Newborn Care

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.  Choosing to use a pacifier can help satisfy the baby’s “non-nutritive” 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. Virginia 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.  Your baby’s umbilical cord will often ooze small amounts of blood. You only need to call the office if this persists, if the cord oozes large amounts of blood, has bad odor or there is redness and swelling of skin around umbilical cord.

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. Using lotion is not necessary unless 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 A&D ointment or petroleum jelly to the area for a few 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 is effective in preventing diaper rash. Peri-anal creams, such as Desitin, Butt Paste, 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.  Persistent diaper rashes warrant a call to the office.

Vitamins

Breastfed babies need vitamin D supplementation because mothers 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/Sol or PolyViSol; they need to take 400IU of either of these by mouth every day. There is also a concentrated Vitamin-D formulation, D-Drops or Carlson’s, which also can be used.

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 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 100.4F (38C) degrees or higher please call our office immediately. We take fevers in newborns seriously because babies with rectal temperatures of 100.4F degrees or higher in the first 3 months of life have a much higher chance of having a serious bacterial infection such as a urinary tract infection, bacteria in the blood, pneumonia, or meningitis.