Disclaimer: This medical information is designed as an aid only for the patients of Drs. Concannon & Vitale.
It is not a substitute for a medical exam and direct advice from your physician.
Drs. Concannon & Vitale, LLC
|CONGRATULATIONS ON THE
BIRTH OF YOUR NEW BABY!
Infant care can be exciting and easy! Use your good judgment and common sense. Do not strive for perfection — be flexible and just enjoy your baby. There are, however, many problems and questions which arise from time to time and which are upsetting to parents. This booklet is intended to answer some of the more frequent situations that may occur in the first three months — sort of like the 'Quick Start' manual that comes with new computers. But — your baby will soon be giving you a test on the material in this booklet, so read it now.
However, it is not meant to be a complete owner's
manual for your infant. There are many available books on the
subject, and we request that you have at least one on
hand for reference. Caring
for Your Baby and Young Child, by the
American Academy of Pediatrics is probably the best.
Women & Infants also offers the Warm Line at 1-800-711-7011 where
new parents can ask general questions regarding their
newborn and breastfeeding issues.
No babies are "perfect," otherwise we'd all be clones.
However, if you notice something not quite right with
your new baby please bring it to our attention.
from friends and relatives is okay but be sure to check
with us if you get advice that is against what you feel
is best. Just as other people, children have individual
needs and wants which cannot all be handled in the same
way. Grandparents should be aware that many things have
changed since they had their babies. You may want to
cite your pediatrician
as the source of the new information. Please be
aware that advice from some web sites may be wrong, not
apply to your baby, or try to sell stuff you just don't
So that you get to know your baby better, you will
routinely room-in with your baby while at the
hospital. It's been shown that babies who stay in
Mom's hospital room tend to have more skin-to-skin
contact, bond better, and breast-feed better. The
hospital will routinely do some blood tests on all
babies to check for problems (low thyroid, PKU, etc).
Your baby will also receive a shot of Vitamin K to prevent bleeding
problems, a shot to protect against Hepatitis-B, and get
a hearing test and
a heart disease test.
A clerk will be by to help you fill out the birth certificate. A little time choosing the name might avoid some teasing about a particular combination of names or initials. Think also about nicknames. What about the spelling? Make certain that the name is suitable not only for a baby but also for an adult. A name lasts forever — it is worth thinking about.
Some new mothers check into the hospital with their maiden names.
If your baby will be carrying a different last name
please let us know now so that we can match up the
medical records. Be sure to call your health
insurance company as soon as possible to register
your new baby. Oh — and
don't forget to obtain a social security number as soon as
possible for your new 'tax deduction', and then set up a
529 College Fund.
Your full term infant will usually be between 6 to 9 pounds in weight (2800 to 4000 grams), and be between 18 to 22 inches in length (46 to 56 cm). The baby may normally lose up to one tenth of its birth weight in the first week, but should regain the birth weight by two weeks of age. Infants will gain weight at about one half to one ounce a day in the first few months.
You may notice a yellowish color to the baby's skin
during the first few days of life. This is jaundice and occurs
quite commonly due to the immature liver. Usually any
yellow tint has disappeared by a week of life. If the
amount of yellow color in your baby gets worse after you
take the baby home, please let us know as soon as
Most babies will get newborn
acne, a rash on the cheeks and face that is
worse at one month of age. This is not scarring, and is
bothersome only to the parents. It will fade over a week
or so and no creams or lotions are necessary. Many
babies will get a rash that looks sort of like insect
bites on the second or third day. This rash is not
bothersome and will fade in a few days. Don't be upset
if your infant's skin isn't perfect
— babies in TV and magazine ads actually wear
All babies sneeze a lot — that's how they clear their noses. The nostrils of a baby's nose are very small, so that a little bit of mucus goes a long way to blocking them up and making them sound congested. Use the nasal aspirator (bulb syringe) you were given at the hospital to cleanse the nose of any mucus blockage.
If congestion persists as a problem, use saline nose drops to loosen and liquify the mucus. These may be purchased inexpensively (Little Noses, and others). Place four or five drops down one nostril, wait 15 seconds, then suck out with the bulb syringe. Repeat this on the other side. You may do this up to four times a day if needed. We try to avoid other medicines in the first year or so.
Some normal enlargement of the baby's breasts is due to Mom's hormones. Occasionally, some milky discharge may come out of the nipples. Both conditions are normal in the first month. Don't squeeze the breasts, but do call us if there seems to be increased redness or soreness of the baby's breasts. There often is a slight bump noted to the lower end of the breast bone. This is normal and usually becomes less noticeable with age.
The abdominal (belly) wall around the navel may be weak and bulge out when the baby cries. These umbilical hernias are common and usually close by themselves during the first years of life.
Whether circumcised or not, all male infants should be able to pass urine out in a nice forceful stream, not a spray. The uncircumcised penis can essentially be left alone at this point. After one month, use gentle retraction on the foreskin during bathing. The foreskin may not completely pull back until 4 or 5 years old.
Follow your obstetrician's advice for care of your son's circumcision. For the first few days the tip of the penis may appear raw, red, and to have some yellow crust. Wash the area with water and a soft wash cloth after each bowel movement. A small amount of Vaseline or A&D may be applied to the top of the penis to prevent it from sticking to the diaper for the first week or so.
Arms and Legs
All infants shake
their arms and legs when crying. Your baby's legs may
seem somewhat bowed
from being in the cramped quarters of the uterus. This
will normally resolve as the child grows. Having your
infant push off with its legs, as if standing, will not
cause any worsening of this bow-leg condition.
Newborns do come equipped to do some things like breathe, sleep, etc., but most things need to be learned and perfected. The baby knows how to suck, but learns to eat more effectively at each feeding. But being born is hard work — so the baby may not feed particularly well during the first two days of life. Babies will let you know they're hungry by crying, moving the arms and legs, making sucking noises, and by sucking on their fingers.
Always hold your infant securely and close to you when feeding — this closeness is important for bonding. Support the baby's head with your elbow or forearm.
Your baby should be fed on demand, that is, whenever he or she is hungry. Strict feeding schedules are not necessary for either breast-fed or bottle-fed infants. Sometimes new babies will cluster feed, several times and hour, but will later even out. Ultimately, babies will put themselves on a fairly regular schedule of every two to five hours or so. Of course, hunger isn't the only thing that will make a child cry, so check to see if there's something else upsetting him or her.
Newborn babies cannot be expected to sleep through the night and night feedings as a newborn actually help establish good breastfeeding. Later on, night feedings are best done without much talking or playing with the baby so that there is little stimulation. If night feedings are a problem, you may find it helpful to awaken the infant for more frequent daytime feedings in order to encourage longer sleeping times at night.BREAST FEEDING
Breast milk is perfectly designed for babies. Until a relatively short time ago all infants were breast fed. There is no reason to be concerned about whether or not the milk will come in. Indeed, all mothers have their milk come in essentially on schedule. The milk may be just a small amount at first, and may vary from watery to creamy, but the milk will still be ideally suited to your baby's needs at that time.
The hospital nurse will help you in the technique of breast feeding if you ask. Prior to feeding, cleanse your hands and your nipples with water. Next get into a comfortable position, either sitting down or laying down.
Babies have what is called a rooting reflex — if you touch the infant's cheek with your nipple the infant will automatically turn the head toward the breast, latch on, and begin sucking. It is helpful for the baby to get as much as possible of the dark area around the nipple (the areola). You may have to press your finger on the breast to keep it away from the baby's nose, since this is the only way they can breath while attached.
Let your baby nurse from both breasts at each feeding time. The first day, limit time to only 3 to 5 minutes on each breast. Gradually work into a pattern of 10 to 15 minutes on each side, timed from the start of milk let-down. 90% of the milk will be passed by this time, so you don't have to don't let the baby suck much longer unless you want to. Alternate the breast that the baby feeds from first since the baby's strongest sucking occurs when it's just beginning.
When it's time for your baby to stop nursing, insert your finger in the side of the mouth to break the suction. After feeding, let your nipples air dry for 10 to 15 minutes so as to toughen the nipples and prevent soreness.
If your nipples are becoming sore, sit up for one feeding and lie down for the next. Expose the nipples to light and air as much as possible, and apply some lanolin. If your breasts tend to leak, do not let them stay covered with wet pads in-between feedings. Avoid soaps and alcohol wipes as these tend to be too drying.
Some women have nipples that seem flat or inverted. This can be a frustrating experience for both you and your baby. One exercise that may be helpful is to gently pull out the nipple and roll it between your fingers for a minute or two. This can be done once or twice a day before feeding your infant.
There are some things a nursing mother needs to do to ensure an adequate supply of breast milk. Avoid over-fatigue if at all possible. Try to nurse your infant in a quiet room that allows you to unwind both physically and emotionally. To keep up with your increased fluid demands, try to drink one glass of water each time you breast feed. You should continue to take vitamins during the time that you will be nursing your infant, and take supplemental calcium, such as 6 to 8 Tums® per day. A nursing mother can generally eat all the foods that agree with her. However, some gassy foods in your diet may create a gassy baby, so avoid cabbage, broccoli, onions, and the like. Coffee and chocolate may have to be limited. Although a balanced diet with adequate protein and calcium intake is essential, you don't have to drink a lot of milk to produce a lot of milk. Some breast fed babies seem to be sensitive to cow's milk protein that gets passed on through Mom's breast milk.
If you are placed on any medication during the time you are
breast feeding please check with your doctor or us. Most
common medications such as antibiotics are okay, even
though some gets into the breast milk. Of note, new
evidence shows that smoking or ingesting any marijuana
(THC) products while pregnant or breastfeeding is
definitely harmful for your baby's brain
development. THC can be found in breast milk for
at least 6 days after the mother uses marijuana, so DO
If you wish to supplement with formula, it is best to wait for two to three weeks to let your milk fully come in. Supplemental feedings can be given at various odd times for convenience sake, or maybe at the same time each day, perhaps at 6 pm, to let Dad get to know the child better.
Exclusively breast feeding babies past six months old should receive vitamins A, D, and C, plus iron in the form of PolyViSol with Iron drops or the like.
Breast feeding for the first time can be occasionally
frustrating, and many mothers may need a little help. If
you're having problems please ask the hospital nurses,
your obstetrician, a breastfeeding (lactation)
consultant, or a friend who has successfully breast fed.
There are several good books on this topic, such as A
Guide For Breastfeeding Mothers by Women &
Infants Hospital, The
Art of Breastfeeding by the LaLeche
League, or Nursing
Baby by Karen Pryor. Don't give up if
you really want to breast feed.
Infant formulas,and others have been modeled after breast milk.There are several major brands such as Enfamil and Similac as well as several generic brands of formula such as Parents Choice, Target, etc. If you are on the WIC program. whatever formula is provided to you by them is acceptable. As of 2017 in Rhode Island, this formula is Similac.
Regular cow's milk is not suitable as a food for babies. Among the disadvantages of cow's milk are too much salt and minerals, and a lack of vitamins, iron, and the proper protein.
Infant formulas come in both regular and gentle varieties.
We usually recommend the regular unless
there is some problem that would make gentle or soy
formula a better alternative — such
as sensitivity to cow's milk, severe colic, or the like,
and then only with our specific recommendation. All of
the necessary vitamins are contained in these formulas.
All these types of formula are perfectly healthful for
your infant, and we recommend using one or the other
until your infant is one year of age. Because of
contamination issues we do not advise purchasing formula
manufactured in foreign countries, such as China.
Infant formulas now only come in high iron variety. Grandma may insist that babies become constipated or colicky on high iron, but research indicates that is not so. Babies grow so fast that they need the high iron content to prevent anemia later on.
The type of formula, ready-to-feed or powdered, makes no difference in nutrition. Ready-to-feed is more convenient when traveling, but much more expensive. Simply pour directly into the bottle to feed.
Powdered formula is
both convenient and less expensive, and has a longer
shelf-life. Follow the directions on the side of the
can. Use the scoop buried inside the can of powder, and
add the correct amount of cold tap-water to each
scoopful of powder, shake, then heat.
The amount of formula a newborn will take at each feeding will vary from one to four ounces. If the baby finishes all of one serving add one ounce to the next. When bottle feeding, always make sure that the nipple remains full of formula, not air. Never prop a bottle in the baby's mouth. Remember that the infant requires the support and closeness of being held securely in your arms.
Sucking is sometimes more important to the infant than eating. To satisfy this instinct babies will suck on their hands, fingers, and anything else they find. Once you have firmly established breastfeeding, many infants find pacifiers a useful alternative. The good news is that there is evidence that the rate of SIDS (sudden infant death syndrome) is less in young infants that are put to sleep with pacifiers. But there is also some evidence that if pacifiers are used over the age of 12 months, the child may have a higher rate of ear infections.
Pacifiers come in many different sizes and shapes. Generally, a one piece pacifier is preferred to those made up of different components which, rarely, come apart. Most newborns have difficulty holding in a pacifier at first, so a little help from Mom or Dad is appreciated if the baby seems to enjoy sucking it. Never tie the pacifier around the baby's neck because of the risk of becoming strangled. Trying to wean your child from the device may become difficult if not done by one year.
For babies who are frequent 'spitters,' we recommend
trying these remedies. Feed smaller amounts more frequently so as
to avoid overloading the stomach. Burp the baby every
two ounces, or when you switch from one breast to the
other. Place the infant in a car seat position for 15 to 20 minutes
after feeding. Raise
the head of the crib mattress slightly by
placing a pillow underneath the mattress in the crib
frame. Finally, you might try using cooler formula
The baby's first bowel movements are a sticky green-black material called meconium. After a few days they become lighter and looser. The stools will vary in firmness from well-formed to loose. Breast-fed infants later have stools typically described as "watery scrambled eggs." The baby typically may have anywhere from one movement every 3 to 4 days to 6 times a day. The color of the stools may be yellow, green, or brown. The baby may turn red and fuss with every bowel movement, or may seem totally unaware of them. All of the above situations can be normal.
Change your baby's soiled diapers as soon as you can. Have all the diaper changing equipment at hand when you start. Remember to never leave your baby unattended on the changing table as this is often where they first learn to roll over — onto the floor, unfortunately. Disposable wipes are okay if your baby tolerates them, but not all do. Unscented wipes are probably better if your child is sensitive. Place soiled diapers into a Diaper Genie or quart size plastic zipper lock bags to avoid the stink.
Constipation is present when the stools resemble hard clay pebbles. Mild constipation in a young infant can be helped by giving an ounce or two of clear apple juice or white grape juice. Do not use enemas, suppositories, or laxatives in a newborn without a doctor's direction.
present when the stools contain a great deal of water
which soaks through the diaper. Call us if your newborn
baby has unusually frequent loose diarrhea stools, or if
diarrhea persists beyond a day or so.
If your baby has a problem diaper rash we suggest that you leave the diaper off as much as is reasonable in order to air-dry the area. Sometimes snipping the elastic gathers around the leg holes will allow more air drying when your baby is up and about.
There is little that the parent can do except to comfort the baby
until the attack stops. Make sure that the baby isn't
just hungry, wet, or lonely. Hold the baby close to you
as you walk around the room. Alternatively, hold the
baby on its stomach across your knees and gently vibrate
with your legs. Automatic baby swings tend to give a
brief diversion. Pacifiers, soft music, dim lights,
rocking chairs, baby-carrying harnesses, and car rides might all
be tried with variable success. Carry your child around
with you frequently during the day. You cannot spoil the
baby by holding them too much in the first half
your baby's upper torso (not hips) with a thin, light
blanket often helps colic by recreating that sense of
being held tightly in the womb. The nurses at Women
& Infants Hospital are all expert at this, and can
teach you how to tightly swaddle your infant if you ask.
It is important to remember that colic does not
interfere with the general health and growth of your
baby, and that the condition is temporary. Colicky
babies are frustrating
to their parents and to anyone else living in the
household. Remind everyone that colic is not the baby's
fault, it is not your fault, and that they will get over
it — sooner or later. If
colic becomes a real problem for you or your infant call
us for an appointment.
Dads, remember that you too share in the development of your baby. Relax, get involved, and find out how enjoyable your son or daughter is. By the way, we need to you to start now to develop those future Red Sox players!
Older children in your household may feel threatened or confused by the new competition. This is perfectly normal, and may show up as a return to bedwetting, thumb sucking, etc. Try to call your older children often while you are in the hospital. When arriving home with your new baby, have Dad bring the baby in while Mom gives 30 minutes or so of undivided attention to the older kids. It helps to give a small gift to your older children so that they don't feel forgotten — what with all of the presents the new baby will be getting. Pets can also be jealous of the new intruder. Be sure to supervise your animal until it adjusts to the baby.
A newborn is not immune to all diseases. Try to keep
your baby away from
crowds, and from any individual who may have a
cold or contagious illness, including any close-up
contact with any siblings who are sick. During your
infant's first few weeks at home those handling the baby
should first wash
their hands. Simple soap and water work
be waterproof and fit
tightly into the crib so that there are no gaps
to catch arms or legs. No
pillow should be used until one year. Do not use bumper pads,
loose blankets, stuffed animals, or waterbeds
in the crib until the child is six months or older. On
cold nights have the baby sleep in fitted blanket
Research now show that most cases of SIDS or crib death is
related to stale air that builds up around the baby's
nose. For these reasons, always place the baby on
its back to sleep
for the first six months. We strongly advise against
the baby sleeping in the parents' bed as this can be
dangerous when Mom or Dad roll over. If
possible, do try to have your baby sleep in a separate
crib or basinette located in your bedroom for the first
year. Run a fan in the
room to keep air circulating, but the fan
should not be pointed directly at the baby unless the
room temperature is very warm. Of, course, do
not allow smoking anywhere in the house.
Lastly, use of a pacifier by the baby has been
shown to reduce risk.
In general, place your baby in the crib drowsy, but still awake.
Infants must learn to put themselves to sleep. Failure
to follow this simple rule often results in later
difficulties getting the child to sleep. Alternate the
end of the crib (left or right) to which you lay down
your baby's head so as to lessen the chances of
developing flat areas on the skull.
Judge the dress of the infant by the way the temperature seems to you; in other words, dress the baby the same way you dress yourself. During the winter put on a hat if needed. A fine red rash around the trunk (prickly heat) may mean that the infant has been dressed too warmly.
Clean any milk spit up on the clothes with soda water. Wash the baby clothing and linen in a mild detergent such as Dreft. Many laundry detergents with additives may be too harsh for the baby' skin. Avoid using fabric softener dryer sheets such as Bounce as babies may be sensitive to the chemicals in them.
Don't have the house too quiet when the baby is asleep. Allowing normal noise levels will help the newborn to sleep more soundly.
Children who are raised in a home with a smoker have higher rates of colds, asthma, and ear infections. Prohibit smoking anywhere in the house. If people must smoke, allow smoking only on an outside porch or in the back yard.
During the winter months an inexpensive humidifier or vaporizer should be used to maintain normal household moisture levels that help keep mucous moist and unclogged. Do not put any medicines into the humidifier, but do wash them out periodically.
Do not use the sponge bathinette inserts as they can harbor harmful germs. Dove soap should be used along with lukewarm water. Daily bathing is unnecessary and may cause overly dry skin. Bath additives such as oils and bubble baths should be avoided. Don't use Q-tips — anything that can't be cleaned with the corner of a washcloth isn't worth cleaning, and may be hazardous.
Never leave your baby unattended in the car. During the summer, car interior temperatures can reach levels that can quickly kill a child. Pre-cool cars in the summer, and preheat cars in the winter before placing the baby into the car seat.
Have a plan of what to do should your child become
ill. It is
unfair to your child, and to other children, to send
your child to day care sick and contagious.
Save up any sick time to be available for your child
when they are ill. You might set up an arrangement among
your relatives, friends, or coworkers to baby sit when
the child is ill. An understanding boss can truly
be a Godsend
Call our office the day you both get home to schedule the first visit. Make sure to call your employer or insurance company to have your new baby added onto the health insurance plan the same day you call us.
Well-baby visits begin within one week after you leave the hospital, more or less depending on your situation, then again after another week or two. Immunizations (baby shots) start at the two-month old visit. Further well-baby visits are usually scheduled at four, and six months, and then every three months of age until eighteen months old. We'll discuss these shots with you in advance each time.
We expect calls
from parents of newborns, so call us 943-7337. To
access further parenting information please try the
links from our website at: DrConcannon.com
When you have questions outside of office hours
which you think are urgent and can't wait until
the next day, call us.
Our answering service will contact the doctor, and we
will return your call as soon as possible. Please have a
pen, paper, and the phone number of your pharmacy handy for
when we call.
We have sick child coverage arrangements with several
other local pediatricians that are available to discuss
or see your baby the next morning if necessary. So,
call us first!
If your infant is less than one year of age, and is seriously
ill, we recommend taking your baby to the Hasbro Children's
Hospital Pediatric Emergency Room. After your child is
one year old, or for less serious emergencies, urgent
care centers that are experienced with children are
usually fine, such as Just Kids RI Child Sick Care
or Concentra Urgent Care.
Thank you for reading this book! Good Luck!Rev. 9/2018 NewBabies