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
BIRTH OF YOUR NEW BABY!
care can be exciting
and easy! Use your good
judgment and common
sense. Do not strive for perfection — be
flexible and just enjoy your
There are, however, many problems and questions which arise from time
time and which are upsetting to parents. This booklet is intended
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. It is not,
however, meant to be a complete owner's manual for your
There are many available books
on the subject, and we request that you
have at least one to refer to. Caring
for Your Baby and Young Child, by the American Academy of
Child's Health by Dr. Barton Schmitt, are probably two of
best. Women & Infants Hospital now offers a free weekly
e-mail program to new parents. You can register by calling 1-800-921-9299 or online
Women & Infants also offers the Warm Line at 1-800-711-7011 where new parents can
ask general questions regarding their newborn to a maternal-neonatal
No babies are "perfect," otherwise we'd all be clones. If you notice something not quite right with your new baby, however, please bring it to our attention. Getting advice 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. Children, just as other people, 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.
So that you get to know your baby better, we strongly
you 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
for problems (low thyroid, PKU, etc). Your baby will also receive a shot
of Vitamin K, a shot to protect
against Hepatitis-B, and get a
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. Make certain it will not be strange or difficult for future playmates to say. 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
let us know now so that we can match up the medical records. Oh — and don't forget to obtain a social security number as soon as
for your new 'tax deduction.'
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
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
If the amount of yellow color in your baby gets worse after you take
baby home, please let us know as soon as possible.
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. Don't be upset if your infant's skin isn't perfect — babies in TV and magazine ads actually wear make-up.
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 the mucus. These may be purchased or made at home by adding 1/4 tsp of salt to one cup of lukewarm water. 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, and 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. After one month, use gentle retraction on the foreskin during bathing. The foreskin will 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 stool. A small amount of Vaseline 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
arms and legs when crying. Your baby's legs
may seem somewhat bowed from
being in the cramped quarters of the
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
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. Ultimately, babies will put themselves on a fairly regular schedule of every two to five hours or so. If you feel that your infant is demanding to eat more frequently than is reasonable, you may try to extend the time by offering a pacifier or an ounce of water. 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. 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.
By now you have already decided to breast feed or bottle feed.
forms of feeding should adequately nourish your infant. Breast milk is
especially designed for babies. Infant formulas, such as Similac®,
been modeled after breast milk.
Until a relatively short time ago all infants were breast fed. If you are sincere about breast feeding 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.
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 don't let the baby suck much longer. 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 or A&D® ointment. 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.
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 p.m., to let Dad get to know the child better.
Exclusively breast feeding babies past six moths old should receive vitamins A, D, and C, plus iron in the form of Vi-Daylin® Drops.
Breast feeding for the first time can be occasionally
many mothers may need a little help. If you're having problems please
the hospital nurses, your obstetrician, a breastfeeding (lactation)
consultant, or a
who has successfully breast fed. There are several good books on this
such as A Guide For Breastfeeding Mothers by Women &
Womanly Art of Breastfeeding by the LaLeche League, or Nursing
Your Baby by Karen Pryor. Don't give up if you really want
to breast feed.
There are several major brands of formula available. Because of the excellent quality and ethical marketing of Similac® formulas, we recommend them highly. If you are on the WIC program. whatever formula is provided to you by them is also acceptable. As of 2010 in Rhode Island, this formula is Gerber Good Start®.
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 milk-based
(such as Similac®) and soy-based
(such as Isomil®).
We usually recommend the Similac® unless there
is some problem
that would make soy formula a better alternative
— such as sensitivity to
milk, severe colic, or the like, and then only with our specific
recommendation. All of the necessary vitamins are
in these formulas. Both types of formula are perfectly healthful for
infant, and we recommend using one or the other until your infant is
year of age. Because of contamination issues we do not advise
purchasing formula manufactured in foreign countries, such as China,
unless you have no other option.
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, concentrate, or powdered, makes no difference in nutrition. Ready-to-feed is more convenient when traveling, but more expensive. Simply pour directly into the bottle to feed. This type can typically be purchased in 32 oz. cans, or in 4 oz. individual bottles.
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 warmed tap-water
to each scoopful of powder.
comes in 13 oz. cans is another option. To prepare, mix
13 oz. of water to achieve 26 oz.
formula. When making only one bottle of this type, mix equal parts of
concentrate and warm tap water to make formula that is then ready to
If you are using well water or are not sure of the quality of
supply, you may wish to use terminal
usually done only for the first 4 to 6
weeks. Mix the concentrated or powdered formula as usual and pour into
individual bottles, then cap the bottles loosely. Place the bottles in
the rack of the sterilizer, pour about three inches of water into the
and cover. Boil gently for 25 minutes. Cooling requires one to two
After cooling, screw the caps on tightly and store in the refrigerator
until needed within the next two days. Follow the manufacturer's
directions for the newer microwavable sterilizers.
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. 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
Feed small amounts more
frequently so as to avoid overloading the
stomach. Burp the baby every
or when you switch from one breast to
other. Place the infant in a car seat
for 15 to 20 minutes after
feeding. Raise the head of the
mattress slightly by placing a pillow underneath the mattress
in the crib frame. Finally, you might try using cooler
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 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.
Grandparents may remember the days of cloth diapers and diaper service. These are no longer readily available, and were never as good as modern disposable diapers anyway. 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.
Diarrhea is present
stools contain a great deal of water
soaks through the diaper. If your newborn baby has unusually frequent
stools, or if diarrhea persists beyond a day or so, call us.
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
the attack stops. Make sure that the baby isn't just hungry, wet, or
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.
soft music, dim lights, rocking chairs, baby-carrying harnesses, and car
rides might all be tried with variable success. Carry your child
with you frequently during the day. You cannot spoil the baby by
them too much in the first half year. Swaddling your baby 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
It is important to remember that colic does not interfere with
health and growth of your baby, and that the condition is temporary.
babies are frustrating to
their parents and to anyone else living in
household. Remind everyone that colic is not the baby's fault, it is
your fault, and that they will get over it —
sooner or later. If colic becomes a real
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
from crowds, and from any individual who may have a cold or
During your infant's first few weeks at home those handling the baby
first wash their hands.
The new hand sanitizer gels such as Purell® work very
should 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 pajamas.
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. Run a fan in the nursery 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, seems to help decrease any problem.
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.
We strongly advise against the baby sleeping in the parents'
this can be dangerous when Mom or Dad roll over. If you are
breastfeeding, you might have the baby sleep in a bassinette in your
bedroom for the first few months.
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 a hat on 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
your child when they are ill. You might set up an arrangement among
relatives, friends, or coworkers to baby sit when the child is
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.
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.
If your infant is less than one year of age, and is seriously ill,
recommend taking your baby to the Hasbro
Children's Hospital Pediatric
Emergency Room. After your child is one year old, or for less serious
local hospital accident rooms and urgent care centers are usually fine.
Thank you for reading this book! Good Luck!Rev. 04/2010 NewBabies.htm