The suggestions that follow are not intended to be a set of rules by which you must raise your baby. Please don’t try to follow any set pattern for the care of your baby. Although many people have suggestions on how they feel you should raise your baby, the advice of well meaning friends and relatives may be politely ignored. Remember, this is your baby, and take other’s suggestions with that in mind. If you desire alternatives to our suggestions, we will be happy to discuss them with you.

Baby Needs

• Car seat
• Digital thermometer (ear thermometers are often inaccurate for kids under 3 years old)
• Measuring droppers (use with all medicines because regular tableware may vary in volume)
• Bulb syringe
• Crib
• Smoke detector

Room Temperature

Ideal room temperature for your baby is 68 to 72 degrees.

Clothing

Dress your baby as you would dress yourself. Your baby’s hands and feet may feel cool, but if his body is warm, he’s fine. Cotton material is best. Avoid wool as it may irritate your baby’s skin. Always wash new clothing before putting it on your baby for the first time. Use Dreft to wash clothes and diapers. Softeners and anti-statics are best avoided until the baby is at least 5-6 months old. Dryer sheets (softeners) can be especially troublesome.

Crib

Your baby’s crib slats should be no more than 2 3/8 inches apart. The surface should be free of splinters and painted with a non-lead based paint. The mattress should be the appropriate size for the crib. Bumper pads are helpful until 6 months of age. Do not permit hanging toys to be within reach of your baby. The mattress should be firm, not too soft. Avoid pillows as they present a suffocation hazard. Do not let babies sleep on waterbeds as they can also suffocate your child.

Sleeping

Your baby will sleep a good deal and may be awake a total of only 4 hours a day initially. The most recent recommendations are that normal babies be put down to sleep on their back. Studies suggest that this may reduce the incidence of SIDS. Babies are normally very noisy when they sleep. They move around, grunt, and breathe with varying patterns. This activity can keep parents awake if they and the baby are in the same room. When a baby awakens to be fed, you will hear them even if they are a couple rooms away. We recommend that for your baby’s safety, she should not sleep with you in your bed.

To encourage your baby to sleep through the night, do not awaken her for a night feeding unless we recommend it. If she awakens on her own (beyond 6 months of age) allow her ten minutes of fussing before you pick her up. She may choose to go back to sleep. It is also helpful to put your baby to bed when she is drowsy, but awake. This will encourage your infant to associate going to sleep with her bed.

Bathing

Bath time is usually a fun time for babies and parents alike. Until your baby’s umbilical falls of and the navel has healed, you should only sponge bathe. No soap is necessary for the first several weeks. Thereafter, use a mild soap and a gentle baby shampoo. Always test the water temperature with your elbow first. Wash the baby’s scalp each time you bathe him. Wash his face with warm water only- no soap. Never insert anything (including Q-tips) into the ear canal. Ear wax that is accessible to your finger is all that needs to be removed. Babies do not need daily baths. Never leave your baby alone or with brothers or sisters in the bath for any reason. Let the phone or doorbell ring.

Lotions & Powders

Your baby’s skin will look its best without the addition of numerous lotions, powders, or home-made concoctions. Most infants’ skin requires no supplemental lotions. It is common for newborns to have dry, peely skin. This will resolve on its own. If, however, your baby develops areas of apparent dry skin, use a mild moisturizing cream, such as Lubriderm, Moisturel, or Eucerin. If she develops a rash, discontinue all products and contact us if it persists.

Cradle Cap

Cradle cap is a combination of dried oil with the peeling of old skin from the scalp. It is not dry skin which requires baby oil; in fact, this may aggravate the condition. To aid in its removal:

1. Lather the scalp using baby shampoo at the beginning of the bath. Allow the scalp to soak 5-10 minutes, then rinse.
2. Take a soft brush or toothbrush and gently stroke the scalp to loosen old skin. Doing this two or three times a week is adequate in most cases. If this is ineffective, you may try Selsun® medicated shampoo two times per week. Carefully shield the eyes when using the shampoo.

Umbilical Cord

The umbilical cord will usually fall off within 1-3 weeks, and until it does, the navel (belly button area) should be kept clean and dry. Apply alcohol to the base of the cord 1-2 times daily until it falls off. When it falls off, there may be some oozing of blood, but this will stop. After the cord has fallen off and the area has healed, you may begin tub baths. If the area looks red or infected, you should contact us.

Circumcision

If your baby is circumcised, the area may be kept covered with a thin layer of Vaseline until it has healed to prevent irritation from the diaper. No other care is needed, and no band-aids should be applied.

Care of the Diaper Area

The diaper area should be cleaned with water and a mild soap. Diaper wipes are also acceptable. If a red spot develops, Aquaphor, Vaseline, or A&D Ointment can be used as an aid to healing. If the diaper rash is particularly severe and does not respond to these ointments, we should be contacted.

The following steps aid in preventing diaper rash:

1. Frequent diaper changes.
2. Cleanse area after each change.
3. Allow to dry completely.
4. Use Desitin, Vaseline, A&D Ointment, or Aquaphor if areas of irritation or redness are present.

If diaper rash occurs:

1. Increase frequency of diaper changes, rinse with water, and air dry at each change.
2. Avoid diaper wipes.
3. Leave baby undiapered when possible
4. After air drying, apply Desitin, Vaseline, Aquaphor, or A&D Ointment with each change.
5. Call us if the rash doesn’t respond to these measures in several days.

Heat Rash

This rash consists of small red bumps in the armpits, groin, and on the back of the neck. Sponge the area with a cool cloth and allow to air dry.

Other Rashes

Many newborns have a rash which may appear on their chest, back, arms, or legs. This looks like little splotches which come and go. This fades by two weeks of age and needs no treatment.

During the first two months of life, infants often develop a rash on their faces that resembles acne. This is newborn acne and is due to a normal hormonal change that infants go through. This is best treated by washing the face with plain water once a day and blotting the skin dry. The baby’s face should be exposed to air, and it’s helpful to prop her from side to side to sleeping to help with this. Powders, oils, and creams are not helpful and should be avoided. This newborn acne will not lead to scarring. If the face appears particularly dry, apply a small amount of Moisturel or Eucerin lotion once a day.

Teething & Teeth

At 2-4 months of age, babies start to drool because they don’t swallow their secretions well. Teething is not associated with fever greater than 100.5, runny nose, or cough. Looser stools may occur. Teething often causes discomfort. Most teeth begin to appear at 4 to 12 months. If this causes particular discomfort, give oral Tylenol up to every 4 hours as needed. Infants may enjoy chewing on cold teething rings.

Brushing teeth should begin after teeth have erupted. Use a soft bristled brush or washcloth with a small amount of water or baby toothpaste before bedtime. Your baby should first see a dentist around 18-24 months of age.

Visitors & Visiting

Friends and relatives are interested in your baby and want to hold, hug, and kiss him. Unfortunately, you may not know who has a cold, sore throat, cough, or other infection. Therefore, we would tend to overprotect babies for the first few months. Encourage friends and relatives to wash their hands before holding your baby and refrain if they are ill. Weather permitting, you may take your baby outdoors after the first several days. In the winter, it is best to wait several weeks before taking your baby out. For the first two months, it is best to avoid contact with other children and with large groups of people such as in a crowded shopping center.

Sun Exposure

In the summer, your baby’s skin will need to be protected when she is outdoors, even from indirect sunlight. Babies should be shielded from direct sun exposure whenever possible. Sunscreen lotions with SPF of at least 15 are recommended, especially when swimming. It should be applied to a small test area prior to generalized use to check for sensitivity. Be careful not to get sunscreen into your baby’s eyes because it will sting. We also recommend hats on babies for protection, as well as encouraging extra fluids on hot days.

Travel

Infants generally travel very well. Plan ahead to allow more frequent stops for feeding and diaper changes. Infants should always travel in approved car seats in the rear facing position until the baby is 20 lbs. and 1 year old.

For those babies taking airplane rides, it may be helpful for the baby to be nursing or sucking on a pacifier during take-off or landing. This allows for equilibration of ear pressure during changes in altitude.

Feeding

Feeding time is a pleasurable time for both parent and child. Both of you should be comfortable. Choose a room that is quiet and a chair that is comfortable. This will help you to be calm and relaxed as you feed your baby. Your baby should be warm and dry so that he is comfortable too. Hold your baby in your lap, with his head slightly raised, and resting in the bed of your elbow. Place a pillow under your elbow for added support. Whether breast feeding or bottle feeding, hold the baby comfortably close. Do not drink hot liquids or smoke while feeding your baby. A spilled drink or falling ash could seriously burn your child.

BREAST FEEDING

Breast feeding is a very natural and beautiful way of feeding your baby. It is an active process that requires two participants. To successfully breast feed, a mother must have her own personal motivation. A woman should not feel guilty for not wanting to breast feed. This is a personal choice.

There are numerous advantages of breast feeding. Mother’s milk is readily available, fresh, warm, and is designed by nature specifically for babies. Breast milk contains all the fluid and nutrients necessary for babies to grow and develop for the first 6 months of life and maybe even to a year. Infants who are breast fed have a lower risk of infections because breast milk contains antibodies, proteins which help prevent infection. These benefits are seen only in babies breast fed for at least 3 months.

Because breast milk is a complete diet for young infants, there is no need to begin solid foods until 4-6 months of age. Breast milk contains iron which is easily digested by babies. Breast milk may, however, be deficient in vitamin D. An infant vitamin drop should be added at 1 month old if the baby is exclusively breast feeding or consuming less than 16 ounces of formula daily.

Nursing should begin as soon as it is convenient after delivery in a setting that is relaxed for the baby and mother. This may be in the delivery room, recovery room, or postpartum room. The initial attempts by the infant to breast feed are to stimulate milk production rather than to obtain calories. At first, your baby may not nurse well at each feeding, but each day, nursing will improve. Don’t be discouraged if your baby does not seem interested in nursing each feeding. Babies are all born with extra body water which they lose over the first 3-4 days. During this time, their appetite will gradually improve.

During the first 3-5 days after birth, your breast secretions are called colostrums. This is a thick, yellow liquid secreted in small amounts which contains high concentrations of glucose, calories, and antibodies (to prevent infection). Your baby should initially nurse from each breast for 5 to 10 minutes at each feeding on demand or about every 2 to 3 hours.

Alternate the first breast offered at the beginning of each feeding. If your baby becomes drowsy before finishing feeding, you may want to switch breasts after 8-10 minutes of nursing to prevent your baby from tiring and completing his feeding. If your baby has a particular problem, such as jaundice, we may suggest a temporary supplement with formula. However, if both you and your baby are healthy, these supplements are unnecessary.

For the first 3 to 4 weeks of life, we feel it is best for you and your baby to have a demand feeding schedule. Most babies fall into a rather predictable 2 to 4 hour feeding schedule. As a general rule, you may feed your baby up to every 2 hours if there is a time of day when he is awake and fussy. During the day, if your infant sleeps longer than 4 hours, wake him up to feed him. At night, let your baby sleep as long as he wants. This will gradually allow a longer sleeping stretch to occur at night.

During the first 3 to 4 weeks, you will produce a transition, or immature, milk which is not quite as rich as mature milk. For this reason, your baby may want to nurse frequently (that is, every 2 to 3 hours). This is normal, and although it is tiring for nursing mothers, it is nature’s way of making your milk supply meet your baby’s demands. Supplemental formula and solid food are not recommended unless you have discussed this with us.

It is best to burp your baby halfway through and at the end of a feeding. Breast fed babies normally have yellow, seedy, watery stools. These may occur after each feeding and tend to become less frequent as your baby gets older. Older breast fed babies may only have one or two stools per week. This is normal. As long as the stools are not hard and pellet like, your infant is not constipated.

While you are breast feeding your baby, your health is important. It is important that you get extra rest, eat a well-balanced diet, and drink extra fluids. It is helpful to drink a glass of water while you are nursing to insure that you are taking in the additional fluids your body requires to produce an adequate milk supply. Occasionally, your baby may be bothered by something you eat. Common offenders are caffeine containing drinks, nicotine, chocolate, spices, tomatoes, vegetables in the cabbage family, and orange juice. Don’t give up any food unless it regularly bothers your baby. You should remain on your prenatal vitamins as long as you are nursing.

Certain medications will come through in the milk, but usually only in small amounts. However, discuss any medicines you will take with the doctor in the office. Let your physician know that you are nursing if she wants to prescribe medication. If you have a cold or other viral illness, it is best to continue nursing right on through your illness.

If you need to be away for a feeding, you may pump your breasts and store the milk so that your baby can be bottle fed with breast milk. Breast milk may be kept refrigerated for 24 hours and frozen for 90 days. Do plan ahead, though, because you will probably need to pump your breasts more than one time in order to obtain enough milk for a single feeding (usually 4 to 6 ounces).

How long to breast feed is your choice. As it sometimes takes 4-6 weeks for you and your baby to establish a regular pattern of nursing, it is generally a good idea to continue for at least this long. Many babies are breast fed for 9 to 12 months. They can then be weaned directly to a cup. The greatest concern for most new mothers is, “Will I be able to produce enough milk for my baby?” The amount of milk produced is determined by the amount taken in by your baby. The milk glands are stimulated by the baby’s sucking to produce more milk. Generally, mothers are able to produce much more milk than their infant needs. If your baby is having six or more wet diapers per day, he is almost certainly receiving an adequate amount of milk. In order to determine if your baby is receiving enough milk, we will follow his weight and examine him periodically. Supplemental bottles of formula may be offered after your milk supply is well established. Supplemental bottles (or bottles) introduced too early may interfere with the baby’s appetite for breast milk and thereby interfere with nursing. After 2-4 weeks, an occasional supplemental bottle of formula generally does not interfere with breast feeding. Breast feeding alone is not an effective form of birth control.

BREAST CARE

Wear a well-fitting nursing bra 24 hours a day for comfort and support. Your breasts should be washed with a mild soap and water daily and air dried. Before each feeding, wash your hands. Some nipple tenderness is quite normal at first and will pass within the first few days. Sore nipples can be helped by exposing them to the air as much as possible and varying feeding positions. If you have sore nipples, nurse no longer than necessary to empty your breasts (5-10 minutes on each side).

When your milk first comes in, or a feeding is missed, your breasts may feel tender and full. This results from stretched milk ducts which are engorged with milk. Several measures can be used to relieve this fullness: a cool cloth on the breast between feedings, applying warmth (a warm shower or heating pad) on the breast before feeding to enhance let down, feeding the baby on the fuller side first, gentle hand expression of milk, and nursing frequently for shorter periods of time.

Bottle Feeding

During the first day of life, most babies will take ½ to 1 ounce at each feeding. This will increase gradually so that by 72 hours of age, your baby should be taking at least 1-2 ounces each feeding. As your baby grows, the amount of formula taken at each feeding will increase, and the number of feedings each day may gradually decrease.

Several forms of formula are available- powered formula, concentrated liquid (which is mixed with water), and Ready-To-Use (requires no mixing but is slightly more expensive). Most mothers use the powered or concentrated liquid form. Powered formula is prepared by adding one scoop of the powder to 2 ounces of water. Concentrated liquid is prepared by adding equal parts water and formula (i.e. one 13 ounce can of formula plus 13 ounces of water).

If you have city water, you do not need to sterilize the water before mixing it with the formula. If you have well water, it is necessary to boil the water used to mix the formula for the first four weeks. Water boiled for 5-10 minutes can be placed in a clean jar and kept in the refrigerator for mixing that day’s formula. Once mixed, formula should be refrigerated and used within 24 hours. Washing bottles, nipples, and caps in the dishwasher or in soapy water and rinsing in hot water is satisfactory. Sterilization is usually not necessary.

The brand of bottle and/or nipple you use is not important. The nipples should drip slowly when the bottle is inverted. It may be necessary to enlarge the hole in the nipple with a hot needle. Nipples that drip fast should be discarded. The cap of the bottle should be loose enough so that air bubbles can enter the bottle as the baby sucks.

Your baby should be kept on formula for the first 12 months of life. These formulas provide every known requirement your infant needs during the first 4-6 months if she receives no solids at all. Do not give your baby cereal or baby food until we have discussed it at a well baby visit. Formula is probably best accepted if it is at room temperature. Formula can be warmed by using a pan of warm water or running the bottle under warm water. Do NOT microwave formula. Many babies have been burned. Test the bottle to make sure it is not too hot or cold by dropping a drop onto the inner aspect of your wrist. old the bottle inverted so that the nipple end is always filled with milk. Burp your baby half way through the bottle and after the feeding is completed. You may burp her by holding her upright in a sitting position or on your lap and gently patting on her back. She may feed as long as she wants.

Introduction to Baby Foods

Solid foods are not started until 4-6 months. Breast milk or formula will supply all the nutrients necessary for growth and development. The following suggestions are given to help you and your baby add solid foods. When you start baby foods, always use a small spoon. A “baby spoon” or small spoon with a long handle is recommended. Remember, a baby has to learn to use the tongue and throat muscles in order to take solid foods from a spoon. At first, this may be confusing to your baby, but with repeated practice, your baby will do better.

1. Never put baby foods in a bottle or use an “infant feeder” unless you have discussed this with your baby’s doctor.
2. Put the food towards the back of the baby’s tongue. This will help to decrease spitting out. If she does spit some out, it’s probably because it is new to your baby and not because it doesn’t taste good.
3. Start with 1-2 teaspoons once or twice a day, as your doctor directs, and gradually increase the amount to 4-5 teaspoons.
4. Offer only one new food at a time. Offer a new food at least 3-4 days before introducing a new one. That way if signs and symptoms such as rash, hives, diarrhea, or vomiting develop, you will know which food to eliminate.
5. If your baby rejects a food, offer it the next day or wait a week or so and try it again. Babies do develop likes and dislikes.
6. Baby foods may be commercially prepared or you can make your own as long as they are well cooked, strained, or put through a blender or baby food mill. Do not add spices, salt, honey, or sugar. Do not keep longer than 24 hours unless frozen.
7. As new varieties of foods are introduced, your baby’s meal patterns should be like the rest of the family’s with three meals a day and 1-2 snacks.

What food should be started first? Although there is no set pattern, the following guidelines may be helpful.

1. Cereal - Cereals can be started at about 4 months of age. Start with rice cereal first. Mix 1-2 teaspoons with a small amount of breast milk, formula, or apple juice. Increase amounts gradually. Do not add sugar, salt, or honey.
2. Fruits - Fruits can be started at about 4-5 months of age. Start plain fruits first. Fresh, mashed bananas may be used instead of commercially prepared ones. Save mixed fruits for last. These may be offered 2-3 times per day.
3. Vegetables - Vegetables can be started at about 4-6 months of age. Begin with yellow vegetables such as carrots, squash, and sweet potatoes, or mild tasting green vegetables. Start mixed vegetables after your baby has had the plain ones first. Offer these 2-3 times per day.
4. Meats - Strained meets are added last, generally at about 8-9 months of age. Mixed dinners are a good way to try new meats.

Around 6 months of age, your baby will be ready to start using a cup. Start by offering very small sips of a liquid (water or formula) several times a day. You may want to use a cup or a “sippy cup” as your baby decides she wants to do it herself.

Bowel Movement

A baby may normally have a bowel movement after each feeding or only every 2 to 3 days. The frequency of bowel movements is not usually of great consequence. The stools are usually soft and greenish-yellow but may take on the color of something the baby has eaten.

Your baby may strain when he has a bowel movement, but unless the stool is hard and pellet-like, this is normal. You need not become concerned unless the stools are very watery or quite firm and hard for the baby to pass. If one of these is the case, contact us during office hours. Do not use medicines, home remedies, or suppositories without contacting us.

It is very unusual for breast fed babies to be constipated. They normally have stools which have a seedy and watery consistency. As they get older, they become very efficient at absorbing your breast milk. They often change from having a stool after each feeding to having one only once or twice a week. This is normal! They may still grunt and strain to have a bowel movement, but when it comes, it will invariably be loose and seedy.

Fluoride

Daily ingestion of adequate fluoride from either fluoridated water or a vitamin-fluoride product can mean healthier teeth for your child. If the fluoride content of your family’s water source (such as well, filtered, or bottled water) is unknown, this can easily be determined and reported to you by the Indiana State Board of Health. We offer WAF-kits (Water Analysis Fluoride) at cost to you at our office. This comes complete with all instructions and a mailing label. If your water source is determined to be deficient or contains a minimal amount of fluoride, we will write you a prescription for the appropriate vitamin and/or fluoride product.