Newborn

Handbook
Polaris Parkway Internal
Medicine and Pediatrics

110 Polaris Parkway, Suite 250

Westerville, OH 43082
(614) 865-4800
(614) 865-4900 (fax)
www.polarisparkwayimpeds.com

Bradley A. Lisko, MD
Phillip N. Simon, MD
Keith DeLong, MSN, APRN, FNP-C
Lauren McClain, MSN, APRN, FNP-C
Important Phone Numbers

Polaris Parkway Internal Medicine & Pediatrics

(614) 865-4800
(614) 865-4900 (fax)

Nationwide Children’s Hospital

(614) 722-2000

Poison Control
(800) 222-1222

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Table of Contents

Congratulations! ........................................................... 6
General Tips for Phone Calls ........................................ 7
Getting to know your baby........................................... 8
Noisy Breathing ........................................................ 8
Sneezing ................................................................... 9
Hiccups ..................................................................... 9
Spitting up ................................................................ 9
Grunting, Red in the face, Straining with bowel
movements or infrequent bowel movements ......... 9
Swollen Breasts and Vaginal Bleeding.................... 10
Blue feet/Hands...................................................... 10
Dry Skin................................................................... 10
Birthmarks .............................................................. 10
Puffy eyes ............................................................... 11
Facial rashes ........................................................... 11
Bowed Legs............................................................. 11
Newborn Jitters ...................................................... 11
Weight Loss ............................................................ 12
Umbilical Hernia or “Outie” button belly ............... 12
Intestinal Gas .......................................................... 12
Head shape ............................................................. 12

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Feeding your baby...................................................... 13
Breastfeeding ......................................................... 13
Bottle and Formula Feeding................................... 18
Solid Foods ............................................................. 19
Baby hygiene and care ............................................... 20
Bathing and Other Basics ....................................... 20
Nails20
Navel Care .............................................................. 21
Vaginal Mucus ........................................................ 21
Diaper Rash ............................................................ 21
Uncircumcised Boy................................................. 22
Circumcised Boy ..................................................... 22
The Nursery ............................................................ 22
Clothing .................................................................. 23
The Pacifier ............................................................ 23
Crying ......................................................................... 23
Sleep........................................................................... 25
Laundry Hints ............................................................. 27
Illness ......................................................................... 29
Fever ...................................................................... 29
Taking Baby’s Temperature ................................... 30
The Common Cold.................................................. 31
Ear Infections ......................................................... 34

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 Sore Throat ............................................................. 35
Vomiting/Diarrhea.................................................. 35
Infants and disease exposure ................................. 36
Teething.................................................................. 37
Well child visits ........................................................... 38
Safety .......................................................................... 39
Auto Safety ............................................................. 39
Home Safety ........................................................... 40
Personal Safety ....................................................... 40

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Congratulations!
The birth of a baby can be exhilarating, miraculous,
frustrating, happy, tiring, and a lifelong challenge!
There are often tears of joy as well as tears of
frustration and feelings of being overwhelmed. We
want to work hand in hand with you in the care of
your child, providing you with the necessary
information to care for him and help him to grow and
develop healthily. We are available to care for your
child when he is ill and to reassure you when he is not.
We strive to be with you throughout your journey.

We have put together this booklet to guide you

through the newborn period. Whether this is your
first child or not, this booklet serves as a resource for
what to expect during the first year of life. Of course,
this is an overview and not a comprehensive user
guide for all babies. As you will learn, not all babies
follow the rules, and there are times when you have
tried everything you know without improvement. This
booklet is not meant to be a substitute for the specific
advice of your child’s pediatrician. If you have
questions that are not addressed in this booklet or
need more answers, we are here to help you with
that, too.

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General Tips for Phone Calls
 For life-threatening emergencies when moments
count, call 911 or take your child to the closest
emergency room for stabilization.
 Please call during regular office hours for general
pediatric questions. We will return your call the
same day.
 For children that are ill or need attention the same
day: We do have same day “sick” appointments
that are available daily. Please call when the
office opens as 7:00 AM. Please try not to wait
until late afternoon to call about a child that has
been sick all day.
 For Emergency Calls after office hours: If your
child is ill and you need advice at night, one of our
physicians will be available to answer your
questions; however, if your questions can wait
until morning, we would appreciate your calling
when the office is open.
 Please take your child’s temperature prior to
calling for advice regarding an illness.
 Have a pencil and paper ready in case we need to
give instructions. If calling after hours, keep your
phone available after calling the doctor if possible.
The caller ID may show as “Private”.

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 Have your favorite daytime and nighttime
pharmacy numbers ready should we need to call
in a medication. If you wish to refill medications,
you can generally call the pharmacy and ask them
to fax a refill request to our office. You shouldn’t
need to call our office directly. We will not refill
medications on the weekends and after hours.
 For poisonings call the Poison Control Center at
1-800-222-1222, and then call your physician.
 Should we fail to return your call after office hours
within a reasonable amount of time, call again as a
safeguard against telephone trouble, wrong
numbers and human error.

Getting to know your baby

Before you know if something is wrong with your
baby, you need to know what behaviors are normal. It
can take some time to get to know your newborn, so
we have listed some common normal baby behaviors
that may be concerning to you.

Noisy Breathing- Most babies will have a rattle sound

when they breathe, and parents may think that the
baby always has a cold. If the child is exhibiting no
other signs of illness, do not be too concerned. Little
babies (like all human beings) normally have mucous
in their noses, but sometimes have trouble expelling
it. Infants breathe through their noses during the first
few months. Excess mucous may be removed with a
nasal suction bulb and saline solution

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Sneezing-All babies sneeze repeatedly. This does not
mean they are getting sick. They are just cleaning their
noses.

Hiccups- Babies will frequently have hiccups, and they

usually bother the parents more than the baby! Do
not be alarmed.

Spitting up- Many parents become very worried

because their baby spits up during the first few days.
Fluids which the baby has in his stomach after birth
may cause it to be upset. Also, it is not unusual for
your baby to bring up food during the first few months
whenever he burps or after he has been active.
Although spitting up is an inconvenience, it seldom is a
serious problem in a child who is growing and
developing normally. Time and acceptance on your
part usually handles this problem best.

Grunting, Red in the face, Straining with bowel

movements or infrequent bowel movements- Just as
your baby develops their own feeding patterns, he will
develop his own schedule for moving his bowels.
Normal stool patterns can include a bowel movement
after each feeding or one every second or third day.
Initially, the stool is a tar-like black sticky material.
With the onset of breast milk feedings, the stools
become yellow, and can be seedy or pasty, semi-
formed or loose. Formula-fed babies will have pasty
stools; while breast fed babies will have a thin,
smoother loose stool. The consistency varies daily
with each bowel movement. You may have noticed
that the baby’s muscles are generally weak - that is
why he doesn’t sit up or control his head well. The

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same applies to the abdominal muscles, which, in
older children and adults, provide the force to move
the bowels with control. Your baby has to work harder
and longer to have his bowel movement. It is not
unusual for a baby to grunt, fuss, and turn red when
he is preparing to move his bowels. Instead of
becoming anxious, keep him secure and comfortable.
Two problems concerning bowel movements should
be brought to our attention:
Crying or screaming with the passage of
the stool.
Recurring small hard, bead-like stools.
(Constipation means hard pellet like
stools, not infrequent ones.)

Swollen Breasts and Vaginal Bleeding- Both male and

female babies frequently have swelling of breast
tissue, and female babies often have some bloody
discharge from the vagina during the first week of life.
These are related to stimulation of the tissue by the
mother’s hormones during the pregnancy and
gradually go away after birth.

Blue feet/Hands- Often a baby’s hands and feet will

look blue in color. This is a common occurrence and
need not cause alarm.

Dry Skin- Dry, flaky skin is perfectly normal for several

weeks after delivery and usually requires no
treatment.

Birthmarks- Most babies have a collection of red,

mottled spots on the backs of their necks and
between their eyebrows. These spots generally fade

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with time. It is very common for dark-skinned infants
to have a dark spot at the base of their spine. This,
too, will fade with time.

Puffy eyes- Many infants will have puffy eyes for

several days after birth. This swelling is temporary and
is nothing to worry about.

Facial rashes- These are common in the first few

months of life and are due most often to maternal
hormonal influences or irritations to the infant’s skin.
These rashes will upset you, but they will soon fade.
The best treatment is simply to help keep the area dry
and clean. Rashes may appear like small, shiny, white
pimples without any redness around them or
collections of a few small red spots or smooth pimples
on the cheeks. At times they fade, and then get red
again.

Bowed Legs- The legs of the newborn are normally

bowed from the curled up position in the uterus for
the nine months of pregnancy. Until the child starts to
walk well, the legs will probably remain bowed
because nothing has stimulated them to change.
Likewise, the feet may turn slightly inward or outward,
but this is usually normal. If you have questions
concerning the walking pattern of your child, please
ask us at the next well child checkup visit.

Newborn Jitters- Most infants startle easily and may

jerk violently when disturbed. This is normal reflex. It
may involve the arms, legs, chin, and at times, be
vigorous.

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Weight Loss- Your baby is born with an excess of
calories and water from which he is self-nourished for
the first few days. For this reason the baby will want
very little of the first feedings offered him, and may
lose up to 10% of his weight. For example, a 7½ lb
baby can lose up to 12 ounces before he starts to gain.
Most of this weight loss occurs in the first 24 hours. By
the 4th or 5th day your baby will begin to show an
increased appetite and then a slow but steady weight
gain.

Umbilical Hernia or “Outie” button belly - It is typical

for a baby to have an umbilical hernia. In utero, there
was a small opening in the abdominal muscle wall that
would let blood vessels pass from the cord to the deep
organs of the body. This served as the baby’s lifeline.
Once the cord is off, the muscle slowly grows together
and the hernia disappears. For many infants this
process is completed by one year of age. Most others
are closed by 4 years of age.

Intestinal Gas- Babies pass gas freely without control

from the gastrointestinal tract. This gas comes from a
combination of swallowed air and fermentation of
food in the digestive process. It is normal and it is not
necessarily the cause of colic.

Head shape- The head shows the stress of labor. The

head will return to its normal shape within 5-7 days
after birth.

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Feeding your baby

The bond of love between parent and baby grows

strong when feeding time is pleasurable for both. At
feeding time, your baby receives nourishment from
both his food and your love. The food helps him to
grow healthy and strong. The love, generously given,
helps him feel secure. When feeding your baby, you
should be comfortable. This will help you relax and
enjoy feeding your baby. Hold your baby in your lap
with his head slightly raised and resting on the bend of
your elbow. Whether breast-feeding or bottle-
feeding, hold your baby comfortably close.

Breastfeeding
You have chosen a very natural way to feed your baby,
but it may not seem very natural to you. With the
decline in the number of mothers who breast feed
their babies, we have fewer role models from which to
learn this art. One of the most important factors in
making this successful is to have a support person to
call and to give you suggestions and encouragement.
If you have any questions, call our office.

 Common concerns
One of the most common concerns is if the baby is
getting enough to eat. In general you can judge how
much goes in by how much is coming out. The baby
should have at least 5 to 6 wet diapers per day and
may have many more than this. Breastfed babies tend
to stool fairly often, but each baby is different. Your

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baby may stool after every feeding or only every other
day.

 Getting Started
Ideally, breast feeding is started by putting the baby to
the breast immediately after birth. After this, feedings
are “on demand”, but never more than three hours
apart during the day. This is important not only for the
infant’s nourishment and hydration but also to
stimulate the breast to produce more milk. Breast
feeding is an infant-driven process. Early feeding
should not be on a strict schedule or controlled with
“stop watch timing”. In the first week it may take 3 or
4 minutes for the milk to let down and well over 15
minutes for the fat content to rise. Although it is most
helpful to stimulate both breasts frequently, by having
the infant feed from both, using the second breast
may not always be possible before the infant falls
asleep only to awake hungry in an hour or two. The
best way to avoid this is to feed your baby
immediately after his nap rather than nursing him to
sleep.
Sore nipples usually are not associated with the length
of nursing time, but the position of the infant at the
breast. When mothers complain of sore nipples, the
first step is to observe the infant being put to the
breast with particular attention to the position of the
infant in relation to the mother; that is, abdomen
facing abdomen and infant facing the breast. For
centuries mothers have successfully used the scissors
hold of the breast to assist in presenting the breast to
the infant. Women who have sore nipples, small
hands, and large breasts, or an infant who has

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difficulty latching on may find the C-Hold more
effective. In either case, the hand must be sufficiently
back from the nipple to allow the infant to grasp with
ease the areola (the circular area of different color
surrounding the nipple of the breast) 1½ to 2
centimeters from the base of the nipple. The areola
and nipple will elongate, which will touch the roof of
the infant’s mouth and the tongue. The infant must be
able to hold the breast in place when the mother
takes her hands away. The average breast feeding
infant nurses every 2 to 4 hours for 10 to 12 feedings a
day for the first few weeks, but may nurse as often as
every hour or as long apart as every 4 hours.
Individual feeding lengths vary. Some infants nurse
briskly and can be done in 10 minutes on a side;
others take longer. A mother will learn her infant’s
pattern of long and short feeds. The milk supply is well
established after 10 to 14 days. Weight gain is about 1
ounce per day when the milk supply is established. A
means of monitoring adequate breast milk intake is
monitoring the baby’s weight, and counting the
number of wet diapers, which should total five to six
per day. Occasionally an infant who is well fed and
gaining weight may seem to demand excessive
sucking; this infant may benefit from a pacifier.
Breastfed babies tend to regain their birth weight by
two weeks. If you are concerned about your baby’s
weight, please call our office and schedule an
appointment for a weight check.

 Nursing
Wear a bra, especially at night. Make sure that you
burp the baby between breasts. Start on the same
side you finished with at the previous feeding. Be

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comfortable in a quiet atmosphere with no
interruptions. Silence your phone, if need be. Be sure
that the baby latches on well; try different positions.
Always release the suction before you remove your
baby from the breast. Do this by placing a clean finger
in the side of your baby’s mouth between his jaws.
Don’t take him away until you feel the suction break.

 Sore Nipple Prevention

To prevent nipple tenderness, start with correct
positioning and latch on.
· Be sure to sit up in a comfortable chair with
plenty of back support.
· Cradle Hold: Place a pillow or two in your lap
to support the baby. Place your baby’s head
on the crook of your arm. Make sure your
baby is turned towards you-chest to chest-at
breast level.
· Football/Clutch Position: Put a pillow or two at
your side to help support your arm and your
baby. Support your baby’s neck and the lower
back of his head in your hand, with your
forearm supporting his upper body against
your side.
· Lying down position: Lie on your side with
pillows supporting your back and your top leg,
which is bent forward. Place your baby on his
side facing you.

 Sore Nipple Treatment

· Nipple care: Let nipples air dry for at least 15
minutes after nursing. Don’t use soap to wash;
use lanolin only after nipples are dry; change

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 nursing pads after every feeding or if your
milk lets down between feedings.
· Sore, cracked nipples: Don’t nurse on sore
side. You will need to hand express or pump
some milk out each nursing on the sore side to
be comfortable. You may use lanolin on sore
nipples. When you start back, start first with
the good side and then break in the sore side
for a few minutes (just like you did when you
started to nurse). Increase the time nursing as
nipple starts to heal.
· Mastitis (plugged duct): Contact your
obstetrician. Put heat on the area, take
Tylenol and get plenty of rest. Again you may
need to express enough milk before nursing
on the sore side to be comfortable. When you
are ready to start nursing, break the sore
breast in gradually as you did when you
started nursing.

 General
· Breast milk: Can be frozen for up to 6 months.
Put it in a plastic bag and date the bag. Make
sure that you thaw milk quickly.
· Mother’s nutrition: Baby takes about 500 to
1000 calories out of your body daily. Eat a
well-balanced diet. Drink plenty of fluids, at
least 8 to 10 glasses of water daily.
· Foods to avoid: Garlic, onion, chocolate, spicy
foods, (tomato paste based foods), gassy
foods (cabbage, cauliflower, broccoli, beans,
fresh vegetables). Don’t drink a lot of coffee,
tea, or coke because of the caffeine.
NutraSweet appears to be safe.

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 · Medications: Check with your doctor about
prescribed medication. Tylenol occasionally
for a headache will not hurt your baby. Do not
take harsh laxatives. Mineral Oil is okay for
mom to take. You should continue to take
prenatal vitamins.
· Weaning: The ideal time for nursing is 9 to 12
months. You may go longer or shorter if you
choose. If you stop nursing before your baby is
12 months old, you will need to use formula
up to 12 months old. Check with your
pediatrician for which type to use.
· Normal breast-fed baby’s stools: Stools should
be yellow, mustard colored and seedy
appearing. It can be normal to have an
occasional green stool. There may be many
stools initially, but may decrease to 1 stool
every 3 to 5 days.

Bottle and Formula Feeding

There are many infant formulas on the market and
you have probably been bombarded with samples in
the hospital. There are 3 main types of formula.
 Cow-Milk (Enfamil, Similac, Carnation)
 Soy-Based (Prosobee, Isomil)
 Pre-Digested formulas (Alimentum,
Nutramagin)
Many babies do well with a cow-milk based formula.
In certain circumstances your baby may need another
formula. Call our office and we will discuss this with
you. Newborn babies generally take 1 to 3 ounces of
formula every 3 to 4 hours. They will generally have 5
to 6 wet diapers per day and may have more. Stools
should be yellow/brown and seedy. All babies are
different and may have none or many stools per day.

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Feed every 2 to 4 hours during the day and when they
wake at night unless otherwise directed by your
doctor. Feed the formula recommended by the
pediatrician. Burp every 1/2 - 1 ounce. Make sure that
you boil bottles 15 minutes or put in dishwasher until
baby is 1 month old. If using concentrate, mix formula
1:1, use within 24 hours. Formulas contain all needed
vitamins. Ask your doctor about fluoride.

Solid Foods
Since the recommendations for feeding solids change
as more scientific information is obtained, and all
babies have individual needs, we will discuss the
introduction of solids with you at one of the routine
well baby visits at our office. Some general guidelines
are:
 Cereal: Begin feeding cereal 3 to 4 months after
the baby is born. Start with rice, then oatmeal.
Mix with breast milk, water, or formula and feed
it with a spoon.
 Juice: May start if needed at 6 months. Use
apple or white grape juice- dilute 50% with
water. Never give more than 4 ounces per day.
It is advisable to start juice in a sippy cup rather
than a bottle.
 Vegetables: 5 to 6 months, start with any one,
but feed the same one for 3 days before starting
a new one. No corn.
 Fruits: Begin feeding at 5 to 6 months or after
vegetables. Again, feed the same one for 3 days
before starting a new one. No citrus fruits.
 Meats: Begin feeding after 6 months or after
cereal, vegetables and fruits.

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  Cup: Introduce the cup at 6 months, if you wish,
once a day so they will get used to drinking from
it. Transition off of bottles at 9 to 15 months.

Baby hygiene and care

Bathing and Other Basics

Most infants need a bath only 2-3 times a week. Clean
the face, chin, neck, and diaper area daily. Withhold
regular tub baths until the cord is healed. Until then,
sponge bathe and keep the cord dry. Use mainly water
for the first weeks. Soaps are drying to the newborn’s
already dry skin. Mild soaps can be used in small
amounts. Do use soap daily to clean the diaper area
skin. Take care to wash and dry the skin folds at neck,
arms, groin, vagina or scrotum. Keep the skin clean
and dry. If your baby’s skin seems excessively dry, feel
free to use an unscented moisturizer once they are 2
weeks old or older. To clean the eyes use a clean cloth
or cotton balls dipped in water. You may shampoo
the baby’s hair with baby shampoos or liquid baby
soaps. Use a soft brush to scrub the scalp. Never leave
your baby unattended in the bath.

Nails
Keep nails clean and short. Cut them squarely across
using clippers or nail scissors, or nails can be filed
gently. Have someone help you. One of you hold the
baby and the hand or foot, while the other clips the
nails. A good time to try nail care is during a nap, as
many babies will sleep through this.

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Navel Care
Care of the umbilical cord is especially important since
this can be the source of a serious skin infection. Do
not use a Band-Aid or other covering over the
umbilical cord stump. A small amount of bleeding
before and after the cord drops off is normal.
Remember, the umbilical cord is not really a part of
your infant. It is part of the discarded placenta. There
are no nerve endings on the cord. Most cords fall off
within two to three weeks.

Vaginal Mucus
Little girls may have white mucus in their vagina with
occasional streaks or blobs of blood during the first
few weeks of life. This is caused by hormone changes
following birth. Simply wipe away front to back while
cleaning and bathing. The mucus may take a month to
resolve completely.

Diaper Rash
Because babies have sensitive skin, they are prone to
developing rashes and irritations, especially in the
diaper area. Usually, irritation is due to prolonged
periods of wetness or contact with fecal material.
Prevention and treatment both require frequent
diaper changes. Exposures of the rash to air for
several hours a day, avoidance of plastic or rubber
pants, and thorough cleansing of the area will heal
most rashes. If there is no improvement after a few
days of such treatment, a diaper rash cream such as
Desitin or A & D Ointment, may be used. If these
remedies bring no improvement, please call us for
advice.

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Uncircumcised Boy
Clean the outside of the uncircumcised penis as you
would any other part of the baby’s body. The foreskin
of the uncircumcised penis is normally attached to the
glans of the tip of the penis in layers of tissue. As the
baby grows, the skin will eventually separate and
allow the foreskin to slide back naturally. You should
never try to force the skin back as this could cause
bleeding and possible infections. In some boys, the
skin retracts by one year of age. In others, full foreskin
retraction may occur as late as adolescence. As long as
your baby can urinate normally, you should not be too
concerned about whether the foreskin retracts yet.

Circumcised Boy
If your baby has been circumcised, your doctor will
give specific instructions on how to care for it
depending on what type of circumcision is done. If a
small plastic ring is attached, simply clean with
solution of ½ water and ½ hydrogen peroxide every
diaper change until the plastic ring falls off (usually
about 3-8 days later). If the foreskin is removed
completely, you may be instructed to apply Vaseline
on the front of the diaper until the circumcision heals.

The Nursery
Your baby should have his or her own room if
possible. Furnishings should be of a type that is easily
cleaned so they will not collect dust. All painted items
should be lead free. The baby may sleep in a bassinet,
or you may use a crib from the start. The mattress
should be firm and flat and protected with a
waterproof cover. No pillow should be used. The
mattress should fit snugly and there should be no
more than two fingers width between the crib and the

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sides of the mattress. Bumpers are no longer
recommended. Try to keep the temperature between
68 and 75 degrees. Provide adequate ventilation, but
avoid drafts. Usually, a single baby blanket will be
enough covering, even in cold weather.

Clothing
Your baby requires no more clothing than an adult and
perhaps less. Make an effort to dress the baby
according to the temperature without overheating
him. If the baby perspires, then he is too warm.
Clothing should be loose fitting, lightweight, and soft
textured.

The Pacifier
All babies have an instinctive need to suck. This need
goes beyond the sucking that accompanies feedings
and is often confused with a need for more food. If
your baby has been fed, but is busily chewing its
thumb or fingers, you may wish to substitute a
pacifier.

Crying
All normal newborn babies cry a certain amount of the
time, just as they sleep and suck. During the first few
weeks, crying is about the only way they have of
expressing themselves and of telling you their needs.
A baby may cry when he is hungry, too cold, too
warm, has an “unburped” burp, has a wet or soiled
diaper, wants to be held, or just because they feel out
of sorts.
It is very common for a baby to cry or fuss at about
the same time each day, often in the evening, and
they may go on for quite a while for no apparent

23
reason. This period of fussiness often causes concern
for new parents because they usually think that their
baby is still hungry. It’s tempting to keep offering
more milk, but this seldom really helps for more than
a short time. Sometimes, a stroller ride or a warm
bath at the fussy period helps relax the baby. Holding
the baby doesn’t hurt, either.
A reassuring fact about crying is that this causes no
physical harm to the infant, so you need not worry if
your baby cries or fusses for a while before you attend
to his needs. In fact, many new babies fuss for fifteen
or twenty minutes after each feeding or before going
to sleep. It is really pretty good exercise.
The amount of time a baby spends crying peaks at
about 6 weeks (3 hours average). By 12 weeks the
crying time decreases to approximately one hour a
day on average. If your baby is fussy or colicky, here
are some things to know:
 Your baby will outgrow colic.
 Your baby’s crying is not causing emotional
damage. The colic is not your fault.
 It did not happen from something you did or did
not do during your pregnancy or early days with
your baby.
 It just happens.
Not all fussiness is colic. There can be medical causes
of extreme fussiness in infants. Acid-reflux and an
allergy to cow’s milk are among the more common
medical causes of extreme fussiness.
Here are some suggestions for calming a fussy baby:
 The first thing to do is to make an appointment
with your baby’s doctor to be sure there isn’t any
medical reason for the crying.

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  Motion seems to help soothe colicky babies. This
includes walking the baby, rocking, using a wind-
up infant swing, or going for a ride in the car.
 Some infants settle down if they are swaddled
firmly in a blanket.
 Some babies settle down when held against a
warm chest, even if you are still.
 Some babies settle down with music or a
recorded heartbeat.
 Some babies prefer steady noise, like a vacuum
cleaner.
Colicky babies often seem eager to eat, and then cry in
the middle of feeding. A pacifier may soothe a colicky
baby. If nursing, try eliminating the following foods
from your diet: all beans, chocolate, nuts, berries,
coffee and other caffeinated drinks, cow’s milk,
cabbage, onions and excessive sweets.
If you eliminate cow’s milk from your diet to relieve
your baby’s fussiness, be sure you talk to your doctor
about a calcium supplement for yourself.
If you smoke cigarettes, STOP! Don’t hesitate to have
your baby reevaluated by your baby’s doctor if the
crying doesn’t improve.

Sleep
During the first 10‐14 days, most newborns will sleep
more than they do anything else. They usually awaken
for feedings and then sleep in between. Babies
usually sleep through the night between 3‐4 months.
Prevention of sleep problems begins in the newborn
period. Putting your baby down while drowsy, but not
fully asleep is recommended.

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Sudden Infant Death Syndrome (SIDS) is the leading
cause of death in infants older than one month of age.
SIDS frequency peaks in babies two to three months of
age and is less common after six months of age. While
the causes of SIDS are not known, researchers are
beginning to understand the risk factors for SIDS. The
following are highlights from the November 2005
American Academy of Pediatrics Policy Statement on
SIDS. The entire statement is available in the Health
Topics section of the AAP website, www.aap.org.
 Back to Sleep: Placing your baby to sleep on his
back is the most effective way to prevent SIDS.
Since the “Back to Sleep” campaign began in
1992, the incidence of SIDS has dropped by more
than 50 percent in the U.S. Babies placed on their
sides tend to roll onto their stomachs while they
are sleeping; the side position is not safe. Babies
who sleep on their backs are less likely to vomit
and choke than babies who sleep on their
stomachs.
 Keep your baby’s face and head uncovered
during sleep. Tuck covers in so that your baby
does not wriggle under the covers, or else dress
her warmly and put her down without any
covers. Keep fluffy toys and pillows out of your
baby’s bed. Do not use a bean bag or water bed
for your baby.
 Keep baby in your room but NOT in your bed.
This is probably the most controversial of the
new AAP recommendations. A baby who sleeps
in his parents’ room is less likely to die from SIDS
but sharing a bed with your baby is not safe.
Sleeping in the same bed as parents is thought to

26
 increase the risk of SIDS by increasing the chance
of covering the baby’s face with soft bedding
and/or increasing the chance of overheating the
baby. The safest place for a young baby to sleep
is in a bassinet or crib next to their parents’ bed.
 Don’t let your baby get overheated. Overheating
increases the risk of SIDS. Do not overdress your
baby for sleep nor use too many blankets. Do
not keep the room too warm.
 Avoid cigarette smoke. Infants whose mothers
smoked during pregnancy have a higher
incidence of SIDS. Smoking also increases the
chance of SIDS after your baby is born. No one
should smoke in a house where a baby lives or
visits. No smoking in the car either.
 Offer a pacifier at naptime and bedtime. The
reduced risk of SIDS is compelling, and the
evidence that pacifier use inhibits breastfeeding
or causes later dental problems is not. The AAP
recommends use of a pacifier throughout the
first year of life, when placing the infant down to
sleep. The pacifier does not need to be reinserted
when the infant falls asleep and the pacifier falls
out of the mouth. If the infant refuses the
pacifier, he should not be forced to take it. For
breast-fed infants, delay pacifier use until a
month of age to ensure breast-feeding is
established.

Laundry Hints
Along with babies, comes lots of laundry! If you plan
to use cloth diapers this is especially true. Baby’s

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laundry requires a few changes from the usual wash
day routine because of the tender and sensitive
nature of their skin. Many of the products that you
normally use for the family wash are too harsh for use
on the baby’s clothes. Be sure that you read the
washing instructions that come with all of your new
baby clothes so that you will receive full use from
them. Diapers, especially, are made of many new
blends and are easily ruined if not washed properly.
If you are using a non-automatic washing machine and
soap, rinse diapers three times and add one-half cup
white vinegar to the final rinse. Very thorough rinsing
is a must. If you are using an automatic machine,
normal washing procedures may be used with either
soap or detergent.

General Hints
 We recommend a mild hypoallergenic detergent
for washing diapers. Do not use fabric softener if
baby has a rash.
 Wash all new baby clothes, blankets, sheets and
other items before using them.
 Use a separate container for diapers and other
baby clothes. If you have an extra diaper pail, it
can be used for soiled clothes.
 One or two cups of white vinegar in a half-bucket
of water make an excellent diaper-soak. It will cut
down on the urine odor and prevent an ammonia
diaper rash. Liquid bleach also works well.
 Unfold the diapers before placing them in the
diaper pail. This affords even washing when you
put them in the machine.
 Use hot water for diapers, warm water for other
clothes.

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  Do not overload the washer. Clothes will not be
adequately washed if you pack the washing
machine full.
 Rinse thoroughly. If you have your own machine,
run the clothes through another rinse to make
sure all the soap is rinsed out. If you wash your
clothes at a commercial laundry, make sure the
machine is not too full to allow adequate rinsing.
 Avoid fabric softeners. These agents contain
chemicals that can irritate the baby’s skin. For
stubborn stains from stools, an occasional
washing with bleach is fine—but make sure that
you rinse thoroughly. Fabric softeners and dryer
sheets have been reported as a common cause of
allergic problems in young children.
 Line or tumble dry. If you dry in a dryer, remove
the diapers as soon as the cycle is through to cut
down on wrinkles and facilitate smoother folding.

Illness
While we do our best to keep your baby well, we
know that all babies get sick at some point. Below are
some of the more common illnesses, and what you
should know about them:

Fever
Fever is one of the many symptoms of an illness. It
often accompanies many colds and viruses.
Treatment for a fever depends on what you think is
causing the fever and how ill the child appears. Under
two months of age, call your doctor immediately for
any fever 100.4 or more rectally. For older infants and
children, if the symptoms are mild and the child does

29
not appear to be in distress, treat the fever with
Tylenol or Motrin/Advil to make him/her more
comfortable. The fever itself does not cause any
problems. (i.e. brain damage) or will not continue to
climb if you do not treat it. Again, we try and reduce
the fever only to make the child feel better. You may
have your child checked by the doctor if there is any
change or the fever persists especially more than
three days. If your child appears acutely ill or is having
more discomfort, he needs to be seen by a physician.
Look for specific sources of the fever: Does he hit his
ears or complain of earache, is he vomiting, does he
have diarrhea, is he coughing, does he have a
headache? Do not use aspirin to control your child’s
fever due to the link to Reyes Syndrome during viral
illness.

Taking Baby’s Temperature

The rectal thermometer is the gold standard of infant
temperature taking. It is recommended for children
under 2 months of age when it’s important to know
the exact temperature, so your doctor can determine
the proper course of action. For older babies, there
are more options. When you speak with your doctor,
let them know which method you used.
Rectal Thermometer: Apply petroleum jelly to
the thermometer tip. Lay your baby on his belly
and hold him steady with one hand on his back.
Gently slide the thermometer about a half inch
into the rectum, then hold it in place between
your second and third fingers for two minutes, or
until the thermometer signals that it is done.
Underarm Thermometer: Place the tip of the
thermometer in the center of your child’s armpit.
Hold his arm against his chest for two to four

30
 minutes. Do not use an arm thermometer in
children less than 2 months old because they are
not accurate for this age group.

The Common Cold

A “cold” is the word we use to describe congestion in
the nose and sinus areas caused by virus. There are
many viruses that cause a “cold” and they are all
contagious. Most colds occur in the winter because
people are in closer contact indoors and can spread
the virus more easily. Colds have nothing to do with
how cold it is outside. Many parents notice their
children getting viral upper respiratory infections (a
more specific term for “cold”) as soon as they are
around other children, such as day care or nursery
school. The average preschool child will get 6-10 viral
illnesses each year!
Signs and Symptoms
· Fever that lasts 24 to 48 hours.
· Runny nose that lasts about a week or two: At
first the drainage will be clear. After a few
days, it will change from clear to yellowish-
green and sometimes back to clear. This is
because the constant drainage irritates the
lining of the nose and causes microscopic
bleeding. The tiny blood cells break down and
turn yellow and green, just as a bruise turns
color. Do not let this normal color change
worry you. Sometimes this irritation of the
nose will cause a regular nosebleed too.
· Coughing: Many parents worry about their
child’s cough because it sounds like it is
“coming from the chest”; however, the cough
is good because it prevents mucus in the
throat from going into the lung. Because your

31
 child’s chest wall is thin, the large airways
(windpipe and bronchi) project the sound of
the cough like a megaphone, so that it sounds
and feels loud and like it is coming from the
lungs.
· Postnasal drainage down the throat: This
often causes a sore throat.
· Achy and tired: Children often get cranky.
· Your child may not sleep well at night because
the congestion will wake him/her up. Others
may sleep a lot.
· Your child often does not feel like eating
because he/she either feels too bad or it hurts
to swallow.
· Some children have diarrhea. Others have
constipation because they don’t eat their
normal food.

Treatment
· The cold is a virus. There are no medicines
that can cure these viruses yet. We can only
treat the symptoms of the virus. So even if
you do nothing, the cold will go away.
· If your child is comfortable, we recommend
no treatment.
· To loosen and /or decrease mucus drainage,
you can use a suction bulb just before eating
and sleeping. You can use normal saline nose
drops if the mucus is thick. The drops will
loosen the mucus and make suctioning easier.
You can use these drops as often as necessary
since they are non-medicated. You can also
use a humidifier at night to moisten the air.

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 This helps keep breathing airways open and
reduce coughing.
· There are some over the counter medications
for children that can help decrease mucus for
children over four. These are not
recommended for younger children.
· For children who wake up a lot due to a
stopped up nose, Neosynephrine Pediatric
nose drops (1/8% strength) can be used at
bedtime to help dry up the nose. We do not
recommend using this in the daytime or for
more than 3 days because using these drops
repeatedly can actually make the nose more
stopped up.
· To help decrease coughing at night, raise the
head in the bed or crib by putting large stable
blocks under the front legs of the bed. Raising
the head helps decrease the postnasal drip
pooling in the back of the throat. Older
children can usually raise their heads by using
an extra pillow.
· Give your child extra liquids to drink, such as
Pedialyte. Some mothers notice that milk
seems to make their child’s congestions worse
when they have a cold: other children do fine
with milk. Do not be concerned if your child
does not eat very much when he/she has a
cold. His/her appetite will come back later.
· Use acetaminophen (Tylenol), Ibuprofen
(Motrin/Advil) for fever or general discomfort.
Motrin/Advil should not be used in infants
under six months of age.

When to Call the Doctor

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 · If the fever is not gone in 48 hours.
· If the fever goes away and comes back again a
few days later.
· If your child’s symptoms get worse instead of
gradually getting better.
· If your child is under 2 months old (even with
a mild cold).
· If your child seems very ill.
· Anytime you are anxious about your child,
please call your doctor’s office.

Ear Infections
Earache is a common complaint in children. If a middle
ear infection is present the pressure change in the
middle ear space is causing the earache. Usually the
child will also have a fever and may be quite irritable
or complaining of decreased hearing ability. Keep in
mind, however, that small children sometimes have
difficulty localizing pain, and thus not all earaches are
due to middle ear infections. Earaches do not
represent an emergency situation, but usually should
be evaluated within 24-48 hours, during our regular
office hours. The pain can cause great discomfort and
there are several steps that can help this problem.
 Tylenol or Motrin can be given in appropriate
amounts.
 A warm towel or heating blanket can be
applied to the affected ear.
 Warm oily drops (baby oil, sweet oil) can be
put into the ear canal to help relieve the pain.
Do not use the oil if your child has ear tubes.
If we find a middle ear infection is present, then
antibiotics will usually be given to your child.
Unfortunately these medications do not cause a
dramatic resolution of the earache or fever. It may

34
take 24-48 hours before the child begins to improve.
In general, we will need to see your child during our
regular office hours before prescribing such a
medication.

Sore Throat
Most sore throats are caused by viruses as is the
common cold and are not treated with antibiotics.
Some sore throats, however, are caused by a
bacterium called streptococcus. This typically causes
swollen tonsils with white patches on them, fever and
swollen glands under the jaw. All the symptoms,
however, can occur with a viral sore throat as well, so
that the exact diagnosis of strep is made by a throat
culture. When strep is suspected or proven, treatment
with antibiotics is needed. It is extremely important to
complete the FULL COURSE of antibiotics to clear up
the strep infection and prevent complications.
Stopping the medicine after the symptoms are gone
does not kill all the strep and can allow complications
such as, rheumatic heart disease and kidney disease.
Occasionally, a red sand-papery rash associated with
strep throat can be seen. This is scarlet fever or
scarletina. It is not more serious than simple “strep
throat” and the treatment is the same.

Vomiting/Diarrhea
By definition, diarrhea is more frequent or more
watery bowel movements. In some infants it may be
hard to distinguish this condition from their normal
stool pattern. It can be caused by a number of
conditions such as: overeating, food allergies, too
much juice, antibiotic usage, but it is usually caused by
viruses. Vomiting is the forceful emptying of the
stomach through the mouth. It is usually caused by

35
viruses as well. If your child has vomiting and/or
diarrhea we will usually advise you to give your child
extra fluids (like Pedialyte or breast milk). You should
offer smaller, more frequent amounts of liquids rather
than giving large amounts at once. Your child may not
want solid foods for a day or two, and this is fine.
Once the vomiting subsides (usually 24-48 hours),
infants may be restarted on their regular formula. If
the diarrhea is still persistent (it may last up to 1-2
weeks), the infant may be placed on Isomil DF (or soy
formula) or LactoFree for 1-2 weeks. If the infant is
taking solid foods, he may slowly begin taking such
things as bananas, rice cereal, applesauce, and dry
toast (BRAT Diet).
Watch out for signs of dehydration. We find that a
sensitive indicator of dehydration is how frequently
your child is urinating. In most cases if the child is
urinating every 8 hours or so, he is not yet seriously
dehydrated. A moist mouth is another indicator of
good hydration. These instructions are only guidelines
for treating this common problem in children.
If you have any questions, or feel that your child is
becoming dehydrated, please give us a call.
Your child needs to be seen if:
 He has no urine output for 12 or more hours
 No tears with crying and mouth is dry
 Blood in diarrhea or vomiting
 Severe abdominal cramps
 Fever for more than 72 hours
 Repeated forceful projectile vomiting
especially if under eight weeks old

Infants and disease exposure

Infants less than two months of age can get sick very
fast if they are infected with germs instead of just a

36
cold. Because of this you should limit your baby’s
exposure to illnesses and day care until the baby is at
least two months of age. Group day care will create
many exposures for babies. There will be times when
babies can’t avoid illness. Whenever family members
bring home colds and fevers, brothers and sisters
especially, the baby will usually catch them too.
Making good hand washing the rule is the best way to
help prevent young infants from catching infections.
Mothers who are nursing and become sick may
continue to nurse unless told not to, because the
germs that cause colds and stomach flu do not pass
into the breast milk.

Teething
A baby may begin to get teeth as early as 2 ½ or 3
months of age or as late as 18 months. It can cause a
baby to be fussy at times as early as 2 months of age.
You can try having him chew on a hard/cold object like
a teething ring to alleviate some of the discomfort. If
your child appears to be very ill, it is not due to
teething, and you should give us a call. Teething does
not cause significant diarrhea or high fever.

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Well child visits
The mainstay of pediatric care is preventative
medicine. During each checkup, your child will receive
a complete physical examination, growth
measurements, necessary immunizations and/or
screening tests appropriate for age. Your provider will
also discuss nutrition and development with you.
Please feel free to ask questions during these visits!
Below is a list of the well child check schedule:

Routine Well Child Visits

Newborn Visit Well check-up
2 weeks Weight Check with the nurse
1 month Well check-up
2 months Well check-up, vaccines
4 months Well check-up, vaccines
6 months Well check-up, vaccines
9 months Well check-up, vaccines
12 months Well check-up, vaccines
15 months Well check-up, vaccines
18 months Well check-up, vaccines
24 months Well check-up, vaccines

Information about each immunization will be provided

at the time of your child’s appointment. If you would
like to read about to each vaccine before the
appointment, you may look at the CDC website,
www.cdc.gov/vaccines/pubs/parents-guide/default.htm

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Safety

Auto Safety
After the immediate newborn period, a leading cause
of death and injury in infants and children is auto
accidents. Your baby should always be placed in the
rear seat facing backwards to prevent injuries caused
by air bags. If your child must ride in the front seat (in
a pickup truck, for example) see if the passenger side
airbag can be disabled. The car seat should be marked
that it is an approved product. It’s the law and its good
sense that you must secure your baby in an approved
car-safety device. If a car seat has been involved in an
accident, even a minor one, it is recommended that
you discard it and purchase a new one. For this
reason, you should be very cautious about purchasing
or borrowing a used car seat. In addition, all car seats
have an expiration date, and should not be used
beyond that date. Make it a habit to use a car seat
100% of the time your child is riding in a vehicle. You
should be a good role model and a safe driver or
passenger by using your seat belt. General weight
guidelines are:
 Newborn to 20 lbs.: rear-facing
 20 to 40 lbs.: forward facing in rear seat after
1 year of age
 Children 40 lbs. and above should use a belt
positioning booster seat until they reach age 8
or 57 inches tall

39
Home Safety
Your house should be child-proofed once your baby
can get around (by crawling or scooting). Child-proof
latches on low cabinets are helpful, but all poisons,
detergents, drain cleaners, cleaning solutions,
polishes, cosmetics, after-shave lotions and medicines
should be placed in high cabinets, well out of your
baby’s reach. Electrical outlet covers should be used.
Avoid toys that can fit into baby’s mouth. Make sure
cribs and changing tables are away from drapery
cords.

Personal Safety
To guard against accidental choking, avoid tying
anything around your child’s neck, such as a pacifier or
necklace. Avoid pinning a pacifier or toy on a long
cord, shoelace, ribbon, etc. to your baby’s clothing.

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 My precious little baby
I have loved you from the start.
You are a tiny miracle
held closely to my heart.
Each day I feel your presence,
each day you quickly grow.
Each day your heart beats softly,
as only I could know.
I'll hold you closely in my arms,
and remember each year through,
of this very special time of life,
of taking care of you.

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