Feeding
We support both breastfeeding and bottle feeding moms, and you will have to decide which is best for your situation.

• Breastfeeding: If you decide to breastfeed, please call us if you are having difficulty. We will do everything we can to help you feed your baby successfully. Initially, the baby may be very sleepy. For the first two weeks, attempt to feed every 2-3 hours around the clock. After the first two weeks old, try to feed every 2-3 hours during the day, and let your baby wake you at night after your milk supply is established and your baby is back to birth weight. Keep the nighttime feedings boring so your baby won't become accustomed to playing at night.
• Bottle feeding: Babies generally do well on any of the commercially available formulas. Most infants will take 1-3 ounces every 3-4 hours during the day during the first 2-4 weeks. Each month older generally translates to an ounce more in feeding. For example, while a 2 month old will likely eat 3-4 ounces per feeding, a 3 month old will likely eat 4-5 ounces per feeding. Feeding schedules for some newborns work best if the hours are set roughly and the baby is allowed to eat when he/she becomes hungry. Feeding schedules for other newborns work best on a routing schedule. We'll help determine which type of feeding schedule is best for your newborn during your first few well child visits. Regardless of which type of feeding scheulde, let your infant wake you at night for feedings. Never prop the bottle and never spend more than 30 minutes trying to feed your baby. Do not give your baby water unless we have told you to do so.
• Solid foods: Breast milk and formula provide all the nutrition your infant needs until they are 6 months old. We will discuss starting solids at the 4 or 6 month visit. Until that time, do not give your infant anything except breast milk or formula. Some infants are exceptions and we will help you with those decisions.

Sleeping
Your baby should be placed on his/her back in a crib or bassinet with a firm, flat mattress. This position is thought to decrease SIDS (sudden infant death syndrome). An infant will sleep up to 20 hours per day. Consistently putting your baby to bed at the same time and keeping nighttime feedings short and boring will help get your baby on a normal routine. During the day when your baby is alert and playing, put him/her on his/her belly. This position is important for the development of upper body strength and helps prevent a flat head.

Bathing
Newborns should be bathed 2-3 times each week and as needed using a gentle cleanser such as Cetaphil or Aveeno. Do not completely immerse in water until the cord has fallen off. Do not use baby powder, baby oil, Baby Magic, or fragrant soaps or lotions on your infant's skin. It is normal for newborn skin to appear dry and to peel. We may suggest baby oil for cradle cap.

Dressing
Wash new clothing in a gentle soap such as Dreft before putting them on your baby. A good rule of thumb is to dress your baby as you are dressed. On cold days, put a hat on your baby's head to help keep in the warmth. Lace, elastic bands on heads and arms, snaps, and embroidered figures are often irritating.

When To Go Out In Public
It is best to keep babies at home as much as possible during the first 6 weeks of life to limit their exposure to germs. Remember that they do not have a competent immune system yet and cannot fight infection well. Have visitors wash their hands well before handling the baby.

Do not wake your infant to share with visitors. Small children with runny noses and unclean hands are your greatest source of infection. Avoid kissing a baby if you have a cold sore.

Umbilical Cord
Avoid giving a full immersion bath until the cord has fallen off (usually between 1-3 weeks). However, a good sponge bath (including face and head) can be necessary. As the cord separates, there may be drainage or a small amount of blood present. If this occurs, soak the cord with alcohol with each diaper change. Don't forget to soak the base of the cord which is often concealed by skin. Hold pressure for 10-15 minutes if there is bleeding, and call us if this does not stop the bleeding. Call if there is a foul odor or redness around the cord.

Circumcision
Apply Neosporin or Vaseline to the circumcision with each diaper change until it is well healed. If it bleeds, hold pressure for 10-15 minutes and call us if this does not stop the bleeding. If stool contaminates the circumcision, wash gently with water and apply Neosporin.

Jaundice
It is not uncommon for babies to become slightly yellow. This jaundice color usually occurs by the second or third day and peaks around the fourth or fifth day. If your baby is yellow, place him/her in indirect sunlight and feed more frequently. Call us if your baby is yellow, lethargic, and not waking to feed.

Signs of Illness in a Newborn
Crying for long periods, decreased feeding, increased sleeping, and vomiting are all ways your infant may be telling you he/she is sick. If your infant has any of the above symptoms or is just not acting normally to you, take his/her temperature rectally. If the rectal temperature is 100.4 or higher and your infant is less than 3 months old, call us immediately day or night. We consider a temperature of 100.4 or higher potentially serious until your infant is over 3 months old. Beyond 3 months of age, fever is significant but not as worrisome as in the early infancy period. Hand washing and limiting visitors are the best ways to avoid illness.

Smoking/Vaping
No one should ever smoke around your infant. Cigarette smoking has been linked with sudden infant death syndrome, frequent upper respiratory infections, ear infections, and asthma. Insist that all smokers smoke outside.

Rashes
Newborns will often have several kinds of rashes at the same time. Neonatal acne is caused by maternal estrogen and will go away in a few months. A red splotchy rash may be present shortly after birth. This rash is called erythema toxicum and is a normal finding. It usually looks like tiny red bumps or pimples with surrounding redness. This rash goes away by the time babies are a week old. Babies can also have heat rash which looks like bright red tiny bumps. It is often on the face, scalp, neck, upper chest, and sometimes it is on the trunk as well. None of these rashes are serious, and they will go away with time. Please call us for any rash that looks like blisters or any severe/unusual rash.

Diaper Rashes
Mild diaper rash is best treated with a thick barrier cream like Desitin, A&D, or Boudreaux's. First, wash your baby's bottom with lukewarm water, dry well, then apply a layer of a thick barrier cream. It is also helpful to leave their bottoms exposed to the air as much as possible. If the diaper rash is very red and bumpy, try a light layer of Lotrimin or Nystatin before applying the barrier cream with every diaper change. If the rash looks raw and ulcerated, using Maalox mixed with Aquaphor 50/50 topically works well. The antacid properties of Maalox combined with the barrier properties of Aquaphor work together to allow the irritation to heal.

Nasal Congestion
Nasal congestion is very common in infants and can cause difficulty with feeding because they are unable to breathe through their noses. You can make your own saline nose drops by adding 1/4 teaspoon of salt to 1 cup of warm water and letting it cool. Discard and make fresh drops each day. You can also purchase these at a pharmacy. Place 3-4 drops down each side of your infant's nose, wait 30 seconds, then suck out the mucous with a bulb syringe. You will need to do this before feedings and laying your infant down to sleep. If the nose is just stuffy, use the drops and do not suction.

Fussiness and Crying
Infants cry frequently and often without apparent reason. As you get to know your infant better, you will often be able to tell by the cry if he/she is hungry, wet, tired, or just needs to be cuddled. Many babies have a fussy period at approximately the same time each day and this may last for several months. You cannot “spoil” your infant by holding him/her too much but it is okay to let them cry for a short time after you have checked to make sure they are not wet, hungry, or have some other need. Often parents take this crying personally. You must remember that a baby’s only form of expression is crying. Don’t let yourself get upset. Take a break if you can, and let someone else care for the baby for a few hours.

Stools
The number of stools per day differs drastically between babies. Your baby may have a bowel movement after every feeding or may go 48 hours between stools. It is perfectly normal for a baby to turn red and strain during a bowel movement. Call us during office hours if your baby goes more than 48-72 hours without a bowel movement and is fussy or has pebble-like stools. You should also call us if your infant is having green, excessively watery, and frequent stools. Mustard-colored liquid stools are normal for breastfed infants. Green stools with mucous and/or streaks of blood associated with a fussy baby may indicate a milk protein intolerance. If this occurs, please bring us a stool sample to test for blood.

Spitting Up
Many babies spit up after feeding. This is typically normal and you should not be concerned unless your infant is not gaining weight appropriately, has pain with spit up episodes, or green or yellow fluid in the emesis. Call us if your baby spits up most or all of his/her feedings on a regular basis.

Hiccups and Sneezing
Babies sneeze to clear their airways. This does not mean they are sick. Hiccups are perfectly normal. You do not need to give the baby water or anything else to make the hiccups go away. They will go away on their own.

Safety

• Car seats: Until your infant is 2 years old, the car seat must face the back of the car. Make sure it is properly secured in the car and that the infant is properly secured in the seat. All infants and children less than 12 years of age should be in the back seat at all times. A baby or any child less than 12 years old should never sit in a seat armed with an airbag. Children should remain in car seats until they are 40 inches tall and 40 pounds in weight. These children may then be in a booster seat until they are 4 foot, 9 inches tall (57 inches).
• Smoking: Passive smoke is detrimental to infants and children. Please stop smoking or smoke outside every time.
• Sleeping: Placing your infant in bed with you places him/her at risk for suffocation. Your baby can sleep in a bassinet next to your bed early on. Your infant should not sleep in bed with you. Transitioning your newborn to their own crib early on will help make them a better sleeper. Always place your infant on their back or side to sleep.
• Infant CPR: We recommend that every parent or caregiver know CPR. Call the American Heart Association for information on local courses.

Suggested Reading

• Caring for your baby and young child: birth to age 5. Steven P. Shelov, M.D., FAAP. Bantam Books.
  This book has a nice overview of development, offers suggestions on dealing with common behavior problems, and has a section on common illnesses.
• Solve Your Child's Sleep Problems. Richard Ferber, M.D. Simon and Schuster, 1985.
• Good Behavior. Stephen Garber, PHD, Marianne Daniels Garber, PhD, and Robyn Freedman Spizman, St. Martin's Paperback edition, February, 1991.
• Coping with a Picky Eater. William G. Wilkoff, M.D., Simon and Schuster, Inc. 1998.
• The Care and Keeping of You: The Body Book for Girls. Valorie Lee Schaefer, Pleasant Company Publications, 1998.
• 1-2-3 Magic. Thomas Phelan, PhD. Sourcebooks; 6th edition, 2016.