Are You Expecting?Congratulations! This is an exciting time, but we realize that there are many questions you may have concerning the care of your baby. We have prepared this general outline, which should be of help in answering some of these. If you have further questions, we will be happy to discuss them with you.
We welcome new babies into our practice, regardless of location of birth. We personally attend to babies in the newborn nurseries at Morristown Memorial Hospital and St Clare's Hospital in Denville.
Questions about cord blood storage? click here
Questions about NJ State Newborn Screening testing (done in newborn nursery for all babies born in the state)? click here SUCCESSFUL FEEDING IN NEWBORNSHow can you tell whether your baby is getting enough breast milk or formula? The best gauge of good nourishment is growth. All babies, both breast and formula fed, tend to lose up to 10% of their birth weight in the first three to four days after birth. Daily weights are checked in the newborn nurseries to evaluate for the change in weight, ensuring that the weight loss is within normal parameters and not excessive weight loss. Measurements of weight, length, and head circumference will be performed at each check-up. It is one of the reasons for regular check-ups. Also, regular bowel movements and frequent wet diapers are signs of adequate intake. Regular bowel movements can range from 10-12 times every day to one time every three days, and are normal if they are yellow, green, or brown. You should call the office if there is no bowel movement for more than three days, especially in the first 2-3 weeks after birth.back to top
BREASTFEEDING RESOURCES AND INFORMATIONwww.breastfeedingonline.com
www.lalecheleague.org or 1-800-LaLeche
www.ilca.org or call 1-919-861-5577 to find a lactation consultant near your home
Morristown Lactation Department "Warm Line" 973-971-5371
St Clare's Breastfeeding "Warm Line" 973-983-5262
Breastfeeding is the best choice for your baby. There are only a very few maternal health or medication concerns which would compel us to guide you away from breastfeeding. Breast milk is the optimal choice for nutrition, raises I.Q., provides protection against infections, and provides long-term protection against diseases, including lowering the rates of diabetes, asthma, allergies, obesity, and SIDS. However, the first few days of breastfeeding are often a challenge, and it is typical for mothers to struggle with helping newborns to latch and to struggle with a fear of inadequate milk supply. The initial fluid that is expressed is called colostrum and is extraordinarily nutritious but small in amount. Colostrum is replaced by breast milk 4-6 days after birth, after milk-letdown. Breast milk is more plentiful than colostrum.
It is best to feed from both breasts at each feeding. Ideally, try to have 8-12 feedings per 24 hours in the first 1-2 weeks after birth, in other words, every 2-3 hours. DO NOT BE DISCOURAGED if this seems difficult at first. We will support you and help you with any problems that may arise. In addition, the nurses in the maternity wards may offer guidance with technique. There are also lactation consultants (breastfeeding specialists) that are available if needed.
It is best to breastfeed exclusively during the first two weeks in order to establish a good feeding pattern, a good supply, and to make you and the baby comfortable. After two weeks we recommend giving your baby one bottle a day of expressed breast milk (or formula). This is a good time for dad to do a feeding while the baby gets accustomed to a bottle. This will help breastfeeding moms be flexible and therefore capable of using a babysitter or daycare if necessary.
Do not give your infant water, juice, tea, or other drinks in the first 6 months unless otherwise directed by your doctors (as may occur if your infant is constipated).
For exclusively or nearly exclusively breastfeeding infants, we recommend giving your infant tri-vitamins (such as TriViSol with iron): 1 mL per day. This provides the infant with a source of Vitamin D, which is not present in breast milk. We recommend that breastfeeding continue as long as possible, ideally through the baby's first year. We will discuss the introduction of solid foods at the baby's 4-6 month visits. Breastfeeding mothers are encouraged to continue taking a daily "prenatal" vitamin (prescribed by obstetricians) throughout breastfeeding.
We recommend that room temperature expressed milk be discarded after 4-6 hours. Expressed milk can be stored for up to 5 days in a refrigerator and up to 3 months in a freezer. Frozen milk should be thawed in the refrigerator and used within 24 hours. DO NOT USE MICROWAVES for defrosting or warming milk. FORMULAWe recommend a cow-milk formula with iron (such as Enfamil Lipil, Enfamil Gentlease, or Similac Advance with iron). There are three forms of formula: powder, ready-to-use, and liquid concentrate. The powder form is ideal for breast-fed babies who take only one or two bottles a day.
Sterilization of bottles and supplies is not necessary. Bottles and nipples should be washed with hot soapy water or in a dishwasher. Allow them to air dry. Liquid concentrate is made by mixing equal portions of concentrate and water after cleaning the top of the can with water. You can make either one bottle at a time or the entire can. If you are supplied by city-water, it is not necessary to boil the water. With well-water you should boil the water for ten minutes and let it cool prior to preparation of the formula. Once the can is opened, use the contents within 48 hours. Bottles should be capped, or the can should be covered with plastic wrap, and stored in the refrigerator.
Formula should be served at room temperature. Running hot tap water over the bottle for a few minutes or soaking the bottle in a pan of hot water is sufficient. DO NOT HEAT THE BOTTLE IN A MICROWAVE OVEN.
When feeding, hold your infant in a comfortable position with the head slightly raised. Do not prop the bottle and leave the baby to feed unattended. Begin with two to four ounces per feeding for the first few weeks and increase slowly to six to eight ounces by two months. If the bottle is not finished within one hour, discard the remainder. Do not re-feed from the same bottle.
Be flexible with the feeding schedule. Demand feeding is best and may vary from every two to four hours. During the day it is best to wake your baby at four hour intervals for feeding. If the baby sleeps more than this amount at night, enjoy the sleep!
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SOLID FOODWe generally start solids between 4 and 6 months. Breast milk or formula is continued until your child's first birthday. As cow's milk doesn't supply the balanced nutrition your child needs and is often hard on babies' sensitive digestive systems, it should not be given until your child is one year of age. After the first birthday, we typically recommend whole milk, and 2% milk at 2 years of age.
Infant cereals: begin with a tablespoon of cereal and mix it with
enough formula or breast milk to make it thick enough to stay on a spoon. Give your baby a tablespoon per day for 3-4 days. If there is no adverse reaction, increase to twice per day. Gradually increase the amount every 1-2 weeks to a maximum of 4-6 tablespoons per serving.
Fruits and vegetables: Serve single ingredient fruits and vegetables at first. It is advisable to get your baby into a routine eating schedule. A typical schedule could be:
AM: breast feed or bottle, cereal, fruit
Noon: breast feed or bottle, fruit or vegetable
PM: breast feed or bottle, fruit, vegetable, and cereal
At 5- 6 months of age, the three meal schedule continues with the addition of other foods, including meats. Continue breast milk or formula with iron until one year of age.
By 9 months you may start offering your baby a cup from which to
drink. Most babies can be weaned from the bottle between 12 and 15 months of age. DO NOT PUT YOUR CHILD TO SLEEP WITH A BOTTLE OF MILK OR JUICE. It can cause serious tooth decay.
As the child gets older and acquires more teeth, different textures and mixtures of food may be given. AVOID GIVING FOODS THAT CAN CAUSE CHOKING, including nuts, whole hot dogs, popcorn, raw carrots, whole grapes, etc. DO NOT GIVE HONEY PRIOR TO 12 MONTHS OF AGE, as it can cause infant botulism.back to top
POSTPARTUM DEPRESSION1 out of 8 new moms experience postpartum depression. If you or a loved one has feelings of sadness that last more than a few weeks, it is time to reach out for help. 1-800-328-3838 or www.njspeakup.gov
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CARE OF THE MOTHERDiet: Eat a normal, well-balanced diet. As a nursing mother, you will need to consume 500-600 more calories per day than you did before pregnancy. Drink plenty of fluids - at least two quarts a day is advisable. Avoid smoking within the home and make every effort to wean yourself from tobacco. Alcohol and coffee may be taken in moderation.
Nipple care: Washing your nipples with water is all that is necessary for routine care. Avoid excessive washing or use of soap directly on the nipples. If redness or soreness develops, it is best to expose your breasts to air. You also may use commercial creams or lanolin after nursing.
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BURPINGInitially, your baby should be burped after approximately one ounce. With breastfeeding, burp the baby about halfway through each breast and again after finishing each breast. The frequency of burping can be reduced as your child grows.
Occasional spitting up is normal for babies and is usually due to swallowed air or excessive intake. Feeding in a more upright position or more frequent burping may help if spitting up becomes excessive.
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FLUORIDEFluoride supplementation has been found to be beneficial for tooth development. Most water in New Jersey, except for a few areas, is not sufficiently fluoridated (less than 0.3 ppm). We will give you a prescription for fluoride drops at age 6 months. back to top
Frequently Asked Questions (FAQs) about Newborn CareSleeping: Newborn babies sleep a lot, usually waking up every 2-4 hours for feeding. By four months of age, most babies are sleeping through the night, although some cooperative babies start much sooner. You may have heard that starting solid foods will make a baby sleep through the night. There is no evidence that this is true. Your baby may start to wake once again during the night after they have been sleeping more continuously. This is a normal developmental phase, and a normal pattern of nighttime sleeping will soon return. Remember that the American Academy of Pediatrics recommends that babies be put to sleep on their backs to reduce the risk of SIDS (Sudden Infant Death Syndrome).
Fever:
If your infant is less than 2 months old and has a temperature that is greater than 100.5 F rectally, call the office immediately or go directly to the emergency room.
It is important to understand that while fever is generally an indicator of infection, it is actually therapeutic. The level of fever is not as significant as the child's associated symptoms. By itself, fever will generally not cause your child harm. We advise treating fever only for the purpose of making your child more comfortable. If there is concern about a child with any fever, call the office. There are effective methods of controlling fever:
1) Acetaminophen drops, children's syrup, chewable tablets, or suppositories: This can be given every 6 hours if needed. For dosing, see our "Is your child sick?" section on the bottom-left corner of the home-page of this website.
2) Ibuprofen drops, children's syrup or chewable tablets: these can be given every 6-8 hours as needed to a child over 6 months. For dosing, see our "Is your child sick?" section on the bottom-left corner of the home-page of this website.
3) Sponge baths: do not use alcohol to bring down fevers. Alcohol may cause chills and discomfort. It is best to use lukewarm water and sponge the skin. This may be repeated as often as necessary.
4) Clothing: dress your child in lightweight clothing. Overdressing may cause heat retention and even raise the fever.
Hiccups, sneezing and congestion: Hiccups and sneezing are normal reflexes for all babies. Sneezing is a way babies keep their airways clear and does not necessarily indicate that the baby has a cold or allergies. Nasal congestion is also common, but if there is labored breathing, fever or decreased feeding, please call the office. If your child is uncomfortable with nasal congestion, you may try saline nasal drops and a bulb syringe or nasal aspirator to suction out the mucus. With a medicine dropper put a few saline drops in one nostril, wait a few seconds, and then suction with the syringe. Then do the same with the other nostril. Do not do both nostrils at once as it will be difficult for your child to breathe. Please use commercial preparations of these non-medicated nasal saline drops (such as Little Noses Non-Medicated Saline Drops).
Breast swelling and vaginal discharge: Baby girls frequently have slight vaginal discharge and bleeding after birth. Both girls and boys frequently have breast swelling. These conditions may persist for several weeks, and are not a cause for concern.
Stools: There is a wide range of normal frequency and character of bowel movements. Babies can have bowel movements after each feeding or one every three days. Breast-fed babies' stools tend to be loose and "seedy," while formula-fed babies tend to have more solid stools. Stool color normally can range from yellow to dark green. Babies tend to strain and become red-in-the-face even with normal bowel movements. However, stools that are hard or pellet-like may indicate constipation. As long as your baby seems happy and content, is eating normally and has no signs of illness, don't worry about minor changes in the stools.
Skin: A baby's skin is rarely clear of rashes in the first 4 to 6 weeks. These rashes are usually on the face and can be small discrete lesions or pimples. They may come and go. If you notice a widespread rash on the body or have concern that a rash is serious, call the office.
One of the most common newborn rashes is "newborn acne". The rash appears on the face, neck, and upper chest. It usually disappears in 6-8 weeks. It is helpful to wash the area with mild, unscented soap once or twice daily. Do not apply oils, lotions, or creams - they only worsen the appearance.
Crying: All babies cry. It is their way of saying "I'm hungry, I'm thirsty, I'm wet, I want to be hugged, I'm bored." In time, you will learn to distinguish the different cries. If you check the baby and all is well, don't worry. At this age, babies cannot be "spoiled," so it is normal to pick up your baby when it is crying. Pacifiers often help calm babies and have been shown to decrease the risk of SIDS. The pacifier can easily be discontinued at four to six months of age and the baby won't miss it. Swaddling for colicky babies often helps. For more information about swaddling and colic see www.thehappiestbaby.com.
The Umbilical Cord: The umbilical cord stump usually falls off by itself in one to four
weeks. Keep the area clean and dry. Oozing and slight bleeding is common before and after
the cord stump falls off. It should dry out in 1-2 days.
Bathing: Many babies have dry skin in the neonatal period. Frequent baths will only dry the skin more. A bath given every other day is sufficient. We recommend a baby bath products or a mild, unscented soap such as Dove. Do not immerse the baby in a tub until the cord stump has fallen off and healed. Sponge baths are advised until that time, avoiding the area of the cord. Hair washing is also not necessary more than 2-3 times weekly. You may use either soap or baby shampoo on the hair. Use of lotions or creams is not routinely necessary. Peeling of the skin on the hands and feet is normal and usually subsides after 3-4 weeks.
Genitalia/Diaper Area: There is no special care needed for the penis, unless it is circumcised. If your baby has been recently circumcised, generously apply petroleum jelly to the penis for the first 1-2 weeks after the procedure. In females, you may separate the labia and gently cleanse with a wet piece of cotton, wiping only from front to back. Also, clean the vaginal area after bowel movements in the same manner.
The key to preventing diaper rash is keeping the skin dry. Frequent diaper changes as soon as possible after urination or bowel movement is recommended. Clean the area with a washcloth, paper towel, or cotton ball and warm water with each diaper change and pat the area dry. A small amount of petroleum jelly in the skin creases will help keep that area protected. If you notice a rash developing, use of petroleum jelly is acceptable. Exposure to air is the best treatment for most rashes. Avoid commercial "wipes" during the first month. Call our office if no improvement is noted.
Out of Doors: You may take your baby outside for short periods of time in nice weather whenever you are well enough to go. Avoid prolonged direct sun exposure and wind. Also, avoid crowds (such as in shopping malls and supermarkets) during the first two months and try to avoid exposing your infant to young children.
Dress: Dress your baby as you would dress yourself, according to the temperature. A baby should not be overdressed on warm days. A hat is advisable on very sunny days to
protect the skin.
Room Temperature: Room temperature should be comfortable, but not too warm. A temperature of 68-72ºF is ideal. If the temperature is lower, dress your baby
appropriately.
Eyes, Ears, Nose: Do not clean the nose or ear canals with cotton swabs. If a yellow discharge is noted from the eye, it may be cleaned with a washcloth and warm water. If the discharge persists or if redness or swelling occurs, call our office.
Infant Safety: A safety-seat is required by law for all infants and children under 8. A baby who is held in your lap has no protection from sudden stops. All new car seats should be in the back seat of the vehicle, preferably in the center seat when possible, and rear-facing until BOTH 1) one year of age AND 2) a weight of at least 20 pounds. Remember that a car seat should NEVER be put in the front seat if you have front airbags. The Morris County Division of Transportation wants to make parents aware of two car seat inspection stations that are located in the area. One is the Chester First Aid Squad building, 100 North Rd., in Chester, and the other is the Atlantic Ambulance building, 120 Dorsa Ave., in Livingston. THE LIVINGSTON CAR SEAT INSPECTION STATION IS AVAILABLE EVERY WEDNESDAY WITH NO APPOINTMENT NECESSARY, FROM 9 AM TO 3:30 PM. CALL 973-971-6477 if you have any questions. The inspection stations are a free service sponsored by Northern NJ Safe Kids/Safe Communities.
Diarrhea
At home you will notice a developing pattern of bowel movements by your baby. If there is a change in this pattern, such as increased frequency or watery stools, precautions should be taken. Infants and children with increased frequency of watery stools could develop dehydration. Signs of dehydration include failure to urinate, dry mouth, and/or listlessness. If any of these signs develop, or the child is less than 6 months old, call the office immediately. Continue feeding breast milk or formula as well as regular food as it has been determined that proteins, carbohydrates, and fats help the intestines heal. It is important to replace the fluids that your child is losing in the stools. If the diarrhea continues to be frequent despite these measures, call the office.
Vomiting
Vomiting associated with a fever may represent a viral gastroenteritis (commonly called "stomach flu") or more serious infection. If your child is vomiting, has a fever, and appears ill, or is less than 6 months, call the office immediately. If there is little change from normal behavior and no fever, there are some steps to take to prevent dehydration. It is best to stop giving milk during the first day. Clear liquids such as an electrolyte solution (Pedialyte or others) should be given frequently in small amounts. One to two ounces every half hour should be tolerated well. After 12-24 hours, the diet may be advanced to soft foods if liquids are being tolerated. If vomiting persists for more than 24 hours, call the office.
Teething
Your child's first teeth can appear at any age, usually between 3 months and 1 year. The bottom teeth are generally the first to erupt, although order and age are very variable. Some children do very well with teething while others become irritable and fussy. There are children who don't eat as well as usual while the teeth are breaking through the gums. Also, runny nose and loose bowel movements are sometimes reported. Fever over 101ºF is usually not a symptom of teething.
The discomfort of teething can be relieved by rubbing the gums with an ice cube wrapped in a washcloth. You can also give your baby a hard teething ring to chew. If your baby wakes at night because of pain due to teething, you may give acetaminophen at the usual dose.
Toddler Safety
Once your child starts crawling and walking there are many potentially dangerous situations which could arise. At 6 months of age it is advisable to begin to "baby-proof" your home. Outlets should be covered so that fingers or metal objects cannot be inserted. Cabinets at floor level should be emptied of poisonous liquids and medications, and should be locked. If there are stairs at home, gates are recommended to prevent accidental falls. Infants should be closely supervised while near screen or storm doors.
Walkers: Walkers are one of the leading causes of injuries to infants. Children should never be left unattended while in walkers. Care should be taken so that they cannot tumble down steps, go through glass doors, collide into furniture holding lamps, etc., that could fall onto your infant, or hit their heads on sharp corners of furniture. It is difficult for infants to control the walker once it gets started. Finally, there is no truth to the belief that children walk earlier if placed in a walker. BE CAREFUL! Stationary walkers are a much safer alternative.
Poisoning: IF your child swallows something dangerous (medications, plants, cleansers, etc.) first call the Poison Control Center (1-800-222-1222) or go to the Emergency Room immediately. We recommend that you write the poison control center's phone number next to your home phone and/or program it into your cell phone.
Never leave a baby alone on a changing table, bed, or bath, even for a moment.
To prevent accidental burns from hot water, the water- thermostat in your home should be turned down in your house to less than 120º F.Office Hours and Phone Advice: The office is open from 9 AM to 5 PM during the week, with evening hours on Thursdays. If you need to be seen on the weekend, please call by mid-morning on Saturday (there are Saturday morning hours only for emergency sick visits).
After hours, please call our service number, 973-263-0066, and leave a message. With this service, you will have the option of leaving an emergency message, for which we will rapidly return your phone call, or a non-urgent message, for which we will typically return your call within 1-2 hours. Non-urgent calls are not returned between 10 PM and 8 AM. For emergencies, you may call at any time. For routine questions and any scheduling of appointments, it is best to call during regular office hours. We will return your call as promptly as we can.
You and Your Baby: This is your baby to enjoy, delight in, be proud of, and love. If you have the urge to pick up and hug the baby, go ahead and do so! All babies need love and can never receive too much from their parents. Relax and enjoy!
Call the office to make the appointment for your first visit. A weight check and jaundice check may be recommended to you by your doctor at the time of discharge from the hospital. The American Academy of Pediatrics has a recommended schedule of well child visits that we follow during your child's first two years: (3 years and thereafter, annual check-ups are recommended.) See our immunizations info for more details. back to top
AT HOME WITH THE BABYOnce you get home, there will be many questions that arise, along with new experiences for you and your baby. The next few paragraphs will try to help prepare you for these common problems. If, however, there are any questions about your child's health, please do not hesitate to call our office.
Advance Preparations: Standard Items that are useful to have at home include:
1) infant nasal bulb-syringe/aspirator
2) cool mist vaporizer/humidifier
3) acetaminophen infant drops (do not give to a child less than 2 months old without first calling the office)
4) digital rectal thermometer
5) antibiotic ointment or cream
6) bandages
7) petroleum jelly
8) ibuprofen (for fever or pain in infants greater than 6 months of age)
When to call: During the first 2 months it is often difficult to determine what is bothering the baby. You should call us immediately with the following situations:
1) fever over 100.5º F rectally in the first two months
2) refusal to nurse or take the bottle for 2 consecutive feedings
3) persistent projectile vomiting
4) less than 3-4 wet diapers in a 24 hour period
5) frequent watery diarrhea
6) unusual restlessness or irritability
7) or for any concerns for which you would like immediate feedback
Colic Excessive irritability in a young infant is sometimes called colic. The baby usually cries, turns red, and pulls the knees up toward the chest. The crying is usually worse in the evening hours, between 4 and 8 PM. These babies may pass more gas or need to be burped more often than other babies. Most of the time there is no "cure" for colic other than patience and passage of time. The symptoms subside by 3-4 months of age. The important thing to do is to make the baby comfortable. Turning the baby on the stomach, stroking the back, swaddling in a blanket, rocking, cuddling, a ride in a carriage/stroller or car, and a warm bath are some ways to make the baby happier. For more information about swaddling and colic see: www.thehappiestbaby.comImmunizationsAll children are immunized against hepatitis A and B, diphtheria, pertussis (whooping cough), tetanus, polio, measles, mumps, rubella (German measles), varicella (chicken pox), rotavirus, Haemophilus Influenza type B (HIB), pneumococcus infections, and influenza (flu) in the first two years. Most of these immunizations are begun at 2 months of age.
Hepatitis B: This disease can cause jaundice and both acute and chronic liver disease, including liver cancer. Hepatitis B vaccine is the first anti-cancer vaccine developed. The first dose is typically given at birth. Reactions to this immunization are rare. Local pain and swelling are possible.
DTaP (Diptheria, tetanus, whooping cough): Possible reactions include fever, swelling and pain at the site of injection, and slight irritability. If your child develops a fever greater than 104º F or has other unusual symptoms, contact the office. You may give acetaminophen drops for discomfort or fever during the 48 hours following immunization.
HIB (Haemophilus influenza type B): Serious bacterial infections caused by this organism include meningitis and epiglottitis. Reactions to the immunization are rare and include mild fever and pain at the site of the injection.
PCV (Pneumococcal Vaccine): Serious infections caused by this organism include meningitis and pneumonia. Possible reactions to immunization include fever and vomiting in a small percentage of children.
Rotavirus: Rotavirus is an extremely common cause of severe infantile diarrhea and vomiting, which often results in dehydration and hospitalization. Possible side effects of the vaccine include a small incidence of mild vomiting and diarrhea. This is the only vaccine we administer as a tiny drink, not as an injection.
Polio: All polio immunizations are now given in the form of inactivated polio, by injections. Reactions to the immunization are rare.
Influenza (flu): Flu vaccine is recommended for family members of infants less than 6 months of age and recommended for all children at least 6 months of age. As of the 2010-2011 flu season, the same vaccine that protects against seasonal flu will also protect against H1N1 (swine flu).
Hepatitis A: The first dose is at or after one year of age. This disease causes flu-like symptoms, along with vomiting, diarrhea, and jaundice. In unusual cases, this virus can lead to severe liver failure. Side effects of immunization include pain at the site of injection, low-grade fever, and fussiness.
Varicella (Chicken pox): The vaccine is given at or after one year of age. The purpose of the vaccine is to prevent varicella and its complications, such as meningitis and pneumonia. A small percentage of children may develop a fever and a rash resembling a very mild case of chicken pox from one to three weeks after the injection.
MMR (Measles, mumps, German Measles): The first dose of this vaccine is at or after one year of age. Possible reactions include fever and rash, which may occur from one to three weeks after the injection. It is not a serious reaction and usually resolves quickly.
See also immunization info. back to top
RELATED ARTICLESColic
Feeding Your Baby
Newborn Characteristics
Sleeping
Breastfeeding Resources
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Engorged Breasts
Fluoride
Formula, Supplementing with
Getting Started
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Herbs to Avoid While Nursing
How do I know my baby is getting enough milk?
Jaundice, Breast Milk
Mastitis
Nipple, Cracked
Nipples, Sore
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Weight Gain, Slow
Weight, Appropriate for Babies
When a Nursing Mother is Ill and Needs to Take Medications
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