CRYING
Your baby has many different cries and you will quickly learn to distinguish them. Crying can be caused by hunger, a wet or stool-filled diaper, gas, being too hot or being too cold, being uncomfortable, or just letting off steam. Changing the baby, rocking him, walking him around, and of course feeding him if he is hungry, are the obvious things to do. Remember that even babies need to let off steam. If you are sure he is okay, it will not hurt him to cry for short periods of time. If you feel your baby's cry is an unusual one, that he looks ill, acts strange, has lost appetite for a couple of meals, or has other symptoms, call the office.

BOWEL HABITS (only parents and Pediatricians could be interested)
Every baby will establish her own bowel habits, so do not force yours upon her. Breast stools are often very frequent, soft and runny. They range in color from bright yellow or orange through a browny-green. They can occur twice during a single feeding (up to 12 per day) or just once a week. Bottle fed babies' movements tend to be firmer and less frequent. They tend to be yellow-green or brown in color with firm "seeds" in them. The average bottle-fed infant has one to three stools per day.

BURPING
Babies need to burp if they swallow air while they are eating or if they swallow air as a result of crying. Small air bubbles get "trapped" under fluid in the stomach and can cause discomfort. Some babies burp easily while others do not. It is not essential that the baby burp if he is comfortable and happy. To burp the baby, hold him on your cloth covered shoulder and gently pat or rub his back. You can also sit him up on your lap with one hand under his chin for support and the other gently circling and patting his back.

EATING
Be sure you are comfortable, relaxed and not rushed when feeding your baby. It should be a pleasurable experience for both of you. Some babies are gulpers and will eat quickly while others take their time. Thus, there is no set length of time for feeding. There is also no set amount to feed your baby each time. If the baby sleeps or is quiet for three or more hours between feedings and is gaining weight, then she is getting enough. It is usually not necessary to offer the baby any solid foods until she is four to six months of age. All nutrients, short of vitamins we will prescribe for you, are supplied in breast milk and formula.

ACTIVITY
Some newborn babies sleep 20-hours a day while others sleep only 12. Some babies are extremely active and constantly kick, flail their arms and legs, and cry, while others lie passively. Some babies will remain in the position they are placed in while others will scoot around due to the random movements of their legs and arms. Some babies like to be swaddled in clothing and blankets while others do not. Your baby has her own personality from the very start. Enjoy learning about your baby's quirks and desires. Make an effort to mold your baby to make life easier for yourself; however, this is not always an easy task.

Physical Characteristics

SKIN
Many babies' skin dries out, cracks or chaps in the first few days of life. This represents an adjustment of the baby’s skin to an environment other then the warm, soft intrauterine environment. You can use a sparing application of moisturizing (non-scented) cream such as Keri lotion or Eucerin cream.

Babies sometimes develop a rash in the nursery, which comes and goes over the first couple of weeks of life. This rash is characterized by red blotches with small blister-like heads. It is called erythema toxicum, is of unknown cause, is self-limited, and requires no treatment. If multiple persistent blisters develop, the baby should be seen.

Another rash which generally appears between four and eight weeks resembles acne. It also comes and goes, is especially bad when the child is agitated or hot, and goes away without treatment. It is more common in breast-fed infants and in warm weather. Washing the pimples with water and a soft washcloth can help a little. Do not squeeze them.

Diaper rash is very common and Desitin A&D ointment or Vaseline should be used liberally on any irritation in the diaper area. A worsening diaper rash over three to five days, despite use of creams, probably deserves a phone call to the nurse. We recommend frequent diaper changes.

NAVEL (UMBILICUS)
The umbilical cord represents a potential for infection in the newborn. When diapering, try to keep the diaper below the navel so it will stay dry. Do not immerse the baby in a tub until the cord falls off. Sponge bathe the baby to keep him clean. Cords usually fall off at five to ten days of age, but can remain on a lot longer, especially if they constantly get wet. It is common for a cord to bled slightly during the separation process so don't be frightened by this. Rubbing alcohol does not need to be used routinely. Simply keeping it dry will speed its falling off.

GENITALS
FEMALE: The vagina is an area which must be kept very clean. The proximity of the urethra (urinary outlet) creates the potential for introduction of bacteria and thus infection in the bladder. The folds of the labia should be spread open to remove accumulated debris. Always clean top to bottom. Cotton balls wet with tap water are useful. Roughly 5-10% of female infants will have vaginal bleeding in the first two to seven days of life. This bleeding represents withdrawal of maternal hormones, is normal, self-limited and benign.

MALE: The circumcised penis should be washed gently with soap and water, two or three times a day. Pat it dry carefully and apply Vaseline until it is no longer sore or raw-looking. The penis often looks swollen, red and awful for the first few days. However, it heals well in seven to ten days. Call us if bleeding persists or a discharge develops. If your son is not circumcised, wash the penis gently as you would other parts of the body. In most cases, the foreskin cannot be retracted, so don't force it. Nature and time will take care of this.

BREASTS
All infants, male or female, may develop breast engorgement. You will feel lumps under the breasts from about one-week of age. Don't squeeze the milk out or the baby will continue to produce it. The swelling should be symmetrical and not sore, hot or red. The breast engorgement recedes spontaneously over one to six weeks.

HEAD
The fontanel (soft spot) varies in size from baby to baby and does not close until between 6-18 months. It is often seen to pulsate and this is normal. It will bulge with crying and straining. If it bulges continuously when the baby is quiet, let us know. A flaky whitish or yellowish scale can occur on the scalp and is called cradle cap. Scrubbing with a soft facecloth with soap and water can be helpful. Stubborn cradle cap can require using Sebulex, Selsun Blue shampoo or a medicated cream from us.

EYES
Yellow material may collect in the corner of the baby's eyes due to the plugging of the nasolacrimal duct (tear duct). Wipe this material away. If the eyes get red, lids get swollen or there is excessive drainage, let us know.

NOSE
All babies sniffle and snort. They also will often sneeze. This does not mean the baby has a cold. If there is drainage from the nose, use a bulb syringe to help remove it to make the baby more comfortable. A cool mist vaporizer or humidifier, especially in the dry heat of homes during the winter can be helpful. Be sure to clean out your humidifier daily with diluted bleach.

EARS
The outer part of the ear may be cleaned with a damp cloth or Q-tip. Do not insert a Q-tip into the ears. This only pushes wax further in. You also run the risk of hurting the baby if you put Q-tips in the ears.

MOUTH
This is the center of the baby's universe, yet no special care is required. Small whitish cysts can occasionally be seen on the palate. These are benign and go away by themselves. A fungus infection (oral thrush) occasionally develops in newborns. It looks like milk curd stuck on the inside of the cheeks but cannot be removed easily by a Q-tip. Contact us for medication if this occurs.

FINGERNAILS AND TOENAILS
They are usually soft and pliable for one to two weeks after birth. Don't bother cutting them at this point because they might bleed. Once they are hardened, they may be cut with blunt scissors. Some people find it an easier task when the baby is sleeping. Nails left uncut will break off by themselves making cutting optional.

Feeding

BREAST
If you have chosen to breast-feed your baby, your milk provides complete nutrition. About 80-90 percent of milk is taken from the breast in the first four to five minutes of vigorous nursing. After this period the volume of milk decreases but the baby will get the hind milk which is high in fat and, therefore, will satisfy her hunger best. If your breasts are sore, chapped or cracked and you have completed a feeding but the baby seems still interested in sucking, you can certainly let her suck on something like a pacifier. You may need to give us a call or speak with a lactation consultant about properly positioning your baby at the breast in order to avoid sore nipples or to correct the problem once it occurs. Breast creams are not generally recommended because they can be ingested by the baby and are not particularly good for her. A little bit of expressed milk on the tip of your nipple may also help if your nipples are a little bit sore.

During the first two hours after birth, the infant is alert and eager to suck. At this time she is ready to start nursing. Some people suggest that you start with only a few minutes per side for each feeding, but over the past few years we have learned that the time spent nursing is not what causes sore nipples, it is mostly improper positioning. Start with up to 10 to 15 minutes per side. You may need to increase a little bit more as your baby desires.

Initially, your baby will get colostrum, which is a thick yellow fluid. This is wonderful stuff, full of protective antibodies and white blood cells to help fight infection and also contains a good deal of protein and sugar to help satisfy her hunger. Babies are born with extra fluid in their bodies so in the first couple of days of life the baby does not need a large volume of feeding. Around day three or four you may notice that your breasts will feel full and engorged and this is the signal that your milk is coming in. Once your milk comes in, frequent nursing will make your breasts feel a lot better. You should alternate which breast you start to feed the baby in order to help stimulate each breast equally.

Once your milk has come in your baby should be nursing at least every two to three hours or approximately eight to twelve times a day. Nursing more frequently is also fine. Scheduling feedings is often difficult. Most babies do best on a modified demand schedule. Though it would be nice to be able to sleep all night, most babies are up a couple of times and really need to eat frequently in order to grow. Your breasts need frequent stimulation in order to get the message to produce milk as much milk as the baby needs. Most babies will switch to a pattern of sleeping longer during the nighttime and less during the daytime at about three weeks of age, and most babies will sleep completely through the night by about four months, although there are no guarantees!

Make sure you get enough rest. This is a lot easier when this is your first baby, and we recommend that you take advantage of naptimes and rest when your baby is resting. You should also make sure that you are eating enough calories to provide nutrition for yourself and an extra 500 calories per day to make milk for your baby. Do not go on a diet now! Try to drink a glass of fluids (this does not have to be milk) each time your baby nurses. Eat any foods you want. If your baby gets fussy four to six hours after you eat a particular food, you may have to choose between eating your favorite food and a fussy baby. Foods which can occasionally cause some problems are baked beans, onions, cabbage, turnip, cauliflower and chocolate. Alcohol really should not be ingested as this does get into your breast milk and is not an ideal substance for your baby. Some medications are okay to be taken while you are nursing. It is certainly fine to be taking Tylenol or Ibuprofen for headache or for postpartum cramping, or prescription pain medication from your obstetrician.

You will know that your baby is getting enough to eat (after your milk has come in around day three or four) when your baby nurses every two or three hours, you can hear sucking and swallowing noises as she is eating, she has wet "scrambled egg" stools at least four to six times a day, and she has several wet diapers a day. We will provide you a prescription for fluoride at six months if you live in a town where the water is not fluoridated. We may also provide you with a vitamin prescription depending on your physician. If you have any concerns or questions about how to properly position your baby or any other concerns about nursing, please give us a call.

BOTTLE
If you choose to bottle feed your infant, formula such as Enfamil or Similac is nutritionally complete. If you use a prepared formula, we recommend the "with iron" variety. If you live in Norwood, Westwood, Sharon, Dedham, or Franklin, fluoride comes in your drinking water. If you live in a town without fluoridation, you will need a prescription for fluoride, which we usually start at six months.

Most babies fall pretty well into a four-hour schedule. Smaller babies tend to eat more often. Try to modify your baby's schedule into something that fits reasonably well into the way that you run your life rather than vice-versa. You'll be happier in the long run.

The proprietary infant formulas come three ways: ready-to-eat, concentrated or powder. Ready-to-eat is easiest, but is also the most expensive. You open the can, put it in the bottle and that's it. Concentrated needs to be mixed in a 1:1 ratio with water. Powdered formula gets made with one scoop of powder (provided in the can) per two ounces of water. You have to decide for yourself which is easiest for your lifestyle.

Bottles, nipples and city water do not need to be sterilized or boiled. Cleaning the bottles with a bottle brush and hot water is quite adequate. Tap water in this day and age generally cause no problems.

Odds and Ends

CROWDS
Do not unnecessarily expose your newborn infant to individuals who are sick or to crowds where infection is bound to be present. However, if dressed appropriately, there is no reason not to enjoy a long walk outdoors. Indeed, if you need to go shopping and there is no choice but to take the baby, by all means go. Just be sensible about the baby's exposure.

SIBLINGS
If this infant is not the first, older children must be dealt with. Certainly, extra time from Dad helps older children adjust to the new infant's arrival. The child between 20 months and three years will be most obviously affected. A good rule of thumb is that what was allowed and appropriate before the new infant arrived is still consistently allowed and appropriate after the birth of the baby.

CAR SEATS
Between the ages of six months and 40 years, auto accidents are the leading killer of people. About 93% of young human beings killed in auto accidents would survive if properly restrained with protective devices. A child should always be restrained while traveling in a car. The law requires that the car seat be used. Children and infants should always be in the back seat of the car because it is safer.

PACIFIERS
Talk to your primary pediatrician on this one. We have different philosophies regarding the use of a pacifier.

FEVER
It is important to note that fever is only a symptom and is not dangerous to a child. However, if your infant under two months of age has a rectal temperature greater than 100.4, please notify our office immediately. Older children may have a fever at the beginning of a cold or other infection. If the child appears very lethargic, refuses to drink liquid, or is vomiting persistently, our office should be contacted. However, if the older child continues to drink (although he may not want to eat) and have some periods of playfulness, you may feel comfortable observing him for 24-48 hours before calling for an appointment. If you have any questions about whether your child needs to be seen by a doctor, call the office.

TEMPERATURE OF THE HOUSE
The house temperature can be what you want it to be (but not below 60 at night). Dress the baby in one layer more than you need for yourself to be comfortable and the baby should be fine.

SUGGESTED SUPPLIES
Acetaminophen drops (any brand)
Bulb syringe
Rubbing alcohol (for umbilical cord)
Vaporizer
Rectal Thermometer
Vaseline
Desitin