When you were born, you cried. And the world rejoiced. NATIVE AMERICAN 03-2010 w w w . p r i m e d p h y s i c i a n s . c o m P r i n t f o r m s a n d c o m p l e t e n e c e s s a r y p a p e r w o r k a t h o m e t o s a v e t i m e i n t h e o f f i c e G e t a n s w e r s t o c o m m o n l y a s k e d q u e s t i o n s A c c e s s h e a l t h i n f o r m a t i o n , s u c h a s i m m u n i z a t i o n s c h e d u l e s a n d t i p s f o r h e a l t h y l i v i n g U s e i n t e r a c t i v e m a p s t o l o c a t e a n y o f o u r P r i M e d P h y s i c i a n s o f f i c e s L e a r n h o w t o b e c o m e a n a c t i v e p a r t n e r i n y o u r h e a l t h c a r e t e a m C o n n e c t t o n u m e r o u s h e a l t h r e l a t e d w e b s i t e s f o r i n - d e p t h i n f o r m a t i o n D i s c o v e r t h e m a n y d i f f e r e n t s p e c i a l t y s e r v i c e s w e o f f e r a n d m u c h m o r e V i s i t P r i M e d P h y s i c i a n s 2 4 h o u r s a d a y ! L o g o n t o w w w . p r i m e d p h y s i c i a n s . c o m t o d a y , t o n i g h t o r a n y t i m e . 303329_Pkt.qxd:303329_pktfldr 3/16/10 2:20 PM Page 1 T h e B a b y B o o k A R e f e r e n c e f o r C a r i n g f o r Y o u r B a b y W h e n y o u w e r e b o r n , y o u c r i e d . A n d t h e w o r l d r e j o i c e d . N A T I V E A M E R I C A N 0 3 - 2 0 1 0 www.primedphysicians.com Print forms and complete necessary paperwork at home to save time in the office Get answers to commonly asked questions Access health information, such as immunization schedules and tips for healthy living Use interactive maps to locate any of our PriMed Physicians offices Learn how to become an active partner in your healthcare team Connect to numerous health related websites for in-depth information Discover the many different specialty services we offer and much more Visit PriMed Physicians 24 hours a day! Log onto www.primedphysicians.com today, tonight or anytime. 3 0 3 3 2 9 _ P k t . q x d : 3 0 3 3 2 9 _ p k t f l d r 3 / 1 6 / 1 0 2 : 2 0 P M P a g e 1 Children aretheliving messages wesend to a timewewill not see. J OHN W. WHI TEHEAD The Baby Book A Reference for Caring for Your Baby 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 1 It was thetiniest thing I ever decided to put my wholelifeinto. ANONYMOUS 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 2 If thisisyour first baby, welcometo theexciting world of parent- hood. If you already havechildren, you areabout to discover how thisnew littleperson, with hisor her own personality, will add a new dimension to your family. In either case, our practiceispleased that you haveselected usto help you carefor your newborn. Welook forward to serving asa guideto you in creating a happy and healthy upbringing for your son or daughter. Keep This Book! This booklet will serve as a reference for you as you begin to care for your newborn. Weve taken many of the most frequently asked questions and issues and included them in this book. This will help you to be prepared for caring for your newborn in the weeks ahead. As you come to the office for future well visits, we will give you additional pages that outline your babys growth and development for his or her age. You may find it helpful to keep these pages with this booklet for reference. Congratulations on the birth of your baby! 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 3 If you can giveyour son or daughter onegift, let it beenthusiasm. BRUCE BARTON 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 4 Table of Contents Your Newborn Child Your Babys Appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Your Babys Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Your Babys Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Caring for Your Newborn Your Babys Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Feeding Your Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 - Nursing Taking care of Mom while nursing Problems while nursing Nursing and going back to work - Bottle feeding - Frequency of feedings - Burping your baby Bathing your Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Diapering and Laundering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Your Babys Health Common Characteristics of Newborns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Newborn Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 - Newborn Screening Test - Caring for the umbilical cord - To circumcise or not to circumcise - J aundice - Routine checkups and immunizations - Dental care Newborn Illnesses/Concerns When to Call the Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Sudden I nfant Death Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Colic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Gastro-Esophageal Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Newborn Safety Car Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Home Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 CPR and First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Poison Control Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Common Illnesses/Concerns Common cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Taking your Babys Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Earache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Head I njuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Sleep Problems in Infants and Toddlers Develop a Regular Schedule and Sleep Routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Feeding During the Night . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Toddler Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Nightmares . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Sleep Terrors and Sleepwalking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Index and References Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Using the I nternet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Suggested Web Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 5 When thefirst baby laughed for thefirst time, thelaugh brokeinto a thousand pieces and they all went skipping about and that was the beginning of fairies. J AMES MATTHEW BARRI E 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 6 1 Now that youveexperienced themiracleof pregnancy and birth, youll bespending timegetting to know your beautiful baby. Your Babys Appearance I n the first few weeks your baby will have several unusual features that are unique to this time of his or her life. I n fact, many newborns look slightly peculiar to their parents. There is no need to be alarmed. Every day youll become more familiar with the special physical characteristics that make your baby the unique person that he or she is. The following takes you on a guided tour of your babys primary characteristics the first few weeks of life. For more detailed information, see the alphabetized section on Common Characteristics of Newborns. Babys head When babies are born, their heads are often molded to fit through the birth canal. Although your babys head may seem to be an unusual shape, it will soon take on a more rounded appearance as your baby grows and develops. Babys face Your newborns eyes may appear red and swollen for a few days after birth. This is normal, and there is no need to worry. Some babies appear to be cross- eyed during the first few weeks. Again, this is normal as the babys nervous sys- tem continues to mature. Your baby can see from the time of birth. During the first few weeks, he or she can best focus on objects at around 14 inches away. Babys chest Some babies have what appear to be swollen breasts during the first few weeks. This occurs due to the passage of female hormones from Mom across the placenta during pregnancy. You may notice a white fluid leaking from the nipple. Do not squeeze the nipple or express the fluid. I f the nipples appear red and inflamed, it could indicate an infection. Babys belly The abdomen of your newborn is most noticeable because of the umbilical cord. This cord, which provided nutrition and carried away waste during pregnancy, is cut short and no longer needed and will soon dry up and fall off. For more information on caring for the umbilical cord stump, see page 14. Babys nervous system All newborns have reflexes that they will outgrow as they grow and mature. One common reflex is a shaking or quivering motion of the arms, legs, or chin. This is a normal response and is not cause for alarm. Your Newborn Child 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 7 2 Babys skin I n general, your babys skin may appear to be blotchy, and at times his or her feet or hands may be blue. I n most cases, this happens because the babys blood vessels are immature. There is no need to worry. Babys skin is often dry and there may be some peeling. I n the first few days or weeks of life there are several different harmless rashes that may occur. One of these is milia, tiny white dots on the nose and cheeks that are causedby clogged pores. This condition may be seen from time to time throughout infancy. You may also notice other rashes like infant acne, erythema toxicum (tiny bumps that are firm, yellowish or white, surrounded by a ring of redness) or just sensitive skin. Blisters, open or weeping sores, boils, yellow crusts or red streaks are not expected and need to be evaluated by your doctor promptly. Your Babys Behavior As you spend the first few weeks getting to know your baby, youll become aware of little things that he or she does. Dont be concerned about these motions or behaviors. Most of them are harmless reflexes caused by an immature nervous system and will disappear in two or three months. Babys breathing At times, a baby will appear to have an irregular breathing pattern. As long as your baby seems content, there is nothing to worry about. I f you are concerned, observe your babys breathing rate. I f he or she is not turning blue, breathing is less than 60 breaths per minute, and the pauses between breaths last fewer than six seconds, dont worry. Babies will often take rapid, progressively deeper breaths to completely expand the lungs. Trembling or jitteriness Your baby may experience trembling or jitteriness of arms and legs while crying. J itters are common in newborns; however, some parents mistake these common movements as signs of a seizure. Seizures are extremely rare. During seizures, babies also make jerking movements, blink their eyes, suck rhythmically with their mouths, and dont cry. I f your newborn is trembling but not crying, try giving the baby something to suck on. I f the trembling doesnt stop during sucking, call our office immediately. These behaviors include: Chin trembling Frequent yawning Passing gas Straining with bowel movement Noises caused by breathing or movement during sleep Lower lip quivering Hiccups Sneezing Spitting up (small amounts) or belching Startle reflex a brief stiffening of the body in response to noise or movement (also called the Moro reflex or embrace reflex) 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 8 Bowel movements Babies have a variety of bowel movements. Early bowel movements are green- ish black, progress to appear yellow and seedy, then become darker and more formed. The frequency of bowel movements may vary, from after each feeding, to once every 5 days or longer. Constipation results in hard pellet stools. I t is normal for babies to grunt, strain and turn red while having a bowel move- ment. Please call the office if you notice any blood in the stool, if the stool is pale colored (like clay), or if the stool appears black or tarry. Call the office if your baby has gone more than seven days without passing stool. Babys Sounds While it may be months before you hear your babys first laugh, there are other sounds that he or she will make that youll find very familiar. These include: Crying Crying is your babys only way of communicating with you right now. Crying is your babys way of telling you that he or she is uncomfortable in some way. Typical reasons for crying include being wet, cold, hot, hungry, tired, wanting attention, or feeling some type of pain. I f your baby seems to be inconsolable or becomes more and more irritable, call our office. Throat clearing or gurgling sounds in the throat Gurgling sounds in the throat are caused by mucous or saliva in the throat. You need not worry about these sounds unless it appears that your baby is having a difficult time breathing. Babies younger than two months should rarely cough. Call us immediately if your baby seems to be coughing excessively during the first two months of life. Hiccups Hiccups often begin before birth. These little spasms seem to bother parents more than they bother the baby. No treatment for hiccups is necessary they will pass on their own. I f youd like to try to make your baby more comfortable during a hiccup spell, you can try burping or feeding. Sneezing Sneezing is a way for your baby to clear his or her nose. Occasional sneezes are normal and do not always mean that your baby has a cold. Passing gas Passing gas is a healthy sign. Babies swallow a lot of air while feeding. This process is a natural way for baby to release that air. 3 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 9 4 Babies arealways moretroublethan you thought and morewonderful. CHARLES OSGOOD 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 10 Creating a loving, positiveenvironment for your baby isoneof the most important thingsyou can do asa parent. Your Babys Environment Your baby was born with a blank slate. Babies learn by experiencing life through their senses. Holding, talking, singing, or even dancing with your child are ways to create positive interactions. Read to your child often, even when he or she is an infant. Any type of reading can be interesting and useful to an infant if the words come from the soothing voice of a parent. I f you played music before the babys birth, keep playing it after birth. Children naturally enjoy the rhythm of music. Babys comfort The temperature of your home should be kept at the usual comfort level (between 65 and 70 degrees.) I f your baby is uncomfortable, he or she will give you clues. For example, if babys hands and feet are cold and the rest of baby is warm, you may want to dress your baby in a light sleeper. Babys clothes should be soft, light, loose and simple. Babies dont require any more clothing than the average adult. Dress your baby appropriately based on temperature and time of year. Because your babys head is proportionally larger than the rest of his or her body, a hat should be used when going outside in cold weather. This will help to insulate babys head and to keep the heat from leaving his or her body. Earmuffs dont prevent anything but cold ears. Middle ear infections are not caused by leaving the ears uncovered. Most illnesses are caused by contact with others. Try to keep your baby away from people with colds, flu, or other contagious illnesses. Socializing with your baby For the first 4-6 weeks, you and your baby should stay home. Visitors should be limited, and they should wash their hands before holding the baby. Do not disturb the babys sleep for socializing. You should not allow any visitors who are ill to visit the baby until after theyve recovered. Try to avoid large crowds and exposure to anyone who is sick, for the first 2-3 months of your babys life. 5 Caring for Your Newborn 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 11 6 Feeding Your Baby The choice between nursing or bottle feeding is a personal one. After you have researched all the information, factoring in your needs and desires, make your decision whether to nurse or bottle feed. Then be happy with your decision. It may seem very sim- ple, but it is true. No matter what you decide, if you are happy, your baby will be happy. Nursing Breast feeding (nursing) provides the best nutrition for your baby. After all, breast milk is natures formula. Many new mothers feel a special closeness with their new- born while nursing. And, breast milk also contains antibodies which help protect the baby against infection. When you first begin breast feeding, you can expect very little breast milk. This is normal. During first few days, your body will produce colostrum, a yellow or whitish fluid. Colostrum provides extra protein and minerals as well as the antibodies your baby needs to fight infection. Many new mothers worry about having enough breast milk during those first few days to sustain their babies. Luckily, nature designed newborns to make it through this period without much food. When you breast feed your baby these first few days, his or her sucking action will cause breast milk to be produced. Mature milk (which is produced after colostrum) will come in after three or four days. The nurses at the hospital will lead you through the initial feedings. Major points to remember include: Open your babys mouth by pressing his or her cheek against your breast (the rooting reflex) Gather the nipple together to allow as much of the areola as possible into your babys mouth. Let your baby nurse from each breast at each feeding, beginning each successive feeding with the opposite breast. Help avoid sore nipples by changing position from one feeding to the next. Have the hospital nurse demonstrate the various holding positions. Start with feedings of five minutes with each breast. Gradually increase to ten or fif- teen minutes. Feedings beyond thirty minutes dont increase nutrition and may make you sore. Let the nipple air dry after feedings and between feedings to prevent cracking and soreness. I f this is not practical, or if there is leaking between feedings, a nursing pad can be used. I f cracking begins you may apply a cream such as lanolin. Remember that nursing can be a difficult process, so be patient. Do not hesitate to call for help from the office, or talk with the lactation consultant at the hospital. No matter what you decide, if you are happy your baby will be happy. 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 12 Take care of Mom while nursing Whether nursing or not, it is important to take care of yourself and to be sure to follow the rules for good nutrition. Be careful with any caffeine and alcohol consumption. Make sure that you drink plenty of fluids and continue taking your prenatal vitamins. I f you require over the counter or prescription medication, please notify your physician that you are breastfeeding. Some medications can be harmful to your child or decrease your milk production. If you have questions about medications and nursing, please call our office. Problems while nursing I f for some reason you feel that nursing your baby isnt going well, please ask us for help. Quite often, we have found that parents may perceive that nursing is not going well when actually the baby is thriving. Nursing and going back to work I f you are a working mom, you may have mixed feelings about breast feeding when it is time to return to work. Consider these three solutions: You may decide to express milk, saving it for those feedings when you cant be there. Breast milk can be saved in the refrigerator for 48 hours and a few weeks in the freezer (seechart on page8). An electric pump that expresses milk from both breasts at the same time will make giving breast milk in a bottle much easier. You may decide to offer formula instead of the breast for those feedings when you cant be there. You may decide to switch from nursing to bottle feeding. Gradual introduction is a common technique for allowing the mother and the baby to make the tran- sition smoothly from breast to bottle feeding. That is, change only one feeding from breast to bottle every three days. Decisions that involve switching from nursing to bottle feeding are important ones. I f you feel the need to switch from nursing to bottle feeding because you feel that you arent doing a good job, please discuss it with us. I f you desire the change for other reasons that have to do with your own personal lifestyle, feel comfortable with your decision. 7 Whether nursing or not, it is important to take care of yourself and to be sure to follow the rules for good nutrition. 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 13 8 Storage location of breast milk Temperature Storage Time At roomtemperature . . . . . . . . . . . . . . . . . . .77 degrees F. . . . . .4 hours Cooler with blue ice . . . . . . . . . . . . . . . . . . . .59 degrees F. . . . . .24 hours Refrigerator (fresh milk) . . . . . . . . . . . . . . . . .39 degrees F. . . . . .72 hours Refrigerator (previously thawed milk*) . . . . . . .39 degrees F. . . . . .24 hours Frozen milk** (Freezer inside refrigerator) . . . .4 degrees F. . . . . . .2 weeks Frozen milk** (freezer with separate door outside refrigerator) . . . . . . . . . . . . . .4 degrees F. . . . . . .3-6 months Freezer** (separate manual defrost-deep freeze) . . .4 degrees F. . . . . . .6-12 months *Do not refreezethawed milk ** Container with lid with airtight seal Bottle feeding Formula feeding may be a more convenient solution for your family. You should use an iron-fortified formula such as Similac Advance. Your newborn may take 2-3 ounces of formula at a feeding and will generally want to feed every 2-4 hours. Do not allow your baby to go more than 4 hours between feedings for the first two weeks of his or her life. Keep the following in mind when bottle feeding: Do not use the microwave to heat bottles. Microwaves cause uneven heating of the formula and could burn your baby. Always hold your baby upright or semi-upright for feeding. Never prop the bottle in his or her mouth. Do not let your baby get into the habit of taking a bottle in the crib or bed. Use a pacifier to satisfy your babys need to suck. Do not change your babys brand or type of formula without talking with us first. Frequency of feedings Your babys feeding schedule may be fairly irregular at first. Especially during the first two weeks, he or she may be hungry every 2-3 hours during the day and 2-4 hours during the night. To encourage a feeding, you may have to unwrap your baby to increase his or her level of alertness. I f your child is exclusively breast fed or consumes less than 30 ounces of formula per day, you will need to give him a multivitamin containing 400 I U of vitamin D for bone strength. We will discuss this with you at your two week visit. Your baby should not need anything to eat other than breast milk or formula. Some parents give their babies water in situations when the baby seems hungry in between feedings. I f you decide to give your baby water, limit the amount to no more than two ounces per day. When giving water to your newborn, city tap water is fine, and boiling isnt necessary. I f your water comes from a well, do not give it to your baby until you have had it test- ed for bacteria. Your county health department can help you to obtain testing. 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 14 Burping your baby Babies tend to swallow a lot of air when they feed. You should burp your baby after a feeding by holding your baby upright on your shoulder and gently pat- ting the back. Burping will often make the baby more comfortable. Sometimes babies dont burp after feedings. I f your baby seems comfortable, burping may not be necessary. Bathing Your Baby Bathing is a time of warmth and tenderness for you and your baby. Your babys skin is sensitive but not delicate. You can use soap and water on a regular basis. A bath can be given with a wash cloth and soap and water while your baby is on the changing area. Remember that water itself is drying to the skin. I f the skin looks dry, you may skip the bath for a few days. Sponge baths are recommended until the umbilical stump falls off. After that, you may give your baby tub baths. At first, use only an inch or so of water and always check the bath water temperature with your elbow. To help prevent accidental burns, keep your water heater set at 120 degrees F. Limit the amount of soap and lotion used on the babys skin in the first few weeks of life. This will allow the natural oils in the skin to come in. Diapering and Laundering Although they may be more convenient, disposable diapers have an effect on the environment. I f you choose to use cloth diapers, you can wash them the same as you wash the rest of the laundry. One third of a cup of vinegar in the final rinse may help to reduce odor. Avoid using fabric softeners, which can cause irritating diaper rash. 9 Bathing is a time of warmth and tenderness for you and your baby. 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 15 10 Children aretheonly form of immortality that wecan besureof. PETER USTI NOV 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 16 Keeping your baby healthy throughout hisor her lifeisoneof your primary concernsasa parent. Welook forward to helping you in thisimportant endeavor both when your baby isill, and even moreimportantly, when your baby iswell. Common Characteristics of Newborns Barton D. Schmitt, MD, a noted expert on newborn care and author of many baby and child care books, has developed a list of common physical character- istics of newborns. Most are normal, but if you have specific questions, please call the office. The following alphabetized listing is taken from Dr. Schmitts work: Blocked tear ducts. I f your babys eye waters continuously, she may have a blocked tear duct. This means that the channel that normally carries tears from the eye to the nose is blocked. It is a common condition, and more than 90% of blocked tear ducts open up by the time the child is 12 months old. Body hair (lanugo). Lanugo is the fine downy hair that is sometimes present on the back and shoulders of newborn babies. I t is more common in pre- mature infants. I t rubs off with normal friction by 2 to 4 weeks of age. Caput. This swelling on top of the head or throughout the scalp is caused by fluid that is squeezed into the scalp at birth. Caput is present at birth and clears in a few days. Cephalohematoma. This is a lump on the headusually confined to one sidethat occurs when blood collects on the outer surface of the skull under the skin. I t is caused by friction between the infants skull and the mothers pelvic bones during birth. I t first appears on the second day of life and may grow larger for up to five days. It doesnt disappear completely until the baby is 2 or 3 months of age. Ear pits. About 1% of normal children have a small pit or dimple in front of the ear, below the temple. This minor congenital defect is not a problem unless it becomes infected. Epithelial pearls. There may be little cysts containing clear fluid or shallow, white ulcers along the gum line or on the roof of the mouth. They result from blockage of normal mucous glands. They disappear after one to two months. 11 Your Babys Health 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 17 12 Eye color. The permanent color of the eyes usually blue, gray, brown, or some vari- ation of these colors is often uncertain until your baby reaches 6 months of age. Children who will have dark eyes often change to the permanent color by 2 months of age. Children who will have light-colored eyes usually change by 5 or 6 months of age. Feet turned up, in, or out. Feet may be turned in any direction inside the cramped quarters of the womb. As long as your childs feet are flexible and can be moved easily to normal position, they are normal. The direction of the feet will straight- en between 6 and 12 months of age. Flattened nose. The nose may be flattened or pushed to one side during birth. I t will look normal by 1 week of age. Folded ears. The ears of newborns are commonly soft and floppy. Sometimes the edge of one is folded over. The ear will assume its normal shape as the cartilage becomes firmer over the first few weeks of life. Fontanel. This soft spot is found in the top front part of the skull. I t is diamond- shaped and covered by a thick, fibrous layer of tissue. I t usually pulsates with each beat of the heart. I t is safe to touch this area. The purpose of the fontanel is to allow rapid growth of the brain. I t normally closes over with bone when your baby is between 9 and 12 months of age. Hemorrhage on the eye. Some babies have a flame-shaped hemorrhage on the white of the eye. I t is caused by breaking of blood vessels on the surface of the eye dur- ing birth and is harmless. The blood is reabsorbed in two to three weeks. Ingrown toenails. Many newborns have soft nails that bend and curve easily. The nails are not truly ingrown, however, because they dont curve into the flesh or cause irritation. Long second toe. The second toe is longer than the great toe as result of heredity in some ethnic groups, especially those that originated around the Mediterranean Sea. Molding of the head. Molding refers to the long, narrow, cone-shaped head resulting from passage through a tight birth canal. This compression can temporarily hide the fontanel. The head returns to a normal shape in a few days. Scalp hair. Most hair is dark at birth. This hair is temporary and begins to fall out by 1 month of age. Some babies lose it gradually while the permanent hair is coming in. Others lose it rapidly and temporarily become bald. The permanent hair generally appears by 6 months. It may be an entirely different color from the newborn hair. Sucking callus or blister. A sucking callus occurs in the center of the upper lip from constant friction at this point during bottle or breast feeding. I t will disappear when your child begins cup feedings. I f the baby sucks his thumb or wrist, a cal- lus may develop there, too. 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 18 Swollen eyelids. Your babys eyes may be puffy because of pressure on the face during delivery. They may also be puffy and red if silver nitrate eye drops have been used. This irritation should clear in about three days. Swollen breasts. Many babies, both male and female, develop swollen breasts during the first week of life. The swelling is caused by the passage of female hormones from the mother across the placenta during pregnancy. I t generally persists for four to six months but may last longer in breast fed and female babies. Swelling may go down in one breast a month or more before the other breast. Never squeeze the breast because this can cause infection. Be sure to call our office if a swollen breast develops signs of infection such as general redness, red streaks, or tenderness. Teeth. The presence of a tooth at birth is rare. About 10% are extra teeth with- out a root structure. The other 90% are prematurely erupted normal teeth. The distinction between the two can be made with an X-ray. Extra teeth must be removed by a dentist because they can fall out unexpectedly and cause choking. Normal teeth need to be removed only if they become loose, because of the danger of choking, or if they cause sores on your babys tongue. Tongue-tie. The tongue in newborns normally has a short, tight band on the underside that connects it to the floor of the mouth. This band usually stretches with time, movement, and growth. Tongue-tie, or tight tongue, is a rare condition in which the band keeps the tip of the tongue from pro- truding beyond the teeth or gum line. Tongue-tie doesnt usually cause any symptoms or interfere with sucking or speech development. Your Baby Girl Female genitals. The labia minora may be quite swollen in newborn girls because of the passage of female hormones across the placenta. The swelling will go down in two to four weeks. Hymenal tags. The hymen also may be swollen because of maternal hormones and may have smooth 1/2-inch projections of pink tissue called tags. These tags are harmless. They occur in 10% of newborn girls and slowly shrink over two to four weeks. Vaginal discharge. A clear or white discharge may flow from the vagina during the latter part of the first week of life as maternal hormones in the babys blood decline. Occasionally the discharge will become pink or blood-tinged (false menstruation). This normal dis- charge should not recur once it stops. 13 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 19 14 Your Baby Boy Male genitals. The scrotum of newborn boys may be filled with clear fluid that has been squeezed into the scrotum during birth. This common, painless collection of fluid is called a hydrocele. A hydrocele may take six to 12 months to clear completely. I t is harmless but should be checked during regular visits to the doctor. I f the swelling changes size frequently, a hernia may also be present, and you should call our office during regular hours for an appointment. Undescended testicle. The testicle is not in the scrotum in about 4% of full-term new- born boys. Many of these testicles gradually descend into the normal position during the following months. I n 1-year-old boys, only 0.7% of all testicles are undescended and need to be brought down surgically. Tight foreskin. Most uncircumcised infant boys have a tight foreskin that doesnt allow you to see the head of the penis. This is normal and the foreskin should not be retracted. The foreskin separates from the head of the penis naturally by 5 to 10 years of age. Erections. Erections occur commonly in newborn boys, as they do at all ages. They are usually triggered by a full bladder and demonstrate that the nerves to the penis are normal. Newborn Health Soon after babys birth, there are several immediate tests and conditions that must be addressed. This section provides highlights of these conditions. I f you have any ques- tions, please call our office immediately. Newborn Screening Test The newborn screening test involves a blood sample drawn from your baby during the hospital stay. This sample of blood is used for a number of tests for diseases that can be treated more effectively if diagnosed early. The test, which is required by the State of Ohio on all newborns, is nicknamed the PKU, representing the initials of the original test performed years ago. One of the main reason for this test is to check for diseases that are influenced by diet and metabolism. That is why the test cannot be performed until your baby is at least 24 hours old, and after feeding has been established. I n most babies, the newborn screening tests are normal. We will call you immediately if any of the testing is abnormal. Caring for the umbilical cord The transition from before to after birth is very fast. The umbilical cord, which sustained your baby in the womb, is no longer needed. The cord will dry up and fall off within the first three weeks of his or her life. Dont be surprised if you notice a yellow or greenish discharge and a slight odor from the cord. 303329_Text.qxp:303329_text 3/22/10 10:59 AM Page 20 I f you like, you may wash the cord stump once or twice a day with soap and water. This is not necessary, but it may help the cord dry and fall off sooner. I f you wash the cord with soap and water, use dry cotton swabs to thoroughly dry the cord. Be sure to lift the cord to dry the area where the cord meets the babys skin. There is no feeling in the cord and it will not cause your baby any discomfort if you move it to clean around the area. When the stump of the cord falls off, you may see a little bleeding. I f the skin surrounding the cord becomes red and swollen, let us know. To circumcise or not to circumcise I f you have a baby girl youve been spared this decision. I f you are the proud parents of a baby boy, this is a decision you will need to make. There have been many medical theories relating to the advantages of circumci- sion. Some studies have shown a slightly decreased risk of AI DS and urinary tract infection in circumcised males. However, personal consideration is the main reason for circumcising your son. Whether your preference is based on social, psychological, religious, or other factors, the decision whether or not to circumcise is a personal decision not a medical decision. I f you choose to have your baby circumcised, it is normal to see a few spots of blood just after the procedure. You may apply petroleum jelly at each diaper change until the circumcision is healed. Once healed completely (about one week), you should pull the foreskin remnant off the glans, or head of the penis after each bath. This will keep it from sticking to the glans. Call our office if the circumcision bleeds or swells. I f you choose not to circumcise your son, the only care needed is to be sure the area is kept clean. Dont worry about pulling the foreskin back. I t will retract freely on its own. I t may be years before this occurs. Jaundice The term jaundice comes from a French word meaning yellow, and this con- dition is very common in newborns. J aundice occurs because babies bilirubin is high. Bilirubin is a normal waste product that we all eliminate, mainly through bowel movements. Newborns have a tougher time eliminating bilirubin than we do as adults. Some babies have a more difficult time than others. So, as their bilirubin climbs, they turn yellow or jaundiced. The yellow discoloration typically starts in the babys face, and works its way down the body as the level gets higher. 15 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 21 16 The higher the bilirubin, the more yellow your baby may appear. Ordinarily, high biliru- bin causes no problem, unless it is excessively high. This is very unusual. We recommend routine screening for jaundice with a blood test while your baby is in the hospital. We will keep you informed of the results and their significance. Call the office if: Your babys coloring becomes more yellow at home. Your baby becomes sleepier. Your baby doesnt feed as well. Your baby has fewer wet/dirty diapers. We may ask you to get a blood test to determine the level of jaundice. Routine checkups and immunizations Your babys checkups and immunizations are very important. We will discuss your babys growth and development, feeding and bowel habits, behavior, safety, and any concerns that you have. We may also perform routine tests and administer immuniza- tions. For a complete list of immunizations, please see the chart in the back pocket of this booklet. Keep in mind that many of the tests that we do and shots that we give during a well visit cannot be done when your child is ill. Even though you may feel as if you are in the office quite a bit due to illness, it is important to schedule separate appointments for well visits and immunizations. The normal schedule for routine well visits based on the age of the child is as follows: 3-5 days of age 2 weeks 2 months 4 months 6 months 9 months 12 months 15 months 18 months 2 years 2 1 /2 years 3 years 4 years 5 years 6 years and up(annual checkups) through age 18 When your child becomes old enough for school, the information from these checkups (including proof of immunizations) will be required by your school district for enrollment. Keeping to this schedule will help to ensure that your child has what he or she needs for school, but more importantly, for a healthy life overall. Dental care I t may seem a little early to think about your babys dental needs, but healthy teeth actually start in infancy. I f you are bottle feeding, keep bottles out of your babys crib. Bacteria from formula or milk will build up on your babys teeth as he or she sleeps, causing early tooth decay. The bottle should be discontinued by the babys first birth- day, at the latest. J uice should only be given in a cup and limited to two ounces per day. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 22 17 When your babys teeth break through, you can keep them clean by wiping them with a washcloth or brushing them with a small, soft toothbrush. Use no more than a pea-sized amount of fluoride-free toothpaste each night before bedtime. We recommend the first dental visit around age 2. Children over the age of 6 months may need a fluoride supplement if you have well water or unfluorinated water, or if you are exclusively breast feeding or using ready-to-feed formula. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 23 18 Thejoys of parents aresecret and so aretheir griefs and fears. FRANCI S BACON 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 24 When your baby issick, it isoften hard to tell what symptomsare serious. Many times, simpleailmentscan behandled at homewith a littleTLC. At other times, it isimportant to bring thebaby to theofficefor a sick visit. When to Call the Office Any time your newborn develops the following problems, please call the office immediately: 19 Newborn Illnesses/Concerns Rectal temperature of 100.4 degrees F. or greater. Crying that you feel represents pain. Less than 8 to 10 wet diapers per day. Eye drainage. Vomiting or diarrhea beyond the usual spitting and loose stool. Sudden loss of appetite. Turning blue or pale Becoming more jaundiced (yellow) since leaving the hospital. Any change in behavior or appear- ance that concerns you. Less active or is fussy. Convulsions or seizures. Labored, difficult, or rapid breathing. Sudden Infant Death Syndrome Sudden Infant Death Syndrome or SIDS brings fear to every new parents heart. Despite great advances in medicine and medical care, two of every thousand children in this country will die of SI DS. There are very few things we can do to anticipate SI DS. Recently, studies in other countries have pointed to sleep position as being associated with SI DS. Specifically, these studies found that infants younger than six months who slept on their stomachs were more likely to die of SI DS. Because of this, experts have recommended that infants sleep on their backs until they begin to turn on their own and find their own preferred sleep position. When your baby is awake during the day, place your baby on his/her side or stomach to prevent flattening of the head. We also recommend avoiding pillows, stuffed animals, and comforters or puffy bedding. I n some cases, babies may have some other medical condition that puts them at greater risk if they sleep on their backs. I f this applies to your baby, we will discuss this with you. No one really knows why this association of sleep position and SI DS may exist. As further research is completed, we will issue new recommendations to parents on possible ways to prevent SI DS. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 25 20 Cigarette smoke has also been shown to increase the risk of SI DS. I f you smoke, avoid smoking around the baby. Do not let other family members or visitors smoke around the baby. Colic Colic is an extremely frustrating condition for most parents. The cause of colic is unknown, but it results in a baby who may cry for hours for no reason. Colic is not a dangerous condition, and it lasts only a few months. Most infants who become colicky develop the condition around 2 weeks of age, and it is over by the time they reach 4 months. Symptoms Uncontrollable crying or screaming for no reason Tucking the legs close to the stomach as if in great pain Call the office if your baby has colicky symptoms and: Has vomiting, diarrhea, or black or bloody stools Has a fever greater than 100.4 degrees F. (rectal temperature) Has lost weight or is eating less I s under 2 weeks old, or older than 4 months Has colic symptoms for more than 4 hours at a time Home treatment While there is no true cure for colic, some of these tips may help bring you and your baby some relief: Hold your baby so that he or she is in a sitting position at feeding time. This will help to reduce the amount of air swal- lowed during feeding. Also check the size of the nipple holes in the bottles you use. I f the holes are too small, baby may be getting too much air. Trying different styles of nipples may help as well. Burp your baby more frequently after each ounce of formu- la or every few minutes when breast feeding. I f breast feeding, be cautious about how much caffeine you have in drinks such as sodas, coffee and tea. Rock your baby gently, use an automatic swing, or take your baby for a car ride or a walk in the stroller. Motion tends to help some babies. Run the dryer, dishwasher, or vacuum. I n some cases the noise of these appliances calms colicky babies. Let your baby cry him or herself to sleep if nothing else works. Do not let the baby cry for more than 4 hours. Take a break. Let someone else care for your colicky baby for a little while so you can rest. Colic is not a dangerous condition, and it lasts only a few months 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 26 Gastro-Esophageal Reflux While gastro-esophageal reflux has received a lot of attention in recent years as an adult problem, this condition is also common in babies. Reflux occurs due to the immaturity of your babys lower esophagus. The esophagus contains a sphincter muscle (between the esophagus and the stomach) which usually tight- ens after food enters the stomach. With reflux, the normal muscle tone in the sphincter has not yet developed. As a result, food that passes into the stomach can return to the esophagus. Reflux can present itself in different ways. Symptoms Spitting up: I t is not unusual for babies to spit up. I f the spitting up is occa- sional and your baby seems to be comfortable despite the spitting, the solu- tion may be something simple such as smaller, more frequent feedings, more burps, or different formula. Well discuss this at your visits. Irritability: I f your baby is fussy, it may be due to heartburn-like symptoms that are caused by the reflux. There are medications that may help this condition. Call the office if: Spitting up has become excessive and is a source of discomfort for your baby. Your baby is vomiting forcefully. Your baby seems to have any trouble breathing. Your baby chokes or coughs consistently with feedings. You notice that your baby turns blue or pale when choking or coughing. To confirm the reflux diagnosis, we may recommend that your baby get a barium swallow x-ray. This test is similar to an Upper GI in adults. This test will help us rule out other less likely causes of vomiting in an infant. Home treatment Change your babys sleep position by elevating the head of the bed. Burp your baby more frequently. Some medications such as antacids may be used for reflux. Talk with us about possible over-the-counter medications and their potential side effects before using them. 21 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 27 22 Thesoul is healed by being with children. FYODOR DOSTOEVSKY 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 28 Thebest protection against accidentsthat may harmyour baby isto anticipatewhat could go wrongand to avoid thesesituations. Car Safety Beginning with the first ride home from the hospital, make sure your baby is adequately restrained in a car seat. There are a variety of car seats; many of them do not fit all cars, so shop carefully. To ensure your babys safety while traveling in a car, keep the following in mind: Buy a car seat that is safety-approved and follow the instructions for installing the seat both the instructions that came with the seat and the owners manual for your car. According to The National Highway and Traffic Safety Administration, up to half of child car seats are installed incor- rectly. Do not buy second hand car seats, espe- cially older seats or those that have been in a crash. If your child is under one year and under 20 pounds, he must be in a rear-facing child seat. However keep your child rear facing as long as possible, up to the height and weight requirements of your particular seat. If your child is at least one year and weighs more than 20 pounds, he can ride in a forward-facing seat with a five-point harness, until he is at least four years old and 40 pounds. If your child weighs over 40 pounds, he must ride in a booster seat. Boosters properly position the seatbelt. Use a booster with a high back if the cars back seat is below the top of your childs ears. The seatbelt should fit across the childs shoulder, not up against the neck. State law requires children ride in a booster seat until age eight or 4 feet 9 inches tall. Children under age 13 should ride in the backseat to prevent airbag injuries and fatalities. The airbag deploys at an angle that will injure or kill a child, so if your child must ride in front, be sure to turn off the airbag for the passenger seat. Be sure to properly install the car seat, including the LATCH system if available. Follow directions for the car seat and any instructions on the cars sun visor and seat belt. Car seat inspection stations may be available at area fire departments, sheriff or police departments, local health departments and Childrens Medical Center to inspect the installation of your car seat. For details about car seat installation, call the Department of Transportation Vehicle Safety Hotline, 1-800-424-9393. When you call, have the manufacturers make, model number, and year of both your vehicle and child car seat available. 23 Newborn Safety Rear-facing car seat 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 29 24 For more information about proper car seat installation, visit www.nhtsa.gov. Avoid the temptation to skip use of the car seat or seat belt on harried days. Our children learn by repetition and by example. I f you dont require that your child be restrained, he or she will be less likely to cooperate with use of the belt or seat in the future. And most importantly practice what you preach and set a good example for your children always use your own seat belt. Home Safety Keeping your baby safe from injury at home is as important as car safety. Consider the following home safety tips: Be careful when changing or dressing your baby. Many babies roll over for the first time while on the changing table, bed, or countertop, falling to the floor and causing injuries. Keep your hot water heater set at 120 degrees F. This will prevent scalding from hot water. Have smoke and carbon monoxide detectors present on each floor of the house. Besure detectors are in good working order. Never leave your baby more than an arms reach away from you when bathing. Babies can easily roll over and drown in as little as 1/2 of water. I f you are using an old or used baby bed, be sure the slats or bars are no more than 2 3/8 apart. I f the slats are farther apart, your baby could get his or her head trapped, causing suffocation. Cribs should not contain blankets, bumper pads, pillows or soft toys. Do not allow babies younger than 12 months old to sleep or play on a waterbed. Since the baby cannot support his or her own weight on the waterbed, smothering could occur. Avoid attaching a pacifier to your babys clothing. I f you smoke, avoid smoking around your baby. Exhaled smoke has as much tar, nicotine and carbon monoxide as inhaled smoke. Never smoke in the babys room and do not hold your baby while holding a cigarette. Cigarette smoke increases the risk of Sudden I nfant Death Syndrome, ear infections and pneumonia. Even if you smoke in a car or house, when your baby is not present, the baby suffers passive smoke complications. Place plastic outlet covers on all outlets. Keep poison chemicals and medications out of reach, preferably secured by a latch your child cannot open. Any guns kept in the home should be locked up and unloaded. Any ammunition should be locked up separately. Forward-facing booster seat 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 30 Notes 25 First Aid and CPR Would you know what to do if your child stopped breathing? I f you dont already know CPR, take the opportunity to learn it. Courses in both CPR and First Aid are available through the Red Cross, YMCA, and community adult schools. Poison Control Center By calling 1-800-222-1222, you have free, 24-hour access to poison treatment advice. Please use this resource if your child consumes or is exposed to a dangerous substance. The Poison Control Center is staffed by pharmacists, physicians, nurses, and poison information providers who are toxicology specialists. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 31 26 Trust yourself. You know more than you think you do. DR. BENJ AMI N SPOCK 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 32 During thecourseof hisor her infancy and childhood, your baby will from timeto timedevelop common illnesses. Manyof these illnessesrequirea wait and seeapproach whileyou treat your baby at home. It may not alwaysbenecessary to bring thebaby in for a sick visit. Common Cold The common cold, also known as an upper respiratory infection or URI , is a common illness that in most cases can be treated at home and does not require an office visit. Colds are caused by one of several viruses and are not treatable with antibiotics. I n some cases, colds can lead to bacterial infections in the ears, sinuses, eyes or lungs. If this occurs we will need to see your baby before prescribing antibiotics. We will not phone in antibiotics without having seen your child for his or her current illness. Symptoms (lasting one to two weeks) 27 Common Illnesses/Concerns Runny nose Congestion Sneezing Coughing Headache Sore throat Fever Red eyes Call the office if: Your baby is under three months of age and develops anything other than a minor runny nose or congestion (such as significant cough, breathing diffi- culties after suctioning the nose or fever over 100.4 rectal). He or she is not getting better toward the end of the second week of the cold. Your child has audible wheezing, earache, sinus tenderness, eye redness with yellow discharge, sore throat with fever for more than 24 hours, fever that lasts longer than three days, poor fluid intake, decreased wet diapers or shortness of breath. Your child has a high fever of 104 to 105 degrees F. regardless of what day of the illness (see Fever section). Home treatment Make sure your child gets plenty of rest and lots of fluids to drink. You may give your child (over 6 months old) acetaminophen or ibuprofen for pain (headache, muscle ache, etc.). Make sure you purchase the medica- tion appropriate to your child's age. I f your baby is younger than six months, call the office. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 33 28 Keep his or her nose clear by using saline nose drops (a few drops in each side of the nose) and then aspirating out the mucous with a bulb syringe. - Saline drops may be purchased, commercially packaged as Nasal, Ayr, or Ocean, or prepared at home by adding 1/4 teaspoon of salt to one cup of warm water. - Babies are nose breathers, so keeping the nasal passages clear is very important. - I n older children, encourage them to blow their nose. - Use a cool mist vaporizer or humidifier to help keep the nasal passages moist. I n general, over-the-counter cold medications are not recommended for children. Multiple studies have shown that they are not effective. The U.S. Food and Drug Administration recommends these medications not be given to children under two years of age, due to the risk of serious and potentially life-threatening side effects. Fever I n simple terms, a fever occurs when your childs body tem- perature rises above normal. What is normal? I n infants, a normal body temperature is below 100.4 degrees F. (when taken with a rectal thermometer). Fever is one of the bodys important defenses against illness. Fevers that occur as part of a bacterial or viral illness are harmless. When your baby has a fever, it is a symptom of something else, and not a disease or illness in itself. I t is important to allow your babys body to regulate temperature on its own. With a fever, if your child shivers, cover him or her up. I f the baby sweats, uncover him or her. Otherwise, dress your baby normally. One in 30 children will, sometime in the first several years, have a seizure during a fever. These are brief (lasting under two minutes) and harmless. However, call if this happens. Symptoms Higher than normal body temperature Flushed face/cheeks Lethargic behavior in some cases Call the office if: Your infant (three months or younger) has a rectal temperature greater than or equal to 100.4 F. Your child (older than 2 months) has other symptoms such as pain, vomiting, diarrhea, or rashes. Your child (3 months old to 3 years old) has a rectal temperature of 104 degrees F. or higher. Your child (3 months to 3 years old) has a low grade fever (101 to 102 degrees F.) for more than 24 hours. I n general over-the- counter cold medications are not recommended for children. Multiple studies have shown that they are not effective. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 34 Home treatment Give your child plenty of fluids. Fluids should be age-appropriate, such as electrolyte solutions like Pedialyte and I nfalyte for infants and juices, sports drinks or popsicles for older children. Avoid giving only tap water. Treat the fever with over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). These medications will lower the body temperature for a period of time (a few hours) and make your child feel more comfortable. These medications will not make the fever go away completely. Never use aspirin or products containing aspirin. Allow your child to sleep as much as possible. Do not wake him or her for medication or to take the temperature. Consider acetaminophen rectal suppositories when your child cannot take, or refuses, medication orally. They are available at drug stores without a pre- scription (ask the pharmacist since they are kept in the refrigerator). Sponging your child with lukewarm or tepid water (never cold) is recom- mended only if the temperature is higher than 104 degrees F., and he or she is not responding to acetaminophen or ibuprofen. Never use rubbing alcohol to sponge the child. Sponging is optional, not required. I f shivering occurs, stop the sponge bath. Taking Your Babys Temperature Never use a glass mercury thermometer. There are several ways to take temperatures: Rectal temperature This is the most accurate and most recommended for infants. A digital rectal thermometer is used. Place a lubricant such as petroleum jelly on the tip. Then, holding the thermometer like a pencil with one inch protruding from your fin- gertips, insert the thermometer until your fingertips press against the anus. Held in this position, the thermometer cant be over-inserted. Hold inside until the digital thermometer beeps. Then read the results. Clean the thermometer with cool soapy water or alcohol. Hot water will ruin the thermometer. Oral temperature Most children are not ready for this method before 5 years of age. Use an oral thermometer for oral temperatures. Place the thermometer in the space on the floor of the mouth between molars and tongue. Read when the alarm sounds on a digital thermometer. Ear temperature These are obtained commonly after 12 months of age. Home varieties of ear thermometers may not be reliable. When checking temperature with these devices at home, we recommend checking more than once and occasionally double-checking the reading using a rectal or oral thermometer. 29 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 35 30 Axillary (Armpit) Temperatures Axillary temperatures are not generally recommended because the results may not truly indicate the central body temperature. Forehead temperature strips These tools are not recommended since they measure the skin temperature and not the body temperature. Temporal Scanners This new version of thermometer has improved accuracy over the forehead strips and can be used for children older than one year. Earache Earaches are common complaints during childhood, and can be caused by a number of factors. I n most cases, earaches occur because of an inflammation in the ear itself the external or middle ear but occasionally ear pain may be caused by referred pain from the throat, jaw, or teeth. There are two types of ear infections: External ear infections These infections may be referred to as swimmers ear, because they are most commonly associated with swimming, and occur in the summer months. Middle ear infections These infections occur following an upper respiratory infection. Fluid accumulates behind the eardrum causing increased pressure, inflammation, and pain. Ear infections cannot be diagnosed over the phone, so we must see your child before we can begin treatment. We will not phone in antibiotic prescriptions for ear infections without seeing the child first. Symptoms Ear pain and pressure Slight fever if infection is present Call the office if: There is any pus-like drainage from the ear Ear pain persists over a number of days Ear pain is accompanied by a fever Home treatment Give your child acetaminophen or ibuprofen for pain. A single dose of antibiotics will not affect the pain. Antibiotics must be taken over a period of time to effectively heal the infection. Do not use heat on the ear or non-prescription ear drops in the ear. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 36 An accident involving great force (e.g. a fall down a flight of stairs) A child under one year of age A cut that may need stitches Any loss of consciousness or confusion A seizure Vomiting Prolonged crying after the fall Sleepiness after the fall Weakness, unsteadiness, or dizziness Slurred speech Amnesia Blurred or double vision Unequal pupils or crossed eyes Bleeding or draining ears or nose Any other concerns you may have 31 Head Injury Head injuries can be frightening for you and for your child. I f your child receives a blow to the head or falls and hits his or her head, you must decide how significant the injury is. Call the office immediately if the injury involves any of the following: Home observation I f your childs head injury does not have any of the above symptoms, chances are that he or she needs only careful observation at home. I n addition, your observation at home will help assure that complications will be detected as early as possible. Your child should be awakened twice during the night to the point of being alert and responsive. I f more serious symptoms or reactions arise during the course of your observa- tion, please call us immediately. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 37 32 Always kiss your children goodnight even if theyrealready asleep. H. J ACKSON BROWN, J R. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 38 Sleep problems develop asyour baby getsa littleolder and may last through thetoddler years. Common problemsincludedifficulty gettingyour child to sleep, wakingduringthenight, and nightmares. Develop a Regular Schedule and Sleep Routine Developing good sleep patterns in your infant is an important step toward a good nights sleep in the future. Establish a regular schedule for naps, meals, and bedtimes. Children thrive on routine and this will help them to develop a pattern. Use bedtime rituals that allow your child to wind down before bedtime. Rocking, patting, or holding your child are examples of bedtime rituals, but you must allow your baby to fall asleep on his or her own without your need- ing to be there. I f your baby becomes fussy or cries when you leave the room, return briefly to reassure him or her. I f this behavior continues, increase the amount of time you spend out of the room before you return again, until he or she falls asleep. Allowing your child to fall asleep on his or her own will help your baby learn to fall back asleep after nighttime awakening (a normal part of the sleep pattern). I f crying occurs with nighttime awakenings, use similar methods until he or she falls back asleep. I f you use this time to give your child an extra drink or bottle, or to cuddle with you, you are providing a benefit to waking up in the night and reinforcing your babys need to wake up. Feedings During the Night Although one to two feedings at night may still be necessary in late infancy, the need for additional nutrition is rare. Hunger during the middle of the night may be a learned habit your child learns to be hungry at the time he or she is usually fed. I n this case, eating becomes associated with returning to sleep. I f more than one or two feedings are given during the night as your baby gets older, both your and the babys sleep cycle will suffer. You can gradually elimi- nate the middle of the night feedings by reducing the amount of food given, or by moving the feeding times more toward morning. I f multiple feedings occur, you should also gradually increase the time between feedings. Sleep Problems In Infants and Toddlers 33 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 39 34 Toddler Tricks As your baby becomes a toddler, he or she will use a variety of stall tactics or tricks to delay bedtime. Dont be surprised if he or she insists on repeated trips to the bath- room or extra drinks. These tactics do not mean that your child is NOT tired. Your child is ready for sleep but unable to control his or her impulses As a parent, you must set firm limits and enforce them consistently. I n some cases, more concrete measures such as placing a gate across the doorway or making lights and toys inaccessible may be necessary. Nightmares Nightmares typically occur in the later part of the night. They begin as a normal dream that becomes frightening for your child at the end. Your child will awaken frightened and be afraid to go back to sleep. Nightmares often occur more frequently when your child faces new stress such as starting daycare. Nightmares may also occur if he or she has poor sleep patterns, or during illnesses. I f your child is having very frequent nightmares, we should discuss this at his or her next visit. Your child may need an earlier and/or set bedtime. Sleep Terrors and Sleepwalking Sleep terrors and sleepwalking occur as your child partially awakens during the first four or five hours of sleep the deepest stage of his or her sleep. During this period dreams do not occur. A sleep terror can be very disturbing for parents to witness. During this time, your child may suddenly scream and thrash about. His or her eyes may be open or closed; he or she may appear confused and often talks nonsense. Your child may scream for you but not recognize you when you arrive and may push you away. Sleep ter- rors may last several minutes and end suddenly with the desire to sleep. There is usually no recollection of the event the next morning. Similarly, during sleepwalking your child gets out of bed and walks around in a partially awake state. He or she may walk in the direc- tion of light, sounds, or familiar places such as your bedroom, bath- room, or kitchen. I f the child is calm, simply lead him or her back to bed. I f agitated, allow your child to calm down first. In younger children, sleep terrors and sleepwalking are part of their normal development. Symptoms can be worse when your child is overly tired or has chronically interrupted sleep. Psychological triggers are unusual for younger children but may be a contributing factor in older children and adolescents. As a parent, you must set firm limits and enforce them consistently. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 40 35 Notes 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 41 36 Children areonethird of our population and all of our future. SELECT PANEL FOR THE PROMOTI ON OF CHI LD HEALTH 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 42 37 Youresureto havemany questionsasyou begin your journey into parenthood. From newborn to theteenageyears, therearemany resourcesto help answer your questions. Suggested Readings Index and References What to Expect theFirst Year, Arlene Eisenberg, et.al. Caring for Your Baby andYoung Child, American Academy of Pediatrics Caring for your School AgeChild, American Academy of Pediatrics Caring for your Adolescent, American Academy of Pediatrics TheNursing Mothers Companion Kathleen Huggins, RN, MS TheWomanly Art of Breast Feeding, LeLeche League SolveYour Childs Sleep Problems Richard Ferber, M.D. Toddlers, A Declaration of Independence, T. Berry Brazelton, M.D. Making theTerribleTwos Terrific, J ohn Rosemond Six Point Plan for Raising Happy, Healthy Children, J ohn Rosemond Family Rules: Raising ResponsibleChildren Without Yelling, Dr. Kenneth Kaye Healthy Sleep Habits, Happy Child, Marc Weissbluth, M.D. AssertiveDisciplinefor Parents, Lee Canter & Marlene Canter Between Parent andTeenager, Haim G. Ginott You andYour Childs Self-esteem, J ames Harris TheOptimistic Child, Martin E.P. Seligman, et. al. Self-esteemfor Tots to Teens, Eugene Anderson, et.al. Dr. Mom, Marianne Neifert Bringing up Boys, J ames Dobson TheStrong-WilledChild, J ames Dobson Raising Your SpiritedChild, Mary Sheedy Kurcinka Using the Internet We encourage our parents to be informed. But with the power of the I nternet, there is a higher chance of receiving misleading information. For this reason, keep the following in mind when using the I nternet for health topics: For medical subjects, avoid the use of general search engines like Yahoo or Google. While these searches can provide useful information, they are also likely to be somewhat misleading. 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 43 Suggested Websites Organization Web Site Address Allergy and Asthma Network/Mothers of Asthmatics, I nc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .www.aanma.org American Academy of Child and Adolescent Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . .www.aacap.org American Academy of Pediatrics . . . . . . . . . . . . . . . . . . . .www.aap.org American Academy of Pediatric Dentistry . . . . . . . . . . . . .www.aapd.org Car seat information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .www.nhtsa.gov Centers for Disease Control and Prevention . . . . . . . . . . .www.cdc.gov Childrens Hospital Medical Center Cincinnati . . . . . . .www.cincinnatichildrens.org Childrens Medical Center Dayton . . . . . . . . . . . . . . . . .www.childrensdayton.org Congenital Heart I nformation Network. . . . . . . . . . . . . . .www.tchin.org Food Allergy and Anaphylaxis Network . . . . . . . . . . . . . .www.foodallergy.org J ohns Hopkins Childrens Center . . . . . . . . . . . . . . . . . . .www.hopkinschildrens.org KidsHealth from the Nemours Foundation . . . . . . . . . . . .www.kidshealth.org Medscape Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .www.medscape.com/pediatrics Prevent Child Abuse America . . . . . . . . . . . . . . . . . . . . . . .www.preventchildabuse.org Similac Strong Moms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .www.strongmoms.com TeensHealth from the Nemours Foundation . . . . . . . . . . .www.teenshealth.org Virtual Childrens Hospital . . . . . . . . . . . . . . . . . . . . . . . . .www.virtualpediatrichospital.org 38 I nstead, first go to a legitimate medical website then use their search function to find information. Suggestions for medical search websites include: www.aap.org www.cdc.gov www.hopkinschildrens.org However, please consider our office as the first source of medical information for your child. Never hesitate to let us know if you need more information about any health topic, or if you feel that we have not done our job keeping you adequately informed. Ones judgment cannot be better than the information on which he has based it. Arthur Sulzberger 303329_Text.qxp:303329_text 3/22/10 11:00 AM Page 44 T h e B a b y B o o k A R e f e r e n c e f o r C a r i n g f o r Y o u r B a b y W h e n y o u w e r e b o r n , y o u c r i e d . A n d t h e w o r l d r e j o i c e d . N A T I V E A M E R I C A N 0 3 - 2 0 1 0 www.primedphysicians.com Print forms and complete necessary paperwork at home to save time in the office Get answers to commonly asked questions Access health information, such as immunization schedules and tips for healthy living Use interactive maps to locate any of our PriMed Physicians offices Learn how to become an active partner in your healthcare team Connect to numerous health related websites for in-depth information Discover the many different specialty services we offer and much more Visit PriMed Physicians 24 hours a day! Log onto www.primedphysicians.com today, tonight or anytime. 3 0 3 3 2 9 _ P k t . q x d : 3 0 3 3 2 9 _ p k t f l d r 3 / 1 6 / 1 0 2 : 2 0 P M P a g e 1 The Baby Book A Reference for Caring for Your Baby When you were born, you cried. And the world rejoiced. NATIVE AMERICAN 03-2010 w w w . p r i m e d p h y s i c i a n s . c o m P r i n t f o r m s a n d c o m p l e t e n e c e s s a r y p a p e r w o r k a t h o m e t o s a v e t i m e i n t h e o f f i c e G e t a n s w e r s t o c o m m o n l y a s k e d q u e s t i o n s A c c e s s h e a l t h i n f o r m a t i o n , s u c h a s i m m u n i z a t i o n s c h e d u l e s a n d t i p s f o r h e a l t h y l i v i n g U s e i n t e r a c t i v e m a p s t o l o c a t e a n y o f o u r P r i M e d P h y s i c i a n s o f f i c e s L e a r n h o w t o b e c o m e a n a c t i v e p a r t n e r i n y o u r h e a l t h c a r e t e a m C o n n e c t t o n u m e r o u s h e a l t h r e l a t e d w e b s i t e s f o r i n - d e p t h i n f o r m a t i o n D i s c o v e r t h e m a n y d i f f e r e n t s p e c i a l t y s e r v i c e s w e o f f e r a n d m u c h m o r e V i s i t P r i M e d P h y s i c i a n s 2 4 h o u r s a d a y ! L o g o n t o w w w . p r i m e d p h y s i c i a n s . c o m t o d a y , t o n i g h t o r a n y t i m e . 303329_Pkt.qxd:303329_pktfldr 3/16/10 2:20 PM Page 1