General Newborn Instructions
Congratulations on your new baby!
We recognize that one cannot raise a baby according to a book. Common sense and the ability to adapt to a particular situation are the keystones to a successful child rearing. With this in mind, we would like to present the following few paragraphs relating to the care of your new baby.
The American Academy of Pediatrics is an excellent pediatric resource. We recommend the book Caring for Your Baby and Young Child - Birth to Age 5 and www.healthychildren.org
- Keep the umbilical cord clean and dry. If it becomes soiled or becomes foul smelling, apply alcohol around the base of the cord after each diaper change until it is clean and dry again. Sponge bathe your child until the cord has fallen off, usually between 1-2 weeks of life.
- For infants less than 3 months of age, call the office immediately for rectal temperature greater than 100.4 °F, poor feeding, decreased urine output or if your parental instinct tells you that something is wrong.
- Recommended soaps: Hypo-allergenic baby washes, Dove Sensitive-Skin or Cetaphil wash.
- Recommended diaper rash products: Desitin, A&D, and Balmex. Creams and lotions include Lubriderm, Eucerin, Moisturel, Johnson’s Ultra Sensitive, Nivea, and Curel. Generic brands are acceptable.
- Recommended Powders: Baby cornstarch, Caldecene. No Talc! (Johnson & Johnson makes baby powder with cornstarch and talc).
- Your infant should be seen within 48-72 hours after hospital discharge and at 2 weeks of age.
- Important items that may come in handy in the first few months of life include: a cool mist vaporizer, a thermometer you can read (preferably not an ear thermometer), acetaminophen, Children’s Allergy Benadryl Elixir (useful for many minor problems), a blue bulb nasal syringe and saline nose drops. All are available without a prescription.
If you have decided to breast feed, we will do all that we can to make it go as smoothly as possible. While you were in the hospital, you took advantage of the nursing staff that provided instruction and support. We are also available to help you now that you have been discharged. Patience and relaxation are two important qualities needed during the first few weeks. Always start by finding a quiet environment in which to breast feed. It takes time and practice both on the part of the mother and the child to successfully learn the art of breastfeeding.
Breast fed babies must feed 8-12 times per day. At first, allow your baby to feed on the first breast until sucking and swallowing slow or stop. Burp your baby and allow as much time on the second breast as it takes for the baby to avidly feed. Some babies will feed only on one breast per feeding— this is OK. Your baby will benefit from both the fore milk (first few minutes of a feed) and the richer hind milk (the later minutes of a feed). Frequent feedings or “cluster feeds” can also occur in early infancy, so don’t be discouraged if there are short periods of time when your baby feeds more frequently. Frequent feedings will help stimulate your milk production. The only rules of breastfeeding are that you are comfortable, and your baby is getting enough to eat. It is very rare for a mother not to make enough milk.
Frequently, parents are concerned that their newborn is sleepy and not feeding well in the first few days of life. However, most babies start out this way and go on to successfully breastfeed. All babies lose weight after birth. Weight loss of up to 6-8% of birth weight is not uncommon. This loss is usually made up within the first two weeks of life. Patience and perseverance are a must! Once your milk “comes in” there are a few indicators that your baby is getting enough to eat:
- Your baby is nursing 8-12 times in a 24 hour period and you can hear him/her swallowing.
- During the baby’s first week, your baby is wetting and soiling the number of diapers that he/she is days of age. E.g., on day of life number 3, he/she should have at least 3 wet and 3 soiled diapers.
- Your baby seems content after feeding.
Please call the office if your baby is not doing the above things or you have other concerns.
Sore nipples can be a problem with nursing mothers. Many women experience temporary soreness that goes away within the first week of nursing. If soreness does not improve, please contact your baby’s clinician for assistance. Sometimes poor positioning can be the cause of sore nipples. Your baby should latch open with a wide mouth and draw the nipple and some of the areola into the mouth. Let your nipples thoroughly air dry after feeding. Do not wipe away milk left on the breast after feeding; it acts as a natural moisturizer. In addition, you may apply a small amount of Masse cream, lanolin (if you are not allergic to wool) or vitamin E oil if needed.
Although in some instances breast-feeding may take persistence to become established, it is well worth the investment. Successful breast-feeding has many advantages for you and your infant including decreased illness and decreased risk for asthma and allergies. If you need help, please contact the Exeter Hospital’s Family Center (603-580-4324) and ask for the lactation consultant.
Storing and Freezing Breast Milk
Express milk by hand or with a breast pump into a clean container. Once the milk is expressed it may be left at room temperature for 6-8 hours. It may be refrigerated for use within 5 days or stored in an insulated cooler with ice packs for 24 hours. You may add chilled fresh breast milk to a previously chilled amount, but never add additional breast milk to a frozen supply as that will cause defrosting and refreezing of some of the milk. Breast milk may be chilled and frozen in containers labeled with the date. Breast milk should be stored in the freezer chest, not the freezer door. Milk may be safely frozen for 3-6 months in a standard freezer or 6-12 months in a chest or upright freezer. Thawed milk should be kept in the refrigerator and used within 24 hours.
There are several well-tested brands of cow’s milk formula marketed at this time. There is usually no difference in the way a baby tolerates these different brands. Formulas are available as ready-to-feed, concentrate, or powder. In rare cases where there is a family history of formula intolerance or allergy, we may advise that you try a soy-based formula.
To prepare the concentrate, pour one-half of the amount of formula you will need into a clean bottle and add an equal amount of warm water (boiling tap water is not necessary). This will give you the correct amount of warm formula. If you are using ready-to-feed formula, it can be poured into a clean bottle and the chill taken off by warming under hot tap water. Ready-to-feed individual cans may be used at room temperature. Do not use a microwave oven to heat a bottle. This is not recommended because the liquid heats up quickly and can give burns of the mouth and may also destroy some of the nutrients in the formula or breast milk.
The average baby will take 1/2—2 ounces per feed initially and increase to 2-4 ounces per feed by one week. Intake may vary by 2 ounces or more per feed. Formula is the only necessary liquid or nutrient that a baby needs for the first 6 months of life and mature babies usually take in 18-30 ounces per day. We recommend that your baby continue with iron-fortified formula by cup or bottle feedings until 1 year of age.
The average infant will do well if burped once during the middle of a feeding and once at the end. The baby will decide when a burp is necessary by stopping if a bubble really bothers him/her. In general, breast-fed babies burp less well than bottle-fed babies since they ingest less air while feeding. Burping for several minutes is usually sufficient.
Vitamin D and Fluoride
All babies who are breast-fed should be given 400 iu of vitamin D preparation daily starting as early as two weeks of age. Infants on formula need no added vitamins. Please discuss fluoride supplementation with your provider after your child is 6 months of age. Please note that excessive amounts of vitamins and fluoride can be harmful to your child.
Until the cord is off and dry, bathing should be accomplished by sponging. Afterward, using a tub is advisable. A new baby may be bathed every 2-7 days with a moisturizing soap that does not contain hexachlorophene. In general, a baby’s bath is just like your own. All skin surfaces you can touch with your hands should be washed with soap and water, including the face.
Care of the Belly Button/Umbilicus
There may be a discharge from the base of the navel (umbilical cord) before and after the stump falls off. To clean this area, soap and water sponge bathe as needed. As the cord separates (usually between the 7th and 14th day), a small amount of bleeding may occur. This is of no significance and requires no special care other than the above instructions.
Care of the Genitalia: Boys
If you have chosen circumcision, you need to keep the area clean. Apply a thin layer of Vaseline at each diaper change. It is usually healed by the one-week visit to our office. If your boy was not circumcised, DO NOT attempt to retract the foreskin or use cotton swabs to clean underneath it. Normal bathing maintains cleanliness until the foreskin becomes easily retractable (usually by 5 years of age).
Care of the Genitalia: Girls
Girls may have vaginal discharge. This can be white or blood-tinged. DO NOT PANIC IF YOU SEE BLOOD. Bleeding should be mild and may be intermittent. All you need to do is to keep the area clean with water and a soft cloth. The discharge goes away once the mother’s hormones decrease in the baby’s body— usually within 3 weeks.
After arriving home, many babies will have a soft, seedy stool. Some babies have 8-12 stools a day, where other (usually older) babies may have only one every three or four days. The important factor is not so much the frequency of stools, but rather the consistency. If stools are more numerous than ten per day and watery, or hard, pebble-like and painful, you should check with us. Changes in stool consistency and frequency are particularly common from 3-6 weeks of age for both breast and formula fed babies. It often coincides with the infant fussy period described on the next page.
Most babies have fussy periods during their first few weeks at home. Although it usually peaks at about 3-6 weeks of age, it can begin as early as two weeks and last as long as four months. The infant fussy period can be frightening to parents particularly when a baby has been relatively calm for the first few weeks of life. The fussiness and gassiness are especially noticeable during the late afternoon and early evening. Motion of some kind, such as in a swing or a car ride, may help. Fussiness is often interpreted as hunger, yet often feeding only helps temporarily. Frequently, the baby gets fussier and is more uncomfortable because he/she is being overfed. Sometimes a pacifier or small amount of water will help. If the period of fussiness is excessive, please call during office hours so we can discuss it with you.
A fever is any rectal temperature above 100.4°F. Fever is the body’s way of fighting off infection and normally is not dangerous. However, fever in an infant less than three months of age requires an immediate call to us no matter what time of day or night. For older infants and children, acetaminophen can be used for fever if the child is uncomfortable. See the dosing chart on pages 15.-16 Acetaminophen (such as Tylenol®) is strongly recommended rather than aspirin in the treatment of fevers and childhood illnesses. This is because of the strong association with such aspirin use and Reye’s Syndrome. NEVER USE ASPIRIN FOR A FEVER OR ILLNESS. Ibuprofen can be safely used in addition to acetaminophen for most children over six months of age or as directed by your clinician.
Hiccups and Vomiting
Hiccups are very common during the whole first year. They have no significance and there is no treatment required. A burp or a drink of warm water may help, but very often you will find that the hiccups will continue and disappear by themselves. Spitting and occasional vomiting (more forceful) are also common during this period. These often alarm a new parent but are no cause for concern if the baby is otherwise well. If the baby vomits excessively or is in pain with vomiting, please check with our office.
Sneezing & Coughing
These symptoms occur randomly in the first two weeks. There is nothing a parent needs to do for them. When a baby gets a cold, the sneezing and cough are more persistent and usually also involve a runny nose and other symptoms associated with upper respiratory infections. We do not recommend use of infant decongestants or over-the-counter cold medications in children under two years of age. Saline nose drops and bulb suction work well for temporary relief of problematic nasal congestion.
Most of your questions about your baby will come up as you handle things yourself at home. The suggestions on this page are just a general outline. There are many ways to deal with all of the topics we have just covered. The important thing is that you are comfortable with what you are doing. Your own variations may be the most satisfying answers for you.