* There is no "right" feeding schedule that works best for all babies. We recommend a compromise between a strict feeding schedule and a demand-type feeding pattern. Try feeding your baby every 2 to 4 hours during the daytime and allowing your bay to sleep as long as he or she wishes at night. The size of your baby and his or her degree of fussiness may influence the frequency of feeding. In most cases, babies initially feed once or twice each night. By 2 months of age, about one-half of new babies sleep through the night (6 to 8 hours) without awakening.
* Breast milk or formula alone is the best diet for your infant during the first few months. Starting baby food early may cause allergies, hard or lose stools, spitting up, or rashes. Early feedings may also cause your baby to gain too much weight too quickly. Contrary to common belief, adding solids to the baby's diet does not usually help the infant sleep through the night sooner. If your baby seems hungry, he or she may be pacified by extra sucking, by drinking more milk or formula (either more frequently or in larger amounts), or by drinking plain water. Solids are not usually recommended until the baby is 4 to 6 months old, or until the baby weighs more than 15 pounds.
* The baby's first stools contain meconium, a thick sticky substance that is tarry and dark brown in appearance. The frequency and consistency of the baby's later bowel movements may vary from day to day. Some babies stool after each feeding, while others stool daily or every 2 to 4 days. Pasty, seedy, curdy, or runny (like pea soup or heavy cream) stools are all normal. Normal stool color is mustard yellow, but it may also be green or brown. Breast-fed babies usually have looser and more frequent stools than formula-fed babies.
* Straining while stooling is common and does not indicate a problem. If the stools become hard like pebbles, or watery with only small flecks of soled, they are not normal. When such stools occur 3 or 4 times in a row, please call for advice.
DIAPER AREA AND SKIN CARE
* When changing diapers, wash urine and stool from the baby's bottom with plain water. A bland soap may occasionally be necessary. Packaged moist wipes are useful, but avoid those that irritate your baby's skin. Petroleum jelly (Vaseline) may be used at each diaper change to protect the skin from urine and stool.
Mild diaper rash is best treated with a bland protective ointment such as Balmex, Desitin, or plain zinc oxide. These ointments can be removed easily by gently wiping them off with baby oil. Successful treatment of diaper rash requires exposing the affected area to the air. Dry the diaper area will even before applying ointment, and consider cutting the elastic leg bands out of disposable diapers to allow more air-drying. If the rash becomes worse despite treatment, especially when it looks like a weeping burn or pus-filled pimples, the skin may be infected, and you should call for advice.
* If your baby has been circumcised, no special care of the circumcision is necessary. To protect the skin from urine and stool, petroleum jelly (Vaseline) may be applied at each diaper change for the first week or so until healing is complete. An uncircumcised penis also requires no special care. Do not retract the foreskin forcefully, as you may cause irritation or bleeding. Cleaning beneath a tight foreskin is not necessary for good hygiene during infancy.
* Female babies sometimes have a thick creamy or bloody vaginal discharge, caused by mother's high hormone level during pregnancy. It is normal and should be no cause for concern. When discharge occurs, gently cleanse the baby's vaginal labia folds from front to back (top to bottom) with water or baby oil.
* Dry skin can be treated with a bland baby lotion. If a heat rash develops, baby powder with a corm starch base may be applied. The baby's skin should not be powdered directly because he or she may breathe in the powder. Instead, sprinkle powder into your hand before wiping it onto your baby.
* Many babies develop mild jaundice or yellowing of the skin that is harmless. On occasion, severe jaundice may require treatment. If the skin has a "pumpkin" color if the yellow coloring is visible on the baby's palms, soles or stomach, call for advice. When looking for jaundice, the baby should be examined in daylight or under fluorescent light and should not be wearing yellow garments.
CARE OF THE UMBILICUS (BELLY BUTTON)
* The umbilicus should be exposed to air as much as possible. It is not necessary to apply alcohol or other antiseptic solutions to prevent infection – they may also prolong the time needed for healing. Air drying can be done by placing the top of the diaper below the belly button. The scab will usually fall off 5 days to 4 weeks after birth. Associated bleeding or oozing at that time requires no treatment other than swabbing the area clean.
* Sponge baths may be given daily or every 2 days until the baby's belly button is healed and dry; you may then place the baby in a tub. Use a bland soap and rinse it completely from the skin to prevent irritation and rashes.
* It is normal for babies to have crying or fussy periods each day. Most commonly these episodes occur during the early evening and can last for two or more hours. Babies who have excessive and intense crying are sometimes said to have infant colic. Many home remedies are used but few are universally successful. In most cases, colicky babies show marked improvement by 3 months of age. If you believe that your baby has colic, please call for advice.
* Babies should sleep on a firm crib mattress or a similar firm surface. Waterbeds, quilts, comforters, sheepskin, and other soft surfaces are not safe for your baby. During the first 5 or 6 months the safest sleeping position for baby is on its back. Some experts believe that the face-down position may interfere with the baby's breathing.
* The neurological sucking reflex in the newborn period can be strong, and allowing your infant to use a pacifier may help during fussy episodes. After the sucking reflex passes, it is easier to wean from a pacifier than to discourage thumb-sucking. However, in breast-fed babies, to avoid "nipple confusion", it may be best to defer offering a pacifier until nursing is well-established.
TAKING THE BABY OUT
* In emergency situations, the baby may be taken out at any time if dressed properly to prevent chilling. Depending on weather conditions, planned walks maybe started when the baby is a few weeks old. Avoid visiting places that are heavily crowded. Infants traveling in your car should always be strapped into an approved car seat. Do not be lazy. Your baby's safety is very important.
POSTPARTUM " BLUES"
* After giving birth, some mothers experience crying spells and feelings of depression in the hospital or shortly after taking the baby home. These spells may occur because of hormonal changes following delivery, nervousness about starting the new job of being a mother, uncertainty about which or whose advice to accept, and general fatigue. The "blues" are common and normal and will usually disappear after a few weeks. Supportive family and friends can be a tremendous help.
CALLING THE DOCTOR
* You should call the doctor if your baby has a rectal temperature of 101° F or higher (only rectal temperatures should be considered accurate), refuses to suck or feed 2 or 3 times in a row, appears limp or has poor color, is difficult to arouse, vomits most feedings, has persistent diarrhea, or looks very jaundiced. You should also call the doctor if the baby seems ill to you or if you feel frightened about the baby's appearance or symptoms. When calling for an emergency, tell the office receptionist or service operator, "This is an emergency!" so that there will be no misunderstanding about the level of your concern.
* Limit the number of people who handle the baby to close friends and relatives during the first 2 to 4 weeks. People who have colds should avoid contact with the baby whenever possible. Strict hand washing is advisable before handling the newborn. Cigarette smoke is not good for you or your baby and should be avoided. Parents and visitors should avoid smoking cigarettes in areas where the baby sleeps or plays.
THE BABY'S FIRST DOCTOR VISIT
* In most cases, your baby should first be examined at the office or hospital post-partum program a few days after discharge. It is a good habit to make a list of your concerns before your visit. And to avoid distractions, try not to bring your other children with you for this first visit. Call our office to schedule your appointment while you are in the hospital or shortly after discharge. If doctors from our group did not see your baby in the hospital, ask the hospital doctor to prepare a short summary of the baby's course for you. We are all looking forward to seeing you and your new baby. We hope you have fun being new parents, and we wish you all the best!