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The Baby Book

A Reference for Caring for Your Baby

When you were born, you cried.
And the world rejoiced.
w w w . p r i m e d p h y s i c i a n s . c o m
P r i n t f o r m s a n d c o m p l e t e n e c e s s a r y p a p e r w o r k a t h o m e t o s a v e t i m e i n t h e o f f i c e
G e t a n s w e r s t o c o m m o n l y a s k e d q u e s t i o n s
A c c e s s h e a l t h i n f o r m a t i o n , s u c h a s i m m u n i z a t i o n s c h e d u l e s a n d t i p s f o r h e a l t h y l i v i n g
U s e i n t e r a c t i v e m a p s t o l o c a t e a n y o f o u r P r i M e d P h y s i c i a n s o f f i c e s
L e a r n h o w t o b e c o m e a n a c t i v e p a r t n e r i n y o u r h e a l t h c a r e t e a m
C o n n e c t t o n u m e r o u s h e a l t h r e l a t e d w e b s i t e s f o r i n - d e p t h i n f o r m a t i o n
D i s c o v e r t h e m a n y d i f f e r e n t s p e c i a l t y s e r v i c e s w e o f f e r a n d m u c h m o r e
V i s i t P r i M e d P h y s i c i a n s
2 4 h o u r s a d a y !
L o g o n t o w w w . p r i m e d p h y s i c i a n s . c o m t o d a y , t o n i g h t o r a n y t i m e .
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T h e B a b y B o o k
A R e f e r e n c e f o r C a r i n g f o r Y o u r B a b y
W h e n y o u w e r e b o r n , y o u c r i e d .
A n d t h e w o r l d r e j o i c e d .
0 3 - 2 0 1 0
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3 0 3 3 2 9 _ P k t . q x d : 3 0 3 3 2 9 _ p k t f l d r 3 / 1 6 / 1 0 2 : 2 0 P M P a g e 1
Children aretheliving messages
wesend to a timewewill not see.
The Baby Book
A Reference for Caring for Your Baby
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It was thetiniest thing I ever decided
to put my wholelifeinto.
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If thisisyour first baby, welcometo theexciting world of parent-
hood. If you already havechildren, you areabout to discover how
thisnew littleperson, with hisor her own personality, will add a
new dimension to your family.
In either case, our practiceispleased that you haveselected usto
help you carefor your newborn. Welook forward to serving asa
guideto you in creating a happy and healthy upbringing for your
son or daughter.
Keep This Book!
This booklet will serve as a reference for you as you begin to care for your
newborn. Weve taken many of the most frequently asked questions and issues
and included them in this book. This will help you to be prepared for caring
for your newborn in the weeks ahead.
As you come to the office for future well visits, we will give you additional
pages that outline your babys growth and development for his or her age. You
may find it helpful to keep these pages with this booklet for reference.
Congratulations on the birth of your baby!
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If you can giveyour son or daughter onegift,
let it beenthusiasm.
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Table of Contents
Your Newborn Child
Your Babys Appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Your Babys Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Your Babys Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Caring for Your Newborn
Your Babys Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Feeding Your Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
- Nursing
Taking care of Mom while nursing
Problems while nursing
Nursing and going back to work
- Bottle feeding
- Frequency of feedings
- Burping your baby
Bathing your Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Diapering and Laundering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Your Babys Health
Common Characteristics of Newborns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Newborn Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
- Newborn Screening Test
- Caring for the umbilical cord
- To circumcise or not to circumcise
- J aundice
- Routine checkups and immunizations
- Dental care
Newborn Illnesses/Concerns
When to Call the Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Sudden I nfant Death Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Colic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Gastro-Esophageal Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Newborn Safety
Car Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Home Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
CPR and First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Poison Control Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Common Illnesses/Concerns
Common cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Taking your Babys Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Earache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Head I njuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Sleep Problems in Infants and Toddlers
Develop a Regular Schedule and Sleep Routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Feeding During the Night . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Toddler Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Nightmares . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Sleep Terrors and Sleepwalking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Index and References
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Using the I nternet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Suggested Web Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
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When thefirst baby laughed for thefirst time,
thelaugh brokeinto a thousand pieces and they
all went skipping about and that was the
beginning of fairies.
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Now that youveexperienced themiracleof pregnancy and birth, youll
bespending timegetting to know your beautiful baby.
Your Babys Appearance
I n the first few weeks your baby will have several unusual features that are
unique to this time of his or her life. I n fact, many newborns look slightly
peculiar to their parents. There is no need to be alarmed.
Every day youll become more familiar with the special physical characteristics
that make your baby the unique person that he or she is. The following takes
you on a guided tour of your babys primary characteristics the first few
weeks of life. For more detailed information, see the alphabetized section on
Common Characteristics of Newborns.
Babys head
When babies are born, their heads are often molded to fit through the birth
canal. Although your babys head may seem to be an unusual shape, it will
soon take on a more rounded appearance as your baby grows and develops.
Babys face
Your newborns eyes may appear red and swollen for a few days after birth.
This is normal, and there is no need to worry. Some babies appear to be cross-
eyed during the first few weeks. Again, this is normal as the babys nervous sys-
tem continues to mature. Your baby can see from the time of birth. During the
first few weeks, he or she can best focus on objects at around 14 inches away.
Babys chest
Some babies have what appear to be swollen breasts during the first few
weeks. This occurs due to the passage of female hormones from Mom across
the placenta during pregnancy. You may notice a white fluid leaking from the
nipple. Do not squeeze the nipple or express the fluid. I f the nipples appear
red and inflamed, it could indicate an infection.
Babys belly
The abdomen of your newborn is most noticeable because of the umbilical
cord. This cord, which provided nutrition and carried away waste during
pregnancy, is cut short and no longer needed and will soon dry up and fall off.
For more information on caring for the umbilical cord stump, see page 14.
Babys nervous system
All newborns have reflexes that they will outgrow as they grow and mature.
One common reflex is a shaking or quivering motion of the arms, legs, or chin.
This is a normal response and is not cause for alarm.
Your Newborn Child
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Babys skin
I n general, your babys skin may appear to be blotchy, and at times his or her feet or
hands may be blue. I n most cases, this happens because the babys blood vessels are
immature. There is no need to worry. Babys skin is often dry and there may be
some peeling.
I n the first few days or weeks of life there are several different harmless rashes that may
occur. One of these is milia, tiny white dots on the nose and cheeks that are causedby
clogged pores. This condition may be seen from time to time throughout infancy. You
may also notice other rashes like infant acne, erythema toxicum (tiny bumps that are
firm, yellowish or white, surrounded by a ring of redness) or just sensitive skin. Blisters,
open or weeping sores, boils, yellow crusts or red streaks are not expected and need to be
evaluated by your doctor promptly.
Your Babys Behavior
As you spend the first few weeks getting to know your baby, youll become aware of
little things that he or she does. Dont be concerned about these motions or behaviors.
Most of them are harmless reflexes caused by an immature nervous system and will
disappear in two or three months.
Babys breathing
At times, a baby will appear to have an irregular breathing pattern. As long as your
baby seems content, there is nothing to worry about. I f you are concerned, observe
your babys breathing rate. I f he or she is not turning blue, breathing is less than 60
breaths per minute, and the pauses between breaths last fewer than six seconds, dont
worry. Babies will often take rapid, progressively deeper breaths to completely expand
the lungs.
Trembling or jitteriness
Your baby may experience trembling or jitteriness of arms and legs while crying. J itters
are common in newborns; however, some parents mistake these common movements as
signs of a seizure. Seizures are extremely rare. During seizures, babies also make jerking
movements, blink their eyes, suck rhythmically with their mouths, and dont cry. I f your
newborn is trembling but not crying, try giving the baby something to suck on. I f the
trembling doesnt stop during sucking, call our office immediately.
These behaviors include:
Chin trembling
Frequent yawning
Passing gas
Straining with bowel movement
Noises caused by breathing or
movement during sleep
Lower lip quivering
Spitting up (small amounts) or belching
Startle reflex a brief stiffening of the body
in response to noise or movement (also
called the Moro reflex or embrace reflex)
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Bowel movements
Babies have a variety of bowel movements. Early bowel movements are green-
ish black, progress to appear yellow and seedy, then become darker and more
formed. The frequency of bowel movements may vary, from after each feeding,
to once every 5 days or longer. Constipation results in hard pellet stools. I t is
normal for babies to grunt, strain and turn red while having a bowel move-
ment. Please call the office if you notice any blood in the stool, if the stool is
pale colored (like clay), or if the stool appears black or tarry. Call the office if
your baby has gone more than seven days without passing stool.
Babys Sounds
While it may be months before you hear your babys first laugh, there are
other sounds that he or she will make that youll find very familiar. These
Crying is your babys only way of communicating with you right now. Crying
is your babys way of telling you that he or she is uncomfortable in some way.
Typical reasons for crying include being wet, cold, hot, hungry, tired, wanting
attention, or feeling some type of pain. I f your baby seems to be inconsolable
or becomes more and more irritable, call our office.
Throat clearing or gurgling sounds in the throat
Gurgling sounds in the throat are caused by mucous or saliva in the throat.
You need not worry about these sounds unless it appears that your baby is
having a difficult time breathing.
Babies younger than two months should rarely cough. Call us immediately if
your baby seems to be coughing excessively during the first two months of life.
Hiccups often begin before birth. These little spasms seem to bother parents
more than they bother the baby. No treatment for hiccups is necessary they
will pass on their own. I f youd like to try to make your baby more comfortable
during a hiccup spell, you can try burping or feeding.
Sneezing is a way for your baby to clear his or her nose. Occasional sneezes
are normal and do not always mean that your baby has a cold.
Passing gas
Passing gas is a healthy sign. Babies swallow a lot of air while
feeding. This process is a natural way for baby to release that
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Babies arealways moretroublethan you thought
and morewonderful.
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Creating a loving, positiveenvironment for your baby isoneof the
most important thingsyou can do asa parent.
Your Babys Environment
Your baby was born with a blank slate. Babies learn by experiencing life
through their senses. Holding, talking, singing, or even dancing with your
child are ways to create positive interactions.
Read to your child often, even when he or she is an infant. Any type of reading
can be interesting and useful to an infant if the words come from the soothing
voice of a parent. I f you played music before the babys birth, keep playing it
after birth. Children naturally enjoy the rhythm of music.
Babys comfort
The temperature of your home should be kept at the usual comfort level
(between 65 and 70 degrees.) I f your baby is uncomfortable, he or she will
give you clues. For example, if babys hands and feet are cold and the rest of
baby is warm, you may want to dress your baby in a light sleeper.
Babys clothes should be soft, light, loose and simple. Babies dont require any
more clothing than the average adult. Dress your baby appropriately based on
temperature and time of year.
Because your babys head is proportionally larger than the rest of his or her
body, a hat should be used when going outside in cold weather. This will help
to insulate babys head and to keep the heat from leaving his or her body.
Earmuffs dont prevent anything but cold ears. Middle ear infections are not
caused by leaving the ears uncovered. Most illnesses are caused by contact
with others. Try to keep your baby away from people with colds, flu, or other
contagious illnesses.
Socializing with your baby
For the first 4-6 weeks, you and your baby should stay home. Visitors should
be limited, and they should wash their hands before holding the baby. Do not
disturb the babys sleep for socializing. You should not allow any visitors who
are ill to visit the baby until after theyve recovered. Try to avoid large crowds
and exposure to anyone who is sick, for the first 2-3 months of your babys life.
Caring for Your Newborn
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Feeding Your Baby
The choice between nursing or bottle feeding is a personal one. After you have
researched all the information, factoring in your needs and desires, make your decision
whether to nurse or bottle feed. Then be happy with your decision. It may seem very sim-
ple, but it is true. No matter what you decide, if you are happy, your baby will be happy.
Breast feeding (nursing) provides the best nutrition for your baby. After all, breast
milk is natures formula. Many new mothers feel a special closeness with their new-
born while nursing. And, breast milk also contains antibodies which help protect the
baby against infection.
When you first begin breast feeding, you can expect very little breast milk. This is
normal. During first few days, your body will produce colostrum, a yellow or whitish
fluid. Colostrum provides extra protein and minerals as well as the antibodies your
baby needs to fight infection.
Many new mothers worry about having enough breast milk during
those first few days to sustain their babies. Luckily, nature designed
newborns to make it through this period without much food. When
you breast feed your baby these first few days, his or her sucking
action will cause breast milk to be produced. Mature milk (which
is produced after colostrum) will come in after three or four days.
The nurses at the hospital will lead you through the initial feedings.
Major points to remember include:
Open your babys mouth by pressing his or her cheek against
your breast (the rooting reflex)
Gather the nipple together to allow as much of the areola as possible into your
babys mouth.
Let your baby nurse from each breast at each feeding, beginning each successive
feeding with the opposite breast.
Help avoid sore nipples by changing position from one feeding to the next. Have the
hospital nurse demonstrate the various holding positions.
Start with feedings of five minutes with each breast. Gradually increase to ten or fif-
teen minutes. Feedings beyond thirty minutes dont increase nutrition and may
make you sore.
Let the nipple air dry after feedings and between feedings to prevent cracking and
soreness. I f this is not practical, or if there is leaking between feedings, a nursing
pad can be used. I f cracking begins you may apply a cream such as lanolin.
Remember that nursing can be a difficult process, so be patient. Do not hesitate to
call for help from the office, or talk with the lactation consultant at the hospital.
No matter
what you
decide, if you
are happy
your baby will
be happy.
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Take care of Mom while nursing
Whether nursing or not, it is important to take care of yourself and to be sure
to follow the rules for good nutrition. Be careful with any caffeine and alcohol
consumption. Make sure that you drink plenty of fluids and continue taking
your prenatal vitamins.
I f you require over the counter or prescription medication, please notify your
physician that you are breastfeeding. Some medications can be harmful to your
child or decrease your milk production. If you have questions about medications
and nursing, please call our office.
Problems while nursing
I f for some reason you feel that nursing your baby isnt going well, please ask
us for help. Quite often, we have found that parents may perceive that nursing
is not going well when actually the baby is thriving.
Nursing and going back to work
I f you are a working mom, you may have mixed feelings about breast feeding
when it is time to return to work. Consider these three solutions:
You may decide to express milk, saving it for those feedings when you cant be
there. Breast milk can be saved in the refrigerator for 48 hours and a few
weeks in the freezer (seechart on page8). An electric pump that expresses milk
from both breasts at the same time will make giving breast milk in a bottle
much easier.
You may decide to offer formula instead of the breast for those feedings when
you cant be there.
You may decide to switch from nursing to bottle feeding. Gradual introduction
is a common technique for allowing the mother and the baby to make the tran-
sition smoothly from breast to bottle feeding. That is, change only one feeding
from breast to bottle every three days.
Decisions that involve switching from nursing to bottle feeding are important
ones. I f you feel the need to switch from nursing to bottle feeding because you
feel that you arent doing a good job, please discuss it with us. I f you desire the
change for other reasons that have to do with your own personal lifestyle, feel
comfortable with your decision.
Whether nursing or not, it is important
to take care of yourself and to be sure to
follow the rules for good nutrition.
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Storage location of breast milk Temperature Storage Time
At roomtemperature . . . . . . . . . . . . . . . . . . .77 degrees F. . . . . .4 hours
Cooler with blue ice . . . . . . . . . . . . . . . . . . . .59 degrees F. . . . . .24 hours
Refrigerator (fresh milk) . . . . . . . . . . . . . . . . .39 degrees F. . . . . .72 hours
Refrigerator (previously thawed milk*) . . . . . . .39 degrees F. . . . . .24 hours
Frozen milk** (Freezer inside refrigerator) . . . .4 degrees F. . . . . . .2 weeks
Frozen milk** (freezer with separate
door outside refrigerator) . . . . . . . . . . . . . .4 degrees F. . . . . . .3-6 months
Freezer** (separate manual defrost-deep freeze) . . .4 degrees F. . . . . . .6-12 months
*Do not refreezethawed milk
** Container with lid with airtight seal
Bottle feeding
Formula feeding may be a more convenient solution for your family. You should use
an iron-fortified formula such as Similac Advance. Your newborn may take 2-3 ounces
of formula at a feeding and will generally want to feed every 2-4 hours. Do not allow
your baby to go more than 4 hours between feedings for the first two weeks of his or
her life.
Keep the following in mind when bottle feeding:
Do not use the microwave to heat bottles. Microwaves cause uneven heating of the
formula and could burn your baby.
Always hold your baby upright or semi-upright for feeding.
Never prop the bottle in his or her mouth.
Do not let your baby get into the habit of taking a bottle in the crib or bed. Use a
pacifier to satisfy your babys need to suck.
Do not change your babys brand or type of formula without talking with us first.
Frequency of feedings
Your babys feeding schedule may be fairly irregular at first. Especially during the
first two weeks, he or she may be hungry every 2-3 hours during the day and 2-4
hours during the night. To encourage a feeding, you may have to unwrap your baby
to increase his or her level of alertness.
I f your child is exclusively breast fed or consumes less than 30 ounces of formula per
day, you will need to give him a multivitamin containing 400 I U of vitamin D for bone
strength. We will discuss this with you at your two week visit.
Your baby should not need anything to eat other than breast milk or formula. Some
parents give their babies water in situations when the baby seems hungry in between
feedings. I f you decide to give your baby water, limit the amount to no more than two
ounces per day.
When giving water to your newborn, city tap water is fine, and boiling isnt necessary.
I f your water comes from a well, do not give it to your baby until you have had it test-
ed for bacteria. Your county health department can help you to obtain testing.
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Burping your baby
Babies tend to swallow a lot of air when they feed. You should burp your baby
after a feeding by holding your baby upright on your shoulder and gently pat-
ting the back. Burping will often make the baby more comfortable. Sometimes
babies dont burp after feedings. I f your baby seems comfortable, burping may
not be necessary.
Bathing Your Baby
Bathing is a time of warmth and tenderness for you and your baby. Your babys
skin is sensitive but not delicate. You can use soap and water on a regular basis.
A bath can be given with a wash cloth and soap and
water while your baby is on the changing area.
Remember that water itself is drying to the skin. I f the
skin looks dry, you may skip the bath for a few days.
Sponge baths are recommended until the umbilical
stump falls off. After that, you may give your baby tub
baths. At first, use only an inch or so of water and
always check the bath water temperature with your elbow. To help prevent
accidental burns, keep your water heater set at 120 degrees F. Limit the amount
of soap and lotion used on the babys skin in the first few weeks of life. This will
allow the natural oils in the skin to come in.
Diapering and Laundering
Although they may be more convenient, disposable diapers have an effect on
the environment. I f you choose to use cloth diapers, you can wash them the
same as you wash the rest of the laundry. One third of a cup of vinegar in the
final rinse may help to reduce odor. Avoid using fabric softeners, which can
cause irritating diaper rash.
Bathing is a time
of warmth and
tenderness for you
and your baby.
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Children aretheonly form of immortality
that wecan besureof.
303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 16
Keeping your baby healthy throughout hisor her lifeisoneof your
primary concernsasa parent. Welook forward to helping you in
thisimportant endeavor both when your baby isill, and even
moreimportantly, when your baby iswell.
Common Characteristics of Newborns
Barton D. Schmitt, MD, a noted expert on newborn care and author of many
baby and child care books, has developed a list of common physical character-
istics of newborns. Most are normal, but if you have specific questions, please
call the office.
The following alphabetized listing is taken from Dr. Schmitts work:
Blocked tear ducts. I f your babys eye waters continuously, she may have a
blocked tear duct. This means that the channel that normally carries tears
from the eye to the nose is blocked. It is a common condition, and more than
90% of blocked tear ducts open up by the time the child is 12 months old.
Body hair (lanugo). Lanugo is the fine downy hair that is sometimes present
on the back and shoulders of newborn babies. I t is more common in pre-
mature infants. I t rubs off with normal friction by 2 to 4 weeks of age.
Caput. This swelling on top of the head or throughout the scalp is caused by
fluid that is squeezed into the scalp at birth. Caput is present at birth and
clears in a few days.
Cephalohematoma. This is a lump on the headusually confined to one
sidethat occurs when blood collects on the outer surface of the skull
under the skin. I t is caused by friction between the infants skull and the
mothers pelvic bones during birth. I t first appears on the second day of
life and may grow larger for up to five days. It doesnt disappear completely
until the baby is 2 or 3 months of age.
Ear pits. About 1% of normal children have a small pit or dimple in front of
the ear, below the temple. This minor congenital defect is not a problem
unless it becomes infected.
Epithelial pearls. There may be little cysts containing clear fluid or shallow,
white ulcers along the gum line or on the roof of the mouth. They result from
blockage of normal mucous glands. They disappear after one to two months.
Your Babys Health
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Eye color. The permanent color of the eyes usually blue, gray, brown, or some vari-
ation of these colors is often uncertain until your baby reaches 6 months of age.
Children who will have dark eyes often change to the permanent color by 2
months of age. Children who will have light-colored eyes usually change by 5 or
6 months of age.
Feet turned up, in, or out. Feet may be turned in any direction inside the cramped
quarters of the womb. As long as your childs feet are flexible and can be moved
easily to normal position, they are normal. The direction of the feet will straight-
en between 6 and 12 months of age.
Flattened nose. The nose may be flattened or pushed to one side during birth. I t will
look normal by 1 week of age.
Folded ears. The ears of newborns are commonly soft and floppy. Sometimes the
edge of one is folded over. The ear will assume its normal shape as the cartilage
becomes firmer over the first few weeks of life.
Fontanel. This soft spot is found in the top front part of the skull. I t is diamond-
shaped and covered by a thick, fibrous layer of tissue. I t usually pulsates with
each beat of the heart. I t is safe to touch this area. The purpose of the fontanel is
to allow rapid growth of the brain. I t normally closes over with bone when your
baby is between 9 and 12 months of age.
Hemorrhage on the eye. Some babies have a flame-shaped hemorrhage on the white
of the eye. I t is caused by breaking of blood vessels on the surface of the eye dur-
ing birth and is harmless. The blood is reabsorbed in two to three weeks.
Ingrown toenails. Many newborns have soft nails that bend and curve easily. The
nails are not truly ingrown, however, because they dont curve into the flesh or
cause irritation.
Long second toe. The second toe is longer than the great toe as result of heredity in
some ethnic groups, especially those that originated around the Mediterranean Sea.
Molding of the head. Molding refers to the long, narrow, cone-shaped head resulting
from passage through a tight birth canal. This compression can temporarily hide
the fontanel. The head returns to a normal shape in a few days.
Scalp hair. Most hair is dark at birth. This hair is temporary and begins to fall out by 1
month of age. Some babies lose it gradually while the permanent hair is coming in.
Others lose it rapidly and temporarily become bald. The permanent hair generally
appears by 6 months. It may be an entirely different color from the newborn hair.
Sucking callus or blister. A sucking callus occurs in the center of the upper lip from
constant friction at this point during bottle or breast feeding. I t will disappear
when your child begins cup feedings. I f the baby sucks his thumb or wrist, a cal-
lus may develop there, too.
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Swollen eyelids. Your babys eyes may be puffy because of pressure on the
face during delivery. They may also be puffy and red if silver nitrate eye
drops have been used. This irritation should clear in about three days.
Swollen breasts. Many babies, both male and female, develop swollen breasts
during the first week of life. The swelling is caused by the passage of
female hormones from the mother across the placenta during pregnancy.
I t generally persists for four to six months but may last longer in breast
fed and female babies. Swelling may go down in one breast a month or
more before the other breast. Never squeeze the breast because this can
cause infection. Be sure to call our office if a swollen breast develops signs
of infection such as general redness, red streaks, or tenderness.
Teeth. The presence of a tooth at birth is rare. About 10% are extra teeth with-
out a root structure. The other 90% are prematurely erupted normal
teeth. The distinction between the two can be made with an X-ray. Extra
teeth must be removed by a dentist because they can fall out unexpectedly
and cause choking. Normal teeth need to be removed only if they become
loose, because of the danger of choking, or if they cause sores on your
babys tongue.
Tongue-tie. The tongue in newborns normally has a short, tight band on the
underside that connects it to the floor of the mouth. This band usually
stretches with time, movement, and growth. Tongue-tie, or tight tongue, is
a rare condition in which the band keeps the tip of the tongue from pro-
truding beyond the teeth or gum line. Tongue-tie doesnt usually cause
any symptoms or interfere with sucking or speech development.
Your Baby Girl
Female genitals. The labia minora may be quite swollen in newborn girls
because of the passage of female hormones across the placenta. The swelling
will go down in two to four weeks.
Hymenal tags. The hymen also may be swollen because of maternal hormones
and may have smooth 1/2-inch projections of pink tissue called tags. These tags
are harmless. They occur in 10% of newborn girls and slowly shrink over two
to four weeks.
Vaginal discharge. A clear or white discharge may flow
from the vagina during the latter part of the first week
of life as maternal hormones in the babys blood
decline. Occasionally the discharge will become pink or
blood-tinged (false menstruation). This normal dis-
charge should not recur once it stops.
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Your Baby Boy
Male genitals. The scrotum of newborn boys may be filled with clear fluid that has
been squeezed into the scrotum during birth. This common, painless collection of fluid
is called a hydrocele. A hydrocele may take six to 12 months to clear completely. I t is
harmless but should be checked during regular visits to the doctor. I f the swelling
changes size frequently, a hernia may also be present, and you should call our office
during regular hours for an appointment.
Undescended testicle. The testicle is not in the scrotum in about 4% of full-term new-
born boys. Many of these testicles gradually descend into the normal position during
the following months. I n 1-year-old boys, only 0.7% of all testicles are undescended
and need to be brought down surgically.
Tight foreskin. Most uncircumcised infant boys have a tight foreskin that doesnt
allow you to see the head of the penis. This is normal and the foreskin should not be
retracted. The foreskin separates from the head of the penis naturally by 5 to 10 years
of age.
Erections. Erections occur commonly in newborn boys, as they do at all ages. They
are usually triggered by a full bladder and demonstrate that the nerves to the penis
are normal.
Newborn Health
Soon after babys birth, there are several immediate tests and conditions that must be
addressed. This section provides highlights of these conditions. I f you have any ques-
tions, please call our office immediately.
Newborn Screening Test
The newborn screening test involves a blood sample drawn from your baby during
the hospital stay. This sample of blood is used for a number of tests for diseases that
can be treated more effectively if diagnosed early. The test, which is required by the
State of Ohio on all newborns, is nicknamed the PKU, representing the initials of
the original test performed years ago.
One of the main reason for this test is to check for diseases that are influenced by diet
and metabolism. That is why the test cannot be performed until your baby is at least
24 hours old, and after feeding has been established.
I n most babies, the newborn screening tests are normal. We will call you immediately
if any of the testing is abnormal.
Caring for the umbilical cord
The transition from before to after birth is very fast. The umbilical cord, which sustained
your baby in the womb, is no longer needed. The cord will dry up and fall off within
the first three weeks of his or her life. Dont be surprised if you notice a yellow or
greenish discharge and a slight odor from the cord.
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I f you like, you may wash the cord stump once or twice a day with soap and
water. This is not necessary, but it may help the cord dry and fall off sooner.
I f you wash the cord with soap and water, use dry cotton swabs to thoroughly
dry the cord. Be sure to lift the cord to dry the area where the cord meets the
babys skin. There is no feeling in the cord and it will not cause your baby any
discomfort if you move it to clean around the area.
When the stump of the cord falls off, you may see a little bleeding. I f the skin
surrounding the cord becomes red and swollen, let us know.
To circumcise or not to circumcise
I f you have a baby girl youve been spared this decision. I f you are the proud
parents of a baby boy, this is a decision you will need to make.
There have been many medical theories relating to the advantages of circumci-
sion. Some studies have shown a slightly decreased risk of AI DS and urinary
tract infection in circumcised males. However, personal consideration is the
main reason for circumcising your son.
Whether your preference is based on social, psychological, religious, or other
factors, the decision whether or not to circumcise is a personal decision not a
medical decision.
I f you choose to have your baby circumcised, it is normal to see a few spots of
blood just after the procedure. You may apply petroleum jelly at each diaper
change until the circumcision is healed. Once healed completely (about one
week), you should pull the foreskin remnant off the glans, or head of the penis
after each bath. This will keep it from sticking to the glans. Call our office if
the circumcision bleeds or swells.
I f you choose not to circumcise your son, the only care needed is to be sure the
area is kept clean. Dont worry about pulling the foreskin back. I t will retract
freely on its own. I t may be years before this occurs.
The term jaundice comes from a French word meaning yellow, and this con-
dition is very common in newborns.
J aundice occurs because babies bilirubin is high. Bilirubin is a normal waste
product that we all eliminate, mainly through bowel movements. Newborns
have a tougher time eliminating bilirubin than we do as adults. Some babies
have a more difficult time than others. So, as their bilirubin climbs, they turn
yellow or jaundiced. The yellow discoloration typically starts in the babys face,
and works its way down the body as the level gets higher.
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The higher the bilirubin, the more yellow your baby may appear. Ordinarily, high biliru-
bin causes no problem, unless it is excessively high. This is very unusual.
We recommend routine screening for jaundice with a blood test while your baby is in
the hospital. We will keep you informed of the results and their significance.
Call the office if:
Your babys coloring becomes more yellow at home.
Your baby becomes sleepier.
Your baby doesnt feed as well.
Your baby has fewer wet/dirty diapers.
We may ask you to get a blood test to determine the level of jaundice.
Routine checkups and immunizations
Your babys checkups and immunizations are very important. We will discuss your
babys growth and development, feeding and bowel habits, behavior, safety, and any
concerns that you have. We may also perform routine tests and administer immuniza-
tions. For a complete list of immunizations, please see the chart in the back pocket of
this booklet.
Keep in mind that many of the tests that we do and shots that we give during a well
visit cannot be done when your child is ill. Even though you may feel as if you are in
the office quite a bit due to illness, it is important to schedule separate appointments
for well visits and immunizations.
The normal schedule for routine well visits based on the age of the child is
as follows:
3-5 days of age
2 weeks
2 months
4 months
6 months
9 months
12 months
15 months
18 months
2 years
/2 years
3 years
4 years
5 years
6 years and up(annual
checkups) through age 18
When your child becomes old enough for school, the information from these checkups
(including proof of immunizations) will be required by your school district for enrollment.
Keeping to this schedule will help to ensure that your child has what he or she needs
for school, but more importantly, for a healthy life overall.
Dental care
I t may seem a little early to think about your babys dental needs, but healthy teeth
actually start in infancy. I f you are bottle feeding, keep bottles out of your babys crib.
Bacteria from formula or milk will build up on your babys teeth as he or she sleeps,
causing early tooth decay. The bottle should be discontinued by the babys first birth-
day, at the latest. J uice should only be given in a cup and limited to two ounces per
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When your babys teeth break through, you can keep them clean by wiping them
with a washcloth or brushing them with a small, soft toothbrush. Use no more
than a pea-sized amount of fluoride-free toothpaste each night before bedtime.
We recommend the first dental visit around age 2. Children over the age of 6
months may need a fluoride supplement if you have well water or unfluorinated
water, or if you are exclusively breast feeding or using ready-to-feed formula.
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Thejoys of parents aresecret and so
aretheir griefs and fears.
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When your baby issick, it isoften hard to tell what symptomsare
serious. Many times, simpleailmentscan behandled at homewith
a littleTLC. At other times, it isimportant to bring thebaby to
theofficefor a sick visit.
When to Call the Office
Any time your newborn develops the following problems, please call the office
Newborn Illnesses/Concerns
Rectal temperature of 100.4 degrees
F. or greater.
Crying that you feel represents pain.
Less than 8 to 10 wet diapers per day.
Eye drainage.
Vomiting or diarrhea beyond the
usual spitting and loose stool.
Sudden loss of appetite.
Turning blue or pale
Becoming more jaundiced (yellow)
since leaving the hospital.
Any change in behavior or appear-
ance that concerns you.
Less active or is fussy.
Convulsions or seizures.
Labored, difficult, or rapid breathing.
Sudden Infant Death Syndrome
Sudden Infant Death Syndrome or SIDS brings fear to every new parents heart.
Despite great advances in medicine and medical care, two of every thousand
children in this country will die of SI DS. There are very few things we can do
to anticipate SI DS.
Recently, studies in other countries have pointed to sleep position as being
associated with SI DS. Specifically, these studies found that infants younger
than six months who slept on their stomachs were more likely to die of SI DS.
Because of this, experts have recommended that infants sleep on their backs
until they begin to turn on their own and find their own preferred sleep position.
When your baby is awake during the day, place your baby on his/her side or
stomach to prevent flattening of the head. We also recommend avoiding pillows,
stuffed animals, and comforters or puffy bedding.
I n some cases, babies may have some other medical condition that puts them at
greater risk if they sleep on their backs. I f this applies to your baby, we will
discuss this with you.
No one really knows why this association of sleep position and SI DS may
exist. As further research is completed, we will issue new recommendations to
parents on possible ways to prevent SI DS.
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Cigarette smoke has also been shown to increase the risk of SI DS. I f you smoke,
avoid smoking around the baby. Do not let other family members or visitors smoke
around the baby.
Colic is an extremely frustrating condition for most parents. The cause of colic is
unknown, but it results in a baby who may cry for hours for no reason. Colic is not a
dangerous condition, and it lasts only a few months. Most infants who become colicky
develop the condition around 2 weeks of age, and it is over by the time they reach
4 months.
Uncontrollable crying or screaming for no reason
Tucking the legs close to the stomach as if in great pain
Call the office if your baby has colicky symptoms and:
Has vomiting, diarrhea, or black or bloody stools
Has a fever greater than 100.4 degrees F. (rectal temperature)
Has lost weight or is eating less
I s under 2 weeks old, or older than 4 months
Has colic symptoms for more than 4 hours at a time
Home treatment
While there is no true cure for colic, some of these tips may
help bring you and your baby some relief:
Hold your baby so that he or she is in a sitting position at
feeding time. This will help to reduce the amount of air swal-
lowed during feeding. Also check the size of the nipple holes
in the bottles you use. I f the holes are too small, baby may be
getting too much air. Trying different styles of nipples may
help as well.
Burp your baby more frequently after each ounce of formu-
la or every few minutes when breast feeding.
I f breast feeding, be cautious about how much caffeine you have in drinks such as
sodas, coffee and tea.
Rock your baby gently, use an automatic swing, or take your baby for a car ride or
a walk in the stroller. Motion tends to help some babies.
Run the dryer, dishwasher, or vacuum. I n some cases the noise of these appliances
calms colicky babies.
Let your baby cry him or herself to sleep if nothing else works. Do not let the baby
cry for more than 4 hours.
Take a break. Let someone else care for your colicky baby for a little while so you
can rest.
Colic is not
a dangerous
and it lasts
only a few
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Gastro-Esophageal Reflux
While gastro-esophageal reflux has received a lot of attention in recent years as
an adult problem, this condition is also common in babies. Reflux occurs due to
the immaturity of your babys lower esophagus. The esophagus contains a
sphincter muscle (between the esophagus and the stomach) which usually tight-
ens after food enters the stomach. With reflux, the normal muscle tone in the
sphincter has not yet developed. As a result, food that passes into the stomach
can return to the esophagus. Reflux can present itself in different ways.
Spitting up: I t is not unusual for babies to spit up. I f the spitting up is occa-
sional and your baby seems to be comfortable despite the spitting, the solu-
tion may be something simple such as smaller, more frequent feedings, more
burps, or different formula. Well discuss this at your visits.
Irritability: I f your baby is fussy, it may be due to heartburn-like symptoms
that are caused by the reflux. There are medications that may help this condition.
Call the office if:
Spitting up has become excessive and is a source of discomfort for your baby.
Your baby is vomiting forcefully.
Your baby seems to have any trouble breathing.
Your baby chokes or coughs consistently with feedings.
You notice that your baby turns blue or pale when choking or coughing.
To confirm the reflux diagnosis, we may recommend that your baby get a barium
swallow x-ray. This test is similar to an Upper GI in adults. This test will help
us rule out other less likely causes of vomiting in an infant.
Home treatment
Change your babys sleep position by elevating the head of the bed.
Burp your baby more frequently.
Some medications such as antacids may be used for reflux. Talk with us
about possible over-the-counter medications and their potential side effects
before using them.
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Thesoul is healed by being with children.
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Thebest protection against accidentsthat may harmyour baby isto
anticipatewhat could go wrongand to avoid thesesituations.
Car Safety
Beginning with the first ride home from the hospital, make sure your baby is
adequately restrained in a car seat. There are a variety of car seats; many of
them do not fit all cars, so shop carefully. To ensure your babys safety while
traveling in a car, keep the following in mind:
Buy a car seat that is safety-approved and
follow the instructions for installing the
seat both the instructions that came with
the seat and the owners manual for your
car. According to The National Highway
and Traffic Safety Administration, up to
half of child car seats are installed incor-
Do not buy second hand car seats, espe-
cially older seats or those that have been
in a crash.
If your child is under one year and under 20 pounds, he must be in a rear-facing
child seat. However keep your child rear facing as long as possible, up to the
height and weight requirements of your particular seat.
If your child is at least one year and weighs more than 20 pounds, he can ride in
a forward-facing seat with a five-point harness, until he is at least four years old
and 40 pounds.
If your child weighs over 40 pounds, he must ride in a booster seat. Boosters
properly position the seatbelt. Use a booster with a high back if the cars back
seat is below the top of your childs ears. The seatbelt should fit across the childs
shoulder, not up against the neck.
State law requires children ride in a booster seat until age eight or 4 feet 9 inches
Children under age 13 should ride in the backseat to prevent airbag injuries and
fatalities. The airbag deploys at an angle that will injure or kill a child, so if your
child must ride in front, be sure to turn off the airbag for the passenger seat.
Be sure to properly install the car seat, including the LATCH system if available.
Follow directions for the car seat and any instructions on the cars sun visor and
seat belt. Car seat inspection stations may be available at area fire departments,
sheriff or police departments, local health departments and Childrens Medical
Center to inspect the installation of your car seat.
For details about car seat installation, call the Department of Transportation
Vehicle Safety Hotline, 1-800-424-9393. When you call, have the manufacturers
make, model number, and year of both your vehicle and child car seat available.
Newborn Safety
Rear-facing car seat
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For more information about proper car seat installation,
Avoid the temptation to skip use of the car seat or seat
belt on harried days. Our children learn by repetition
and by example. I f you dont require that your child be
restrained, he or she will be less likely to cooperate with
use of the belt or seat in the future.
And most importantly practice what you preach and
set a good example for your children always use your
own seat belt.
Home Safety
Keeping your baby safe from injury at home is as important as car safety. Consider
the following home safety tips:
Be careful when changing or dressing your baby. Many babies roll over for the first
time while on the changing table, bed, or countertop, falling to the floor and causing
Keep your hot water heater set at 120 degrees F. This will prevent scalding from hot
Have smoke and carbon monoxide detectors present on each floor of the house.
Besure detectors are in good working order.
Never leave your baby more than an arms reach away from you when bathing.
Babies can easily roll over and drown in as little as 1/2 of water.
I f you are using an old or used baby bed, be sure the slats or bars are no more than
2 3/8 apart. I f the slats are farther apart, your baby could get his or her head
trapped, causing suffocation.
Cribs should not contain blankets, bumper pads, pillows or soft toys.
Do not allow babies younger than 12 months old to sleep or play on a waterbed.
Since the baby cannot support his or her own weight on the waterbed, smothering
could occur.
Avoid attaching a pacifier to your babys clothing.
I f you smoke, avoid smoking around your baby. Exhaled smoke has as much tar,
nicotine and carbon monoxide as inhaled smoke. Never smoke in the babys room
and do not hold your baby while holding a cigarette. Cigarette smoke increases the
risk of Sudden I nfant Death Syndrome, ear infections and pneumonia. Even if you
smoke in a car or house, when your baby is not present, the baby suffers passive
smoke complications.
Place plastic outlet covers on all outlets.
Keep poison chemicals and medications out of reach, preferably secured by a latch
your child cannot open.
Any guns kept in the home should be locked up and unloaded. Any ammunition
should be locked up separately.
Forward-facing booster seat
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First Aid and CPR
Would you know what to do if your child stopped breathing? I f you dont
already know CPR, take the opportunity to learn it. Courses in both CPR and
First Aid are available through the Red Cross, YMCA, and community adult
Poison Control Center
By calling 1-800-222-1222, you have free, 24-hour access to poison treatment
advice. Please use this resource if your child consumes or is exposed to a dangerous
substance. The Poison Control Center is staffed by pharmacists, physicians, nurses,
and poison information providers who are toxicology specialists.
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Trust yourself. You know more
than you think you do.
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During thecourseof hisor her infancy and childhood, your baby
will from timeto timedevelop common illnesses. Manyof these
illnessesrequirea wait and seeapproach whileyou treat your baby
at home. It may not alwaysbenecessary to bring thebaby in for a
sick visit.
Common Cold
The common cold, also known as an upper respiratory infection or URI , is a
common illness that in most cases can be treated at home and does not require
an office visit. Colds are caused by one of several viruses and are not treatable
with antibiotics.
I n some cases, colds can lead to bacterial infections in the ears, sinuses, eyes or
lungs. If this occurs we will need to see your baby before prescribing antibiotics.
We will not phone in antibiotics without having seen your child for his or her
current illness.
Symptoms (lasting one to two weeks)
Common Illnesses/Concerns
Runny nose
Sore throat
Red eyes
Call the office if:
Your baby is under three months of age and develops anything other than a
minor runny nose or congestion (such as significant cough, breathing diffi-
culties after suctioning the nose or fever over 100.4 rectal).
He or she is not getting better toward the end of the second week of the cold.
Your child has audible wheezing, earache, sinus tenderness, eye redness with
yellow discharge, sore throat with fever for more than 24 hours, fever that
lasts longer than three days, poor fluid intake, decreased wet diapers or
shortness of breath.
Your child has a high fever of 104 to 105 degrees F. regardless of what day of
the illness (see Fever section).
Home treatment
Make sure your child gets plenty of rest and lots of fluids to drink.
You may give your child (over 6 months old) acetaminophen or ibuprofen
for pain (headache, muscle ache, etc.). Make sure you purchase the medica-
tion appropriate to your child's age. I f your baby is younger than six months,
call the office.
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Keep his or her nose clear by using saline nose drops (a few drops in each side of
the nose) and then aspirating out the mucous with a bulb syringe.
- Saline drops may be purchased, commercially packaged as Nasal, Ayr, or Ocean,
or prepared at home by adding 1/4 teaspoon of salt to one cup of warm water.
- Babies are nose breathers, so keeping the nasal passages clear is very important.
- I n older children, encourage them to blow their nose.
- Use a cool mist vaporizer or humidifier to help keep the nasal passages moist.
I n general, over-the-counter cold medications are not recommended for children.
Multiple studies have shown that they are not effective. The U.S. Food and Drug
Administration recommends these medications not be given to children under two
years of age, due to the risk of serious and potentially life-threatening side effects.
I n simple terms, a fever occurs when your childs body tem-
perature rises above normal. What is normal? I n infants, a
normal body temperature is below 100.4 degrees F. (when
taken with a rectal thermometer).
Fever is one of the bodys important defenses against illness.
Fevers that occur as part of a bacterial or viral illness are
harmless. When your baby has a fever, it is a symptom of
something else, and not a disease or illness in itself.
I t is important to allow your babys body to regulate temperature on its own. With a
fever, if your child shivers, cover him or her up. I f the baby sweats, uncover him or
her. Otherwise, dress your baby normally.
One in 30 children will, sometime in the first several years, have a seizure during a
fever. These are brief (lasting under two minutes) and harmless. However, call
if this happens.
Higher than normal body temperature
Flushed face/cheeks
Lethargic behavior in some cases
Call the office if:
Your infant (three months or younger) has a rectal temperature greater than or equal
to 100.4 F.
Your child (older than 2 months) has other symptoms such as pain, vomiting, diarrhea,
or rashes.
Your child (3 months old to 3 years old) has a rectal temperature of 104 degrees F.
or higher.
Your child (3 months to 3 years old) has a low grade fever (101 to 102 degrees F.)
for more than 24 hours.
I n general over-the-
counter cold medications
are not recommended
for children. Multiple
studies have shown that
they are not effective.
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Home treatment
Give your child plenty of fluids. Fluids should be age-appropriate, such as
electrolyte solutions like Pedialyte and I nfalyte for infants and juices, sports
drinks or popsicles for older children. Avoid giving only tap water.
Treat the fever with over-the-counter acetaminophen (Tylenol) or ibuprofen
(Advil, Motrin). These medications will lower the body temperature for a
period of time (a few hours) and make your child feel more comfortable.
These medications will not make the fever go away completely.
Never use aspirin or products containing aspirin.
Allow your child to sleep as much as possible. Do not wake him or her for
medication or to take the temperature.
Consider acetaminophen rectal suppositories when your child cannot take, or
refuses, medication orally. They are available at drug stores without a pre-
scription (ask the pharmacist since they are kept in the refrigerator).
Sponging your child with lukewarm or tepid water (never cold) is recom-
mended only if the temperature is higher than 104 degrees F., and he or she
is not responding to acetaminophen or ibuprofen. Never use rubbing alcohol
to sponge the child. Sponging is optional, not required. I f shivering occurs,
stop the sponge bath.
Taking Your Babys Temperature
Never use a glass mercury thermometer. There are several ways to take
Rectal temperature
This is the most accurate and most recommended for infants. A digital rectal
thermometer is used. Place a lubricant such as petroleum jelly on the tip. Then,
holding the thermometer like a pencil with one inch protruding from your fin-
gertips, insert the thermometer until your fingertips press against the anus.
Held in this position, the thermometer cant be over-inserted. Hold inside until
the digital thermometer beeps. Then read the results. Clean the thermometer
with cool soapy water or alcohol. Hot water will ruin the thermometer.
Oral temperature
Most children are not ready for this method before 5 years of age. Use an oral
thermometer for oral temperatures. Place the thermometer in the space on the
floor of the mouth between molars and tongue. Read when the alarm sounds
on a digital thermometer.
Ear temperature
These are obtained commonly after 12 months of age. Home varieties of ear
thermometers may not be reliable. When checking temperature with these
devices at home, we recommend checking more than once and occasionally
double-checking the reading using a rectal or oral thermometer.
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Axillary (Armpit) Temperatures
Axillary temperatures are not generally recommended because the results may not truly
indicate the central body temperature.
Forehead temperature strips
These tools are not recommended since they measure the skin temperature and not the
body temperature.
Temporal Scanners
This new version of thermometer has improved accuracy over the forehead strips and
can be used for children older than one year.
Earaches are common complaints during childhood, and can be caused by a number of
factors. I n most cases, earaches occur because of an inflammation in the ear itself the
external or middle ear but occasionally ear pain may be caused by referred pain from
the throat, jaw, or teeth. There are two types of ear infections:
External ear infections
These infections may be referred to as swimmers ear, because they are most commonly
associated with swimming, and occur in the summer months.
Middle ear infections
These infections occur following an upper respiratory infection. Fluid accumulates
behind the eardrum causing increased pressure, inflammation, and pain.
Ear infections cannot be diagnosed over the phone, so we must see your child before we
can begin treatment. We will not phone in antibiotic prescriptions for ear infections
without seeing the child first.
Ear pain and pressure
Slight fever if infection is present
Call the office if:
There is any pus-like drainage from the ear
Ear pain persists over a number of days
Ear pain is accompanied by a fever
Home treatment
Give your child acetaminophen or ibuprofen for pain.
A single dose of antibiotics will not affect the pain. Antibiotics must be taken over a
period of time to effectively heal the infection.
Do not use heat on the ear or non-prescription ear drops in the ear.
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An accident involving great force
(e.g. a fall down a flight of stairs)
A child under one year of age
A cut that may need stitches
Any loss of consciousness or confusion
A seizure
Prolonged crying after the fall
Sleepiness after the fall
Weakness, unsteadiness, or dizziness
Slurred speech
Blurred or double vision
Unequal pupils or crossed eyes
Bleeding or draining ears or nose
Any other concerns you may have
Head Injury
Head injuries can be frightening for you and for your child. I f your child
receives a blow to the head or falls and hits his or her head, you must decide
how significant the injury is.
Call the office immediately if the injury involves any of the following:
Home observation
I f your childs head injury does not have any of the above symptoms, chances
are that he or she needs only careful observation at home. I n addition, your
observation at home will help assure that complications will be detected as
early as possible. Your child should be awakened twice during the night to the
point of being alert and responsive.
I f more serious symptoms or reactions arise during the course of your observa-
tion, please call us immediately.
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Always kiss your children goodnight
even if theyrealready asleep.
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Sleep problems develop asyour baby getsa littleolder and may
last through thetoddler years. Common problemsincludedifficulty
gettingyour child to sleep, wakingduringthenight, and nightmares.
Develop a Regular Schedule and Sleep Routine
Developing good sleep patterns in your infant is an important step toward a
good nights sleep in the future.
Establish a regular schedule for naps, meals, and bedtimes. Children thrive
on routine and this will help them to develop a pattern.
Use bedtime rituals that allow your child to wind down before bedtime.
Rocking, patting, or holding your child are examples of bedtime rituals, but
you must allow your baby to fall asleep on his or her own without your need-
ing to be there.
I f your baby becomes fussy or cries when you leave the room, return briefly
to reassure him or her. I f this behavior continues, increase the amount of time
you spend out of the room before you return again, until he or she falls asleep.
Allowing your child to fall asleep on his or her own will help your baby learn to
fall back asleep after nighttime awakening (a normal part of the sleep pattern).
I f crying occurs with nighttime awakenings, use similar methods until he or
she falls back asleep. I f you use this time to give your child an extra drink or
bottle, or to cuddle with you, you are providing a benefit to waking up in the
night and reinforcing your babys need to wake up.
Feedings During the Night
Although one to two feedings at night may still be necessary in late infancy, the
need for additional nutrition is rare. Hunger during the middle of the night
may be a learned habit your child learns to be hungry at the time he or she
is usually fed. I n this case, eating becomes associated with returning to sleep.
I f more than one or two feedings are given during the night as your baby gets
older, both your and the babys sleep cycle will suffer. You can gradually elimi-
nate the middle of the night feedings by reducing the amount of food given, or
by moving the feeding times more toward morning. I f multiple feedings occur,
you should also gradually increase the time between feedings.
Sleep Problems In Infants and Toddlers
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Toddler Tricks
As your baby becomes a toddler, he or she will use a variety of stall tactics or tricks to
delay bedtime. Dont be surprised if he or she insists on repeated trips to the bath-
room or extra drinks. These tactics do not mean that your child is NOT tired. Your
child is ready for sleep but unable to control his or her impulses As a parent, you must
set firm limits and enforce them consistently. I n some cases, more concrete measures
such as placing a gate across the doorway or making lights and toys inaccessible may
be necessary.
Nightmares typically occur in the later part of the night. They begin as a normal
dream that becomes frightening for your child at the end. Your child will awaken
frightened and be afraid to go back to sleep. Nightmares often occur more frequently
when your child faces new stress such as starting daycare. Nightmares may also occur
if he or she has poor sleep patterns, or during illnesses. I f your child is having very
frequent nightmares, we should discuss this at his or her next visit. Your child may
need an earlier and/or set bedtime.
Sleep Terrors and Sleepwalking
Sleep terrors and sleepwalking occur as your child partially awakens during the first
four or five hours of sleep the deepest stage of his or her sleep.
During this period dreams do not occur. A sleep terror can be very disturbing for parents
to witness. During this time, your child may suddenly scream and thrash about. His
or her eyes may be open or closed; he or she may appear confused
and often talks nonsense. Your child may scream for you but not
recognize you when you arrive and may push you away. Sleep ter-
rors may last several minutes and end suddenly with the desire to
sleep. There is usually no recollection of the event the next morning.
Similarly, during sleepwalking your child gets out of bed and walks
around in a partially awake state. He or she may walk in the direc-
tion of light, sounds, or familiar places such as your bedroom, bath-
room, or kitchen. I f the child is calm, simply lead him or her back to
bed. I f agitated, allow your child to calm down first.
In younger children, sleep terrors and sleepwalking are part of their normal development.
Symptoms can be worse when your child is overly tired or has chronically interrupted
sleep. Psychological triggers are unusual for younger children but may be a contributing
factor in older children and adolescents.
As a parent,
you must set
firm limits and
enforce them
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303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 41
Children areonethird of our population
and all of our future.
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Youresureto havemany questionsasyou begin your journey into
parenthood. From newborn to theteenageyears, therearemany
resourcesto help answer your questions.
Suggested Readings
Index and References
What to Expect theFirst Year,
Arlene Eisenberg,
Caring for Your Baby andYoung Child,
American Academy of Pediatrics
Caring for your School AgeChild,
American Academy of Pediatrics
Caring for your Adolescent,
American Academy of Pediatrics
TheNursing Mothers Companion
Kathleen Huggins, RN, MS
TheWomanly Art of Breast Feeding,
LeLeche League
SolveYour Childs Sleep Problems
Richard Ferber, M.D.
Toddlers, A Declaration of Independence,
T. Berry Brazelton, M.D.
Making theTerribleTwos Terrific,
J ohn Rosemond
Six Point Plan for Raising Happy, Healthy
J ohn Rosemond
Family Rules: Raising ResponsibleChildren
Without Yelling,
Dr. Kenneth Kaye
Healthy Sleep Habits, Happy Child,
Marc Weissbluth, M.D.
AssertiveDisciplinefor Parents,
Lee Canter & Marlene Canter
Between Parent andTeenager,
Haim G. Ginott
You andYour Childs Self-esteem,
J ames Harris
TheOptimistic Child,
Martin E.P. Seligman, et. al.
Self-esteemfor Tots to Teens,
Eugene Anderson,
Dr. Mom,
Marianne Neifert
Bringing up Boys,
J ames Dobson
J ames Dobson
Raising Your SpiritedChild,
Mary Sheedy Kurcinka
Using the Internet
We encourage our parents to be informed. But with the power of the I nternet,
there is a higher chance of receiving misleading information. For this reason,
keep the following in mind when using the I nternet for health topics:
For medical subjects, avoid the use of general search engines like Yahoo or
Google. While these searches can provide useful information, they are also
likely to be somewhat misleading.
303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 43
Suggested Websites
Organization Web Site Address
Allergy and Asthma Network/Mothers of
Asthmatics, I nc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
American Academy of Child and
Adolescent Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . .
American Academy of Pediatrics . . . . . . . . . . . . . . . . . . .
American Academy of Pediatric Dentistry . . . . . . . . . . . .
Car seat information . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Centers for Disease Control and Prevention . . . . . . . . . .
Childrens Hospital Medical Center Cincinnati . . . . . .
Childrens Medical Center Dayton . . . . . . . . . . . . . . . .
Congenital Heart I nformation Network. . . . . . . . . . . . . .
Food Allergy and Anaphylaxis Network . . . . . . . . . . . . .
J ohns Hopkins Childrens Center . . . . . . . . . . . . . . . . . .
KidsHealth from the Nemours Foundation . . . . . . . . . . .
Medscape Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prevent Child Abuse America . . . . . . . . . . . . . . . . . . . . . .
Similac Strong Moms . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TeensHealth from the Nemours Foundation . . . . . . . . . .
Virtual Childrens Hospital . . . . . . . . . . . . . . . . . . . . . . . .
I nstead, first go to a legitimate medical website then use their
search function to find information. Suggestions for medical
search websites include:
However, please consider our office as the first source of medical
information for your child. Never hesitate to let us know if you
need more information about any health topic, or if you feel that
we have not done our job keeping you adequately informed.
Ones judgment
cannot be better
than the information
on which he has
based it.
Arthur Sulzberger
303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 44
T h e B a b y B o o k
A R e f e r e n c e f o r C a r i n g f o r Y o u r B a b y
W h e n y o u w e r e b o r n , y o u c r i e d .
A n d t h e w o r l d r e j o i c e d .
0 3 - 2 0 1 0
Print forms and complete necessary paperwork at home to save time in the office
Get answers to commonly asked questions
Access health information, such as immunization schedules and tips for healthy living
Use interactive maps to locate any of our PriMed Physicians offices
Learn how to become an active partner in your healthcare team
Connect to numerous health related websites for in-depth information
Discover the many different specialty services we offer and much more
Visit PriMed Physicians
24 hours a day!
Log onto today, tonight or anytime.
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The Baby Book
A Reference for Caring for Your Baby
When you were born, you cried.
And the world rejoiced.
w w w . p r i m e d p h y s i c i a n s . c o m
P r i n t f o r m s a n d c o m p l e t e n e c e s s a r y p a p e r w o r k a t h o m e t o s a v e t i m e i n t h e o f f i c e
G e t a n s w e r s t o c o m m o n l y a s k e d q u e s t i o n s
A c c e s s h e a l t h i n f o r m a t i o n , s u c h a s i m m u n i z a t i o n s c h e d u l e s a n d t i p s f o r h e a l t h y l i v i n g
U s e i n t e r a c t i v e m a p s t o l o c a t e a n y o f o u r P r i M e d P h y s i c i a n s o f f i c e s
L e a r n h o w t o b e c o m e a n a c t i v e p a r t n e r i n y o u r h e a l t h c a r e t e a m
C o n n e c t t o n u m e r o u s h e a l t h r e l a t e d w e b s i t e s f o r i n - d e p t h i n f o r m a t i o n
D i s c o v e r t h e m a n y d i f f e r e n t s p e c i a l t y s e r v i c e s w e o f f e r a n d m u c h m o r e
V i s i t P r i M e d P h y s i c i a n s
2 4 h o u r s a d a y !
L o g o n t o w w w . p r i m e d p h y s i c i a n s . c o m t o d a y , t o n i g h t o r a n y t i m e .
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