Successful breast-feeding can be particularly gratifying and offers many advantages. During the first 3-4 days after birth, your breast will produce a thin but nutritious substance called colostrum. This will provide adequate nutrition until your milk comes in at 3-4 days.
You may start nursing right after delivery. The first few feedings should be 5-10 minutes per side, and nursing time should be gradually increased, over the next 3-4 days, until the baby sucks for 10-15 minutes on each side at each feeding.
Babies will nurse every 2-3 hours (from start to start). Initially you should wake the baby after 4-5 hours of sleep for feeding. Once the baby is nursing well, usually after 5-7 days, there is no need for nighttime waking (most babies will wake on their own to feed for the first 2-3 months).
Many women experience breast fullness after 3-4 days. For relief you may massage, use warm soaks, and hot showers. Encouraging frequent breast-feeding is most helpful. Sore or cracked nipples also may occur. It helps to keep the nipples dry and exposed to air between feedings and also to start feedings on the better side. After feeding, the breast will be moist with milk. Allowing this milk to dry is also helpful. Many cultures treat irritation of the skin with human milk. Even more effective is the use of a low intensity lamp or electric hair dryer set on warm several times a day.
Occasionally, nursing mothers will experience blocked milk ducts or breast infection. If this occurs, contact your obstetrician and notify us.
While nursing, adequate rest and proper diet are essential. Try not to take medications when nursing and curtail smoking and drinking. Make sure to drink plenty of fluids to replenish your breast milk, including adequate low fat milk. Eat a balanced diet of meat, fish, cheese, cereals, and vegetables and continue taking prenatal vitamins.
FORMULA FEEDING Commercial formulas offer a good alternative to nursing for the first year of life. Formulas have proteins derived from either cow’s milk or soybeans, and come as Ready-to-Use, or you can prepare them from a concentrate or powder.
Initially, most babies take 1-2 oz. per meal and feed every 2-4 hours (remember this means from start to start). As your baby consistently finishes the bottle, add more to the next meal’s bottle. With time, most babies settle into a regular schedule and will begin to sleep more at night while feeding more during the day. Other suggestions:
1) You do not have to sterilize bottles. It is okay to hand wash with soap and water or use a dishwasher. You should sterilize well water for the first two months. 2) It is easiest to make a day’s worth of formula at one time, storing it in the refrigerator in pitcher or individual bottles. It is also not necessary to warm bottles-room temperature is sufficient. 3) During check up visits we will discuss vitamins, fluoride, and the introduction of solids. 4) In general you should use either powder or concentrated formula prepared with city water. This insures the baby will receive enough fluoride to protect against dental cavities.
BATH You should sponge bathe your infant until the umbilical cord separates and is dry. When bathing, use a gentle soap on the body, water on the face and baby shampoo for the scalp. Baby oils and lotions are not necessary the first several weeks of life, and may actually cause rashes.
SKIN CARE A newborn baby’s skin will often appear dry and scaly. This flaking off of the outer layer of skin is a normal process and does not require lotions or creams. Rashes are common in newborn infants and generally resolve on their own. You should contact the office if you notice:
1) boils, blisters, or pustules 2) bruises or bleeding spots 3) jaundice (yellowness)
CORD CARE The remnants of the umbilical cord usually will fall off within several weeks. Recent research has shown it is unnecessary to apply rubbing alcohol to the cord. Just sponge bathe your baby until the cord comes off. Please call the office if the cord develops a foul odor or the skin around the cord becomes red. It is normal for the cord to ooze blood and also to see a yellow mucoid material inside as the cord separates.
VAGINA Female newborns often have a bloody and/or white mucosy discharge for several weeks after birth. This is due to mother’s hormones and requires no treatment.
CIRCUMCISION After circumcision the penis will take 4-6 days to heal. During this time, apply Vaseline with diaper changes. As part of the normal healing process, a yellow-white material often forms on the penis. This is not an infection and does not require treatment.
BREAST Some newborns of either sex will have breast enlargement, and often there is a small amount of breast milk present. Both of these conditions are normal and eventually resolve. Do not massage or squeeze the breasts. Call the office if the breasts become red or tender.
HEAD The soft spot near the front of the head allows for head growth before closing between 9 and 24 months of age. It may enlarge during the first 2-3 months of age, and it may pulsate or become tense when the baby cries. A second smaller soft spot may be present in the back of the head and closes by 2-3 months of age.
STOOLS Normal newborns have quite variable stool patterns. During the first few days, the stools are dark and tarry. There is then a gradual transition to a more typical infant stool depending on the infant’s diet. Some infants can go with every feeding. Breast-fed infants usually have frequent loose, yellow, and seedy stools. Babies who take formula may strain to have a bowel movement. If you are concerned about constipation, please call during office hours.
BABIES ARE BABIES It is normal for babies to occasionally cry, sneeze, cough, yawn, burp, hiccup, pass gas, spit up, and look crossed-eyed. Sneezing and coughing are the baby’s way of cleaning the respiratory tract. Crying is baby’s way of saying I’m hungry, I’m wet, I’m thirsty, Please hold me, I want to turn over, I’m too hot, I’m too cold, I have a stomach ache, or I’m bored. Many well babies have daily fussy periods. These become longer and louder until about age 6 weeks. They gradually disappear by age 2-3 months. The fussiest babies cry hard with their knees against their chests and are said to have colic. Frequent burping, extra holding or using a Snugli, and motion (baby swing), often relieve colic. If these suggestions do not help, call the office.
FEVER Fever occurs quite commonly in children. Fever is a temperature above 100 F by any route you measure it. High fever does not indicate a more dangerous illness. In fact, temperature above 103 F often occurs with minor viral infection in children between ages 2 and 6 years. Fever itself is not harmful; in fact, it is one of the body’s mechanisms to fight infection. We do, though, treat fever to make a child more comfortable. You should call the doctor if:
1) An infant less than 4 months of age develops temperature greater than 100 degrees F. 2) Any unexplained fever lasts more than 3 days. 3) Your child still acts lethargic or otherwise ill despite lowering the temperature.
WHEN TO CALL THE DOCTOR Some problems won’t wait until the morning; the following guidelines will help you decide when to call the doctor after office hours.
1. Breathing difficulty 2. Persistent projectile or greenish vomiting 3. Persistent or bloody diarrhea 4. Convulsions 5. Head injury associated with loss of consciousness, behavior changes or persistent vomiting. 6. Large burns or gaping wounds. 7. Persistent pain unrelieved by acetaminophen. 8. Poor or significant change in feeding especially in infants less than 6 months old. 9. Fever in an infant less than 4 months. 10. Ingestion’s (poisonings)
MEDICATIONS TO HAVE AT HOME 1. Acetaminophen drops and syrup (Tylenol) 2. Benadryl
POISON CONTROL Maryland Poison Center 1-800-222-1222
SIBLING RIVALRY Sibling rivalry is a natural part of having two or more children. The following may make the transition easier.
1) Older brother and sisters appreciate small presents from the baby. 2) Within reasonable limits, you should allow older siblings to help care for the baby 3) Though family activities are nice, each child also needs regular special time alone with one of the parents. 4) Be lenient, but set reasonable limits.
SAFETY Accidents are the number one cause of death between the ages of one and 45. We participate in The Injury Prevention Program, sponsored by the American Academy of Pediatrics. During check-ups we distribute literature on accident prevention.