bulb syringe. Repeat in the other nostril. The best time for this procedure is prior to feeding or sleeping, since a baby depends on easy nose breathing while he sucks.

Eyes

Often mucus collects on the eyelids and lashes. A moist washcloth is usually sufficient to remove the mucus. Wipe from the inside out. If the whites of the eyes or tissue around the eyes are red or swollen we want to see the baby.

Ears

Only clean the outside of the ears. Do not insert Q-tips into the ear canal. You cannot tell how deep you are going, and more often than not you push the wax further down. You can also damage the eardrum.

Diaper Rash

Diaper rashes are usually due to irritation of the skin from the damp diaper. Wash the diaper area with a soft cloth and warm water. Be sure to spread and clean the creases around the labia of little girls. Pat the area dry with a clean soft cloth. If a rash develops, apply a protective cream or ointment to the skin until healing occurs. This will act as a barrier between the diaper and the baby’s skin. Leave the baby out of the diaper for as much time as possible. You can use a cloth diaper and omit the rubber pants. If the rash does not improve, or if it consists of large water blisters with pus, we want to see the baby.

Stools

There is a wide range of normal stooling patterns. Some infants stool with each feeding, others may go two to three days between bowel movements. If the stool is soft in texture, either pattern is acceptable. Breastfed baby’s stools are typically mustard yellow and seedy and more frequent initially than formula fed baby’s stools. Almost all babies will strain and appear uncomfortable when they stool. Again, if the texture is soft, this is normal and requires no attention. If the stool is hard, and especially if there is evidence of blood streaking, we would recommend giving 1 ounce of prune juice mixed with 1 once of water. If these measures are unsuccessful please call us. We want to discourage the use of suppositories and laxatives and we do not recommend enemas for infants.

Face rashes

Often newborn infants will have pin-point “white headsâ€� surrounded by reddened areas on their face. If these come and go, they require no particular care except routine gentle bathing. If you child has an extensive face rash or appears to have blisters and/or pus, we would like to see your child in the office. Occasionally, your baby’s face will get irritated from drooling and turning his head back and forth on the bed. Gentle bathing and allowing the baby to lay his head on a soft, clean, absorbent cloth diaper will be helpful. Do not use cream or lotions, etc. on the face. However, if the rash on the cheeks is from drooling during sleep, Vaseline applied to the face can help to prevent it.

Bathing

Until the cord falls off and heals you should only sponge bathe the baby. Any basic non-perfumed soap is acceptable. Remember too much soap is drying. Once the cord has healed, tub baths may be used. Gently clean your baby’s face and scalp to remove excess oil and skin debris. A soft washcloth will do the trick. Try to keep the suds out of the infant’s eyes. Your infant’s skin has its own protective oils so commercial oils, lotions, and powders are not usually necessary. Be sure that the water temperature is lukewarm.

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Growth Patterns

GROWTH CONSIDERATIONS

If your baby is gaining weight and growing appropriately, then your particular approach to feeding is working. Remember that your baby’s size is a function of his heredity as well as his nutritional intake. There is a wide range of normal weight gain, so do not worry if your infant seems significantly larger or smaller than another baby the same age. At each well baby check we will let you know what we think of your baby’s growth.

 

Most obesity in infancy is simply due to overfeeding. Nursing moms naturally terminate a feeding when sucking stops and thus obese breastfed babies are few. When there is left over formula, your baby does not have to finish the bottle. If your baby demands more volume or suckling, it is preferable to offer a pacifier. An overweight baby is not necessarily the healthiest one.

 

If your baby feeds poorly or does not appear to be growing well in the first 4 weeks, please feel free to come into the office for us to weigh him and evaluate if a problem exists.

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Newborn Incidents and Problems

NORMAL INCIDENTALS:

1) Crying

Crying is a baby’s way of communicating. It conveys a variety of messages which, with experience, you will come to recognize. At times an episode may reflect the need for a diaper change, at others, it may signify hunger or discomfort. There will be periods when you will be unable to comprehend the cause for the tears. This is not uncommon. It does not necessarily mean there is anything wrong with you, the milk, or even the baby. It may just be normal.

Some babies between 3 weeks and 3 months of age will have a fussy period that lasts for hours. They may draw up their legs and pass gas. They faces may get beet red. They may be very difficult to comfort. Some may respond simply to being picked up and held. For others, rocking or a car ride may break the spell. For these episodic attacks there is usually no magic cure. We are on your side. We know that the noise can be annoying, especially if it occurs when you are trying to do something else (like sleep!) Furthermore, no one likes to see any child cry in apparent distress.

Nonetheless, if these episodes are based on colic or gas we want you to understand the following important points:

  1. There is no magic medicine. If there was, everyone would know about it!
  2. Colic, and the crying associated with it, does not cause the baby physical harm.
  3. The colicky baby does not run a fever or act sick in between spells. He continues to feed well and act bright and alert.
  4. Aside from offering you reassurance and empathy, we urge you to try the following approach: Do whatever simple physical act you can to relieve the baby. Examples are playing soft music, swaddling, swinging and repetitious noise. To try to cut down on the episodes, burp the baby over your shoulder after every 1/2-1 ounce, or between breasts during breastfeeding. Extend the time over which the baby is fed.
  5. Occasionally, when your baby does not respond to various measures, he may only need to be left alone awhile. Crying will cause fatigue and he will then rest.
  6. GET HELP . Allow Dad, a neighbor, or Grandparents to take over care for a short time daily.

If these measures are not successful please call. Despite our recommendations and interest be prepared for some frustration. More often than not, the real treatment is tincture of time.

2) Hiccups/Sneezing:

Hiccups and sneezing are common and of no concern.

3) Temperature:

The best air temperature is a comfortable one — 68-72 degrees. In very hot weather, a diaper will suffice. There is a greater tendency to overdress (and hence, overheat) than to underdress. Overdressing can cause sweating and an irritating heat rash.

4) Out of Doors:

Provided the weather is comfortable, and the baby is dressed appropriately, the newborn infant may go outside almost any time after the first week. Avoid crowded places. Do your best to keep the baby shaded; this is particularly important in Florida. Keep the baby’s head covered with a cap and refrain from sun exposure during the hours of 10:00 a.m. to 3 :00 p.m. – especially near the water. To protect the eyes, we also recommend sunglasses with UV protection.  Do NOT apply sunscreen to infants less than 6 months of age.

5) Visitors:

For the first month especially, we like to recommend as little exposure and handling as possible by visitors outside the immediate family. This is done to minimize the exposure of the newborn to a variety of infectious diseases. Children other than brothers and sisters should probably not have intimate contact with the baby at first.

6) Teething:

This will normally begin between 5-8 months. Drooling and thumb or finger sucking may occur months before this. Teething may cause some local discomfort, which may cause the baby to be somewhat irritable. It does not, however, cause fevers, diarrhea, vomiting, constipation, runny nose, etc. In short, it doesn’t make the baby SICK. Here again, there is no magic medicine. Teething rings may be helpful, as may an occasional dose of acetaminophen (Tylenol). In general, however, nothing but time is required. Teething biscuits and cookies can be dangerous since babies can choke on them. Medications to rub on the gums are not generally helpful.

 

**SIGNS OF ILLNESS**:

We want you to call us if your baby that has the following problems:

  1. Lethargy and listlessness (i.e., lying around, sleeping much more than usual, with or without fever.)
  2. Vomiting repeatedly (not just spitting) especially if the vomitus is green or projectile (very forceful) vomiting.
  3. Refusal to eat several times in a row.
  4. Labored, distressed, or rapid breathing.
  5. Changes of color — especially blueness of the lips and fingernails, or yellow discoloration of the skin or eyes.
  6. Extreme irritability.
  7. Fever greater than 100.4 F.

 

SOME PROBLEMS WITH NEWBORNS :

1) Jaundice

Some degree of jaundice (yellowish discoloration of the skin and eyes) is common and not abnormal for your newborn baby, especially if breastfeeding. If it becomes significant, we occasionally must treat your baby with special light therapy, which may delay discharge home from the hospital. Occasionally, we must follow blood tests for jaundice after discharge, or even re-admit your baby for therapy if necessary.

2) Infection

If you have been ill near the time of delivery, or if your water broke or leaked for an extended period of time your baby may need to be observed closely for any signs of infection. If necessary, your baby may need to be kept in the hospital for evaluation and treatment.

3) Metabolic problems

Occasionally, infants may have problems with the level of blood sugar, calcium, etc. especially if you are diabetic or if your baby is very large for age or premature. Your baby can be treated for these problems.

4) Respiratory problems

Occasionally, a newborn infant can develop breathing difficulties of varying degrees, especially if premature. If this becomes severe, your baby can be better managed in our Neonatal Intensive Care Unit at All Children’s Hospital. We are very fortunate to have this specialized regional facility in St. Petersburg for expertise in the care of the sick newborn.

5) Prematurity

If babies are born before term (less than 37 weeks) the above problems and other may occur, and may require intensive care at All Children’s Hospital.