Newborn Nuggets

 Prepared with loving care by the doctors, nurse practitioners, and office staff for your education and enjoyment.

What is a nugget?

It’s not really compressed chicken parts to be dipped in sweet and sour sauce.  In medical speak, we refer to a nugget as a valuable lesson or a small piece of information that can help us learn a concept.  This is how we hope to impart you with this handout.

Disclaimer: The nuggets provided to you in this booklet are not intended to take the place of your health supervision visits with your Dr. or nurse practitioner. Please use the advice to assist you and make you feel more comfortable in the care of your precious newborn.

We also frequently recommend reviewing our practice website, www.pediatricsoflima.com  and its links to other information. Congratulations on the birth of your new baby. We are honored that you have chosen our pediatric practice to help care for your baby and provide guidance on your journey.

Pediatrics of Lima, Inc (419) 222-4045 www.pediatricsoflima.com

Please enjoy our Newborn Nuggets and let us know your comments.

BACK TO SLEEP:

This mantra is catchy but it is also life-saving. A Newborn should sleep on his/her back only. No side sleeping. No Belly down (prone) sleeping.  Never let your baby sleep in your bed, especially during the first 6 months of life when the risk for sudden infant death syndrome (SIDS) is at its highest risk.  We also discourage co-sleeping because it leads to dependence on sleeping with you and take months to years to break this habit.

Co-sleeping babies are at risk for rolling over, suffocation, and falling out of bed which can lead to bone or skull fractures. 

Please also do not try to protect the baby in your bed or couch with the pillow fortress.  Also, we never advise leaving a baby alone on a changing table, bed, couch, or kitchen table with or without a car seat. We all have many stories of unintended falls and subsequent injury when this is done.

We do encourage having your baby learn to soothe him/herself and fall asleep without rocking him/her completely to sleep.  Try to make this key sleep transition point a part of your healthy putting baby to sleep routine.

Your baby’s crib mattress should be somewhat firm so baby’s face will not become covered in the event of turning over during sleep.  We suggest not having pillows or blankets inside the bassinet or crib.

Typically the room temperature for a sleeping baby should be less than 77 degrees F. You can gauge this by the temperature that a parent (not the most “hot-blooded” one) is comfortable wearing lightweight clothing. 

POOP ON PACIFIERS:

First of all, we would never suggest to you to have poop on your baby’s pacifier.  Poop, in this case, refers to the old military term for the scoop on what is important information you should have.

If you, as a parent, were previously a patient in Pediatrics of Lima, your parents the proud grandparents of your new edition might recall our booklet The Poop Sheet. It was the 80’s and 90’s version of this booklet. But like the disappearance of the 80’s hairstyles and the 90’s Hammertime pants, there are few of these in existence.

Pacifiers, although controversial in some circles, actually are often helpful for soothing your baby by suppling nonnutritive sucking.  Studies have demonstrated early pacifier use may reduce the risk for SIDS and even likely improves rates of breastfeeding.

SOOTHING YOUR BABY (RELAXATION TIME FOR MOM AND DAD)

The Five S’s, Swaddling, Side/Stomach position, Shushing, Swinging, providing Sucking on a pacifier are methods to help calm your baby.

BREAST-FEEDING:

Pace yourself- too much too soon can cause unnecessary nipple pain. Gradually increase the length of feeding sessions during the first week.

A bottle-fed baby usually eats 1 to 1 ½ oz. (30-45 ml) per feeding over the first few days.  A breastfed baby only eats about ½ to ¾ of an ounce per breast each feeding over the first few days.

During the first 3 to 5 days of your baby’s life, the milk you are producing is called, Colostrum.  The “pins and needles” feeling of the breast letdown reflex usually occurs after 3 to 5 days.  Not every mother experiences this, but if you do, it is a very reassuring sign that your milk production will be adequate.

After the fifth day, your full milk supply comes in.  At each feeding, about 80% of the milk you produce in the first 5 minutes is the “Fore Milk”, which is lower in calories than the nutrient and fat enriched hindmilk that is delivered in the next 4 to 5 minutes.  Allowing your baby to nurse more than 10 minutes on a single breast during the first week is probably unnecessary since you will not produce additional milk but might have additional pain.   This is one of the most common reasons for discontinuation of breastfeeding.  For other advice talk to a lactation consultant, read books, discuss with our office, or friends or relatives who have successfully breastfed.

BREAST CARE FOR NURSING MOTHERS:

Some experts suggest that breast pain caused by nursing may be lessened by applying warm wet tea bags to the nipples.  Some women may also find nipple pain relief by using soft silicone nipple shields.  Also, try to change the angle at which you hold your child while he/she nurses.

Routinely apply Medical grade lanolin cream to your nipples after every feeding.  Do not routinely use soap to clean your nipples, simply rinse them with lukewarm water.  If you develop sore or cracked nipples consult your doctor.

Ensure that the baby is properly latched on the areola and that the baby’s suction is released by your finger before latching off.

The breastfed infant needs extra daily vitamin D.  You can find Vitamin D at most drug stores or online.  After the first week, you should give your baby 1ml, daily as long as you are mostly breastfeeding.

A recent report has said that breastfeeding mothers may safely drink some caffeine while nursing. So enjoy moderation.

BOTTLE FEEDING:

Good News: boiling or sterilizing bottles for formula feeding is unnecessary.  Wash your baby’s bottles the same way you would your dishes.

It is acceptable to use tap water to mix powder or concentrate formula. No need to spend extra money on nursery water.  Please be aware it is not necessary for a breast or bottle-fed to be given extra water.

Be aware of the need to change nipple sizes as your baby grows.  The nipple size controls the amount of formula your baby receives with each feeding.

There are many bottle systems on the market.  Choose the one you feel works best for your needs.

GROWTH SPURTS:

Nearly all full-term infants experience growth spurts at about 2,6 and 12 weeks.  The baby will demand more quantity and more frequent feedings.  This is not a signal to start solid foods or cereal yet.

BOWEL MOVEMENTS AND URINATION:

Yes, Poop and Pee are also known as elimination on our checkup forms that we ask you to complete.  Let’s say there is a lot of normal variation.  If you like stool-gazing to see different types and colors of poopy diapers go to www.feedingexpert.com(what is your baby’s diaper trying to tell you) link has the pictures.  Fortunately, it is not scratch and sniff.  Seriously, this is a helpful visual link with good advice.

The number of pee diapers is a good sign for adequate intake and hydration. By 1 week 6 wet diapers daily are typical.  The urine may look orange in the diaper from the clearing of jaundice (bilirubin): see jaundice section for details.

With the new improved super absorbent diaper materials, it can sometimes be hard to tell wet diapers.  Also, your baby may have little “gel balls” in the diaper.  Nothing to worry about, your baby is not peeing these out.

SCALP CARE:

The small front “soft spot” on the top of the head called the “anterior fontanel”, is where the plates of the bone of the baby’s head remain open to allow a large amount of brain growth that occurs in the first year of life.  It is safe to gently clean this area along with the rest of the scalp about every 2 to 3 days.

If your baby’s scalp is scaly or has orange plaques of “cradle cap” (yes it is cap not crap), we suggest shampooing the scalp daily with a baby shampoo that has selenium sulfide in it.

You can also put a small amount of baby oil or mineral oil on the scalp soak it in for a few minutes, rinse gently with lukewarm water and can also comb or brush off the loose scale.

SKIN CARE:

In the first few weeks, most babies peel or molt just like snakes. It is ok to apply lotion but realize this is a normal phase.  Daily application of emollients or skin creams may reduce redness and rash particularly in children prone to atopic dermatitis (eczema).  Often there is a family history to suggest watching for this.

Avoid the use of “calming creams” or products that contain lavender or tea tree oil because of their link to the development of breast lumps.

SKIN MARKS:

Newborns and infants often have many “birthmarks”.  We will sort out for you what they are and if there is any reason to do any other follow up or treatment.  The stork likes to bite and the angels do kiss their babies.  Any concerns can be brought to our attention at your office visits. You may also wish to photograph any skin findings on your cell phone or digital camera and we can review at your office visit.

FINGERNAILS:

Filing your baby’s fingernails with an emery board every few days is preferred until the nails grow long enough to require clipping.  Nail clipping is best done as a team approach one holder and the brave clipper. It is still easy to accidentally clip the skin. Just keep calm and apply triple antibiotic ointment if needed. Don’t cry it is not your fault if you snip the cuticle.

JAUNDICE:

This word is translated from Latin to French meaning “to yellow”.  Although sometimes the color is closer to orange.  In your information from the hospital, a review of when to be concerned and what to do for jaundice is usually provided to you at discharge.

Indirect sunlight from a window doesn’t seem to be very effective or necessary.  Good luck seeing the sun in Ohio in the winter months anyway.

Call if your baby is not feeding well and if the color is increasingly orange bronze or green.

BELLY BUTTON, UMBILICAL CORD, NAVEL CARE:

You would think after hundreds of years of modern medical care, a uniform approach could be agreed on.  The pendulum swings back to NO alcohol swabs.   Simply dry care and observe seems to allow the cord to fall off sooner and not cause redness or irritation of the skin on the belly around the navel.

Do not give your baby a full in the tub bath until the cord falls off.

If you see a little blood, clean it off, nothing to worry about.

If the navel has a bad odor, it usually is not a concern right away but you should call the office within 1 day if not improved.  Call anytime if you see redness on the belly around the navel and your baby also is not acting well.

THE PRIVATES:

GIRLS:

A Thick, white vaginal discharge is common after birth.  Gently wipe with a soft cloth. Don’t scrub too hard it will hurt and it’s not needed.  Sometimes a small amount of blood can occur during the first 2 weeks, this is temporary and normal. Be sure to clean between the folds, all the nooks and crannies so to speak after she poops.

BOYS:

If your baby boy is circumcised follow the directions your doctor gave you. The petroleum jelly only needs to be gently applied to the area on the head of the penis.  Not necessary to glob it on heavily or fold it in the diaper and get it all over.  During the first few days of healing the circumcision may have a soupy yellow material, this is a normal healing process.

Clean gently with a soft cloth if poop gets on him after a bowel movement.

If no circumcision was done, do not pull the foreskin back.  All you need to do is clean gently like any other area of skin.

PREVENTING INFECTIONS:

It is wise to avoid crowds during the first 2 months of your baby’s life.

Avoid second-hand smoke.  Always wash your hands and everyone else who contacts your baby should wash hands before any touching.

A fever is a temperature of more than 100.5 degree F.

For any fever in the first 2 months of life, contact the office immediately for care instructions.  Again see  www.healthychildren.org  Symptom checker link and search fever. The type of thermometer and location where you take the temperature from can vary.  www.healthychildren.org is also available as an app. for I-phone and Android smartphones.

VACCINES:

For parents and close contacts we strongly advise as does the AAP(American Academy of Pediatrics) that you protect your baby by building a cocoon of protection by immunizing yourselves with TDaP and annual flu vaccines.  This is not for mom only but certainly dad, siblings and all close relatives who will spend time with your baby.  All we have to do is see the recent whooping cough epidemic and the many bad flu seasons. These measures can be life-saving for your baby. For more information about immunization safety and effectiveness, visit  www.chop.edu/vaccines.

PERIODIC BREATHING:

In the first three months of life, nearly all babies will have times when they actually stop breathing for nearly 5 to 10 seconds.  The babies will then breath more rapidly like after running a race for 30 or 50 seconds.  This cycle will often repeat and is totally normal.

However, if a baby stops breathing for more than 20 seconds or develops any persistent blue color of the lips, tongue, or central areas, this is cause for concern.

Also, if baby loses muscle tone and or turns pale he/she should be seen by a doctor.

SPITTING UP SPIT HAPPENS:

Oh yes, it does!  Nearly all babies spit up or regurgitate some feedings.  Even vomiting an entire feeding once in a while is common and not a problem.  Not all spitting up is serious. Contact the office for advice if concerned to distinguish normal from concerning events.   Again www.healthychildren.org symptom checker (spit up) will provide initial advice.

VISION AND EYE CARE:

Your newborn is extremely near-sighted at birth.  For a visual depiction of this see the pictures in our office of vision development.  As they say, a picture is worth a thousand words.  Clean the crusty yellow matter in the inner corners of the eyes by using a soft cloth or cotton ball with lukewarm water. 

Your newborn received antibiotic ointment at birth to protect against eye infection.  If there is a large amount of sticky discharge from either or both eyes, check for redness of the white part of the eye and puffy swelling of the eyelids.  If any questions about infection call for an appointment.

NOSE CARE:

Your newborn has a keen sense of smell and can recognize your scent.

Since newborns are primarily nosed breathers clear nasal passages are very important.  A baby will often sound snorty or stuffy.  Relief can be provided by running a cool mist vaporizer or humidifier in the room.  Not necessary to add any medications.  Infant nasal saline (salt water) drops placed gently in the nose can clear your baby’s nose of snot or spit up milk.

Most of the time it is not necessary to use a bulb syringe to suction the nose.  This generally annoys the baby and is not always successful in clearing the nose, unless you are comfortable or experienced with doing this. If you are not able to clear the mucus in the back of the nose, plug the other nostril when you use the suction bulb.

NEWBORN SCREENING TEST:

Your baby will have had a screening for hearing.  If he/she passed no other testing is necessary, but continue to observe his/her response to sound.  If the test was not passed, further testing will be arranged by the audiologist and should be completed.

Blood testing usually obtained from a heel-stick sample is sent to the Ohio Department of Health State Lab for metabolic testing.  You should have received a brochure in the nursery to explain in the state metabolic screening testing program.   Our office typically receives results within 2 weeks.  We will inform you of the results at your follow up visit.  If the screening result is outside the normal range for any of these tests you will be called to make appropriate follow up arrangements.

We recently have added a screening test for identification of cyanotic congenital heart disease (CCHD).  This is a non-invasive test with the use of a pulse oximeter probe usually done after 24 hours of life.

Also, babies now have a transcutaneous bilirubin (TCB) test done after 24 hours of life.  This is a meter that measures bilirubin levels and then can be evaluated by a graph knowing the newborns hours of age.   See also the section in the manual on jaundice.

Your baby’s blood type is typically checked, if mother’s blood type is O, and or Rh negative.  You can ask your provider for this information if you would like to know.

Shortly after birth, your newborn has his/her weight, length, and head circumference measured and plotted on a graph to assess percentile based on gestational age.  The gestational age is determined by a standardized physical and motor assessment done on all babies and sometimes repeated after 24 hours for improved accuracy.

ACKNOWLEDGMENTS:

Thank you to Stan L Block, MD, FAAP for his ideas and thoughts about a newborn care “owners “ manual.

The caring and compassionate staff of Pediatric of Lima,