Newborn Care

NEW PATIENTS: NEW MOMS AND DADS
Congratulations! After nine months of anticipation and long hours of labor, you and your new baby are home from the hospital. We know that you’ve been reading many books and getting advice from friends and family. We know that each child is different, so for specific concerns please call our office at 810 220 3700.

If you are home after < 48 hours from giving birth, your baby should see the doctor within the next 2-3 days. At this initial visit, we will check the baby’s weight, look for jaundice and answer questions.

One reason why this first month can be especially difficult is that you are still recovering physically from the stress of pregnancy and delivery. It may take weeks before your body is back to normal, your incisions (if you had an episiotomy or C-section) have healed, and you're able to resume everyday activities. You also may experience strong mood swings due to changes in the amount of hormones in your body. These changes can prompt sudden crying episodes for no apparent reason or feelings of mild depression for the first few weeks. These emotions may be intensified by the exhaustion that comes with waking up every two or three hours at night to feed and change the baby.
If you experience these so-called "postpartum blues," they may make you feel a little "crazy," embarrassed or even that you're a "bad mother." Difficult as it may be, keep these emotions in perspective by reminding you that they're normal after pregnancy and delivery. Even fathers sometimes feel sad and unusually emotional after a new baby arrives (possibly a response to the psychological intensity of the experience). To keep the blues from dominating your life, and your enjoyment of your new baby, avoid isolating yourself in these early weeks. Try to nap when your baby does, so you don't get overtired. If these feelings persist past a few weeks or become severe, consult your pediatrician or your own physician about getting extra help.
With a new baby, constant visitors, an aching body, unpredictable mood swings, and, in some cases, other siblings demanding attention, it's no wonder the housework gets neglected. Resign yourself ahead of time to knowing that the wash may not get done as often as it should, the house will get dustier than usual, and a lot of meals will be frozen or takeout. You can always catch up next month. For now, concentrate on recuperating and enjoying your new baby.

Fathers
Some fathers feel shut off from the child and from the mother's attention and affections, especially if the baby is breastfed. The problem is not helped by the fact that the obstetrician for these usually prohibits sexual intercourse first few weeks. Even if it was allowed, many women simply aren't interested in sexual activity for a while after delivery because of the physical exhaustion and emotional stress they may be experiencing at this time.


A positive way for men to deal with these issues is to become as involved as possible in caring for and playing with the new baby. When you spend this extra time with your baby, you'll get just as emotionally attached to her, as her mother will.

This is not to say that moms and dads play with babies the same way. In general, fathers play to arouse and excite their babies, while mothers generally concentrate on more low-keyed stimulation, such as gentle rocking, quiet interactive games, singing and soothing activities. Fathers tend to roughhouse more, making lots of noise, and move the baby about more vigorously. The babies respond in kind, laughing and moving more with Dad than they do with Mom. From the baby's viewpoint, both play styles are equally valuable and complement each other beautifully, which is another reason why it's so important to have both parents involved in the care of the baby.
Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

Well Child Care

Seeing children and parents at regular intervals is important in maintaining your child's health. Evaluating growth and development, discussing safety, nutrition, behavior and answering age related questions are the functions of well child/adolescent visits. We encourage the following schedule of visits; (the ages mentioned are approximate):

- Prenatal
- Hospital Newborn Exam
- 2-5 days of age
- 2 Weeks
- 2 months
- 4 months
- 6 months
- 9 months
- 12 months
- 15 months
- 18 months
- 2 years
- Yearly visits thereafter
During some of these visits, immunizations will be given and routine laboratory tests may be done.

Vision and hearing tests are also given regularly. We encourage advance scheduling of well childcare. For infants, please schedule your next check up at the end of your visit. Otherwise, we suggest you call 2-4 weeks ahead of the time you wish to be seen. We attempt to schedule older children (5 year and older) for their physicals in the summer to keep sufficient time available to see our sick children during he illness season.

Sick Child Care

Please call us if you are bringing your child in, so that we can have both the chart and a time available. We will see sick children on the same day whenever possible. The best time to call is in the morning.

If you have an appointment for one child but you have an additional sick sibling, please call ahead so that we can accommodate you.

The Common Cold

Colds last from five to seven days, usually with a gradual one to two day onsets, followed by full-blown symptoms.

Young Children can normally get up to six colds yearly; adolescents average two to four per year. Frequent colds in young children are important in building immunities. More than 100 different viruses may cause a cold. This explains why colds can frequently recur in winter.

Children's colds almost always seem worse at night. In daytime the child swallows secretions from his/her irritated nose easily. But in sleep, secretions accumulate in the throat causing a gag or cough. Coughing is a good thing in one sense, for it guards against aspirating mucous into the lungs.

Your child will be more comfortable if the obstruction of his/her nose is relieved. Encourage an increased intake of fluids. Use a cool mist humidifier or a vaporizer..
Use a rubber bulb aspirator to suction the nose of a young infant. Salt water (saline) nose drops help loosen the mucus so it is easier to suction. Commercially prepared saline drops such as Ocean can be used. Use 2 drops in each nostril prior to suctioning. Unless instructed by your doctor, never use decongestant nose drops or sprays in infants and toddlers.

Never use oral cold medicines in infants younger than 6 months because they can cause drowsiness and other side effects. For larger children, follow the package instructions. Try not to use medications unless the child is really bothered by the symptoms.

(Sometimes, they can cause drowsiness or excitability depending on the medication.)

Call our office if:

1. Your child develops a fever of greater than 100.5 degrees Fahrenheit 3 or more days after the onset of a cold.
2. Your child is coughing for longer than 7 days.
3. Your child develops any difficulty breathing more than is due to just a stuffy nose.

DIARRHEA

What is diarrhea?
A virus or bacteria in your child’s intestines can cause diarrhea. This makes your child's bowel movements (BMs) looser and come more often. Mild diarrhea is when your child has a few loose BMs. When the BMs are watery, the diarrhea is severe.
When your child has diarrhea, it is important to make sure your child does not lose too much water. If your child has these signs, he or she could be dehydrated:

• Dry, sticky mouth.
• No tears.
• No urine in over 8 hours.
• Dark urine.

Taking care of the diarrhea can keep your child from losing too much water.
Taking Care of Watery (Severe) Diarrhea
If your baby is less than 1 year old and bottle-fed:

• Give him fluids more often than you would normally and as much as he wants. Fluids prevent dehydration.
• Give your baby Kao Lectrolyte or Pedialyte instead of formula for 4 to 6 hours.
• After 4 to 6 hours, give your baby formula again. You may need soy formulas if the diarrhea is severe or doesn't improve in 3 days.

If your baby is over 4 months old, try:

• Rice cereal, strained bananas, and mashed potatoes.

If your baby is less than 1 year old and breast-fed:

If your baby is over 4 months old, try rice cereal, strained bananas, and mashed potatoes.

If your child is over 1 year old:

If your child does not want to eat solid food, give your child milk or formula rather than water.
Taking Care of Mild Diarrhea

Call our office right away if:

Your child has had more than 8 BMs in the last 8 hours.
The diarrhea is watery AND your child also throws up clear fluids three or more times.
Your child starts acting very sick.
Call us during office hours if:

• There is mucus or pus in the BMs.
• Your child has a fever that lasts more than 3 days.
• The mild diarrhea lasts more than 2 weeks.
• You have other concerns or questions.

Vomiting

Vomiting is usually caused by a viral infection like the “flu”. It can be a sign of a more serious illness, so if your child has vomited at another time, please call the office before instituting these instructions.

Treatment:
Initially give 1 to 2 teaspoons of Emetrol (a non-prescription, harmless medication) every 20 minutes for 1 hour. Then give small amounts (1 to 2 tablespoons) of room temperature clear liquids such as Pedialyte, Gatorade, flattened ginger ale or 7-up, popsicles, or Jell-O water. The liquids should be given every 15-20 minutes, and the amounts may be gradually increased. Do not give milk, solid foods, or aspirin. If vomiting occurs, give your child no liquids for 1 hour, then start again with small amounts of clear liquids or Emertol.

When your child has not vomited for 8 hours, you may start soft solid foods such as applesauce, bananas, rice cereal for babies, and toast, crackers and bland soups for older children. Continue to avoid milk for 24-48 hours.

Call our office if:

• A baby less than 6 months old is not keeping any of the fluids after 4 hours of this treatment.
• Vomiting occurs for more than 12 hours in a child under 6 months, or more than 24 hours in any other age.
• Your child has decreased urination, dry mouth and loss of usual tears (these could be signs of dehydration).
• Your child cannot keep down medications such as seizure medicine or antibiotics.
• Your child becomes confused, agitated, or difficult to arouse.
• There is any blood in the vomit.

Any other symptoms which begin to alarm you.

Constipation

Constipation is the passing of hard, dry, and sometimes painful stools.
Look for these signs:

• In a newborn, firm stools less than a day. Keep in mind that for some infants it is normal to have stools every 3-4 days and not be constipated.
• Stools that are hard dry. And associated with painful bowel movements. However keep in mind that straining is not uncommon for kids and doesn't mean the child is in pain.
• Blood in or on the outside of the stools.
• Stomach pain relieved after having a large bowel movement.
• Soiling between bowel movements. Soiling looks like diarrhea on the child's underpants or diaper. It is liquid that has leaked around a large solid stool.

Keep in mind:

CONSTIPATION: What a parent should do?

For babies 0-6 months of age (and not eating solids):

1. Add extra water to the diet (about 1-3 oz each day).
2. Mix 2 oz. of water and 1 oz. of prune juice and use in one day.

Increase physical activity (for example: playing, rocking, moving legs or gently massaging the infant.)

For babies 4-12 moths of age (and eating solids) or children:

• Encourage your child to drink plenty of fluids. Offer juice or water frequently.
• Give 2 oz. of water (or fruit juice) with 1 oz. of prune juice each day. Do this for 3 days.
• Increase physical activity. For example, allow plenty of floor time for play and movement.

Add high fiber to the daily diet, such as fruits, vegetables, prunes, cooked beans, apricots, plums, peas, broccoli, whole grain breads, whole grain cereal, graham crackers, and bran muffins. Strained foods have little fiber and won't help with constipation.

• Add 1 teaspoon (tsp.) of bran to moist foods such as mashed potatoes, cereals, applesauce, casseroles, or ground meats. Give an extra 2-4 ounces of fluid for each teaspoon of bran you add to the diet.
• If your child needs more, add 1 more teaspoon every 2-3 days. Make sure you give an extra 2-4 ounces of fluid for each teaspoon of bran.

• If the above doesn't work within 3-5 days, call the child's doctor.

FEVER

Fever is part of the body's normal response to infection. Viruses cause most of these infections, but occasionally a bacterial infection may be present. Fevers due to viral infections usually last 2-3 days. Most children with fever will be tired, irritable, and have loss of appetite. Fevers usually increase in the evening and at night. This increase does not necessarily mean that the infection is becoming more serious. The height of the fever does not bear any direct relationship to the seriousness of the illness. High fever of itself is not dangerous and does not cause brain damage. The appearance and overall functioning of your child are of more significance than the actual height of the fever.
An Approach to Fever:

• If fever develops in a child greater than 3 months old who has no other symptoms and acts well, it is safe to wait and see what happens. Fever is a common symptom of colds and flu like illnesses.

Fever in infants less than 3 months of age should never be taken casually. It may represent a serious infection, and a physician should almost always see such children, unless a DTaP shot was given in the preceding 24 hours.