QUINCY PEDIATRIC ASSOCIATES, INC. Andrew J. Pryharski, M.D. David M. Belcher, M.D. James T. Christian, M.D. 191 Independence Avenue Quincy, MA. 02169 617-773-5070

David A. Irons, M.D. Carrie M. Jones, M.D.

and

Mary A. McGaugh, M.D. Laura H. Scharf, M.D. Julianne Hertko-Adams, M.D. 769 Plain Street Marshfield, MA. 02050 781-837-5070

Call Hour: 7:00 AM to 8:00 AM at 617-773-5070 Office Hours: By Appointment

_______________________________________________________ ______ GENERAL INSTRUCTIONS RELATED TO NEWBORN CARE Your baby is doing well and has had a thorough physical examination. These instructions will help you meet the needs common to newborn babies, and will give you helpful hints on how to keep your baby healthy and happy. Your child is an individual--adapt these instructions to your baby. We will be happy to give you guidance and answer your questions while you are in the hospital, later by phone, and during your visits to our office. Your baby should have her first office visit when two weeks old, unless there are problems which require a visit sooner. Visits will include questions and answers, developmental checks, physical examinations, immunizations, occasional laboratory testing, and more. Please call now to set up your baby's newborn appointment, usually by age 1 week. We have a doctor's call hour at 617-773-5070 each morning from 7 to 8 o'clock, and all day long a specially-trained nurse will be available to help solve your problems. Please do not hesitate to call, and always bring a pencil and paper to the phone. All babies normally sneeze, yawn, belch, have hiccoughs, pass gas, cough, and cry. They may occasionally look cross-eyed. Hiccoughs may often be stopped by giving a few swallows of warm water. Crying is his way of saying (not necessarily in order) I'm hungry, I'm wet, I'm thirsty, I want to turn over, I'm too hot, I'm too cold, I have a stomach ache, I have gas, or I'm just plain bored! You will gradually learn what the baby means. A normal, healthy baby will often cry for a little while each day, usually in the early evening, and could cry for an hour or so without doing himself any harm.

During the first few weeks of life, it is normal for babies to show the effects of their mother's hormones. Both sexes may have engorged breasts and even produce milk. Do not squeeze the baby's breasts as this may further stimulate milk production! Female infants may even bleed from the vagina for a day or two, simulating a menstrual period. These discharges are normal, and may be cleaned up with soft, moist cotton. Friends, relatives, and perfect strangers will want to hold your baby. Avoid sick visitors--especially children. Most germs are probably passed through kissing, sneezing, coughing, and direct contact. FEEDING Feeding is one of baby's first pleasant experiences. Hold your baby comfortably close, with his head slightly raised and resting in the bend of your elbow. Other "holds" may work well for nursing infants. Nursing: Before feeding the baby, rinse the breast with plain water and pat dry. Place two fingers on each side of the nipple and press slightly so that the nipple sticks out. You will then be able to guide the nipple into the baby's mouth. Sometimes you may need to encourage your baby to nurse. Do not push him toward the breast. Instead, gently stroke his cheek nearest the breast. He will then turn his head to hunt for the nipple (rooting reflex). Your baby not only sucks at the breast, he also milks it by chewing at the base of the nipple. You may become sore at first. This usually resolves as your breasts toughen up. We are not opposed to occasional supplementation with sugar water, though it is not usually necessary. When first born, babies should nurse on each side during each feeding--start with about 5 minutes per side, working up to 8-10 minutes on the first side and then allow her to finish on the other. "Burp" her after each side. When nursing is well established, you may want to nurse your baby at only one breast each feeding. Alternate this order at the next feeding. Many mothers wonder whether the baby is getting enough. If you are leaking occasionally and the baby is having frequent bowel movements, urinating well, and seems bigger, you are doing well. Staying relaxed is the key to successful nursing. Bottle Feeding: Sitting comfortably and holding your baby with his head supported, tilt the bottle so that the neck of the bottle and the nipple are always filled with formula. This helps your baby get formula instead of sucking and swallowing air. Never prop the bottle or leave the baby during a feeding.

Use a milk-based formula with iron unless we have told you otherwise. You may use ready-to-feed, concentrate, or powder. Formula should be made fresh daily and kept refrigerated. Follow the manufacturer’s directions carefully, especially when using concentrate or powder. A fresh bottle may be kept refrigerated for up to 48 hours. Do not re-use partially finished bottles. Sterilizing is now considered optional. Bottles should be cleaned with good hot water and dried completely. Dishwashers do a very good job. The amount of formula your baby takes will vary with age. Begin with 1-2 ounces at first, progressing to 3-4 ounces every 3-4 hours by about 2 weeks of age. You will find that sometimes the baby will take a bottle in 15-20 minutes, sometimes she won't. This is perfectly normal. The time to increase the amount in each bottle is when she cries for, and consistently finishes, more. Burping the baby will help to remove swallowed air. Even if fed properly, both bottle-fed and breast-fed babies will swallow some air. Hold the baby upright over your shoulder and pat or rub his back until he lets go of the air, or place him face down over your lap and gently rub his back. The baby can also be burped by holding him in a sitting position (baby leaning slightly forward) on your lap with your hand supporting his stomach. As a baby gets older, it isn't always necessary to interrupt a feeding to burp him, but do it after each feeding. Occasionally what seems like an entire feeding will come up with a well-needed burp. Though messy, this is not necessarily a problem unless it happens repeatedly. A schedule with flexibility. Feed every 3-4 hours. Breast fed babies may feed "on demand" until nursing is well-established (1-2 weeks). Feeding schedules work best with some flexibility, but most new babies eat about every 3-4 hours. Crying does not always indicate hunger, so beware--you may be feeding the baby every hour if you're not careful. This makes for very cranky parents! Though not required, warm water may be given once or twice a day. Some babies don't like water, and your baby may refuse it. This is normal. One teaspoon of sugar may be added to four ounces of water when "sugar water" is desired. Have a lead test done on your home water supply.

VITAMINS-FLUORIDE-SOLID FOODS Breast milk and most formulas today contain adequate amounts of vitamins, so they are not required for babies. Fluoride, which strengthens the enamel in the teeth, should be given starting at six months of age, if you are nursing or if there is no fluoride in your town water supply. Breast fed babies are sometimes given vitamins, at the doctor's discretion. If needed, rice cereal may be started at about 2 months of age, but this is seldom required. Routine introduction of solid foods begins at age 3-4 months. This will all be reviewed at your baby's first office visit. BABY CARE Bathing: Until the cord falls off, (and circumcision is healed), wash your baby with soap and water by sponging. Bathe daily or every other day. Face: Eyes: Nose & Ears: Scalp: Body:

Wash with plain water, soft cloth, and soap. Cotton balls help to clean around the eyes with cool water. Cleanse outer areas only. Don't worry about the canals or nostrils. Baby's head should be lathered gently. Work from front to back to keep soap out of eyes. Be sure to wash in the creases, and rinse well.

Do not use oil or lotions. Keep your baby clean between baths using a face cloth and water. Cord care: Keep the cord area clean and dry. Wash around it with soap and apply rubbing alcohol by cotton-tipped applicator. Crusted blood may appear around the navel after the cord falls off (10-14 days). This is normal. Circumcision: Watch for swelling or bleeding. Use Vaseline on a gauze pad until the skin heals (5-7 days). Any remaining foreskin should be gently retracted and cleansed daily. Uncircumcised males require no specific cleansing or retraction of the foreskin. Stools: Your baby may have a bowel movement after each feeding or may go three days (5-7 if nursing) without a stool and be normal. Your baby may

strain when he has a stool, and this is perfectly normal. As long as the bowel movement is normal (yellow/brown, seedy, and mushy), this is not considered constipation. If the stools are bloody, excessively watery, or formed into hard pellets, please phone the office for advice. Diaper Care: Change your baby's diaper as soon as possible after each wetting or bowel movement. Cleanse the diaper area with warm water and a face cloth. Use Vaseline, not powder, to keep urine and stool off of the skin. Do not use powder, as inhaled powder can be damaging to the lungs. Plastic pants retain moisture, damaging the skin. Wipes are not recommended for routine use. Whether using disposables or cotton diapers, you must change the baby frequently to avoid diaper rashes. If possible, use a good diaper service. In a home washer, use normal washing procedures. 1/2 cup vinegar in the last rinse may help remove soap residues. Room Temperature: Keep an even, comfortable temperature in the baby's room. On hot days, provide ventilation. Dress the baby with the same weight clothing that you use yourself--less if it's hot, more if it's cold. Sleeping: You may expect your baby to do a lot of sleeping. The American Academy of Pediatrics recommends that babies should sleep on their back. Keep the baby bundled for the first few Clothing: Your baby does not require as much clothing as an adult. Dress him according to the temperature. A fairly good rule to follow is to take your baby out whenever the weather is pleasant. Babies may sleep outdoors on a nice day after they are two weeks old, but avoid temperature extremes. Car Seats: Purchase an approved infant restraint seat before the baby goes home. Make the first ride a safe ride! Face the seat to the rear. Place the car seat in the rear, passenger side of the car. ADDED INSTRUCTIONS --Cut the straps off your baby's dressing table to avoid entanglement. --Unless you feel a night phone call is urgent, please save it for the morning call hour--7 to 8 AM. --Always take rectal temperatures in a newborn, and call immediately with any fever in a baby under one month of age.

--Always bring a pencil and paper to the phone. Keep your pharmacy's number posted near your phone. --We recommend cool mist vaporizers/humidifiers. --Call us if the baby becomes jaundiced (yellow color to the skin), or if the baby begins to feed porly or develops a fever in the first month of life. Lacerations and injuries are routinely treated in our office during regular office hours. After hours, please call the office number and we will arrange for your treatment, either at the office or at the hospital. Try to call the office at any hour before going to a hospital emergency room. The Quincy office is open 7 days a week for sick visits. Well visits are available Monday through Saturday. Our Marshfield office is open Monday through Friday. If you have an HMO/PPO and we are your primary care physicians, we must authorize any referral treatments or visits or your insurance carrier may deny coverage. Please do not make referral appointments without discussing the matter with us first. NOTES

12/06