NEWBORN CARE Dear Mom & Dad, These instructions and suggestions are designed to help you through the first few weeks of your baby's life. As you already know, your newborn child is a very healthy and happy baby, but there will be many changes through the next few weeks and this booklet is to help you better understand and deal with these changes. This guide will not cover every possible problem or situation that you may encounter, so please call us at any time with any concern you have, @423-968-2599.
GOING HOME When you and your baby leave the hospital, this is a significant change in the environment of the newborn. Any pattern that you have seen emerging in the nursery will probably change when you get home. The baby will be in unfamiliar surroundings and this will change their sleeping and eating patterns for the first few days until they adjust to their new environment. Your baby may cry for no apparent reason during the first few days as they adjust to this change in setting. Please do not be alarmed at these changes for as the baby becomes accustomed to the new home they will smooth out these rough edges. It is important to limit your trips with the baby. For the first two weeks we suggest that you stay at home in order to allow both of you to have some time to relax and adjust, the fewer visitors the better the first few weeks - because of this. Certainly, family and close friends will want to come over to see the baby but we do not recommend an open door for all visitors in those first two weeks. After the baby's checkup at two to three weeks old we will then allow the baby more freedom as far as trips and visitors. We are conservative in this matter because of the risk of infection to a newborn. The more people the baby is around, the more risk of infection. If a baby under two months of age gets an infection and thus a fever greater than 101°F, rectally, they will be automatically admitted to the hospital for a work-up of possible infection. This will require a spinal tap, blood work and chest X-ray. It may additionally require an IV and IV antibiotics for three to five days. Therefore, we feel that is is less traumatic to stay at home for the first two weeks than it is to risk an infection and, thereby, a hospital admission so soon after delivery. This is for the baby's protection. After the two-week checkup, trips to friends' houses or to grandparents are acceptable as are strolls in the warm sunlight. Until two months of age you should avoid large crowds such as church nurseries, shopping centers and grocery stores. This, again, is to avoid the risk of infection.
FEEDING We recommend, a "demand style" feeding schedule. This is a per the recommendation of the American Academy of Pediatrics Committee of Nutrition. A schedule of feedings will be frustrating to you and the baby, and if you try to keep a hungry baby from eating until a pre-set time, this will drive both you and the baby crazy. Also, it is extremely difficult to wake up a sleeping baby to try and adhere to a schedule. Therefore, a "demand" feeding schedule where the baby eats as much as often as they want will be much more pleasing to you and your baby. Only in the second six months of life is a schedule something to strive for and we will discuss this at future well-baby visits. FORMULA INFORMATION; NEW BABY INFORMATION; Additional Formula Info
CORD CARE The navel still has the umbilical cord stump attached and this requires frequent use of rubbing alcohol on the cord to help dry it up faster. You should lift the cord and squeeze alcohol down around the base six to eight times a day or with each diaper change. Be aggressive and do not worry if a little bleeding occurs, because this is normal. The more you do this the faster the cord will fall off and the sooner the baby can be bathed in a bath tub, Remember not to place your baby in a bath or water until the remaining cord has fallen off. This will also prevent infection from occurring in the umbilical cord. After the cord falls off there will be some oozing and bleeding for several days and it is again necessary to continue the alcohol treatments to the cord until there is a completely dry navel.
CARE OF THE PENIS If you have a baby boy and have had him circumcised, it is necessary to cleanse this area with warm soapy water. You do not actually need to rub the area of the circumcision but simply squeeze warm soapy water over this area washing around the scrotum with a wash cloth. Then, rinse by simply squeezing warm water over the area. We do not recommend putting vaseline on the area of circumcision because this occludes the pores and slows the healing of the area. If, however, you see some bleeding from the area of the circumcision, put a small amount of vaseline on that area once a day until the bleeding stops. If your baby is not circumcised, you do not need to retract the foreskin. As the baby grows, he will retract this himself, or if necessary, we will do it at a later well-baby visit. It is potentially dangerous to try and retract the foreskin in a young baby under six months of age because this can lead to infection or to a stricture around the area that is pulled back. Therefore, simply cleanse with warm soapy water and leave the rest to us. SHOULD I HAVE MY SON CIRCUMCISED?
VAGINAL CARE If you have a baby girl you will notice there are some secretions inside the labia around the opening to the vagina. This is normal and should not worry you. It is also normal to occasionally have some bleeding from the vagina. This is a result of the baby being exposed to high levels of estrogen while being carried by you and is, in actuality, a mini-period. This will stop within three to five days of starting and there is no treatment necessary. You may take a very soft wash cloth or kleenex and wipe the secretions from around the vaginal opening but do not worry about getting it completely clean. These are natural oils and secretions form the outside of the vagina and will gradually clear on their own.
BOWEL MOVEMENTS Your baby's bowel movements will change significantly during the first two months of life. Breast fed babies tend to have a bowel movement with every breast feeding. These bowel movements are either green or yellow and are very liquid. They may even be "seedy". As the baby gets older these bowel movements will become more firm and you do not need to worry about the nature of the bowel movements. It is also possible that if you are formula feeding the baby it will not have as many bowel movements. Formula fed babies generally have one bowel movement a day or every other day. They are firmer than breast fed babies and are the consistency of peanut butter. They are either brown, green, or yellow. Sometimes they may even be black. It is also important to note that babies will strain a lot in the early weeks of life when having a bowel movement. This is generally because the anus has a tight sphincter and it takes several weeks of having bowel movements to loosen this to its appropriate tone. Therefore, do not be alarmed if the baby seems to be straining as long as it has a bowel movement as described above...one every day or more often. Even if he/she has a bowel movement every other day, this is also reasonable. If they go more than two days without a bowel movement, you should call or email us and we will discuss this with you(423-968-2599). Sometimes, newborns will even have some blood in their stools, secondary to a rectal fissure. This simply means that there is a slight tearing inside the rectum and a little blood comes out with bowel movements. This will generally last less than three days and there is no cause for alarm. The body will heal itself without any intervention from us.
SLEEP PATTERNS Once again, this is an area where babies vary significantly. They will sleep different intervals and have different patterns every day for the first few weeks. Some days they may sleep sixteen to twenty hours and some days they may sleep as little as eight hours. This again, is normal in the first few weeks of life and should not concern you. Do not look for any schedule of sleeping during the first few weeks. We, unfortunately, can almost assure you a one hundred percent chance of the baby getting their days and nights mixed up in the first two months of life. There will generally be seven to ten days when the baby will sleep all day and be awake at night. This is normal and nothing to concern you. It is very frustrating we know, but, there is nothing you can do to change this pattern. Simply realize that the baby is trying to get their pattern adjusted and will accomplish this on their own. There is no medicine or intervention that will help. You should not try to keep the baby awake or shorten their naps during the day in hopes they will sleep longer at night because, unfortunately, this doesn't happen. Therefore, our advice is to grin and bear it and realize that it will last for a short period of time.
COLIC Colic is a very strange phenomenon where the baby has cramping abdominal pains secondary to gas formation. Almost all babies will have periods of colic and they are generally in the first two months of life. Colic generally occurs in the evening hours and has to do simply with an immature digestive system. Sometimes, if you are breast feeding, something that you have eaten will cross to the baby through the breast milk causing gas which leads to colic. Another reason for colic is allergy to cow's milk formula. If this occurs, we sill simply switch to a soybean formula and this will usually solve the problem. Finally, babies do not need solids in the first four months of life because they are too complex to digest by the baby's immature digestive system. Partially digested solids will lead to gas formation and colic. Therefore, we recommend, as does the American Academy of Pediatrics Committee on Nutrition, that you strictly breast feed or formula feed for the first four months with some occasional water or juice as suggested by us at well baby visits. We will go over this with you at the appropriate time.
PHONE CALLS TO THE DOCTOR We have given you our phone number in the beginning paragraph(423-968-2599) and would simply like to remind you that you can call us at any time. Routine questions can be answered during our standard call-back times at lunch or in the afternoons following office hours. However, if you have an emergency, you can call any time...twenty four hours a day...seven days a week. Please call the office number and Dr. Makres or Dr. Hommel will call you back. Also, we have a nurse line for questions, our nurses are very knowledgeable on matters concerning pediatric patients. They try and return calls every day around or after lunch and again at the end of the day. However, if they are busy they return calls when ever they get a chance. Contact them at 423-968-1986.
OFFICE APPOINTMENTS Your baby's first office appointment should be 2-3 days after discharge. You may make this appointment by simply calling the office during normal working hours and the front office staff will be happy to set this up for you. We would also like for you to know that we are in the office every Saturday morning and on Sundays. Dr. Makres is on call and will be seeing patients in the office as needed during those days. Therefore, you should never have to go a complete day without being seen if it is necessary. If you call at night or on the weekends the answering service will take your call and will give it to Dr. Makres when he checks with them. He generally checks calls at night and on the weekends every 90-120 minutes. If it is an emergency please state this to the answering service that your call is an emergency, but if you feel you need immediate attention please call 911 or go to the emergency room. Otherwise, they will hold the call until we check with them.
Finally, we would like to once again remind you that your baby is a very complex little person who has many organ systems trying to function in a maturing manner. Therefore, the first few weeks of life will be a changing every few weeks. Each day will be different as far as the feedings, sleeping, and other routines. You must simply relax and realize that within a few weeks things will smooth out. Rest when you can and enjoy your baby because these are also very exciting and rewarding weeks.
We thank you for taking the time to read this information and will see you at your next visit.
Dr. Makres on COLIC: "Colic is abdominal pain with cramping. It is derived from the word, colicky, which means cramping. Therefore, a baby who has colic is a baby who is cramping and having abdominal pain secondary to gas formation. There are four basic reasons why babies have colic: The first reason is if baby is breast feeding and is eating something that is upsetting to baby's system. The top three foods that cause colic in a breast fed baby are Tomatoes and Tomato products(yes that means fresh tomatoes out of the garden and pizza), Chocolate and the mother drinking too much milk or eating too many dairy products. The second reason for colic is feeding the baby too soon. A baby's digestive system is not ready to have solids generally during the first four to six months of life. Only as it matures is it able to digest solids properly. Therefore, if a baby is fed solids too early they go undigested which leads to gas formation, which leads to abdominal cramping, which in turn leads to colicky abdominal pain. The proper sequence for solid foods is cereal at four months, fruits at six months, vegetables at eight months and meats at ten months. However, no solid is more important than either breast milk or formula during the first year of life. The third reason for colic is a baby being allergic to milk, especially cow's milk. All standard formulas are made from cow's milk, if a baby is allergic to cow's milk(only about 3% of babies are) they will develop gas leading to cramping abdominal pain. This is the simplest one to fix by simply changing to a soybean formula. In this formula the source of protein is soybeans and the source of sugar is sucrose. Whereas in regular cow's milk formulas the source of protein is animals and the source of sugar is lactose. The fourth reason and the hardest to treat, is simply due to an immature digestive system by the baby. In this case the baby does not put out enough digestive enzymes to digest even formula or breast milk, much less digest any solids. They have colic which usually starts at about two to three weeks of age and is very very bad. The colic can last up to seven-to-nine months but fortunately most cases do not last as long, less than 7-to-9 months. There are tricks that can be used to treat this such as Mylicon drops, Maalox liquid or Zantac." TDM