Normal Newborn Care

Let us examine your new baby, head to toe, so that we can become familiar with the activities and features that make your child unique normal, and the most beautiful baby on earth? Please note that most of your “friendly” advice will not come from our office. It will come from grandparents, relatives, friends and the person behind you in the checkout line at the grocery! Please use this office as your “objective” guide to baby care!

First Day Home

It is amazing how most babies instantly transform from being beautiful, quiet, perfect infants in the hospital to demanding and crying babies the second they arrive home. It is true, however, that babies become more alert and hungrier 24-48 hours after birth. The first few days are a major adjustment for babies and parents alike. This can be a difficult time, but it is also a time to finally settle down and start to get acquainted with one another. You will find your baby loves to be handled. Babies are comforted by gentle, firm handling and prefer to be wrapped snugly in a light blanket and cuddled.

What is Normal?

Let's face it. Babies are STRANGE. They burp, sneeze, spit up, pass gas, make faces, grunt and cross their eyes on a daily basis. All these things are NORMAL for them. They can turn red in the face and make horrible sounds in the process of having a perfectly loose stool and this WON 'T mean they are constipated!

Your baby's head may have undergone some “molding” during the birth process. It may look a little lopsided and have some bruising. The skull bones may also overlap slightly. This is normal and gradually goes away in a few days. All babies have “soft spots” where they skull bones come together. The biggest one is on top of the head in the front. This area may even pulsate, which is normal. It is not a tender area and may be washed thoroughly.

Eyes - Your baby's eyes may have some swelling or discharge in the first day or two after birth due to irritation from the antibiotic ointment placed in the eyes at birth to prevent infection. Any discharge should be rinsed away with water and a clean washcloth. If the discharge doesn't clear within a few days, call the office during office hours and speak with the triage nurse. Many babies have tear ducts that don't function well in the first few months of life. These babies collect mucus in their eyes until the tear ducts start to drain. This is NOT an infection. Treatment involves keeping the eyes rinsed with warm water and massaging the tear ducts. This technique can be demonstrated in the office. Contact our office during regular hours if your infant has persistent eye drainage. We usually treat this problem conservatively as 90% resolve by 12 months of age.

After the first few days, your baby will begin to open his eyes more and look around. Babies can't focus well or follow moving objects at birth. However, they can see short distances and like bright colors. Over the first 2 months, they begin to focus better and begin to track moving objects. They may occasionally look cross-eyed and this is not a cause for concern unless it persists longer than 4 months.

Nose - Your baby's nose may become congested with mucus, particularly in the first few weeks after birth. Use a bulb syringe with a plastic tip to clear the mucous. If the congestion isn't relieved with your baby's spontaneously sneezing or with the use of the bulb syringe, you may use saline nose drops. These can be purchased over-the-counter at any store or pharmacy (Ocean, Ayr, etc.). Use 2-3 drops in one nostril, then suction after a few seconds. Repeat, on the other side. If the stuffiness doesn't interfere with your child's breathing or feeding, try not to let it bother you. Some babies sound stuffier than others. Simply propping up your baby in an infant seat may help. Persistent congestion is often related to exposure to cigarette smoke or wood heat.

Nipples – May babies have nipples that appear raised and swollen. They may even have a mild discharge. This is due to hormonal changes and will normally subside in 3-4 months. Don't squeeze or rub medication on the nipples, as it will only irritate them.

Genitals - Both boys and girls may be swollen at birth. Girls commonly have a white discharge with some blood streaks from the vagina for up to 1-2 weeks after delivery. Boys often have swollen scrotum, which usually contains fluid (a hydrocele); this normally resolves on its own during the first few months of life. If the swelling comes and goes or worsens, it may indicate a hernia. Call the office if this occurs.

Bowed legs or feet – After birth, this is not a cause for alarm and almost never requires treatment. It is usually due to how they were “packaged” while in the womb and straightens out in due time. If you are able to passively move your baby's lets or feet into a neutral position, they will get there on their own eventually.

Umbilical cord – Your child's umbilical cord will drop off at some point during the first 2-3 weeks of life. It is normal for there to be a few drops of blood when this happens and there may be some drainage intermittently for several days. Clean the area with alcohol when you notice blood or discharge. If the area develops red streaks on the skin or a foul odor, call the office. If your child appears to have an “outie” or protruding umbilicus after the cord is off, no special treatment is needed. Sudden movements, bumps and noises produce startle reflexes (jerky movements, throwing arms and legs out wildly). Babies also jerk or twitch for no apparent reason, even while asleep. Gentle, firm handling and calm, reassuring voices are easily sensed by your baby. As your comfort and confidence levels increase day by day, your baby will also be calm and will overact less often.

Breathing pattern
Your will notice breathing may vary over 10 to 20 seconds from being very shallow and quiet, increasing in intensity to being deep and strong. This is called periodic breathing. Babies also appear to “sigh” and “catch their breath”. They occasionally sound “rattly”, especially during or after feedings. This is due to secretions above their airway and the babies will not act bothered by this. It will only bother we parents, as we would like to have them “clear their throats”, but they don't! This is normal.

Newborn Rashes

Stork bites - Flat; pink birthmarks may be present at the bridge of your child's nose, eyelids or the back of the neck. About half of all newborn babies have some form of these. You may notice the spots becoming more pronounced when the baby is crying and fainter when the baby is quiet. The spots on your child's eyelids. (Sometimes called “angel's kisses”) will usually fade away in the first 3-4 months of life. Spots on the forehead or nose often take longer to fade away and may not entirely fade away. Spots on the neck usually don't fade but are covered up as the hair grows.

Mongolian spots – These are bluish flat birthmarks seen most commonly in dark skinned babies on the back and buttocks. They may be present on any part of the body and usually appear less noticeable after the first 2-3 years of life.

Milia – These are tiny white bumps seen on the face of about 40% of newborns. They are basically plugged skin pores and usually open up and disappear by 1-2 months of age. No ointments should be applied to them.

Erythema toxicum – Over half of all newborn babies develop red blotches in the first week of life, some with a small white lump in the center. These can literally appear and disappear before your very eyes but they are NOT hives and do NOT mean your baby is allergic to anything in particular.

“Drooling rash ” – A rash may often appear on the chin or cheeks due to excess drooling or contact with stomach contents after a baby spits up. Some of this can be helped by placing a clean towel under your baby's face during naps.

Jaundice :

Most babies develop some degree of jaundice (yellow/orange skin color). This is not present at birth but becomes noticeable at 2-3 days and usually peaks at 5-7 days. It is usually seen more with breast-fed babies and may persist to some degree for 2-3 weeks. Notify our office if during the first two weeks of life you notice increasing jaundice or jaundice plus:

Excessive sleepiness

Poor Feeding

Less than 1-2 bowel movements a day

Less than 3-4 wet diapers a day

If your baby has jaundice but is feeding well, urinating and stooling, it is usually not a problem. Call us if you are concerned and we can see your child and/or obtain a bilirubin level. Treatment is usually simple observation and occasionally phototherapy.

 

Stools

Newborns may have up to 10 loose stools per day, especially if breastfeeding, or may not have a stool for a week or more at a time. As long as your baby's tummy feels soft and the stools aren't rock hard or so watery they leave large water rings in the diaper, things are probably just fine. Again, many infants grunt and turn red in the face when having a stool. This does not in itself mean your baby is constipated. Small babies should not be given enemas; always call the office during regular hours if you are concerned about your child's stool pattern.

 

Sleep

It is normal for newborn babies to sleep much of the time. They often awaken only for feedings or diaper changes. As your baby gets older, he/she will sleep less and play more. If you happen to have a “good” baby who wants to sleep all day when first coming home from the hospital, be sure to awaken the baby every 4 hours at least during the day so the baby doesn't sleep through too many feedings. At night, if the baby wants to sleep for a longer period of time, LET THE BABY SLEEP if your baby is gaining weight appropriately! If at all possible, your baby should sleep in his/her own crib and own room. Babies normally are very noisy when they sleep. For your baby's safety, under no circumstances should you sleep with him/her in your bed. Babies should sleep on their backs or propped to the side. Crib death (sudden infant death syndrome) has been shown to occur only half as often when babies are positioned in this way. By 5-6 months, many children can roll to front and positioning is no longer an issue. Keep the crib free of pillows or items that could cause suffocation until 12 months of age. Awake “tummy time” is most beneficial for all babies as long as their heads are free from anything that could block their airway.

Things you will need for your new baby

1. Thermometer – A digital thermometer is fine. The “ear thermometers” currently in vogue are fine for babies over three years of age but a rectal digital thermometer is more accurate and more important issue in infants during the first 2 months of life. We are concerned about potential breakage of the glass thermometers. (These are no longer recommended for any age child.) The ear thermometers have the advantage of being very quick to use but the temperatures can vary significantly. The thermometer strips available to be used on a child's forehead are NOT RECOMMENDED! They are unreliable for children. We are really more interested in trends than the actual temperature in those 4 months old and older.

2. Medicine spoon/dropper – Kitchen teaspoons and tablespoons are not accurate for the measure of medications so a medicine spoon or dropper, preferable one that measure in both teaspoons and milliters, is needed.

3. Infant acetaminophen drops (Tylenol/Feverol) – Call before giving these to a child under 2 months of age. After 2 months, feel free to use this as directed for fever, teething pain, etc.

4. Car Seat - This is one of the more important items to obtain for your child. Most seats are now safety tested to meet government standards. At Renaissance Pediatrics, we have a certified care seat specialist here to assist you in any questions; you may have or make sure that your car seat is installed correctly. Please call the office and ask for Kim to assist you.

5. Plug-in outlet adapters – Small plastic adapters to plug into empty electrical outlets are important once your baby begins to explore!

6. Diapers – Either cloth or name brand disposable diapers are fine. Generic brands or off brands of disposable diapers do tend to create more problems with diaper rash.

7. Patience & a sense of humor! – Enjoy your baby

 

Frequently Asked Questions

Clothing – Clothing should be loose fitting and allow for easy movement. Don't overdress your baby. Dress him as you would yourself. Your baby's hands and feet may feel cool, but if his body is warm, he is fine. Cotton material is best. Wool may irritate your child's skin. Wash new clothing before putting it on your child for the first time. Dreft detergent is a good choice for washing clothes and diapers. Softeners, tide, and anti-static additives (i.e. Bounce) are best avoided for the first year, as they frequently cause skin irritation.

Crib – Your baby's crib slats should be no more than 2¾ inches apart and the surface should be free of splinters and painted with a non-lead based paint. The mattress should be the appropriate size for the crib. Do not permit hanging toys or window curtains within reach of your baby.

Room Temperature – Ideal room temperature for your baby is 65-70 degrees (no different than you probably keep it anyway!). Central or room humidifiers may provide additional humidity during winter.

Skin and Hair Care – Your newborn's umbilical cord should be keep clean and dry. Cleansing with alcohol 3-4x per day around the base of the cord is sufficient. Once the umbilical cord is off and, if you have a circumcised boy, once the plastic ring is off the circumcision, the baby may be bathed in the tub (or sink). Until then, sponge your baby with warm water only or with a very mild soap. Babies don't need to be bathed daily, just when dirty. (Once or twice a week is often enough during the winter.) Again, plain water or a very mild soap is all that are needed. Baby oils and lotions can clog your baby's pores, causing rashes, and should be used with caution, if at all. Hair should be washed with a mild baby shampoo. You may wash around the outside of your baby's ears with a Q-tip or soft washcloth. Do not insert Q-tips or other objects into your baby's ear canal.

Cradle Cap – If your baby has oily, yellowish scales and crusts on his scalp, he/she probably has “cradle cap”, a common condition in young infants. Applying baby oil to the crusts before shampooing will help soften them so they are more easily removed. Use Selsun Blue or Sebulex shampoo and an old toothbrush to scrub the scales up and clear the problem fairly easily. Use the Selsun Blue daily until the scales have cleared, then once or twice a week to keep the problem from flaring up again.

Diaper Rash – Diaper rash is a common problem among babies. You can help prevent it by keeping your baby's diaper area clean and dry. At each diaper change, the area should be cleansed with water and a soft cloth or with diaper wipes that don't contain alcohol, oils or perfumes. Once a day, wash the diaper area with warm water and soap. Allow your baby's bottom to air dry before putting diapers back on.

If your child develops a diaper rash around the rectal area, a barrier cream such as desitin, triple past or Vaseline should be used. If the area is very red and “scalded” looking, your baby's stools my be somewhat acidic. Applying Maalox (yes, like you drink!) and then covering with Vaseline will speed the clearing of the rash. Renaissance Pediatrics has a special butt cream for sale at the office. Please ask your pediatrician at the time of your next visit.

If your child has recently been on antibiotics, diagnosed with thrush or has developed red bumps over the front of the diaper area, he/she may have a yeast infection causing the rash. Generic Lotrimin cream used twice daily should clear this. (Lotrimin is now available over-the-counter). If unsure, call the office during regular hours.

Breastfeeding – Breastfeeding is a very natural and beautiful way of feeding your baby. It is an active process that requires two participants. To successfully breastfeed, a mother must have her own personal motivation and should not be coerced into breastfeeding by a husband, doctor or friends. A woman must not be made to feel guilty for not wanting to breastfeed or for some reason being unable to do so. At Renaissance Pediatrics we have a nurse practitioner who is a Certified lactation consultant. Please contact the office to schedule an appointment with Marth Holley, RN, CPNP to answer any of your breast feeding questions.

There are numerous advantages to breastfeeding. Mother's milk is readily available, fresh, warm and designed specifically for human infants. Breast milk contains all the fluid and nutrients necessary for your baby's growth and development in the first 12 months of life. Infants who are breast-fed have a lower risk of developing infections because breast milk contains immonoglobulins, proteins that help prevent infection. There is also evidence that infants who are breast-fed have less chance of developing asthma or food allergies.

Because breast milk is a complete diet for young infants, there is usually no need to begin solids until 4-6 months of age. Babies who are exclusively breastfed require vitamin D supplementation.

While some babies are born instinctively knowing exactly how to breast feed, others are a bit more unpredictable. Every infant, mother and delivery experience is different and while breastfeeding is sometimes effortless, it can take a great deal of work! If you discover your baby having difficulty with feeding when you arrive home, feel free to call the office. We can often offer advice over the phone and do have a lactation consultant available for assistance. If phone advice isn't working, we are happy to have you come into the office, where one of our staff can actually work with you and your baby.

In terms of general care, nursing mothers should wear a good nursing bra day and night during the first few weeks of nursing to provide extra support for full breasts. Nipples should be washed occasionally with mild soap and water, although letting leftover milk or colostrums dry on the nipple will sometimes help form a protective film in cases of sensitive nipples. Frequent nursing and drinking plenty of fluids, as well as getting plenty of REST (ha) will help ensure a good milk supply. Unless instructed otherwise, prenatal vitamins should be continued and diet should be continued as it was prior to delivery. Nursing mothers need about 500 calories per day more than usual while breastfeeding (i.e., the same amount of calories needed during late pregnancy). There are no specific dietary restrictions but if a certain food seems to upset your baby's stomach, avoid it. Caffeine is one of the main offenders, so tea, coffee and sodas should be taken in moderation and discontinued if your baby seems to have any discomfort. Also, mothers who drink large amounts of cow's milk may aggravate gas problems in an infant with lactose intolerance. Alcoholic beverages should be limited to an occasional glass of wine, but that's it! Don't drink any hot liquids while nursing your baby as spills could cause accidental burns. Lastly, please don't smoke around your baby while nursing or at any other time.

THE FIRST FEW DAYS:

After delivery, you may notice a creamy white substance secreted from your breasts. This is colostrum and, while it is secreted in small amounts, it contains high concentrations of glucose, calories and antibodies (to prevent infection). Within 3-5 days after delivery, your breast milk will “come in.” This early breast milk is high in protein but contains less fat at first than it will later on. A mother who pumps her breast in the first 2-3 weeks after delivery may panic when she finds her milk looks about as satisfying as dishwater! Don't worry. This is “transitional milk” and will gradually become more mild-like in appearance as the fat content increases in the first few weeks of nursing. Please don't let a well meaning relative or friend convince you your milk is “too weak” in those first few weeks!! If you have concerns, call the office. We can weigh the baby and talk with you about how feedings are going. If your baby is gaining weight well and having 4-6 wet diapers each day, your milk supply is probably just fine.

Many mother experience Breast Engorgement soon after leaving the hospital. This is a sense of fullness in the breast, caused early on by altered blood flow through the breasts and later on by overproduction of milk relative to what the baby needs. Applying hot packs and massaging the lumpy or tender areas of our breasts just prior to nursing will enhance the letdown reflex so the milk is more easily emptied from the breasts. Sometimes using a breast pump to pump a small amount of milk out will soften the breast, making it easier for your baby to latch on. A breast pump may be obtained from the hospital prior to the release after delivery; just ask! Many hospitals rent breast pumps to women whether or not you delivered at that hospital.

Babies should be fed on demand! Initially, he/she may need to be awakened every 4 hours through the day to remind her to eat. Typically, though, by the fourth or fifth day of life, babies become quite good at “demanding” feedings as often as every 90 minutes around the clock! This can be quite exhausting for a new mother. The good news is that after a “growth spurt” in the second or third week of life, most babies settle down to a little more humane schedule (meaning every 2-4 hours). Remember, if your baby sleeps a longer stretch of time at night, DON 'T ARGUE as long as he/she is gaining weight appropriately! Your child may nurse anywhere from 5-20 minutes per breast, depending upon how vigorous her suck is and how hungry she is at the time. Every baby is different, so don't worry if your baby is a “grazer” or a very quick feeder. Alternate the first breast offered each feeding.

Many parents ask about SUPPLEMENTAL FEEDINGS for breast feed babies. This is an individual decision and is often based, in today's society, more upon work obligations than mother's preference. If you will be in a situation where you are unable to pump at work and need to substitute a bottle feeding for the times you will be away from your baby, this can be done. One good rule of thumb is to not offer your baby a bottle feeding at all during the first month of breastfeeding. The bottle is MUCH easier for the baby to use and babies figure this out quickly, often deserting the breast in favor of the “quick fix.” On the other hand, if you breastfeed your baby exclusively for 3-4 months and then decide to try a bottle, often the baby won't even attempt a bottle feeding. There is a window of opportunity during the fourth to fifth week of life when a baby can be offered a bottle feeding, just once every 3-4 days with a bottle feeding substituted. This gives the mother a chance to gradually adjust to the new feeding schedule, minimizing breast discomfort, and also gradually introduces the new schedule to the baby. Some babies take bottle feedings better from their fathers or other caretakers than from MOM. Depending upon your individual situation, you may opt to use frozen (or refrigerated) breast milk that was pumped at an earlier time or a powdered commercial infant formula. If using pumped breast mild, remember it takes two pumping sessions to get enough milk for a single feeding. (A breast pump isn't as efficient as a hungry baby!)

Breast milk may be refrigerated for 36 hours or frozen for up to 3 months. When thawing frozen milk, it is best to place the milk container in a bowl of warm water. Do not try to thaw milk in microwave; this breaks down some of the components of the milk and can potentially be overheated, resulting in burns to your baby's face or mouth.

Your baby does not need extra water during the first few months of nursing. Water is present in breast milk in adequate amounts for your infant

Most over the counter medications are acceptable for use when nursing. So are many prescription medications. Always remind the physician prescribing any medication that you are breastfeeding. Birth control pills today have lower concentration of hormones and may be taken while breastfeeding. You may notice some decrease in the volume of breast milk with these, however, remember breastfeeding alone is NOT an effective form of birth control!

Most women breastfeed for 9-12 months. This is a situation that is negotiated between each mother and child individually. Many mothers wean their infants from the breast directly to cup feedings. Other questions about breastfeeding may come up. Feel free to call the office with any specific questions. We are eager to help make the nursing experience an enjoyable one for you and your baby.

WHAT ABOUT BOTTLE FEEDING?

For those of you who are unable or do not desire to breastfeed, there is an alternative in infant formula. There are various types of good infant formulas available. We can discuss the best type for your particular situation if and when the need arises. Infant formula with iron is recommended for the first 12 months of life for infants who are not breast-fed. Changing to cow's milk at an early age can cause significant anemia; also, the cow's milk has more salt, protein, cholesterol, and phosphorus than is recommended for infants. Most infants will take 1-3 ounces of formula every 3-4 hours in the first few weeks of life. During the “growth spurt” on the second to third week of life, your baby may want to eat every 90 minutes! Let the baby make the rules. Feed him as much as he/she wants as often as he/she wants, as long as feedings aren't closer together than every 90minutes. If you have a baby who sleeps most of the time, be sure to awaken him/her every 4 hours during the day to “remind” her to eat. (During the night, if she'll sleep, let her sleep if she is gaining weight appropriately!)

Bottle and nipples should be washed in hot, soapy water. If you have an automatic dishwasher, just run the bottles through a cycle in the top rack. There is no need to boil or sterilize nipples or bottles if your baby is doing well.

Boil tap water for the first 6 months of life. If you have well water, you may boil it for the first few months or use bottled “nursery water” available at many area groceries for mixing formulas.

Most formulas come in powdered, liquid concentrate and ready-to-use formulations. The powdered form is least expensive and is handy for traveling. It is also most economical for breastfeeding mothers who only use an occasional formula feeding.

Your baby does not need extra water during the day until taking more than 32 ounces of formula each day. Water is present in both breast milk and infant formula in adequate amounts and your baby will benefit most by drinking ONLY milk during the first few months of life.

BEGINNING SOLD FOODS :

For some reason, friends and relatives tend to fixate on when a baby has his/her first water bottle and first bowl of cereal! Any pediatric allergist will tell you, however, the most important factors in the development of food allergies (other than family history) are breastfeeding and delaying solid foods. Breast-fed babies are afforded some degree of protection from food allergies, and the longer a child is exclusively breast-fed, the better. The sooner solid foods are introduced, the more chance there is of developing allergies over time. Our goal is to delay sold foods until somewhere between 4-6 months of age. This will vary from baby to baby, however, we can't realistically expect a baby with a birth weight of 10 pounds to be ready for solids at the same time a baby whose birth weight was 5 pounds.!

If your baby is breastfeeding and sleeping through the night, DON 'T start solids, If, however, he/she has been sleeping 8 hours at night and is now waking for two additional night feedings, he may be ready for solids. If your baby is bottle feeding and taking more than 32 ounces of formula in a 24-hour period, you may give a solid feeding supplement if he‘s still hungry after 32 ounces.

Rice cereal is a good choice for your baby's first solid food. It may be mixed with breast milk, formula or apple juice until quite thin, then fed to your baby with a spoon. NO more than 4 oz of juice per day in the first year of life. DO NOT USE AN INFANT FEEDER! These lead to overeating, potential choking or aspiration and defeat the purpose of teaching your baby about eating solid foods. After several weeks on rice cereal, you can begin to slowly introduce your baby to different solid foods. A good rule of thumb is to introduce solids slowly, using one new food for 5-6 days before trying another. Most pediatricians recommend cereals first, followed by either yellow vegetables or green vegetables, and then fruit. After 6 months, meats may be introduced. Juices should be treated as fruits (but no orange juice until around 12 months of age). Juices should be diluted to half strength with water. Some foods, including eggs, orange juice, and peanut butter should not be given to children during the first year of life. These foods are considered “high risk” in terms of developing food allergies, especially if received early in life. Honey should not be given to children during the first year of life because raw honey may contain spores causing botulism in young children (which can actually severely harm your child). These foods can be discussed in more detail during office visits.

Please stop the use of the bottle at 12 months of age, as your child must develop past the sucking stage, and the fact that rubbing of the teeth with a nipple can cause the teeth to be worn away causing “bottle caries' (or dental decay as the enamel is worn away).

CIRCUMCISION: The decision as to whether to have a newborn son circumcised is no longer considered as a medical one. While statistically there is a higher chance of urinary tract infection in an uncircumcised male, the chance is still extremely low (1%). Most physicians do not inflict their personal feelings, pro or con, on families but allow the families to make their own decision on this very personal issue. If you wish your newborn son to be circumcised, this can be performed in the newborn nursery by the OB physician prior to discharge from the hospital. A local anesthetic is injected to numb the area. If you do not want your newborn son to be circumcised, no special care of the foreskin is needed.

HERNIAS : Inguinal hernias appear as bulges or swollen areas in your child's groin (or scrotum, in males). The bulges often change in size, becoming larger or smaller in the course of a day. They may be slightly tender. If you notice any swelling in your child's groin (boy or girl), notify the office. Hernias appearing in the groin area are not an emergency but do require surgical repair usually in an outpatient basis. It is only an emergency if the baby is very fussy, the area won't reduce (become smaller) with mild pressure or if the area is discolored and the baby is not feeding or is vomiting.

Umbilical hernias occur when a weakness in the muscle around the “belly button” causes it to protrude outward. These are very common and usually cause no problems. When a child cries, the umbilicus will protrude more, but it won't break! The hernia usually resolves on its own by school age without treatment. Taping a 50 cent piece over the area won't make things go away any sooner (don't tell grandma that!) and your child could develop an allergic rash from the tape.

SPITTING UP : This is very common in newborn babies and is due to a weakness of the muscle at the upper end of the stomach. It improves with age and has usually cleared up by the time a baby starts walking. Most spitting up has nothing to do with what formula your baby is on so formula changes after leaving the newborn nursery are rarely indicated. Please call the office before changing your baby's formula.

Giving your baby slightly smaller feedings more frequently and avoiding tight diapers will help somewhat. Although burping during feeding is important, a baby should be burped when he or she pauses in feeding and sucking NOT interrupted. Burping is less important than giving smaller feedings. If your baby is still having a significant amount of vomiting despite these measures, call the office and we can discuss possible thickening with cereal or other measures.

Most “spitters” start having problems during the first week of life. If your baby has not had problems in the past but suddenly begins to vomit during the third or fourth week of life, be sure to call the office during regular office hours.

TEETHING : Teething may cause a baby to be fussy or have a low-grade fever (usually not over 100). Teething may cause loose stools and some irritant diaper rash. Do Not use ibuprofen under 6 months of age. Teething does not cause high fevers. To make your baby more comfortable during teething episodes, give acetaminophen just as you would for any other type of pain. Children's Motrin (ibuprofen), now available over the counter, is often even more effective for teething pain. A frozen bagel makes a good pacifier or you can try one of the water-filled teething rings that can be placed in the refrigerator or freezer for cooling. Teething biscuits, raw carrots or other foods, which can break off into chunks and choke your baby, should not be used. Teething gels with contain xyclocaine, are NOT recommended. These can cause toxicity with heart arrhythmia if swallowed in sufficient quantities.

Some babies enjoy chewing on nipples (including Mom's) or pacifiers while teething. Others actually begin refusing nipple feedings (even the breast). If this happens, try giving acetaminophen or ibuprofen about 1 hour before feeding time or using a sipper cup for fluids.

DENTAL CARE : Your child's gums should be massaged daily with a wet washcloth until the first tooth erupts. You may then change to a soft toothbrush with plain water or just a pea-sized amount of toothpaste on the brush. Fluoride is important for preventing tooth decay but TOO much can discolor your child's teeth. Your child will need help with brushing until about school age. Younger children aren't coordinated enough to maneuver the toothbrush everywhere it needs to go. Most dentists like to begin seeing children around the second or third birthday for routine dental care. Check with your family dentist as to his or her preference. If your family dentist does not see young children, we can refer you to a pediatric or family dentist who does see younger patients. Sugary treats or drinks in excess should be avoided. The leading cause of tooth decay in children under 2 years of age is taking a bottle or breastfeeding in bed at night. This should be avoided.

PACIFIERS : Most pediatricians don't have strong objections to the use of pacifiers in infants who seem to have a strong need to suck. A properly shaped pacifier is less damaging to the developing mouth than sucking on a thumb or finger. Pacifiers should be of a one-piece design to avoid the possibility of an infant swallowing or choking on a part of it. Pacifiers should not be placed on strings tied around a baby's neck or any string used which is long enough for a baby to strangle. The use of pacifiers should be for sleep (nap/bedtime) use only, not for walking around. The time to discontinue the use of the pacifier seems to work at either 4 months or 15 months of age. Do not expect the child to stop. There is evidence that the use of the pacifier does not decrease speech in the toddler.

THRUSH : Thrush appears as white, curd-like plaques coating the gums, tongue and sides of baby's mouth. It can't be washed away. Normally this is seen in young babies who are still nursing or on bottle feedings. Occasionally it is seen in an older child after a course of antibiotics. It is caused by a fungal (“yeast”) infection. If you think your child may have thrush, call the office during regular office hours and a prescription can be phoned in to treat it.

All bottle nipples and pacifiers should be soaked in hot water for 15 minutes or boiled while the baby is being treated for thrush. The medication prescribed should be continued for 3 days after the thrush appears to be totally gone. When using the medication squirt ½ ml on the mouth and scrub the cheek and tongue with a q tip. Sometimes using vinegar or paste of baking soda and water 4 times per day on a q tip also works either by itself or in conjunction with the prescribed medication.

COLIC : Colic is seen in 10% of healthy, well fed babies and usually begins around the third to fourth week of life. Hopefully it ends by the third month. These babies have an excessive amount of fussy crying and appear to be in pain. There may be multiple causes for what we presently term “colic”, but nobody is sure exactly what the causes are. It is seen in both breast-fed and bottle-fed babies. It is not the result of inadequate parenting so don't blame yourself if your child has this problem. There are several things to try to help the crying spells.

1. Rhythmic, soothing activities – try carrying your baby in a front pack or pouch. An automatic baby swing, rocking cradle or buggy ride may help. Sometimes a drive around the block in the car may help. Putting the baby in an infant seat on top of the clothes dryer and then running the dryer with some sneakers in it will sometimes soothe the baby. (Be sure the seat is secured to it won't jiggle off onto the floor!)
2. Sucking a pacifier calms some babies. If your baby has eaten in the past 2 hours, don't feel you must feed him more, as that is just a sucking reflex and can actually worsen the problem. Colicky babies aren't usually hungry.
3. Holding the baby and placing them on a warm water bottle wrapped in a towel or warm towel on there tummy or swaddling her may help. Be extra careful that the “warm” is not hot as baby's skin is easily burned.
4. Soft sounds may calm your baby. Soft music or a recording of sounds from mother's womb may be used, quiet CD or radio also have the same effect

If your baby is dry and has been fed, it is perfectly all right to close the door to his room and let him cry for a while. Check on him periodically, but try setting a timer for 20 minutes and use this time to do something YOU want to do! Colic can be very frustrating and exhausting for parents if you don't take “time out” occasionally. New mothers in particular should try to take a least one nap each day. You can also try to increase the amount of time your baby sleeps at night by not allowing her to sleep more than 3-4 hours at a time during the day. Again, be sure to allow Dad to take his “turn” and take the child for a walk or to allow you to go for that relief walk.

SUN EXPOSURE : In the summer your baby's skin will need to be protected when he/she is outdoors, even from indirect reflected sunlight such as under an umbrella. Babies should be shielded from direct sun exposure when possible. PABA free sunscreen lotions of a 15 rating or greater are recommended routinely for any sun exposure to provide maximum sunburn protection. Skin cancer is on the rise. Studies have shown each case of sunburn increases this risk. Though probably safe for the four month old child, it is not recommended until 6 months of age .

TRAVEL : Infants generally travel very well. Plan ahead to allow more frequent stops for feeding and diaper changes. Infants should always travel in APPROVED car seats. For those babies taking airplane rides, the only precaution needed is to have the baby nursing or sucking on the pacifier during landing. This allows for equilibration of ear pressure during changes in altitude. Call ahead and request the bulk head for extra room, and try to keep your child buckled in their car seat while on the plan.

WELL CHILD CARE – PHILOSOPHY OF MODERN PEDIATRICS
The role of the pediatrician is not only to see your child for acute illnesses but to also provide comprehensive well child care. During the first two years of life, your child will be seen frequently. Growth and development will be followed closely and immunizations will be given. Testing for those with risk factors to tuberculosis, lead, or anemia will be discussed. In the first two years we will also discuss proper nutrition and help you with other problems such as discipline or sleep, etc. so that you and your child can build a solid and healthy foundation for future growth and development. Older children should have yearly check-ups. During these visits, a physical examination will be done to catch any potential problems early in order to treat them early. Also, any problems with bedwetting, school learning problems, nutrition, sports, weight lifting, and developmental issues will be discussed. Check-ups are scheduled every 2-3 months during the first 2 years of life, yearly until school age and then every 1-2 years unless needed more often for sports participation .

IMMUNIZATIONS (read more about vaccines in this AAP News article)

Hepatitis B (HEP B)- This vaccine provides protection against the Hepatitis B virus, which can be transmitted across the placenta at birth or later in life via blood or sexual contact. It may be given at birth and is strongly recommended for adolescents. Side effects are minimal, with usually just some tenderness at the injection site. The Hepatitis B series is now a required immunization for all children entering public schools for the first time.

Polio vaccine (IPV) – Polo is a disease that can paralyze. The vaccine is now an injectable and is given in four doses. There are very few side effects

Hemoglobin/lead screen – These tests may be indicated at around 9-12 months to screen for anemia or exposure to lead in the environment. We will discuss at the well child visit whether these are indicated for your child.

PPD - A TB skin test is recommended in the event of a TB exposure. If any family member is diagnosed with TB or develops a positive skin test or any immune deficiency, it is important to let us know as this will change the schedule for your child's testing.

VARIVAX – At 12 months or older, this vaccine is nearly 90% effective in preventing chicken pox. Side effects may include some fever and pain at the injection site. Also, 2-4 weeks after receiving the vaccine a child may actually develop 4-5 spots like the chickenpox. No special precautions are needed in a child who develops these spots, as the odds of passing the virus on to otherwise healthy people are very slim. However, they should avoid people with known immune deficiencies or who are on chemotherapy. The vaccine is 95% protective, but those who get chicken pox despite the vaccine usually have a mild case of less than 50 spots.

MMR – The measles, mumps and rubella (German measles) vaccine is given in two doses. Reactions to this don't occur until 1-2 weeks after the vaccine is given. There may be fever, rash and aching joints. During this time, your child is NOT contagious to others at all. Acetaminophen or ibuprofen will help make your child more comfortable. Getting the MMR vaccine is much safer than getter any of these three diseases. We will keep you posted as to the risk factors such as Autism or other developmental changes after the vaccine, but to date the studies are not conclusive as to their being any problems.

DTaP – This vaccine protects your child against diphtheria, tetanus and (whooping cough) pertussis. Each child receives five doses. A tetanus booster is given every 6-10 years after entrance into school. Your child may experience fever, irritability and pain or swelling at the injection site in the 24-48 hours following this vaccine. Acetaminophen and cool compresses usually help and discomfort. There have also been rare reports of cases of encephalopathy (nerve and brain damage), usually temporary, in one of every 100,000 – 300,000 children following DTaP immunization. With the newer generation of acellular vaccine DTaP we rarely see any side effects at all.

HIB – Each child receives three-four doses. This vaccine protects your child from infection with the bacteria Haemophilus influenza type B, which causes epiglottis and meningitis in childhood. Side effects are rare and include fever and redness at the injection site.

PREVNAR – This vaccine helps protect infants and toddlers from diseases caused by the streptococcus pneumonia bacteria. These include meningitis, bacteremia (blood poisoning), and pneumonia and ear infections. Prevnar is given in a series of four doses and has side effects similar to those seen with other childhood vaccines.

Flu Vaccine – Any child over 6 months of age may receive the influenza vaccine. This protects against infection with the influenza virus, which causes a weeklong illness of headache, sore throat, fever, muscle aches and dry cough. Epidemics of influenza occur each winter and each year a flu vaccine is “custom made”, based on a prediction of which strains of virus will be predominant in the coming winter months. The vaccine is best given in the fall months to allow time for immunity to develop before “flu season” hits. We attempt to call in children who are considered at “high risk” for complications from influenza, including our asthmatics, diabetics, children with heart disease or other chronic lung disease and children on aspirin therapy for medical problems. If your child has medical history making him/her high risk and you haven't heard from our office by mid- October, call us!

Immunization Schedule

	Newborn	1 Month	2 Month	4 Month	6 Month	1 Year	15 Months	18 Months	4-6 Years	11 Years
Hep B	#1	#2	-	-	#3	-	-	-	-	-
DTaP	-	-	#1	#2	#3	-	-	#4	#5	TDAP
Hib	-	-	#1	#2	#3	-	#4	-	-	-
IPV	-	-	#1	#2	#3	-	-	-	#4	-
MMR	-	-	-	-	-	-	#1	-	#2	-
Varivax	-	-	-	-	-	-	#1	-	#2	-
Prevnar	-	-	#1	#2	#3	#4	-	-	-	-
Hep A	-	-	-	-	-	#1	-	#2	-	-
Rotavirus	-	-	#1	#2	#3	-	-	-	-	-

The total Hep B vaccines are three, as the schedule changes depending on the age of the first does. WE give immunizations according to the current American Academy of Pediatrics guidelines. These may change as new vaccines become available or depending on when immunizations are started. If your child has upper respiratory symptoms (i.e., common cold) without a high fever (104), he or she may still receive immunizations without reschedule for a later time.

TRAVEL VACCINES – For those patients traveling out of the country, i.e. immunizations for plague, typhoid fever, hepatitis A, etc. You can consult with your provider on what shots are needed and where to get them.

FEVER : Repeat after me. “Fever is our Friend (Unless my baby is under 2 months old, in which case I will call the doctor immediately!).

Fever is present if the oral temperature is great than 100 degrees Fahrenheit (37.8 degrees centigrade) or the rectal temperature is 100.5 degrees Fahrenheit or greater. Axillary temperatures are variable but usually a fever is present with an axillary temperature over 99-100 degrees Fahrenheit. A child may “feel hot” without having an increase in body temperature so if you think your child may have a fever and are concerned, use a thermometer to check the actual temperature.

There are many types of thermometers available. We recommend digital thermometers. Thermoscans (thermometers which take the temperature in the ear) are fine for older children (over 3 years of age). If a child under 2 months of age is felt to have a fever, we request you check a rectal temperature before calling us. The thermometer strips available for use on a child's forehead are notoriously inaccurate and not recommended. Mercury thermometers are also not recommended due to possible breakage and mercury exposure. Mild fevers may be caused by too much clothing, recent exercise, hot weather or hot foods. A fever is expected after certain immunizations and is a normal reaction of the immune system to the

Dosage Charts

Pediatricians as a group are very concerned about fever in infants under 2 months of age. This is because their immune systems are still developing, they cannot wall off an infection in their body, and they often do not have clinical signs of severe illness other than the fever.

After 2 months of age, we consider fever a normal response to infection. It should be treated only if your child is uncomfortable or the fever is fairly high (over 104-105). Either an acetaminophen product or ibuprofen (for infants older than 6 months) may be used to treat fevers. The ibuprofen products are particularly effective but may cause stomach upset in some children and should NOT be given to children who are vomiting or having severe diarrhea.

Call immediately if your child has a fever associated with any of the following;

1. Age under 2 months
2. Constant crying as if in pain
3. Fever of 105 or higher NOT responding to medication
4. Stiff neck
5. Purple spots on the skin
6. Difficulty breathing (other than stuffy nose)
7. Your child is becoming difficult to arouse, confused or delirious
8. Your child appears extremely ill or has other signs that worry you

Call the office during regular hours if:

1. Your child complains of sore throat or ear pain
2. Your child complain s of pain with urination or is voiding frequently or wetting the bed
3. Your child has significant cough or any others symptoms along with fever persisting beyond 48 hours

As discussed previously, fever may be treated with medication such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). These may be used together for high fevers, giving the ibuprofen every 6 hours and the Tylenol every 4 hours. If alternating the medication does not seem to help with the infection or fever, having your child drink lots of cold liquids will help. Sponging in a bath with lukewarm water for 20-30 minutes will generally reduce a fever by 2-3 degrees. If this causes more “fighting” than helping, try a Popsicle!

Note: Fevers are normal the first 24-48 hours after a DTAP vaccine and 5-15 days after MMR . Motrin works much better but should NOT be used if your child is vomiting or borderline hydrated. Base dosage on weight, NOT age.

ACETAMINOPHEN (Tylenol/Tempra) DOSAGE CHART

Age	Child's Weight	Drops (80mg/.8ml)	Syrup (160mg/.5ml)	Chewables 80mg
Under 2mo.	Call First
3-9 Mo.	12-17 lbs.	1 dropper	½ teaspoon
10-24 mo.	18-23 lbs.	1 ½ droppers	¾ teaspoon
2-3 years	24-35 lbs.	2 droppers	1 teaspoon	2 tablets
4-5 years	36-47 lbs	3 droppers	1 ½ teaspoon	3 tablets
6-8 years	48-59 lbs.		2 teaspoons	4 tablets
9-10 years	60-71 lbs.		2 ½ teaspoons	5 tablets
11 years	72-95lbs		3 teaspoons	6 tablets
12 years & over	96 lbs. & over		3-4 teaspoons	6-8 tablets

IBUPROFEN (Advil/Motrin) DOSAGE CHART
(For older than 6 months)

Weight	Drops (50mg/1.25 ml)	Dose of Syrup (100MG/5ML)	Chewable (50MG)
13-17 lbs.	1 dropper	½ teaspoon
18-23 lbs.	2 droppers	1 teaspoon	2 tablets
24-35 lbs.	3droppers	1 ½ teaspoons	3 tablets
36-47 lbs		2 teaspoons	4 tablets
48-59 lbs		2 ½ teaspoons	5 tablets
60-71 lbs.		3 teaspoons	6 tablets
72-95 lbs		4 teaspoons	8 tablets

 

DIARRHEA :

Babies usually have mushy, somewhat loose stools. Diarrhea is defined as a sudden increase in the number of stools and looseness of stools compared to your baby's normal pattern. Breast-fed babies may have anywhere from 10 loose stools per day to one stool per WEEK and practically any consistency is normal for a breast-fed baby. (They usually resemble mustard water with a little curd thrown in!) However, if your breast-fed baby has a sudden increase in the usual number of stools, acts sick, has vomiting, fever weight loss, then there is reason for concern. While bottle-fed babies tend to have some more formed and less frequent stools, the same basic rules apply.

Diarrhea is usually caused by a viral infection or occasionally a bacterial infection. It usually lasts several days, sometimes as long as 1-2 weeks. Infections cause diarrhea by causing temporary injury to intestines which causes incomplete digestion and absorption. Children who are otherwise alert and active and having only mild diarrhea do not necessarily require any dietary changes other than limiting juices and sugar-containing supplements (such as Pedialite or Kaolyte) should be given small amounts between nursing to replace the electrolytes lost in the diarrhea stools. These supplements can be found near the infant formulas in groceries and pharmacies. As long as your baby is having wet diapers, a few additional fluids should be all the is needed. Once stools have begun to improve, solids may be added back if your baby had been taking them prior to the diarrhea. Stick with the “ABD diet” – applesauce, bananas, and rice cereal – for a few days. Yogurt, toast and crackers are other bland foods that don't irritate diarrhea in most children. Boiled or baked potatoes without added butter and baked chicken may be added as well.

Bottle fed babies: should receive an electrolyte supplement ONLY for the first 24 hours of significant diarrhea.

Good choices for electrolyte supplementation include:

1. Pedialyte or Kaolyte, or a similar commercially prepared electrolyte drink. These are available near the infant formulas in groceries and are usually in ready-to feed form. Adding crystal lite one teaspoon to 8 oz. of pedialyte can improve the taste.
2. Gatorade may be diluted to half strength with water and used until you are able to get to the store for a premade electrolyte drink. Any flavor is fine-whatever color stool you want to clean up from the diaper! Many children over 12-18 months find this very palatable.
3. Jello water is not the first choice as a “clear liquid” in a child with diarrhea but will do in a pinch until you can get to the grocery. Just mix a box of jello with water as you normally would when making jello, then don't chill it but feed it at room temperature.

Bad choices for a “clear liquid” diet for diarrhea include:

1. Boiled skim milk – boiling milk is dangerous because it causes an elevated salt content in the milk.

2. Kool-Aid, and juices – These contain too much sugar, which can worsen diarrhea. They also don't contain the appropriate electrolytes. Full strength Gatorade may have the electrolytes but contain too much sugar.

3. Soda – Carbonated beverages often aggravate diarrhea, particularly if they contain caffeine. The electrolytes needed to replace losses from diarrhea are not present, once again.

4. Water – Water alone can alter a child's electrolyte status and aggravate salt and electrolyte depletion caused by the diarrhea.

Remember: When we say “clear liquids,” we don't mean every liquid that is clear! After 24 hours on a “clear liquid diet,” “your child should be advanced to half strength formula. Mix his formulas as usual, and then add Pedialyte or extra water to each bottle so the formula is only half as strong as usual.

After one day of half strength formula, you should be able to increase the formula back to the usual strength.

After your child is tolerating formula, the “BRAT” diet may be resumed if he has been taking solid feedings in the past. (Applesauce, bananas, rice cereal, yogurt, crackers, dry cereal, toast, plain baked potato and baked chicken.) During this time stools may temporarily seem to worsen but should begin to thicken and decrease in frequency over the next few days.

If your child's diarrhea worsens as the diet is advanced, call the office during regular hours for advice.

Older children follow basically the same plan; that is clear liquids for 24 hours, followed by an ABC diet and avoiding juices or milk for a few days. Raw fruits, vegetables, bran products, beans and spices may aggravate the diarrhea as well. If your child continues with diarrhea after several days without milk, you may want to resume his mild intake but the lactaid drops (available over the counter) added to the milk or with a lactose-free milk.

Medications are rarely recommended to slow diarrhea as they can actually make things worse. These usually just prolong the symptoms. If your child has had prolonged or severe diarrhea, this may be an option but always check with a pediatrician before using and anti-diarrhea medication.

You should call the office if:

1. Diarrhea is severe (e.g.,bowel movement every hour for over 24 hours)
2. Stools don't improve after 3-4 days on the special diet
3. Mild diarrhea lasting longer than 2 weeks
4. You see blood or mucus in more than 1 stool
5. Your child develops signs of dehydration (a decrease in the number of wet diapers/voids, dry tongue and mouth, increasing lethargy or refusal to drink)
6. Your child's breathing becomes fast or labored
7. Your child has severe abdominal pain

We should see your child if he or she has:

1. Bloody diarrhea
2. Persistent abdominal pain for more than 2 hours
3. Less than 3 wet diapers in a 24 hour period
4. Stools every hour for over 24 hours

See within 24 hours if

1. Diarrhea for more than 2 weeks
2. Fever more than 3 days.

Vomiting

The most common cause of vomiting is a viral infection of the GI tract. Vomiting usually stops within 12-24 hours. It is best treated with clear liquids in small amounts. Wait 1-2 hours after your child's last episode of vomiting, and then begin with just 1-2 tablespoons ½ -1oz.) At a time and gradually increase the amount every 20-30 minutes. Refer to the list of acceptable “clear liquids” listed in the diarrhea section for examples. There are also electrolyte popsicles available now, usually in the formula section near the electrolyte drinks (e.g. Pedialyte, Freezer Pops).

After 8 hours without vomiting, your child may begin the “ABD diet” as discussed in the diarrhea section, and then gradually resume a regular diet.

A suppository for vomiting don't always work and can have significant side effects. For the most part, small amounts of clear fluids by mouth are the most effective and safest treatment of vomiting.

You should call the office if:

1. Your infant vomits for more than 24 hours or your older child vomits for more than 48 hours
2. Your child develops signs of dehydration (decreased number of wet diapers/voids, dry mouth and lips, increasing lethargy, refusal to drink)
3. Your child becomes confused or difficult to arouse
4. Blood appears in the vomitus
5. The vomitus becomes dark green in color
6. Your child develops SEVERE abdominal pain or mild abdominal pain for more than 24 hours
7. Any other symptoms appear that bother you

Sometimes a child wants what we are eating. The child's stomach may not be ready yet and the vomiting comes back – so just start over with the clear liquids.

What about food poisoning?

Vomiting, abdominal cramps and diarrhea occurring 2-4 hours after eating unrefrigerated meat, dressings, pastry or cream sauces may be due to food poisoning. Treatment is supportive with clear liquids and symptoms usually resolve in about 6-12 hours.

Constipation :

Constipation is never an emergency and should not be a reason for after hour's calls. (Please see the information on normal stool description in “Well Days” section.)

Babies often grunt, strain, grimace and exhibit great effort in working up to a good bowel movement. A breast-fed baby may actually seem to be uncomfortable for 1-2 days before his/her “explosion” of a weekly bowel movement

Apple juice or prune juice may help soften hard stools. Usually 1-2 ounces a day in young infants will do the trick.

If your infant is very uncomfortable, you may use ½ of a glycerin suppository (available over the counter) to help the passage of any stool. Insert rectally after lubricating the rectal opening with Vaseline. Occasionally a child will develop constipation at the time of toilet training. This is very normal and everyone needs to “relax” and not increase the anxiety, as that just makes things worse. If your child has chronic constipation, please contact the office during regular office hours.

Common Colds

Most children get around 6 colds per year, twice that many if they're in daycare. Colds (upper respiratory tract infections) are caused by direct contact with a person who has one. They aren't caused by cold air or drafts. Usually, fever lasts for 2-3 days and the runny nose, sore throat, etc. last for about 7-10 days. Over-the-counter cold medications are not particularly effective as a rule, especially in young infants. In the first few months of life, it is better to avoid medications in favor of using a bulb syringe to suction mucus from the nose. Using a hot shower in the bathroom at bedtime may help to “break up” any mucus in you baby's nose so it drains more easily. You can also use saline drops to help loose secretions in your baby's nose. These are available over-the counter (Ayr or Ocean drops, etc.). This is most effective if done before feedings and at bedtime and naptime. Left over antibiotics should not be used for colds. Decongestants may be tried and sometimes help slightly for “stuffy noses” in older children over 2 years. (e.g. Pediacare/Sudafed/Dimetapp). However, these medications can cause excitability or irritability in some children. A cool mist vaporizer may be helpful, particularly in the winter.

Your child should drink lost of fluids, particularly juices. Believe it or not even chicken soup has been shown to have some beneficial effect on the common cold. (Grandma was right!).

While antibiotics do NOT help the common cold, if cold symptoms have lasted more than 7-10 days and/or any of the following signs appear, you should call the office.

Please call the office if:

1. Your child's fever last more than 3 days
2. Your child's eyes become matted
3. Your child complains of ear pain
4. Your child coughs up yellow mucus for more than 24 hours
5. Your child's breathing becomes labored
6. Your child develops thick, green drainage from the nose after having cold symptoms for more than 7-10 days

Cough :

Coughing is normal reflex to clear the lungs of mucus and protect them from pneumonia. During the winter months, viral respiratory infections of the trachea (windpipe) or bronchial tubes can result in a dry cough instead of wheezing. Chronic, loose night time coughs are often present with sinus infections in older children or may be seen in children with allergies.

There are several things you can do to make your child more comfortable during these coughing episodes.

1. HUMIDITY – Dry air tends to make your child more comfortable during these coughing episodes. Shower in the bathroom at bedtime will humidify the air somewhat and may help coughing. You should NOT use Vicks or any medication in a vaporizer for your child's cough; this can do more harm than good!
2. NO SMOKING – No one should smoke in the house or car around your child. This means no smoking indoors, even in another room of the house where the child isn't present. The smoke still gets into the air space in the house and eventually finds the child. MULTIPLE studies have shown that passive smoking aggravates chronic cough, asthma, respiratory infections and ear infections in children. If you would like a handout specifically addressing passive smoking and children, ask at the office and we will gladly provide you with one.
3. MEDICATIONS – If the cough is causing your child to lose sleep, call the office and we can prescribe a medication for use at bedtime. During the day, it is best not to suppress the cough as it serves as protection against developing infection in the lungs. However, in some children, wheeze, which may be due to asthma and a bronchodilator (e.g., albuterol), may be prescribed for use during the day. This won't suppress the cough but will make it more effective in clearing any secretions from the lungs.

You should call the office if;

1. Your child has a fever for more than 3 days with his cough
2. Your child coughs up yellow mucus for more than 24 hours
3. Your child's cough lasts longer than 3 weeks
4. Your child seems short of breath
5. Your child's cough worsens despite treatment
6. The cough causes your child to miss school

NOTE: If your child awakens at night, with a very BARKY COUGH and noisy breathing, place him in the bathroom with a steamy hot shower running. If he or she is having croup (a viral infection of the trachea) this should help. Sometimes taking a child out into the cool night air will also help. If this measure doesn't improve your child's breathing within 10 minutes, you should call for more instructions. Also, if your child is having severe throat pain with drooling or high fever, CALL!

Some fever is expected, but if the fever is above 104 degrees F, schedule an appointment the same day or the next morning to rule out bacterial infection in addition to croup.

If your child starts to get croupier during the night, have your child sit in the bathroom for 10-15 minutes with the hot shower running. This usually stops the attack temporarily so he/she can get back to sleep. If hot steam does not help within 10 minutes, take your child outside – the cold night air often works, too. If your child is still having distress after doing both these things, you should bring him/her into the office, of Emergency Room at night.

EAR PAIN :

Ear pain is common in children and may be due to middle ear infections, outer ear infections (“swimmer's ear”) and pressure from colds. It may also be seen in cold weather in a child who suddenly comes indoors; this is usually NOT due to infection but rather the sudden warming of air in the middle ear causing the air to expand, putting pressure on the eardrum. Infants will often pull on their ears not only from ear pain, but also when they are tired or teething.

If your child has a stiff neck or has had a pointed object placed in the ear immediately prior to complaining of pain, he should be seen immediately. Otherwise, he should be seen within 24 hours.

Call the office during regular hours if you think your child may have an ear infection. Signs include increasing irritability and not sleeping well at night after having had a cold for 3-4 days.

Until your child is seen in the office, give acetaminophen or ibuprofen (see dosage tables under “fever” section), elevate your child's head and use a heat pad or warm towel compresses to the ear. This should keep her comfortable until she can be seen. If all these measures aren't helping, call for a prescription for pain medication until your child can be seen.

SORE THROAT :

Viruses and bacteria (i.e., strep throat) cause sore throats. Hot salt water gargles, cool foods, humidified air, acetaminophen or ibuprofen and lozenges for older children will help the pain.

Your child should be seen during regular office hours if:

1. Sore throat has been present for more than 2-3 days
2. Swollen or tender lymph nodes are present in the neck along with abdominal pain or a rash
3. There has been recent exposure to strep throat or impetigo
4. White spots are present in the back of the throat

Please do NOT use leftover antibiotics if your child has a sore throat. The antibiotics may be too old to do any good. Also, they don't help viruses. If we diagnose strep throat in your child, we will treat with an antibiotic at that time. After 24 hours of medication, your child may return to school or day care.

CONJUNCTIVITS “PINK EYE ” :

Conjunctivitis is inflammation of the white part of the eye and membranes lining it, with or without mucus production. Viral conjunctivitis (“pink eye”) usually present with no other symptoms. Bacterial conjunctivitis usually presents with more mucus, cloudy nasal drainage, cough and possible fever.

Initial treatment at home should be washing the eye with warm water and a washcloth to remove the mucus

If your child is complaining of ear pain or showing signs of bacterial conjunctivitis, call the office during regular office hours and we will help you decide if your child should be seen.

CHICKEN POX :

Epidemics of chickenpox occur frequently. These appear first as small, red bumps resembling insect bites. Within 24-48 hours, they can change to thin-walled blister, then open sores and finally dry crusts. Repeated crops of these sores occur 4-5 days and they may be present on any skin surface, even in the mouth. Your child will probably have a fever with the pox. They usually develop 2-3 weeks after exposure to a contagious person. A child may catch chicken pox from an older person with shingles by direct contact only, as shingles represent basically a reactivation of the chicken pox virus.  If you suspect that your child may have chicken pox, please call our triage nurse during regular office hours.

Please call immediately:

If your child becomes difficult to arouse, confused or delirious, or complains of a stiff neck or severe headache.

Otherwise, your child can be managed at home. Cool baths will help with itching and WON ”T spread the pox. Oatmeal soap is soothing and helps itching. Calamine lotion applied to the pox will also help the itching. Keeping the Calamine cool in the refrigerator seems to make it more soothing. Please note: CALADRYL is not recommended in children with chickenpox! The Benadryl in that particular product is absorbed through the broken skin in children with pox and can result in toxic levels of benadryl in the system. For the same reason, Benadryl sprays or any topical form of Benadryl is not recommended. If your child has severe itching, Benadryl MAY be given by mouth. Itch-X and Saran also can be used directly on the pox to relive itching. If your child develops sores in the mouth, popsicles, mild shakes and cool liquids are tolerated best. Acidic and salty foods. (soda, juices, pretzels etc.) should be avoided until the sores have healed. Your child's fingernails should be kept trimmed and hands washed often to decrease the risk of infecting the pox from scratching. If you suspect the pox may be infected (if they become soft and golden and drain pus), call the office. Fever may be treated with acetaminophen.

Your child will no longer be contagious after the pox have scabbed over (i.e., about 6-7 days). He or she may return to school or day care after a week and needn't wait until the scabs have all fallen off.

LICE :

Nits are pearly white in color and attach firmly to the hair shaft and are not easily removed like dandruff. Lice bugs are 1/16 inches long and are difficult to see. Lice crawl; they do not jump or fly. They are often around ears and the back of the neck.

Treatment recommendations:

1. Nix cream rinse – Shampoo with any shampoo, then apply Nix and leave in for 10 minutes. Rinse. If the nits are strong, you can use ½ strength vinegar to help loosen them. Then, comb out with a fine tooth comb that comes in the package. One time only.
2. Prescription – Use as directed
3. Mayonnaise (not fat free). Apply to the entire head and sleep in a shower cap all night. This will smother the lice. Olive oil works too, but is more expensive and harder to get out of your child's hair.

a) Combs & brushes should be rinsed in Nix or Kwell

b) Combs & brushes should be placed in the freezer overnight.

c) Sheets, pillowcases hats should be run through the wash

d) After treated, your child can return to school

e) Most schools do require that all nits be removed, even if dead, because it is too hard to the school nurse to be sure all nits are killed.

f) Items unable to be washed should be tied up in a plastic sack for three weeks.

POISONING

Poisoning is one of the most common medical emergencies. Each year about 500 children in the United States die from poisoning. Most, if not all, poisonings are preventable. Children are naturally inquisitive and curious and will open drawers and doors to find toxic materials. Make sure that anything potentially dangerous is locked up and away from you child. ALL MEDICINES AT ALL LOCATIONS SHOULD BE LOCKED UP!

The most common ingestants are medicines, gasoline and other petroleum products, furniture polish, household washing products, and Drano-like products. All are potentially lethal and should be safely stored high and away from children. Don't store dangerous material in “friendly containers” (i.e., gasoline in coke bottles).

1. Keep activated charcoal in the house
2. Identify the drug or chemical that was ingested. Have the bottle next to you when you call and estimate the amount taken.
3. Call the Poison Control center at 1-800-222-1222 or the Hospital Emergency room. Keep these phone numbers on an emergency list by your phone.

MINOR ACCIDENTS :

Cuts and scratches – Wash for 5 minutes with an antibacterial soap (i.e., Dial, Safeguard) and water. Cover with a Band-Aid or gauze. Don't use alcohol or Methiolate on open wounds; they sting and can cause tissue damage. If bleeding hasn't stopped after 10 minutes of continuous pressure with gauze or cloth or if the wound edges are gaping open, you will need to have the laceration sutured. After the first few days of the cut, if the wound begins to appear infected with pus or red streaks around it, call for advice as a visit and the starting of antibiotics is needed. If your child's immunizations are up to date recommending a tetanus booster within 5 years if there is a major laceration. If your child hasn't had a routine tetanus booster within the past 10 years, call the office during regular office hours to arrange for a booster.

Abrasions or scrapes – Wash for 5 minutes with soap and water. Remove any dirty particles from the wound with tweezers. If there is tar in the wound, it can be removed with Vaseline. Cut any loose pieces of dirty skin away with sterile scissors. IF the wound is small, leave it open to air. If large, cover with a Telfa pad for 24 hours. Acetaminophen or ibuprofen may be given for pain. If a very large area of your child's body is involved, call the office.

Puncture wounds – Soak in hot, soapy water for 15 minutes. These soapy water soaks should be continued twice daily until healing occurs. Initial bleeding is good as it helps clear the puncture of bacteria. A sterile dressing should be applied between soaks. If the wound begins to look infected, call the office. Check to see if your child's immunizations are up to date as we are now recommending a tetanus booster is only needed if it has been over 5 years since the tetanus or DTAP vaccine. If your child is 15 years of age or older and hasn't had a recent tetanus booster, it may be time for one. Call the office during regular office hours to arrange for a booster within 24 hours of injury.

Animal Bites. – The animal involved should be located and trapped as soon as possible. If it is a wild animal and still on the premises, call the police or animal control agency immediately. Animals most likely to transmit rabies are: bats, skunks, raccoons, foxes or large wild animals. Mice, rats, gerbils, hamsters, gophers, chipmunks and rabbits are usually considered free of rabies. Rarely, squirrels have carried rabies so if a squirrel was the culprit and seemed sick, further investigation is needed. The wound should be washed immediately with soap and water for 15 minutes, then another 5 minutes with alcohol. It may the be left open to air or a loose dressing applied. The offending animal must be isolated for 10 days to observe for signs of rabies. You must also call the county health department to report the attack. If your child's immunizations are up to date, an additional tetanus booster is not needed. Antibiotics are needed only if the wound is very large or requires sutures. Any wound involving the hands or face should be seen by a physician .

Human Bites - These are treated basically the same as animal bites with 1 exceptions;

1. Because human bites are actually more likely to become infected, antibiotics are more often prescribed. Call the office for advice.

Nosebleeds – These are common with trauma and during the winter when the air is dry. During a nosebleed, pinch your child's nose shut for 10 minutes by the clock. (Have him/her breathe through his/her mouth.) This may be repeated once if the bleeding hasn't totally stopped following the first 10 minutes. If bleeding still hasn't stopped after a second attempt, call the office. Do not have your child lay on his/her back and hold their nose, as one can lose a large amount of blood and not realize it. At night, open up the window, use a vaporizer to put moisture into the air, and put a small amount of Vaseline in the nose over the area bleeding.

Head Injury – If your child doesn't lose consciousness, chances are no major harm was done. Your child should be kept awake for one hour after significant head trauma; after this, he or she may nap. Your child should be aroused every 2 hours during the night following a significant blow to the head to be sure his or her pupils are equal in size and that no unusual signs (listed below) are present.

Call immediately if your child develops:

1) Persistent vomiting (more than twice), stiff neck or fever

2) Unequal sized pupils or a pupil that doesn't get smaller when you shine a flashlight on it

3) Confusion or unusual drowsiness

4) Seizures or loss of consciousness

5) Stumbling, problems talking or using the arms and legs

6) Significant bleeding or leakage of fluid from the nose or bruise behind the ear

7) Headaches not relieved by acetaminophen or ibuprofen

If in doubt, call – especially in children under 6 months of age.

Burns – Very large burns, burns of the face, neck or genitals or burns encircling an arm or leg should be seen as soon as possible by a physician. Any electrical burns should also bee seen as soon as possible. Other burns can often be managed at home. Call the office with any questions. The burned area should be rinsed immediately (don't take time to remove clothing) with cold water for 10 minutes.

No butter, ointment or creams should be applied.

Extensive burns should be wrapped in a wet sheet or Saran Wrap and brought to the office or emergency room/

Minor burns (red with only a few blisters) may be managed at home. They should be washed with antibacterial soap twice daily. Blisters should NOT be opened; the outer skin protects against infection. Small burns need to be covered. Acetaminophen may be given for pain. Cold compresses may also be used. If your child is unable to sleep because of pain, call for advice. If several blisters are present, we will probably want to see the burn in the office and will probably recommend an antibiotic cream. Bacitracin and Neosporin are both available over-the-counter and work well for minor burns.

Choking – Any foreign body in the airway may be life threatening. If your child is choking but can make noise and speak, do NOT pound on his back but do seek immediately medical attention. If the choking child is unable to breathe or make a sound, turn her face down on your knees and forcefully give 4-5 back blows with your open hand. If this fails, deliver rapid thrusts to the chest. Repeat en-route to an emergency facility if there has been no response. If you can actually see the object, you may try to remove it with your fingers, but only if you can actually SEE it. If you are comfortable performing the Heimlich maneuver, this is very effective in older children.

ACCIDENT PREVENTION – Accidents are the number one cause of death in children between the ages of l and 16. Most accidents are preventable. Start “child-proofing” at 6 months.

Remember: Prevention is easier and better than treatment do's and don'ts for prevention of accidents;

1) Keep crib sides securely fastened.

2) Use restraints in baby feeder, carriage, stroller, car seats, etc.

3) Never prop baby bottles.

4) Do not hang or tie toys to the crib (your baby may become entangled in the string).

5) Avoid use of pillows

6) High chairs should have a broad base to prevent tipping, a safety strap, and a latch on the tray.

7) Teach your child the meaning of the word “hot”

8) Use gates on stairways to prevent falls.

9) Windows should open from the top or have guards attached

10) In the kitchen area, be alert for spattering grease, keep pot handles turned inward, keep hot containers in the middle of the table at mealtime

11) Always check bath water temperature; never run hot water first, as a child may fall in.

12) Be alert for small objects – peas, buttons, popcorn, beads, and nuts. Avoid nuts and popcorn until your child is 4-5 year old; raisins and gum until 3.

13) Be sure broken glass and razor blades are safely disposed of.

14) Use safety plugs in unused wall sockets; be sure electric cords are not frayed and secure electrical cords so lamps cannot be pulled over.

15) Be careful when using plastic bags, especially dry-cleaner bags

16) Make sure that your child can't get into the Drano, oven cleaner, furniture polish, medicines, alcohol or any other toxic substance. Keep them locked up. If you are using one of these items, put it away in a secure place before answering the phone or doorbell.

17) Always use a car seat or seat belts, even when in someone else's car.

18) Turn water heater temperature down lower than 130 degrees so even the hottest faucet water won't burn as much.

19) Don't use a lawn mower when children are playing nearby.

20) No peanuts or popcorn in the house until your youngest child is 4-5 years old

21) Don't turn your back on your baby when he's on the bed, table or bassinette. Never leave the baby alone in the bath, even for a few seconds.

22) Keep your baby away from loose cords (Venetial blind cords). Make sure no cord hangs in or near your baby's crib

23) Never tie a pacifier around your baby's neck.

24) Consider a smoke alarm near the children's sleeping area. Develop and practice escape routes with children in case of fire.

25) Discourage your child from running with food in his mouth.

26) Teach road safety, i.e. never run into the street, look both ways before crossing. Etc.

a. Teach bicycle safety. Require bicycle helmet use

27) Teach water safety. Never consider a child “water-safe”.

28) Never leave your baby alone in room with pets, no matter how gentle

29) Put plants up and out of reach

30) Use safety latches for cabinets

31) Wood stoves are a leading cause of winter burns. Use safety screens

32) Curling irons are a leading cause of burns. Keep them out of reach of your child

More about car seats

Automobile accidents are the leading cause of accidental death in children. For this reason, utilization of a car seat each time your child rides in the car is an absolute requirement. Unrestrained babies and children become flying missiles during a collision. Their flight is stopped not usually by a parent but rather by the dashboard or car window. Don't bring your child to our office unless he/she is properly restrained? Use of a car seat should start on your baby's first ride home from the hospital. You will find that children accept car seats very well. Car rides are much more enjoyable and relaxing when children know they must be in a car seat riding in a car.

You need to make sure your car seat and booster seat fit properly for all children, even up to 75 pounds. Also, make sure the seat belt rides over the lap and not the midsection, as major abdominal injury occurs in accidents.

CHLDREN UNDER AGE 12 IN BACK SEAT! We are big believers that the front seat is not the place for children. It is the danger seat in a car, so why purposely place your child in danger. The air bags can cause injury to young children as the force of the bag meets the force of the head going forward, which snaps the head and neck backwards – causing paralysis or death. Also the explosive material causes burns and major eye injuries in children.

Car seats must be approved by the National Highway Traffic Safety Administration and must be used as directed. If you have questions about a particular car seat, please contact the office.

Epilogue

We don't receive training to become parents. This is unfortunate because our first child is always our “experiment.” I was constantly looking for the instruction manual that was supposed to come with my children. As we learn how to become parents, a mom and a dad, we also need to learn how to become a family and assist each other in our needs. The needs of a wife and mother are totally different than from a dad and husband. Communication, tolerance, a belief in each other, and the realization that God has given us something special, not someone else, but us. Children thrive and excel when they are brought up in a positive atmosphere of acceptance, love, happiness and approval. All children are different and need to be treated as individuals. No two are alike! This makes parenthood extremely interesting, challenging and, at times frustrating. Please make use of every opportunity to talk to and be with your child, read to your child, tell stories, use your imagination to stimulate their imagination and play. The greatest gifts we can give our children as parents are out love, our acceptance and out time. Most behavioral problems children manifest are simple attempts at getting attention. If we spend more time giving positive attention, children will have less motivation so seek the negative attention. Make efforts to read parenting books and special topic books that relate to your particular concerns. You will find your unique problems are actually universal problems. This helps us realize we are not alone in our parenting endeavors. Parenting is much easier when both parents are on the same wavelength, yet the different approaches make for the great common effort. Effective parenting requires effective communication between spouses.

What make a child successful – You do, through giving your child a feeling of “I am OK”, I am love, I can make a difference, I care about others, and I want to learn. It is not the grades we make or did make that get us through our day, rather what we have inside ourselves. Good luck, and thanks for allowing us to assist you in the development of your child and family.