NEWBORN & INFANT CARE MANUAL

UNIVERSITY MEDICAL CENTER UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE, TUSCALOOSA CAMPUS

850 Fifth Avenue East Tuscaloosa, AL 35401 PHONE: (205) 348-1770

Baby’s Name:

_________________________________

Date of Birth:

_________________

Birth weight:

_____ lb. _____ oz.

Birth length:

_____ inches

TABLE OF CONTENTS

1. INTRODUCTION --------------------------------------------------

1

2. ABOUT OUR CENTER ------------------------------------------

1

3. ROUTINE OFFICE VISITS --------------------------------------

1

4. TAKING YOUR BABY’S TEMPERATURE ------------------

2

5. WHEN TO CALL THE DOCTOR -------------------------------

2

6. FEEDING YOUR BABY ------------------------------------------

2

7. BREASTFEEDING -----------------------------------------------

3

8. BOTTLE FEEDING ------------------------------------------------

5

9. WATER --------------------------------------------------------------

6

10. BURPING -----------------------------------------------------------

6

11. HICCUPS -----------------------------------------------------------

7

12. SPITTING-UP ------------------------------------------------------

7

13. BOWEL MOVEMENTS ------------------------------------------

7

14. BATHING ------------------------------------------------------------

8

15. CARE OF THE UMBILICAL CORD ---------------------------

9

16. FOR BOYS ONLY (care of the penis) ------------------------

9

17. DIAPERS ------------------------------------------------------------

9

18. DIAPER RASH -----------------------------------------------------

10

19. OTHER RASHES AND SKIN CONDITIONS ---------------

10

20. JAUNDICE (yellow skin and eyes) ---------------------------

11

21. SLEEP ---------------------------------------------------------------

11

22. INSIDE AND OUTSIDE -----------------------------------------

12

23. BREATHING -------------------------------------------------------

12

24. NERVOUSNESS -------------------------------------------------

12

25. BREAST ENLARGEMENT -------------------------------------

12

26. VAGINAL DISCHARGE -----------------------------------------

12

27. VISITORS ----------------------------------------------------------

13

28. THE OLDER CHILD AND NEW BABY ----------------------

13

29. ACCIDENT PREVENTION -------------------------------------

13

30. CAR SEATS -------------------------------------------------------

13

31. NORMAL DEVELOPMENT ------------------------------------

14

32. FINAL COMMENT -----------------------------------------------

15

33. RECOMMENDED READING ----------------------------------

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INTRODUCTION We welcome the arrival of your new baby and look forward to working with you in the care of your little one. Each day while you are in the hospital, we will examine your baby in the nursery and talk with you concerning his/her condition and progress. During this time, we will hopefully be able to answer any questions that you may have and help you get ready for the care of your baby after you go home. This booklet has been prepared to help answer some commonly asked questions and to be a guide in the care of your new baby. Questions may come up that are not covered in this booklet. If so, please feel free to discuss these with one of our doctors or nurses. ABOUT OUR CENTER The University Medical Center is a multispecialty outpatient healthcare facility that is a division of the University of Alabama School of Medicine, Tuscaloosa Campus. There are two clinics for Family Medicine (Red and Blue Suites), and one each for Pediatrics, Obstetrics & Gynecology, Internal Medicine, Occupational Medicine, and Psychiatry. There are also complete in-house laboratory and x-ray facilities. Newborns, infants, and children are cared for in both Family Medicine Suites (Blue & Red) and the Pediatric Clinic. If you choose to bring your newborn to our center, you will be taken care of by a highly qualified, caring, friendly professional staff that includes licensed nurses, medical lab technicians, receptionists, and well-trained, licensed physicians. Patients are seen by appointment at the center during regular operating hours which is from 8:30 AM to 5:00 PM Monday through Friday. To make an appointment, call 348-1770 during regular business hours. For urgent medical concerns and emergencies after hours and on holidays, you can reach a physician by calling (205) 348-1770. ROUTINE OFFICE VISITS AGE Newborn 2 Weeks 2 Months 4 Months 6 Months 9 Months 12 Months 15 Months 18 Months 2 Years 3 Years 4 Years 5 Years • • • • • • • • • •

VACCINES HBV #1

LAB WORK newborn screening tests (PKU, thyroid, hemoglobin electrophoresis, & others)

Pediarix #1, HIB #1, PCV7 #1, Rotavirus #1 Pediarix #2, HIB #2, PCV7 #2, Rotavirus #2 Pediarix #3, HIB #3, PCV7 #3, Rotavirus #3 hematocrit, lead level MMR #1, Varicella #1, HAV#1 DTaP #4, HIB #4, PCV7 #4 HAV#2

DTaP#5, IPV #4, MMR #2, Varicella #2 (if vaccines not given at age 4, will be done now) HBV PCV7DTaP IPV MMR MMRVHAVPediarixVaricella Rotavirus-

hematocrit, lead level vision screening urine, hematocrit, vision, hearing vision, hearing, tuberculin skin test

Hepatitis B vaccine pneumococcal conjugate vaccine, 7 valent (“pneumonia vaccine”) Diphtheria, tetanus, acellular pertussis (whooping cough) vaccine Injectable polio vaccine Measles, mumps and rubella vaccine Measles, mumps, rubella, and varicella (chickenpox) vaccine Hepatitis A vaccine combination vaccine with the DTaP, HBV, & IPV vaccines all in one injection Varicella vaccine (chickenpox) Rotavirus vaccine, given by mouth using a dropper

One of the purposes for routine visits is to check on your baby’s growth and development at key intervals. In the first few months, these visits are more frequent because of the rapid growth and changes in the first year of life. Several vaccines are given during the first year as well and at some visits, blood and/or urine tests will also be done to check on your baby’s health. The usual schedule of recommended visits, labwork, and vaccines is listed in the table above. If your baby is premature or has any problems, the schedule may be different in order to meet the needs of your baby.

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With your permission, your baby will get the first vaccine, hepatitis B vaccine (HBV), in the hospital shortly after birth. It is often given on the second day. You will have a chance to hear about each vaccine and ask questions before your baby receives any of the vaccines. TAKING YOUR BABY’S TEMPERATURE 1. Use a clean rectal thermometer. Check to be sure that the reading is below the arrow. Shake down if necessary. 2. Lubricate the tip of the thermometer with petroleum jelly (Vaseline®). 3. While seated, place your baby, tummy-down, across your lap. 4. Insert the bulb of the thermometer about 1 inch into the rectum. Rest the hand holding the thermometer against baby’s bottom so should he/she move, your hand and the thermometer will move with your baby. 5. Hold the thermometer in the rectum about 2 minutes, then read. Clean the thermometer with soap and water or rubbing alcohol (isopropanol), and store in a clean, safe place. WHEN TO CALL THE DOCTOR 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

A rectal temperature of 100.4 degrees (Fahrenheit) or higher in an infant less than 3 months old When a child is listless and appears ill, whether or not there is a fever Persistent vomiting Persistent diarrhea (frequent watery stools) Crying, as if in pain, from unknown causes A fall or accident that may have resulted in a head injury or broken bone Uncontrolled bleeding Limp or refusal to use a leg or an arm Changes in consciousness, fainting or seizure Burn, cuts or animal bites Possible ingestion of poisons or foreign body Rapid, noisy, or difficult breathing Progressive or persistent rash, especially if associated with other symptoms of illness

Before placing your call to the doctor, have a pencil and paper ready for taking notes. Since it may be necessary to phone-in medication for the baby, have the name and phone number of your pharmacy ready. FEEDING YOUR BABY Feeding is just about the most important experience your baby will have during the early months. Actually, there is nothing especially difficult or technical about figuring out what to feed your baby. With breastfeeding, it is predetermined and with most currently used formulas, preparation could hardly be simpler. But, feeding means more to a baby than just satisfying hunger or gratifying the desire to suck. It is the first social and emotional experience as well. The close contact with you and the feeling of love, warmth, and security that your baby acquires from being close to you are just as important to growth and development as the milk. The feeding contact gives your baby the first pleasant and satisfying relationship with another person (you). Your baby learns other things besides love during the feedings. Usually, he/she has to wait at least a few minutes after awakening and begins to feel hungry before you can be ready with the feeding. So, feeding time becomes the first experience in adjusting the baby’s needs and behavior to that of others. This is the essential basis of all social relationships. Furthermore, as you meet your baby’s needs in a consistent and reasonably satisfying way, he/she learns to feel trust and confidence in you. This sort of trust is also an important part of healthy personality development. Your baby will feel or sense your love in the way you hold him/her, the way you talk to him/her and the tenderness with which you care for his/her needs. This is true no matter how inexperienced you may feel. By the same token, your baby will sense it if you are tense, anxious, upset or impatient. The more pleasant and relaxed you can make feeding times, the more you and your baby will enjoy these precious moments together. Feeding Schedule. In the hospital, your baby may be fed on a rather fixed schedule, about every 3 to 4 hours. This is not necessarily what will happen when you go home. Given a choice, you and the baby will most likely stay happier if you feed your baby when he/she seems hungry and not by any

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rigid schedule. Even in the early weeks, your baby can tell you better than anyone else when and how much is right for a feeding. Our recommendation for your baby’s feeding schedule is called the modified demand schedule, which means that you allow your baby to feed whenever he/she seems hungry (demands it) unless the demand is unreasonable. One example of an unreasonable demand schedule would be every hour on the hour, 24 hours a day. At that rate, both you and your baby will get very irritable within a few days. If your baby is trying to feed on a schedule like that, we can tell you how to “modify” his/her feeding pattern. However, given the opportunity, most babies will choose a pattern that works very well for both of you, usually between 2 to 5 hours between feeds. BREASTFEEDING 1. You do not have to have large breasts. Breast size does not affect the amount of milk produced. 2. Regaining your figure after delivery is a matter of proper diet and exercise, before as well as after delivery. 3. Breast milk usually does not “come in” fully until the end of the third day with the first baby. Your baby will get some milk during the first couple of days; a thick, yellowish milk known as “colostrum” which is rich in protein, minerals and vitamins. Fortunately, babies do not need much milk during this waiting period. 4. You should nurse frequently during the first few days because both you and your baby will benefit from the practice. Your baby will also get the benefit of the colostrum. There is no need for other milk or water supplements during this time. 5. After the first few days, breast milk is a thin, floury looking liquid, bluish in color. Do not take this to mean that it is not rich enough or strong enough. 6. Breastfeeding is not entirely a comfortable experience, especially in the early weeks. You may have some discomfort in the first week because of sore nipples, and/or fullness and engorgement of your breasts when the milk “comes in”. To help with this soreness, try some of the following: • Wear a nursing bra with good support. • Manual expression of some milk may help to soften the breasts and relieve some of the pressure. If your baby is available and hungry, he/she can accomplish this for you. • Warm towels applied to the breasts before feeding may help to stimulate let-down. Standing in a warm shower can induce milk flow and relieve engorgement. You may need to stand with your back to the shower so that the water does not hit your breasts directly. • Ice packs after feeding may help to ease swelling and pain. Apply for about 15 minutes. 7. Your nipples may hurt when your baby first begins to suck. The soreness is usually at a peak by the 3rd or 4th day and then gets better over the next week. This discomfort can be helped by: • Washing your nipples with water only, and not soap. • Allowing your nipples to dry out for 10 to 15 minutes after each feeding. This can be done with the nursing bra flaps down under your blouse or nightgown. Application of nipple cream after nursing may help in some cases. • Rotate feeding positions at first, for example lying down, cradlehold, and football-hold. 8. The hospital nursing routine is not a fair trial for breastfeeding for several reasons: • You will probably not have your milk “come in” prior to discharge. • There will be fewer interruptions at home, where you and baby will have free access to each other. • Babies are usually very sleepy at first and often do not nurse well until the 3rd or 4th day. Your baby may feed more frequently during your first day or two at home. The excitement of going home, fatigue of increased activity, and anxiety of being “on your own” all are a part of this. The best way to improve the situation is to rest often, relax when you can, and be patient. Take naps and drink lots of fluids, at least 8 oz. with every breastfeeding. Your milk supply with increase gradually as your baby nurses over the first 10 days. It may take that long for you to be producing breast milk in full volume. Do not let anyone convince you, during this time, that you do not have enough milk to continue nursing. All newborn infants lose weight, even premature babies, during the first few days, regardless of how they are fed. It is normal to lose as much as 10% of their birth weight before starting to gain.

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How to Nurse 1. First and foremost, get comfortable before you begin. Whatever position is most comfortable for you will usually work best. You may want to try lying on your side at first or perhaps sitting in a comfortable chair, supporting your baby with a pillow in your lap or under your arm. 2. Touch your nipple to your baby’s cheek. He/she will turn toward the nipple because of a built-in reflex. Do not try to force your baby to turn. If you do this, he/she will turn instead toward your hand. 3. With your opposite hand, place your index finger above and your middle finger below your nipple, both behind the dark circular area known as the areola. Help your baby take the entire nipple into his/her mouth and as much of the areola as possible. Sucking will be easier and more effective for your baby this way and it will not be as hard on your nipples. 4. If needed, hold your breast back from your baby’s nose with your fingers so that he/she can breathe easily while nursing. 5. When finished, press down gently on the part of your breast next to the corner of your baby’s mouth. This lets air into the mouth and breaks the suction, allowing for easy removal of your nipple. Care of Your Nipples 1. Wash hands thoroughly with soap and water before touching your breasts. 2. Wipe cream (if any) off the nipples with breast pad or soft cloth prior to feedings. Clear water washing of breasts is sufficient; do not use soap on your nipples. 3. If your nipples become very sore, place a modified heat lamp (60-watt light bulb, without lampshade) 1 1/2 feet (18 inches) away from exposed breasts for 30 minutes, twice a day until feeling better. 4. If it seems to help soreness, apply nipple cream as directed. This is usually necessary only the first few days. How Long to Nurse 1. Allow your baby to suck up to 10 minutes on each breast for each feeding the first day. If you or your baby want to nurse longer, change the sucking position so that he/she will suck at a different angle. This will help to minimize some of the soreness you will feel in your breasts the first 3 to 4 days. In addition to the lying down and cradling positions, you may use the football hold with the baby’s feet out beside you. Prolonged nursing at first will not make your milk come in any sooner and may make you unnecessarily sore. 2. Begin gradually to increase your nursing time. Twenty to thirty minutes should be a maximum even after your nipples are well conditioned and you are producing your full quota of milk. The baby gets most of the milk in the first 5 to 10 minutes. The rest is mainly to satisfy his/her desire to suck. How Often to Nurse 1. Often with the first feedings, your baby will not be very wide-awake, hungry, or interested. Do not be discouraged by this slow start. 2. By the 3rd or 4th day your baby will have worked up an appetite and will be raring to go. Most of the time, your baby will want to nurse more often than 4 hour intervals, probably at 2 to 3 hour intervals, but anywhere from 2 to 5 hour intervals are acceptable. 3. Frequent nursing helps build up a full supply of milk. Manual Expression of Milk 1. May be necessary if: • Your baby drops off to sleep before emptying your breast and leaves you uncomfortably full. • You have to skip one or more nursings for any reason. 2. How to do it: • Wash your hands with soap and water. • Place your thumb just above upper edge of areola and your index finger just below the lower edge. • Press your hand inward until you can feel ribs. At the same time, raise your breast with palm of hand. • Press fingers against your breast and open and close in scissors motion. • To empty the entire breast, use the same hand position, but start with fingers at the outer edges of the breast and gently massage down toward nipple.

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3. A hand-held, non-electric breast pump or an electric pump can be used, if you have one. Some models may be obtained at drugstores or medical supply outlets. Freedom bottle. A bottle may be given occasionally in place of nursing if for any reason you need to be away from the baby at nursing time. This practice is a matter of convenience and is not a matter of necessity. It is not recommended until after the first 2 weeks. If you are going to be gone four hours or less, consider using the commercially available presterilized juice bottles such as apple juice or pear juice (Heinz®, Beechnut®, or Gerber®). That way, your baby will still be ready to feed when you arrive home. If you will be gone longer than this, use either breast milk that you have previously pumped and stored, or an infant formula such as Similac Advance®, Enfamil Lipil®, or Nestle GoodStart®. When to stop nursing. This is entirely up to you. You can breastfeed as long as you have ample milk and both you and your baby are enjoying it and doing well. The usual time to stop breastfeeding is the same time that we recommend stopping formula feeding, around the first birthday. Mother’s Diet while Nursing

1. Eat what you please and be observant. If a particular food seems to upset your baby after you eat it, omit it from your diet for a few days, then try again. Caffeine can stimulate babies, making them irritable and fussy for several hours. So, moderation of drinks containing caffeine is in order (coffee, Coca-Cola, tea, etc.), usually no more than one cup of coffee or two soft drinks with caffeine a day. 2. Avoid all alcoholic beverages while breastfeeding. 3. During nursing you will need all the foods which are necessary in any healthy person’s diet. Include at least one serving daily of lean meat, poultry, or fish, eggs, fruit, vegetables, and whole grain cereal or bread. Drink some whole milk each day (unless you are sensitive to milk products). Adequate fluid intake is important. Use supplemental vitamins as prescribed by your obstetrician. Drink at least 8 oz. of liquid with every feeding and at meals. 4. Many drugs are excreted in small quantities in breast milk when taken by the nursing mother. Ask your doctor (obstetrician, family physician, and/or pediatrician) if it is okay before taking any medication while breastfeeding. BOTTLE FEEDING Type of formula. Once having decided to bottle-feed your baby, you will then have a choice of formulas to use. We suggest a commercially prepared formula such as Similac Advance®, Enfamil Lipil®, or Nestle GoodStart® which has been modified in chemical composition and physical properties to be like breast milk. (If you will be getting formula through the WIC program, you will receive Similac Advance®.) Preparation of formula. Infant formulas can be purchased in several different forms such as ready-toserve, concentrate, or powder. As long as you follow the instructions on the package when adding water, the resulting formulas are identical. In our area of Alabama, if you use city water in your home, it is not necessary to boil the water before using it. (This is not true for all areas in the country. If you are traveling, check with local officials, or use Ready to Feed formula or bottled water.) It is also not routinely necessary to sterilize bottles or nipples before using them. Just wash them in hot water as you would other family dishes. Nipples, however, should be boiled before first being used. If you have well water, your baby will need fluoride drops since local well water is deficient in fluoride, a mineral that prevents dental cavities. If you use well water, please ask us for instructions. Some mothers prefer to make up a day’s worth of bottles each morning and keep them in the refrigerator until needed for feedings. The bottles are filled with the approximate amount of formula that the baby is currently taking at each feeding. Once formula is prepared, it should be either used or refrigerated within 30 minutes. Refrigerated formula is good for up to 48 hours before throwing it out. At feeding time, the bottle should be removed from the refrigerator and brought to body temperature and used for the feeding. A bottle warmer can be used or you may hold the bottle under a warm water tap briefly to bring it to feeding temperature. Shake the bottle and test a few drops on the back of your wrist to make sure that the milk is not too hot before feeding the baby. If you warm the formula using a microwave oven, be sure to remove the nipple first, and allow the bottle to sit for one minute after warming. The bottle may explode otherwise, burning you and the baby. Any formula not used within 30 to 40 minutes of beginning the feeding should be thrown out. Do not try to reuse partially emptied bottles, as germs from your baby’s mouth will grow in the milk and after a while may make your baby sick if ingested.

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Some mothers have found that they prefer to make up each formula bottle just before feeding. When formula concentrate or powder is used, warm tap water can be added to make the proper dilution and also to bring the formula to the proper temperature for feeding. Do not add honey or cereal to the bottle. Feeding Formula 1. Wash hands thoroughly with soap and water. 2. Sit in a comfortable chair, cradling the baby in your arms. Always hold your baby. Never prop the bottle in bed or leave your baby unattended. 3. Keep the bottle tipped up so that the milk fills the neck and nipple to prevent the baby from swallowing air. 4. When your baby seems well satisfied and has burped, you may put him/her back to bed. Special Considerations 1. Check nipple holes periodically (you can do this when you check the formula temperature). Adjust the size of the hole to suit the baby. 2. If the holes are too large, gagging, sputtering and vomiting may result. 3. If the holes are too small, your baby may have to work too hard to feed and tire out, or swallow a lot of air around the nipple. For most babies, when the bottle is turned and held upside down, milk should flow in a slow steady drip. If it gushes, discard nipple. If it trickles out only with vigorous shaking, enlarge the hole by heating a small needle in flame until red, then passing quickly into hole and out again (blunt end stuck in cork). Do not crosscut nipples. As soon as feeding is completed, clean nipple by rinsing out and washing with brush and detergent. Rinse thoroughly. Run some water through the nipple to keep it from becoming stopped up. Rinse the used bottle and fill with cold water until ready to scrub with brush and detergent. If you have an automatic dishwasher, it would be fine to use it to wash your baby’s bottles. When you are traveling with your baby either locally or long distances, you should be careful with how the formula is prepared and stored. If using concentrate formula prepared at home, you should carry it in a cooler with ice or a refrigerator. Another option is to carry clean, dry baby bottles and use ready to feed formula in small single feed cans (8 ounces). One more option is to place the correct amount of powdered formula for a single feeding in a clean, dry baby bottle with a lid and mix with the correct amount of bottled water when you are ready to feed your baby. WATER Your baby does not need any water other than what he/she gets from milk (breast or formula) until starting cereal, usually between 4 to 6 months of age. It is okay to offer an ounce or two, once or twice a day between regular feedings (especially in hot weather). Do not worry if your baby does not want the water. The milk feedings will usually be preferred since they satisfy hunger as well as thirst. BURPING 1. Why? Burping is often necessary to help a baby expel swallowed air from the stomach. Air swallowing occurs normally during crying and feedings. Accumulated air can make a baby fretful and uncomfortable. 2. When? You will learn by experience how often you need to burp your baby. One way to tell is when your baby stops nursing, pulls away from the nipple and begins to squirm about. If your baby does not do this, try to burp them between breasts if breastfeeding or after 1 to 2 ounces (about halfway through the feeding) if formula feeding. You should also try to burp the baby briefly before you start a feeding (if your baby has been crying to let you know it is feeding time) and spend a longer time trying at the end of the feeding. 3. How? The best burping position is with baby held upright against your shoulder or in a sitting position on your lap (or beside you on the bed). Pat your baby on the back to help get up the air bubble or rock gently back and forth. Support his/her head and back with your hand. After about six months of age, your baby probably will be able to burp without assistance.

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HICCUPS Most babies have hiccups during or after some feedings (one observer noted 6% of the newborn’s day). Some have hiccups even before they are born. Hiccups are not harmful to the baby, but they do sometimes make them mad. If you still have the bottle or breast available, a few swallows will often make the hiccups stop. Otherwise, just wait for them to stop on their own. SPITTING-UP The term spitting-up is often used when only small amounts of stomach contents are regurgitated. The term vomiting is reserved for larger amounts, especially when they gush out with some force. In reality, it is hard to tell how much a baby is vomiting. Fortunately, it is really not important to determine how much a baby is vomiting, rather look at how your baby is doing. If he/she is throwing up milk, but is mostly happy, resting two or more hours between feeds, and is gaining weight appropriately at his/her checkups, then there probably is not a problem. If he/she is vomiting, irritable, feeding very often, and is not sleeping well, you should call the doctor for advice. Some vomiting is due to the feeding procedure. It may be that the nipple holes are of improper size (either too large or too small) or that the baby is gulping down the milk too fast even from properly sized nipple holes. In the beginning, spitting may occur because of inadequate coordination of the swallowing and sucking. This will improve with experience and maturing. Other things that may increase spitting include over-anxious atmosphere during feeding, bouncing around on a full tummy, and overeating. Remember that as long as your baby is healthy, happy, sleeping 2 to 6 hours between feedings, and gaining weight normally, spitting-up is only a laundry problem, not a problem for your baby. If your baby is a healthy, happy “spitter”, you can expect for the spitting-up to improve considerably around ten months of age. Incidentally, whether or not regurgitated (vomited) milk smells sour and looks curdled has no importance. The first step in the digestive process in the stomach is the action of stomach acid on the milk protein, resulting in souring and curdling. If the milk comes back looking exactly as it did when it went down, it just means it has not stayed down long enough for this to take place. BOWEL MOVEMENTS 1. General Considerations. • A newborn baby’s bowel movements (BM’s) will go through several changes over several months. The first two days, the BM’s are dark green and very sticky (called “meconium stools). Then they become progressively more loose over the next week. • Normal babies may have anywhere from one BM every third day, up to eight BM’s per day (about one per feeding). • After the first two days, normal BM colors include, yellow, yellow-green, and green. • Starting around two weeks of age, BM’s are often quite a production with infants. They grunt, strain, and cry regardless of size, shape, consistency or frequency. This is because they lack the muscle coordination required to grunt and relax at the same time. They will scream, turn purple, and then poop out a normal, soft stool. At around 3 to 4 months of age, a baby may begin to grunt and strain without crying as he/she has a BM. 2. Constipation means hard, dry bowel movements, regardless of how often they occur. A baby might have several BM’s a day in the form of little hard, dry pellets and, thus, be constipated. On the other hand, they might skip a few days and then produce a perfectly normal, soft BM. If you think your baby is constipated let us know and we will tell you what to do. 3. Diarrhea (frequent, watery stools) can be a much more urgent problem, especially in the young infant. If this occurs, BM’s will increase in number and become progressively looser in consistency and greener in color, contain increasing amounts of mucous and, perhaps, smell more offensive. One characteristic of problem diarrhea is that it almost always gets worse before it gets better. If you are suspicious at any time of 1 or 2 BM’s because they seem extra in number, watch closely for a progressive increase. If the number of watery stools is getting more frequent and/or your baby is getting fussy, call the doctor for advice. 4. A breastfed baby • is almost never constipated. • BM’s are quite variable in number. From 6 to 8 or more a day, especially at first (often 1 with each feeding) to 1 every 3 days. • Color is usually pale yellow but often may contain traces of green.

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• Consistency soft to loose, maybe granular. • Odor often rather pungent (strong). 5. A bottle-fed baby • May have frequent BM’s like a breastfed baby in the beginning. Later, usually 1 to 4 BM’s per day. • Color yellow to yellow-orange. • Consistency usually pasty to firm. May contain curds or lumps. BATHING 1. Use a sponge bath until the umbilical cord (belly-button cord) comes off (usually 7 to 14 days). Thereafter, you may tub bathe the baby if desired. Often newborn babies do not like being placed in a tub because they are startled by the insecurity of it. A little later, babies enjoy being in the water, splashing and responding in a positive way. 2. Equipment (have ready before you begin) • Basin, tub, or bathinette. Regular bathtub is unhandy. • Soap such as Dove®, Tone®, or liquid baby soaps like Mennen’s Baby Magic® or Johnson’s Baby Bath® • One or two soft wash cloths • Towel for wrapping and towel for drying • Cotton balls • Cotton-tipped swabs (Q-Tips®) • Change of diapers and clothes • Baby lotion - We suggest baby lotion in preference to oil or powder, although most babies do not require anything at first. • Rubbing alcohol (Isopropanol) 3. Where? Warm room free of drafts with convenient working area and working surface, usually the bathroom or kitchen. 4. When? At your convenience. It makes little difference to the baby as long as the bath doesn’t disturb the eating or sleeping pattern. It may be preferable to bathe before, rather than after a feeding. Bathing at the same time every day helps both mother and baby get used to a routine. 5. How? • Check temperature of the water with your wrist or elbow. The water temperature should be comfortably warm to your skin. • With a soft wash cloth moistened slightly in water, gently cleanse openings of the nostrils and around the eyes. It is not necessary to cleanse the inside of the nose. • Wash face with soap and water, include outer ears and creases behind ears. The wax at the outer opening of the ear canal may be removed with a cotton tip swab or soft cloth. Do not probe inside the ear canal. • Apply soap to the scalp, being careful to avoid soap getting into your baby’s eyes. Hold his/her head over the tub and rinse thoroughly. • Apply soap to neck, chest, arms, hands, back, abdomen, legs, buttocks, and genitalia (private area). Do not miss the skin folds and creases in the neck, underarms, groin, genitalia, etc. These deep creases are easy to forget and take a little special effort to cleanse. If the creases are not carefully cleansed it is easy to get rashes in these areas. • A wet baby will be slippery and you can hold more safely with a clean diaper or small towel. A towel in the bottom of the tub may help too. Support the head and shoulders with one hand, while using your other hand to hold the lower half of the baby’s body, usually holding the buttocks or legs. Lower into tub and release legs, continuing to support the head as before. Rinse thoroughly. Lift out of the tub (or raise sling if using a bathinette). Pat or blot with dry towel, do not rub hard. • Apply lotion lightly if desired, but only below the neck. Avoid using oils or Vaseline on the head and face during the first two months, unless specifically instructed otherwise. • Dress your baby appropriately for the temperature of your house.

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Special comments about bathing 1. Do not avoid the soft spot (fontanelle) when washing the scalp. It is actually a very tough area and you need not be afraid of injuring it while washing with a soft washcloth. 2. In girls, be sure to spread apart the labia (lips) of the genitalia and clean between them, both during baths and when changing diapers, especially after BM’s. The vagina is self-cleaning and does not require any special cleaning inside. Always wipe front to back across the vaginal opening. 3. Never leave your baby alone during baths. Telephones and doorbells can wait. CARE OF THE UMBILICAL CORD The umbilical cord (belly-button cord, navel) usually comes off after about 7 to 14 days. It may come off as early as 4 days. Separation occurs by softening. You may see, as separation occurs, a “gooey” appearing material in the navel and some of this will probably spill to the outside. You may also see a spotting of blood. This may persist for up to a week until the belly button looks dry and healing is completed. 1. Keep the umbilical cord as dry as possible. The drier it stays, the less likely it is to get infected. Avoid getting soaking wet with soap, water, lotion, etc. during baths. 2. Do not use binders, bands, adhesive tape, or dressings of any sort. 3. Keep the diaper edge folded down to avoid constant rubbing and the constant wetness of a wet diaper. 4. Clean the umbilical cord with rubbing alcohol (isopropanol) to keep the cord dry and reduce the chance of infection. 5. Moisten a cotton ball with alcohol and wipe up and down the cord and into the fold around the base of the cord. Continue to cleanse inside the belly button with cotton tip swab (Q-Tip) with alcohol for several days after the cord comes off. 6. Caring for the belly button and cord 2 or 3 times a day is usually enough. If the surrounding tissue becomes inflamed (red), call the doctor. FOR BOYS ONLY Care of the circumcised penis. The circumcision of the foreskin of the penis of a baby boy often leaves him a little fussy for a few hours afterward, and whenever the penis is cleaned during diaper changes for the next couple of days. The penis heals quite rapidly after circumcision and these tissues are back to normal in a week. Wash the penis, including the circumcision area, with a soft wash cloth or a soft wipe (Wet Ones®, Diaperene®, Chubs®, etc.) when changing diapers. Apply a liberal amount of Vaseline® to the penis tip and head of the penis to prevent the healing tissues from sticking to the diaper. It is not necessary to bandage or wrap the penis or circumcision area with gauze except for the day of the circumcision. Continue to clean and apply Vaseline® until the first office visit. Care of the uncircumcised penis. There is no special care needed for the uncircumcised penis during the first few months. Simply clean off the foreskin with bathing and diaper changes as you would the rest of the diaper area. After a few months, during the bath, you can gently pull back on the foreskin of the penis until you meet resistance, to see how far it will retract easily. Then clean the exposed area of the head of the penis with water and pull the foreskin forward again. For most children, the foreskin will be fully retractable by school age. Do not forcibly pull the foreskin back. It is very painful for the baby and may cause scarring. DIAPERS 1. Change the diaper whenever your baby seems uncomfortable because of wetness and after all BM’s. It is usually not necessary or even advisable to wake a baby to change the diaper. Your baby will not be cold because of wet diapers, if it is warm enough in your home. Babies with sensitive skin may require more frequent diaper changes. 2. When changing diapers, clean buttocks and genital area thoroughly. Use a soft wash cloth with soap and water or lanolin wipe (Diaperene®, Wet-Ones®, Chubs®, etc.). If your baby is prone to get diaper rashes easily, apply a thin film of lotion or cream (Desitin®, Balmex®, A&D Ointment®) or Vaseline® over the diaper area after changing to protect the skin from stool and urine contamination. This little bit of precaution may prevent or reduce diaper rashes. 3. Let the diaper area be open to air for 15 minutes without the diaper at least once a day to help prevent diaper rashes.

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4. If you are going to use cloth diapers, folding cloth diapers depends partly on diaper shape. You may fold the diaper into either a rectangular or triangular shape. The contour or fitted diapers require no folding. 5. Washing cloth diapers: • Soak soiled diapers in a large size diaper pail half full with cold water and a half-cup of Ivory Snow® or Dreft® until ready to wash. Those diapers containing BM need to be rinsed out in the toilet before soaking. • Wash in hot water and rinse once or twice in cold water. • It is best to use a nondetergent soap such as Ivory Snow® or Dreft®. • You may use chemical softeners if desired but only every other wash load. • Use Borateem® for whitening white items, 1/2 cup per load. DIAPER RASH Diaper rash is a broad term that is used to describe any irritation or infection in the diaper area of babies. Most babies get a diaper rash sooner or later. Some with sensitive skin may get them frequently and others with “iron bottoms” get them rarely. The rashes will vary from mild redness to open sores covering the genitals and buttocks.

1. Appearance. Patches of rough, red skin. Clusters of small red pimples which may develop a white top. Small to large blisters which may rupture and form shallow ulcers. 2. Causes • Often caused by ammonia produced as bacteria break down urine on the skin or diaper. • Also may be caused by irritation of the skin by bowel movements. • May result from yeast infection. • Less frequently, rashes may be the result of skin sensitivity to soap used for bathing, detergent used for washing diapers, or cosmetics used after bathing and diaper changes. 3. Treatment • Clean the diaper area with extra care when changing diapers. • After cleaning, apply zinc oxide ointment, Desitin®, Vaseline® or other prescribed ointment for skin protection and to speed up healing. • Expose skin of diaper area to air several times a day for 30 minutes at a time. Usually do this when the baby is asleep. When you are “airing them out”, place several diapers and/or an absorbent pad under baby’s bottom. • When there is a bad diaper rash, change diapers as soon as wet or soiled, even during sleep, unless this disturbs the baby so much he/she cannot get back to sleep. • If the rash is not getting better within a couple of days, call the doctor or make an appointment to be seen. • If your baby is prone to frequent diaper rashes, consider applying ointment after cleaning and airing out the diaper area daily even when there is no rash, to help prevent them. OTHER RASHES AND SKIN CONDITIONS Mild face rashes are common in the early months. You may see little shiny white or yellowish pimples or clusters of little red spots, or at times, small rough, red patches. Most of these rashes are normal for babies from birth to two months of age. The “normal rashes” will disappear after that time, leaving no remaining blemishes. If they become unusually thick or widespread we will try to help you control them. You don’t see clear-face babies (like in magazine ads) until they are four months old. Prickly heat is one of the most common types of infant rashes and it may occur anytime of the year, not just in summer. It can appear anytime that a baby is overheated either by too hot a room or by overdressing. Cradle cap is a common problem of the scalp, which appears as flakes or scales which may form a rather dirty and greasy looking crust. Vigorous daily scrubbing of the scalp with shampoo and water using a wash cloth or a soft brush can reduce it. Other special agents are available if needed. We will advise other treatment if it is not improving with shampoo and soft brushing. Thrush is a yeast infection of the mouth. It looks like patches of milk scum stuck to the cheeks and palate. If you think your baby may have thrush, call the doctor’s office or show the doctor at the next check-up. Medications are available for treating this problem. There may be an accompanying diaper rash for which a medicated cream is used.

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Birthmarks occur in many newborn infants, especially on the back of the neck, between the eyebrows, and on the upper eyelids. Some of these appear as irregularly shaped, flat, mottled areas of redness which fade under pressure of the fingers. These birthmarks are collections of blood vessels in the skin and the blood flowing through the vessels produces their color. They are redder when the baby is crying or hot, because blood flow is increased under these circumstances. As time goes on these marks will fade considerably and are not usually noticeable by 10 years of age. If your baby has a birthmark that we have not told you about, please ask us. JAUNDICE (yellow skin and eyes) It is common for newborn infants to develop a yellow color of the skin and eyes during the first week of life, beginning on the second or third day. This yellow color is called jaundice. The yellow color is caused by a build-up of a chemical called bilirubin in the baby’s body. Bilirubin is one of the waste products of the body that is normally eliminated by the liver. Before birth, the mother’s liver was handling this job of eliminating the bilirubin for the baby. After birth, a baby’s liver must take over this job. Sometimes it takes a few days before a baby’s liver can handle the job. Consequently, you see a buildup of bilirubin and the result is jaundice. In normal circumstances the jaundice peaks around the fourth day and slowly goes away over a couple of weeks. Blood tests are done if the baby becomes noticeably yellow, to determine the level of jaundice. If the bilirubin level gets a little too high, we may use phototherapy (blue lights) to help your baby clear the bilirubin from the body at a faster rate. If this becomes necessary for your baby, we will discuss it with you at that time. SLEEP 1. How much? Newborn infants vary tremendously in their sleeping patterns and in the amount of sleep they require. Most newborns will sleep about 15 to 18 hours a day in 2 to 4 hour intervals. 2. Where? If you have one, the baby’s own room is advisable from the start or at least after the first 8 weeks. Do not wait too long to make this move or your baby may resent it (scream at you for awhile). It is very hard for most parents to sleep, if they try to sleep in the same bed with a baby. 3. What position? When putting your baby down to sleep, the safest position is on his/her back. This is a big change over what we use to recommend prior to 1992. Around that time, research around the world demonstrated a marked decrease in the number of babies dying of Sudden Infant Death Syndrome (SIDS) among those who slept on their backs over those who slept on their stomachs (tummies). There has not been an increase in problems such as choking or aspiration for babies sleeping on their backs as was previously believed would happen. 4. Bed • Bassinette: The portability of a bassinette is convenient in the early months, but if you do not have one, it is not necessary to get one. Babies outgrow them all too quickly, anyway. • Crib: Be sure that the slats of the crib are no more than 2-3/8 inches apart. Do not use bumper guards in the crib. • Use a firm mattress, no pillows (until 18 months old). Use a light blanket, no heavy duty, thick quilts. As he/she gets older and wiggles out of the covers, warm sleeper pajamas will work better than blankets. Most children will not stay under covers very well while sleeping until about school age (5 or 6 years). • It is not safe to let your baby sleep on a couch, soft chair, or in an adult bed with a soft mattress, blankets, or pillows. • For the first 4 months, consider warming the place where your baby sleeps between sleeping times with a heating pad turned on low heat. When it is time to lay your baby down, pull up the heating pad and turn it off. After checking to make sure the spot is not too warm, lay your baby on his/her back on the warm spot. This will reduce startling and crying when laying them on the bed. Besides, it is a lot more comfortable to sleep on warm sheets. 5. Noise. Your baby should get accustomed to your routine household noises from the start. 6. Wakeful Periods. These may begin as early as the second week of life. They tend to occur at the same time each day, most commonly in late afternoon and evening. Wakeful periods may initially be fretful times, but later will usually become happy play periods.

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INSIDE AND OUTSIDE For the first few weeks of life, the best place for a baby is in a well-ventilated room, free of drafts. The ideal room temperature in the winter is no cooler than 68 to 70 degrees (Fahrenheit) and in the summer, no more than 80 degrees. Once your baby has regained birth weight, assuming he/she was not born very early, he/she may be taken outdoors on pleasant days. Short intervals are best at first. Longer intervals can be tolerated, as the baby grows older. In the summer, early morning and late afternoon are the best times. In the winter, middle of the day is preferable Avoid direct sunlight. Protect your baby’s eyes from bright glare, both direct and reflected glare off of sand, water or concrete. Dress your baby appropriately for the weather when he/she is to be taken outdoors. Avoid unnecessary exposure to extreme heat or cold, rainy or windy conditions. Use your own comfort and common sense as a guide to dressing your baby, although in cooler weather, babies usually need more covering for their heads. It is much easier to overdress than to underdress. The older and heavier a baby gets, the better the heat regulating mechanism and fat insulation will become. Consequently, your baby will need less clothing and less protection from temperature variations. In hot weather a shirt and diaper is often adequate. A gown should be used at night, over a shirt if the room is cold. Wrapping your baby snugly in a light blanket or a blanket sleeper adds extra security and warmth. BREATHING In the early weeks of life your baby’s breathing may seem quite irregular to you. It may be shallow and rapid at one minute and deep and slow the next. At times, he/she may seem to stop breathing completely for several seconds and then start up again. Very seldom will a baby consistently breathe in the steady, even rhythmical fashion of the older child or adult. Along as this lasts only a few seconds and your baby looks fine, there is no cause for alarm. Babies are often noisy breathers when awake and asleep. They snort and gurgle, huff and puff, sneeze and cough and even snore at times. Most of these sounds are related to the normal mucous that babies have and the small size of their noses. You can help your baby handle any excessive nasal mucous or other liquid by using the bulb syringe. NERVOUSNESS People often refer to babies as being nervous because they are rather jumpy, shaky, tremulous, and easily startled. Babies behave this way because their nervous systems are not fully developed and their reactions are mostly reflex in nature rather than controlled. Control and purposeful direction come gradually as they get a few months older. Whether your child is going to be a nervous child cannot be determined by the normal “jumpy” newborn period. The most dramatic example of newborn jumpiness is the startle reflex. When bright light, loud noise or an abrupt change in position startles a baby, the baby will throw out both arms, open their hands and spread the fingers, bring both arms forward as if to hug, draw up the legs and perhaps begin to cry. We are very happy to see them do this because it is one of the very best indications that the baby has a normally functioning brain and nervous system. Babies will often wiggle and squirm about, jerk, twitch and perhaps even cry out while asleep. Other normal sleep movements include smiles, frowns, grins and grimaces. Babies may sleep sometimes with their eyes partly open and deviated upward. Sometimes their eyes may cross briefly. A newborn baby does not have the strength or coordination of eye muscles to make the eyes move together all the time. If one or both of your baby’s eyes remain crossed for minutes at a time or longer, let us know. BREAST ENLARGEMENT Almost all full-term infants, male and female, show some enlargement of their breasts during the first few months. This happens because of exposure to mother’s hormones during pregnancy. You may see some swelling or you may just feel a thick little button of breast tissue under the nipples. Sooner or later there may be a few drops of whitish secretion from the nipples which is sometimes called “witches milk.” This is a normal occurrence and you need not do anything about it. Avoid squeezing the breasts. VAGINAL DISCHARGE You may see a thin, gelatinous secretion from the vagina of baby girls during the first two weeks. At times, this may be blood-tinged, especially around a week of age. This is a normal occurrence that

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also results from mother’s hormone influences. All you need to do is clean it away and forget it. The vaginal mucous will slow down quite a bit after two weeks of age. VISITORS 1. Take advantage of waking hours to “show off” your baby. Nobody enjoys being disturbed during sleep, including your baby. 2. Avoid exposure to individuals with colds or other contagious illnesses, especially young children (under 6 years old). Remind relatives that your baby is just as susceptible to their “germs” as to anybody else’s. 3. Limit handling of your baby by visitors to a minimum. 4. Always have visitors wash their hands before holding your baby. THE OLDER CHILD AND THE NEW BABY 1. Anticipate at least some expression of jealousy. 2. Prepare your older child for the new arrival by explaining about the baby in language appropriate to the child’s age and understanding. Stress how your child can enjoy the new baby and how much you need his/her help to care for the new baby. Let your child be a real helper by doing simple errands like fetching a diaper or towel for the baby at bath time. 3. Take advantage of any opportunity to spend some time alone with your older child and give reassurance of continued love. But, accept the simple fact that you cannot be at two places or do two things at once. 4. Do not punish your older child for minor acts of jealousy. Emphasize cooperation and “good” behavior by frequent comments, pats on the back, and even small rewards. 5. Have a few small, appropriate gifts for your older child, wrapped to use whenever visitors bring the new baby a gift and forget to bring one for big brother/sister. ACCIDENT PREVENTION Accidents cause more deaths in childhood than disease. They are among the leading causes of death in children of all ages. Infants are, by no means, immune to accidents. Most all such accidental deaths should be preventable by proper protection, education, and discipline. We will give you information throughout the first few years cautioning about the types of accidents most common at different ages and suggesting precautionary measures. CAR SEATS A car seat is very important for your new baby. Don’t ever let your baby ride in a car without being placed in an approved infant car seat, including the first ride home from the hospital. A baby that is not in a car seat when an automobile is involved in a collision often becomes a missile and suffers serious injury. Most of these car injuries can be prevented or substantially reduced by the use of a properly designed car seat. The car seats for infants have the baby facing toward the back of the car while anchored in the seat of the car by the safety belt. There are several models that are crash tested and approved for use. It is now a law in all 50 states to use approved car seats for infants and children riding in passenger vehicles. More importantly for your child, it is a lot safer. From birth until sitting without support, your baby should be in a car seat in the reclined position, facing the automobile seat, preferably in the back seat. The following are some guidelines* to help you select and use a car seat for your baby: • • •

• •

All new car seats sold today must meet federal safety guidelines. Don’t use a seat made before 1982, the year these regulations went into effect. Buy the car seat before your baby is born, so it can be used with the first ride home from the hospital. The most effective restraint is a five-point harness that consists of two shoulder straps, a lap belt, and a crotch strap. A padded armrest in front of your child may make him/her more comfortable, but it does not provide extra protection. Whether you use such an armrest or not, your child must still be fastened into the harness. Be sure the seat fits easily in your car, especially if you will be taking it in and out frequently. Look for a restraint that is easy to fasten and unfasten; you’re more likely to use the seat if it is convenient.

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Installing a Car Seat • • •

• •

•

The center of the back seat is the safest place for a seat to be installed. Be sure to follow the manufacturer’s installation instructions precisely. Thread the lap belt in your car through the correct spaces or holes in the car seat. Be sure the belt stays tight. With seat belts in some cars a special clip, available at baby stores and some auto supply stores, may be required to prevent the belt from slipping and loosening on the car seat. When you rock the seat back and forth, there should be almost no movement. If the seat is equipped with a top tether strap, be sure it is secured correctly. A seat that requires a top tether is not safe if the tether is not used, because the seat will fly forward in an accident, or even if you just stop abruptly. A seat for an infant should be installed facing backward. When your child sits well by himself/herself and weighs at least 18 pounds or is 8 to 9 months old, he/she can move into a properly secured, forward-facing toddler seat or a “convertible seat” used in the forwardfacing position. Adjust the straps in the car seat to your baby’s size. The shoulder straps should come through slots level with, or just above his/her shoulders. The straps should be flat, not twisted, and should be adjusted to fit snugly. The crotch strap should be kept short.

Use of the Car Seat • • • • • • •

•

A car seat can protect your child only if he/she sits in it every time he/she rides in the car, no exceptions. If you have two cars, buy two seats or transfer the seat to the car in which your child will be traveling. Be sure the harness straps are snug against your child’s body. Rear facing infant car seats should not be used in the front passenger seat of a car equipped with air bags, unless it has a manual cut-off switch for the airbag. Check with the owner’s manual or car dealership for specific instructions for your car. In hot weather, drape a towel over the seat when you leave the car in the sun. Before putting your child in the seat, touch the vinyl and the metal buckle with your hand to be sure they are not hot. No matter how short your errand is, never leave your child alone in a car. Always use your own seat belt. In addition to setting a good example, you will reduce your own risk of injury or death in an accident by 60 percent. Let your child use his/her car seat until he/she outgrows it, usually around age four. At that point, he/she must use a lap seat belt instead. He/she may also want a booster seat in order to see outside the window. The boosters that provide the best protection are those that hold the child with a harness or the combination lap-shoulder belts. Raised seats with only a padded barrier in front of the child, but no harness are convenient but provide less protection. After age four, and when your child stops sitting in the booster seat, make sure he/she uses the lap seat belt at all times. Do not use the shoulder harness until he/she is at least four feet tall, so that it rides across the shoulder rather than the neck, where it might cause injury. If your child is shorter than four feet, place the shoulder harness behind his/her back, using the lap belt only. Do not place the shoulder strap across the rib cage and under the arm of your child.

* Adapted from Caring for Your Baby and Young Child, Birth to Age 5: The Complete and Authoritative Guide. American Academy of Pediatrics, Shelov SP, Hannemann RE, editors. NORMAL DEVELOPMENT One of the most enjoyable parts of being a parent, is watching your child grow and learn how to do new things. There are wide variations among children in the rate at which they progress along the road to being a “big person”. A child may be slow to walk, but fast to talk and still wind up entirely normal overall. Some parents make the mistake of comparing their baby’s progress with the accomplishments of their friends’ and neighbors’ babies or with the average baby progress outlined in a number of books and magazines. Sometimes this comparison is with delight and sometimes with disappointment, but it is a mistake in the sense of expecting any two babies to behave exactly alike. Relax and enjoy your baby as a unique person. If you have any questions or concerns about how your baby is developing, please ask your doctor or nurse, either by phone or during your baby’s routine check-ups.

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FINAL COMMENT Parenting is one of the hardest jobs on earth. It is for sure the most important. Unfortunately, it can also be one of the least respected and the lowest paying of jobs. On the good side, nothing can compare with the satisfaction of watching and helping your own baby grow up to be a child, than a teenager, and finally, an adult. From the very start, your feelings about your baby will probably be mixed. Mostly you will feel love and experience pleasure and satisfaction as your baby grows and develops. Along with this, you will also have a feeling of rather frightening responsibility for protection, for teaching, for guiding your little one toward a realization of all his/her best potential. It is natural to feel frustration or anger at one time or another. It is our hope that this booklet will help you get a good start at the most important job you will ever have, caring for your newborn baby.

RECOMMENDED READING For additional information, please consider the following references, available in bookstores, online ordering, and in libraries. General •

Caring for Your Baby and Young Child, Birth to Age 5: The Complete and Authoritative Guide. American Academy of Pediatrics; Shelov SP, Hannemann RE, editors. Bantam Books, NY; 2004. Available at bookstores or by direct order: http://www.aap.org/, click on AAP Bookstore. Direct by phone: (847) 434-4000.

Breastfeeding • New Mother’s Guide to Breastfeeding. American Academy of Pediatrics, Meek JY, Editor, 2002. ISBN 10:0-553-381075, available at bookstores, online, or by direct order: http://www.aap.org/, click on AAP Bookstore. Direct by phone: (847) 434-4000 • The Womanly Art of Breastfeeding (7th ed.). LaLeche League International. Plume Books, NY; 2004. ISBN 0-452-28580-1. Available at bookstores or online. • The Complete Book of Breastfeeding, 3rd ed. Eiger S, Olds SW. Workman Publishing, NY; 1999. Available at bookstores or online. Websites • • •

American Academy of Pediatrics: http://www.aap.org/ Breastfeeding.com, AAP: http://www.breastfeeding.com/ National Immunization website, CDC: http://www.cdc.gov/vaccines/

Michael A. Taylor, M.D. Professor of Pediatrics University of Alabama School of Medicine, Tuscaloosa Campus 8/2008