Birth To Two Months

dearborn-peds-first-year-visitsRobert Levy, MD    Joel Moses, MD

Houda Dagher-Rodger, MD       Melissa Hoisington, MD

Tiffany A. Harris, CPNP   Kerri Bernard, CPNP

2845 Monroe    Dearborn MI  48124    Telephone:  313-730-0070

 

 Birth to Two Months

 

Today’s Measurements:  Height: _________ Weight: _________    Head:  _________

 

Congratulations on your new arrival!  This can be both an exciting and difficult time in life.  It is important to establish a partnership with your health care provider and feel that we are here to answer your questions.  Please schedule your first appointment for a physical soon after discharge.  If you and baby go home at twenty four hours of life, please schedule a visit for a newborn physical in the following one to three days (maximum) following discharge.  If your baby becomes jaundice prior to your scheduled visit for a physical, please call us.  The following is a brief guide to commonly asked questions and newborn issues.

Newborns

  •     Newborns do all kinds of things that may initially appear concerning.  They like to sneeze, cough and sometimes even snort.  These are attempts to clear mucus from the nose and upper airway.  Normal saline drops can be used to help clear the nose.  This often makes babies sneeze, which naturally clears the nose.  Be cautious with the use of a bulb syringe as this may irritate a newborn’s nose.
  •     A stuffy nose often mimics a wheezing sound.  Be assured that newborns do not wheeze in the first month of life.  Let us know immediately if your newborn has nasal flaring, repeated grunting sounds lasting more than a minute or appears to have difficulty breathing and feeding at the same time.
  •     Newborns also get the hiccups a lot.  This sounds painful to adults, but doesn’t really bother your baby.  Sometimes getting your baby to suck will relieve the hiccups.
  •     Babies are often born with plugged tear ducts and this may last several weeks.  Ask us to show you how to massage the area and do apply warm compresses at home.  Your baby may need antibiotic eye drops if there is a green or yellow discharge noted in the eye.

 Jaundice

  •     Jaundice can occur in the newborn period.  The appearance of jaundice begins in the eyes and progresses from head to toe.  Depending on baby’s skin tone, it can be difficult to guess the actual extent of jaundice.  We may run blood tests to determine the level of bilirubin, the substance that causes the yellowing of eyes and skin.
  •     If you and baby go home prior to forty eight hours of life, jaundice may become visible on days of life three and four.  Please let us know if this happens and your appointment is not until the following day.
  •     A small amount of jaundice can be normal and requires frequent feedings to help the body recycle the bilirubin more efficiently by the liver.  Babies with siblings who have a history of jaundice, those who are smaller than average at birth, or babies born before term have higher chances of becoming jaundice.  They need to be monitored more closely.

Feeding

  •     Up to age four months babies only need breast milk or an iron fortified formula to meet their nutritional needs.  They do not need water as this is present in sufficient amounts in breast milk and formula.
  •     Nursing moms should continue to take their prenatal vitamins and eat a healthy diet.  The amount and frequency of feeds varies between babies, even within the same family.  If your baby is acting hungry, feed him/her.
  •     If the baby is full, he/she may just want to suck on a hand or pacifier for comfort.  In general, newborns feed every two to three hours around the clock.  The majority will not sleep through the night for several months after birth.
  •     Always check the temperature of the formula after heating.  When bottle feeding your baby, always keep the head slightly elevated, as if in a semi-seated position.
  •     Cereal in the bottle is not recommended.  Despite the advice of well meaning relatives and friends, it has never been shown to help babies sleep through the night.  In fact, it is possible that introducing cereal or any other solid foods prior to age four months increases the risk of food allergies.
  •     Infants do not need to drink water until six months of age.  It is not recommended to give water prior to this age.  If you feel that your baby may be thirsty, give breast milk or formula.  Both are water based.  Giving water to newborn infants can lower the level of certain electrolytes in the body and cause seizures.

Elimination

  •     Newborns usually have wet diapers with nearly every feeding.  After four days of life, a baby should have at least six wet diapers in a twenty four hour period.  If this is not the case with your baby, please let us know.
  •     Frequency of stools is more variable.  Many newborns will have a stool with each feeding that can be liquid, seedy, yellow or green.  This is more common with breast fed babies.
  •     Nearly all babies give signals that they are having a bowel movement such as grunting, pushing and pulling legs up and turning red in the face.  This is often confused with signs of constipation.
  •     As long as your baby has soft stools, he/she is not constipated.  Please let us know if the stools are hard, contain blood or appear white/grey.  The use of laxatives, enemas, or suppositories of any kind is not recommended.  Please note that after four to six weeks of life it is normal for stools to become less frequent.  This is especially true for breast fed babies.  They become more efficient at absorbing breast milk and may have bowel movements as little as once a week.  Again, as long as they are soft, this is not constipation.

Sleep

  •     All babies should be placed on their backs to sleep.  Over the last few years, this has reduced the incidence of sudden infant death syndrome by as much as fifty percent.
  •     Avoid commercial sleep positioners as they are often made of foam and may cause suffocation.
  •     The mattress should be firm.  Do not place any blankets, pillows, stuffed animals, or any other objects in a bassinet or crib.
  •     For warmth, you can place the baby in a zip up fleece sleeper that has no risk of covering the face.
  •     It is not recommended that you put your newborn to sleep in your bed.  A bassinet adjacent to your bed makes night time feedings convenient and keeps your baby close at hand in the first few weeks.
  •     Make note to alternate the baby’s head position from one side to the other in order to avoid flattening of the skull.  If you notice that your baby prefers to turn his/her head to one side, please let us know.
  •     During wakeful periods, try to keep your baby off of the back of his/her head to decrease the flattening of the head.  This will be easier at two months of life when you will begin short spurts of observed tummy time.
  •     Sleep length and times are variable.  In newborns, normal lengths of sleep can vary between twelve to twenty hours per day.  Some newborns may cry as much as two to three hours per day and for ten to fifteen minutes before falling asleep.

Cord Care

  •     We no longer recommend cleaning the umbilical stump with alcohol.  We have found that this can keep it attached longer.  Avoid tub baths until the stump has fallen off and the base is dry.  It usually takes one to three weeks for it to fall off.  A small amount of bleeding is normal.
  •     You will also likely note a green, thick tissue underneath the stump.  This is dead skin and will be replaced with pink tissue.  There should not be persistent bleeding or an area of spreading redness.  Please let us know if the cord has not fallen off after four weeks of life or if the area appears to be wet a week after the cord has fallen off.

Bathing and Diaper Care

  •     Sponge baths are suggested until the cord has fallen off and the area is dry and well healed.  Washing the diaper area with antibacterial soap or a diaper wipe with each diaper changed will help decrease irritation in the first weeks.
  •     For circumcised boys, continue to apply A&D ointment or Vaseline until all the scabbing has healed in order to keep the area from sticking to the diaper.  You may clean it gently with a cotton ball and water.  In uncircumcised boys, retract the foreskin very gently, as far as it will go without forcing, and absorb any moisture that is trapped by the foreskin.  Never force the foreskin down as this may lead to injury.
  •     In girls, take care to always wipe from the front to back to avoid carrying stool into the urethra and vagina.  After a stool, spread the lips of the vagina and gently wipe the stool away.  Please note that newborn girls often have labial swelling due to the effects of estrogen.  They can also have a mucous like vaginal discharge and even some vaginal bleeding due to the effects of hormones on a newborn girl’s vagina and uterus.

Development

  •     It may seem to you that the first four to six weeks involve mostly eating, sleeping and the production of dirty diapers.  Your baby will smile at random times and this will keep you going.  This is a stressful time riddled with sleep deprivation.  Parents should try sleep whenever the baby sleeps.
  •     Respond to his/her needs promptly and lovingly, which will create a sense of well being and security in your infant.  Your baby will reward you for all of your efforts at around two months of life by cooing and smiling in response.  Take time to talk to your newborn during wakeful hours.  This promotes intimacy, verbal skills and emotional development.  Please note that you cannot “spoil” a baby by holding them too much in the first weeks of life.

Between two to four weeks of life, you will note that your baby is doing the following:

  •  Raising head slightly when on stomach.
  •  Blinking in reaction to bright light.
  •  Beginning to focus and follow objects for short distances.
  •  Responding to sound by either becoming quiet or turning towards the source.

Immunizations

  •     Unless we indicate otherwise in the hospital, your baby’s first set of immunizations will be at two months of age.

Fever

  •     Fever in an infant under two months of age is defined differently than at any other age.  It is defined as a RECTAL temperature of greater than or equal to 100.4 degrees.  If you suspect that your baby is ill, take an axillary temperature (under the arm for five minutes).  If the axillary temperature is 99.4 or higher take a rectal temperature.
  •     A rectal temperature can be obtained by placing a small amount of Vaseline on the thermometer and gently inserting the thermometer about a half an inch into the rectum.  Call us immediately if the rectal temperature is greater than or equal to 100.4 and your child is under the age of two months.  After two months of age, fevers of 100.4 or higher are not by definition emergencies.
  •     Patients between two months and two years of age should be evaluated in the office for temperatures greater than 103.5 degrees rectal or if a 101 degree or higher temperature lasts for more than three days.  Ask all visitors to wash their hands prior to holding your baby.
  •   Do not let visitors who could be sick close to your baby.

 Safety 

  •     Accidents are the leading cause of death in children.  The vast majority of accidents occur in motor vehicles.  It is essential that every car seat undergo an inspection by a certified car seat inspector.  In the hospital, you may see such a person and receive instructions on how to secure your baby in the car seat itself.
  •     Please note that seventy percent of bases are improperly installed in motor vehicles.  Having a properly installed base is as essential to your baby’s safety as proper positioning in the car seat.  Whenever possible, car seats should be positioned in the middle of the back seat.  The handle on the carrier should be down and locked when the vehicle is in motion.
  •     Do not attach toys to the car seat while the vehicle is in motion as these can act as projectiles during a collision.
  •     Do not place any objects in the back seat, such as groceries, as these also can act as projectiles.  Do not use a car seat cover that also fits underneath your baby as it places a barrier between the car seat and the back of the baby’s body.
  •     During a collision, even an inch of fabric can decrease the efficacy of the straps to hold your baby securely.
  •     Remember that all infants need to be placed rear facing until two years of age This is a Michigan State law.
  •     Check the manufacturer’s limits on height and weight for your infant car seat as they do vary.  If your child outgrows the infant car seat prior to a year of age, he/she should still face the rear of the car in a large car seat until two years of age.
  •      Please note that a child should remain in a car seat until he/she weighs about forty pounds.  After this, a child should be in a booster seat until he/she reaches a height of 4’9” and/or is between the ages of eight to ten years.
  •     All children twelve and under should be in the back seat at all times.
  •     When getting a car seat inspection, take your infant/child with you in order to check for proper fitting/positioning.  Members of AAA can contact your local office and request a free inspection.  Others can call local car dealerships and inquire about inspections.  You may also call (313) 586-5488 and ask about getting an inspection through resources at Oakwood Hospital & Medical Center.
  •     Local fire and police departments also frequently have certified care seat inspectors.