This is the "on-line" version of the CROCKETT KIDS Pediatrics "Baby Instruction Manual" given to parents of newborn patients in the practice. It contains some helpful information that many first-time parents can benefit from. It is by no means meant to be all-inclusive!
This “BABY INSTRUCTION MANUAL” was compiled, collected, and parts written by T. Scott Benefield, M.D. Some important sources included:
“Instructions for Pediatric Patients” by B. D. Schmitt, M.D. & “The First Year” -various authors.
CONGRATULATIONS!
You are the proud “owner” of a new baby! Don’t you wish newborn babies really did come with instructions? Since they don’t, we at CROCKETT KIDS Pediatrics have put together this helpful guide to that all-important first year of life. This is merely a guide…and not all babies are the same! If you have a question and can’t seem to find an answer, give Dr. Benefield a call! When all else fails…”read the instructions!”
TABLE OF CONTENTS
Believe it or not, as a new parent you know more about your baby than you think you do! You may be anxious about taking care of your newborn, especially if this is your first child. Actually, your baby can help you decide what to do next! Babies “talk” to us by their actions, telling us how they feel and what they want and need. They can tell you when they are bored, sleepy, or hungry. Some babies are naturally quiet, others are very active. Some eat and sleep at regular intervals…others don’t! As a parent, you’ll want to learn what your baby’s special needs are.
Life as a parent can be both wonderful and stressful! You’re going to sleep less and have to adjust to major changes in your routine. But, despite the sleepless nights and long days…your baby is worth it!!!!
BREASTFEEDING:No one has improved on “nature’s formula,” and
CROCKETT KIDS Pediatrics strongly encourages you to breast-feed. If you are having difficulties, tell Dr. Benefield or discuss this with a lactation nurse at the hospital.Breast-fed babies are fed “on demand.” This usually occurs every 2 - 3 hours initially. As time passes, your baby will develop a fairly regular timetable of his or her own.
BOTTLE FEEDING:If you choose not to breast feed, a cow’s milk formula can provide all the NUTRITION and FLUIDS your baby needs for the first 4 - 6 months of life. If your family has a history of milk allergy or your baby seems sensitive to a formula, Dr. Benefield may recommend a different formula…BUT DO NOT CHANGE FORMULAS WITHOUT TALKING WITH THE DOCTOR!
Bottle fed infants take 2 - 3 ounces of formula per feeding, and will eat every 3 - 4 hours during the first few weeks of life. By the end of the first month, your baby will be up to 4 ounces, with a fairly routine schedule of about every 4 hours. By 6 months, your baby will eat 6 - 8 ounces and will eat 4 - 5 times per day.
Most babies do not need solid foods before 4 months of age. Some babies who have special needs such as reflux may need thicker formula. If you suspect that your baby isn’t getting enough or you feel he or she needs extra food…let us know!
Most babies do NOT need extra water. Breast milk and formula, if mixed correctly, contain all the water and fluids your baby needs! Sometimes too much water can be harmful to babies! If your baby is wetting diapers several times a day, then that is a good way to let you know that your baby does not need extra fluids!
Avoid over-feeding babies too! Most babies indicate that they are full by stopping sucking or turning away. A crying baby is not always a hungry baby too! Avoid simply putting a bottle in a baby’s mouth to quiet him or her. This can lead to overfeeding and bad habits!
Most babies do NOT need extra vitamins. Dr. Benefield will advise you if your baby needs extra vitamins.
*Babies often LOSE weight during the first few days after birth. Most babies are back up to their birth weight by the second week of life, many before this time. The average newborn gains 2 - 3 ounces per day (1 ˝ - 2 pounds per month), and will grow 1 - 1 ˝ inches per month for the first 4 months.
VISION
A newborn baby does not see very well. Newborns can focus their eyes on objects from 8 - 12 inches away. Your baby will blink, roll and close the eyes in bright light. Babies love to look at human faces…especially those of mom or dad! The eyes are more coordinated at 2 months of age and most babies can see at the distance adults do by the time they are 4 months old.
HEARING
A newborn CAN hear. Babies seem to like sounds that change, such as human voices or music. Babies prefer human voices to other sounds and can tell the difference between sounds. Hearing you talk is very important for your baby and will help your baby develop good language and communication skills. Anytime is a good time to express love and praise to your child!
At 2 months, you will begin to hear your baby imitate some vowel sounds, like “ah-ah-ah” or “ooh-ooh!”
REACTING
Newborns have a number of reflexes that are designed to protect them…like crying, gasping, turning their heads side-to-side, and sneezing. Parents shouldn’t rely on these natural reflexes solely to protect the baby…keep things such as pillows and blankets away from your baby’s sleep and play areas.
ACTIVITIES
Smile and talk to your baby a lot! Comfort your baby by hugging and cuddling your baby often. Having quiet times, enjoying bedtime, and singing and reading to your baby are just a few of the ways to spend quality time with your new baby!
The first bath can be a fun, exciting and traumatic event! The first one or two baths can make your baby a little upset…but that’s OK! Pretty soon both you and your baby will love this daily ritual!
***Newborn babies shouldn’t be placed in tubs of water until the umbilical cord (“the belly button stump”) has dropped off. Clean the cord with rubbing alcohol each time you change your baby’s diaper, and pretty soon (within a few weeks), the cord will fall off. If it hasn’t fallen off by 2 weeks or 1 month of age, Dr. Benefield will put some special medicine on the cord to allow it to finally dry up.
Until the cord falls off, sponge bathe your baby.
Items you will need to have within easy reach (and ALWAYS STAY WITH YOUR BABY EVERY SECOND…NEVER TURN YOUR BACK ON YOUR BABY!)
Soft washcloth
Two towels
Disposable or cloth diapers
Clean clothes
Bar of mild soap or liquid baby shampoo. For sensitive babies, DOVE Sensitive Skin Soap is helpful.
Tub with 3 inches of comfortably warm water and a liner to keep your baby from slipping!
WASHING YOUR BABY:
Choose a place that is safe, warm, and free from drafts.
Use the cloth dipped in water to wipe around your baby’s eyes, outside of the nose, and ears. Avoid using Q-Tips in the baby’s ears.
Shampoo the hair and rinse with the washcloth.
Wash the front and then the back of your baby with your hand, and rinse with the washcloth.
When the belly button has dropped off, your baby will be ready for that first bath in the tub!
BATH SAFETY POINTS:
Keep your water heater set less than 120 degrees. Always test the bath water with your hand or elbow.
Don’t use Q-Tips or cotton swabs in the ears!
Don’t use powders around your baby’s face. They can make your baby cough or gasp for breath!
Always use a safe hold when moving your baby! Use both hands…better to drop the tub, a towel, or soap than your precious baby!
ALWAYS STAY WITH YOUR BABY!
Almost every baby gets diaper rashes! Most are due to prolonged skin contact with moisture. Bouts of diarrhea can also cause diaper rash.
Most rashes are usually better in 3 days. If they do not get better with over-the-counter creams, your baby may have a yeast diaper infection and may require a special cream that we may prescribe. Yeast infections are bright red, many times with tiny red dots around your baby’s “private parts!”
HOME CARE FOR DIAPER RASH:
Change Diapers Frequently: keep areas clean and dry. Make sure your baby’s bottom is completely dry before putting another diaper back on. If the bottom is especially raw, avoid baby wipes that may have alcohol and can burn your baby’s bottom!
Increase Air Exposure: Let your baby’s bottom “air out” or “air dry”.
Rinse the Skin with Warm Water and Dry. Avoid soaps as they may damage the skin. If your baby is especially dirty, you may use a mild soap like Dove.
Creams and Ointments: For most rashes, if a cream is needed, use A&D Ointment, Desitin, or Resinol.
Cornstarch is an old-fashioned remedy that helps reduce friction and can prevent future rashes once the bottom is healed.
PREVENTING DIAPER RASHES:
Changing the diaper immediately after your baby has had a bowel movement and rinsing the skin with warm water and drying are the most effective ways to prevent diaper rash.
CALL OUR OFFICE:
If the rash looks infected, with yellow pus, red streaks, or blisters.
The rash looks like a yeast infection, with tiny red bumps, or doesn’t go away in 3 - 5 days.
CRADLE CAP
Cradle cap begins in the first 2 - 6 weeks of life. Your baby’s scalp may look crusty and scaly…almost like “baby dandruff.” It usually is gone by 6 months of age.
HOME CARE FOR CRADLE CAP:
Soften thick crusts or scales with baby oil on the scalp 1-hour before washing the scalp. Make sure to wash all the oil off or it may worsen the cradle cap.
Massage with a brush. While the scalp and hair is lathered, massage your baby’s scalp with a soft brush or rough washcloth. Don’t worry about touching the soft spot…it’s well protected. Once the cradle cap has cleared, use a regular shampoo at least twice a week.
Sometimes babies don’t come out of the womb looking “picture perfect” like they do on TV. Be patient! Most newborn babies have some peculiar characteristics. Fortunately, these are usually temporary. Your baby will begin to look “normal” by 1 - 2 weeks of age. Always call our office if your baby’s appearance is concerning you!
HEAD
MOLDING: Molding refers to the long, “cone-shaped” head that results from passage through the birth canal. The head will return to normal shape in a few days.
CAPUT: This refers to the swelling on top of the head or scalp caused by fluid squeezed into the scalp during the birthing process. It also clears in a few days.
CEPHALOHEMATOMA: This is a collection of blood on the outer surface of the skull. It is due to friction between the infant’s skull and the mother’s pelvis. It usually appears on the second day of life and may grow larger for up to 5 days. It may not resolve completely until your baby is 2 or 3 months old.
SOFT SPOT: The “Soft Spot” is the top front part of the skull. Touching the soft spot is safe. The soft spot may also pulse with each heartbeat and this is also normal. It usually closes with bone by the time your baby is 12 - 18 months of age.
EYES
SWOLLEN EYELIDS: Your baby’s eyes may be puffy because of pressure on the face while passing through the birth canal, or because of the special antibiotic eye drops that are put in shortly after birth. It usually clears in 3 days.
EYE HEMORRHAGES: Flame-shaped hemorrhages may be seen on the white part of the eye. It is caused by birth trauma and is harmless. The blood is reabsorbed in 2 - 3 weeks.
COLOR OF YOUR BABY’S EYES: The permanent color of your baby’s eyes is often uncertain until your baby is 6 months of age.
BLOCKED TEAR DUCTS: If your baby’s eye is continuously watery, he or she may have a blocked tear duct. This is a common condition and most tear ducts will open by the time your baby is a year old. Sometimes the drainage may look infected…turning green or yellow. If this happens, let Dr. Benefield or Dr. Leung know and they will check it out and may prescribe special drops for your baby’s eyes.
EARS & NOSE
Many newborn babies have folded over ears or flattened noses. It may take a week or two for them to look normal!
MOUTH
SUCKING BLISTERS: A sucking blister may form in the center of the upper lip. This is caused by constant friction while feeding. It will disappear when your child begins feeding from a cup. Your baby may also develop a sucking blister on the thumb or wrist too!
TONGUE-TIED: The normal newborn tongue often has a short tight band that connects it to the floor of the mouth. This band stretches with time, movement, and growth. Babies with symptoms from tongue-tie are rare.
“EBSTEIN PEARLS”: These are little cysts or shallow white ulcers that can occur along the gum line or on the hard palate (roof of mouth.) They are quite common and disappear after 1 - 2 months.
TEETH: Although quite rare, some babies actually may have a tooth at birth! Sometimes these extra teeth will need to be removed by a dentist.
BREAST ENGORGEMENT IN YOUR BABY
Swollen breasts are present during the first week of life in BOTH boy and girl babies! This is caused by hormones from the mother passed along to the baby. They may be swollen for several weeks and one may be larger or smaller than the other. Never squeeze the breast! Call the office if the breast develops any redness, red streaks, or tenderness. Sometimes the swollen breast can have a milky discharge (“witches milk”).
FEMALE GENITALS
SWOLLEN LABIA: The labia in newborn girls can be very swollen because of maternal hormones passed along to the baby. This swelling will go away in 2 - 4 weeks.
VAGINAL DISCHARGES: As the mother’s hormones decline in the baby’s blood, a clear or white discharge can flow from your baby’s vagina. It may even become pink or blood-tinged (“false menstruation”). This is normal and should not last more than 2 or 3 days.
MALE GENITALS
HYDROCELE: A newborn baby boy’s scrotum can be filled with clear fluid that is squeezed into the scrotum during the birthing process. This painless collection of fluid is called a hydrocele. It is very common in little boys. It may take 6 - 12 months to go away. It is harmless and will be checked during your baby’s checkups.
UNDESCENDED TESTICLES: The testicles may not be descended into the scrotum in some babies. They usually gradually descend into the normal position during the following months. If the testicles fail to descend then they will have to be fixed. Dr. Benefield or Dr. Leung will let you know if this happens!
TIGHT FORESKIN: Most uncircumcised boys have a tight foreskin that doesn’t allow you to see the head of the penis. This is normal and should NOT be retracted!
ERECTIONS: Erections occur commonly in newborn boys, as they do at all ages. Erections may be triggered by a full bladder. Erections actually demonstrate that the nerves to the penis are normal.
BONES & JOINTS
TIGHT HIPS: Dr. Benefield will test your child’s hips and make sure they are not too tight or too loose.
BOWED LEGS: Bowed or curved legs are very common in newborns because they were crossed inside of mother. These curves will straighten out after your child has been walking for 6 - 12 months.
“INGROWN” TOENAILS: Many newborns have soft nails that easily bend and curve. They will straighten out as the toes get bigger and the nails get stronger.
FINGERS & TOENAILS
Cut your baby’s toenails straight across to prevent ingrown toenails. Round off the corners of the fingernails to prevent accidental scratches to your baby or you! Trim them weekly AFTER a bath while the nails are soft. Use clippers or baby scissors…don’t bite them off! This job may take two people unless you do it while your baby is sleeping!
NEWBORN SKIN, RASHES, & BIRTHMARKS
Newborn skin can quickly change colors and normally becomes dry and flaky during the second week of life. This guideline discusses several common rashes and birthmarks. No baby has perfect skin. Those babies in advertisements wear make-up!
ACNE OF NEWBORN: Many babies develop “acne” of the face, which looks like small red bumps. This may begin in the first weeks of life and last until your baby is 4 - 6 months of age. Since it is temporary, no treatment is needed. Baby oils or ointment may even make it worse!
DROOLING RASH: Most babies get a rash on their chin or cheeks that comes and goes. This is often due to contact with food and acid that has been spat up from the stomach. Rinse your baby’s face with water after feedings if your baby spits up.
ERYTHEMA TOXICUM: Many newborns get a rash called Erythema Toxicum on the second or third day of life. This rash looks like red blotches with a small white lump or pimple in the center. They may look like insect bites. They can be very numerous and be anywhere on your baby’s body. The cause is unknown, but they are harmless and usually go away by 2 - 4 weeks of age.
BIRTH TRAUMA: If delivery was difficult, forceps may have been used to help your baby get through the birth canal. Pressure of the forceps may bruise or scrape the skin. Pressure alone can also cause this. These bruises usually disappear in 1 - 2 weeks. For any breaks or cuts in the skin, use an over-the-counter antibiotic ointment like Neosporin four times daily until it is healed. If signs of infection occur, like fever, red streaks, or drainage, let us know!
MILIA: Milia are tiny white bumps that occur on babies’ faces. It most often occurs on the nose and cheek. They may look like pimples, but they are not infected. They are usually blocked skin pores, which will open up and disappear by 1 - 2 months of age. No ointments or creams are needed.
BLISTERS: Any true blisters or bumps containing clear or yellow fluid that occur during the first month of life must be examined and diagnosed quickly. If they are caused by the herpes virus, treatment is urgent! If you suspect blisters, call our office immediately!
STORK BITES: Flat pink birthmarks can occur over the nose, eyelids, or back of the neck (“ANGEL’S KISSES”). Most will clear by 1 - 2 years of age.
Fever is a warning sign to watch your baby carefully…especially during the first two months of life!!! A RECTAL temperature of
100.4 degrees or higher is a fever in a newborn. Many parents don’t like to check rectal temperatures. You may use other ways such as a pacifier thermometer, ear-check, or under-the-arm…BUT if any of these are high…check a rectal temperature to be sure! Fever in your baby could simply be that your baby is too hot or is bundled too tightly or has too many clothes on…or that your baby has a cold. However, fever can signal more serious infections…so always let Dr. Benefield know if your baby has a fever, or is not “acting right” (such as not eating, not urinating, vomiting, or sleeping too much and is hard to wake up.)Anti-fever medicines like Tylenol or Ibuprofen (Advil or Motrin) should not be used during the first two months of life unless Dr. Benefield says it is “OK.” Giving your baby these too soon may hide or mask a fever that we want to know about. It is OK to give your baby Tylenol before getting shots…we will tell you when!
Most parents want to know “How much should my baby sleep?”
SLEEPY NEWBORNS: New babies sleep a lot! They may sleep for 16 - 20 hours a day. By the time your baby is 3 - 4 months of age, your baby will sleep 13 - 15 hours daily…and even less when they get older.
FREQUENT WAKINGS: Most parents complain that their child has problems with frequent waking during the night. That’s not really the problem. It is natural for babies to wake in the middle of the night. The problem is the time it takes to get them back to sleep! It is natural for you to comfort your child…AND YOU SHOULD! You should always make sure nothing is wrong. Once you realize your baby is not hungry, wet, or sick…simply help your baby learn to fall back asleep! Each time your child wakens, wait a little bit longer to go into your child’s room. Reassure your baby briefly, but don’t try to get him or her back to sleep. YOUR CHILD MUST LEARN TO FALL ASLEEP WHEN YOU’RE NOT IN THE ROOM! It’s also a good habit to put your baby in the bed while he or she is AWAKE! Think about it: if you put your child in the bed after holding them or rocking them to sleep, that is the last thing your baby remembers…being secure in mom or dad’s arms. Who wouldn’t cry or be scared by waking up in a different place?
It sounds tough…but if you are committed and really try…it will work! Ask Dr. Benefield or Dr. Leung more about this if you have problems!
DEVELOP ROUTINES: Develop a bedtime ritual together. You’ll want this to be about 10 - 30 minutes of pleasant time. Your child will look forward to bedtime and find it easier to accept the separation from you as you leave the room. Reading a story or doing other quiet activities together is fun. TURN OFF THE TV!
CAR SEATS: Your baby should ride in a properly installed, federally approved car seat EVERY time you are in the car! Until your baby weighs 20 pounds AND is one-year-old, it should be in the back seat, facing the REAR.
BATHING:
Water heater set less than 120 degrees
Always watch your baby. NEVER turn your back on your baby!
SUFFOCATION PREVENTION
Keep baby powders away from baby’s face.
Keep the crib or baby bed free from small objects like stuffed toys that could be swallowed.
NEVER leave plastic bags or wrappings where your baby can reach them.
FIRE PREVENTION
Dress your baby in flame-retardant clothing.
Install (and regularly check) smoke detectors in the proper places throughout your home.
Do you have an escape plan for emergencies? Who is going to get the baby?
SUPERVISION
NEVER leave your baby alone in the house, yard, or car.
JIGGLING
NEVER jiggle or shake your baby’s head too vigorously.
Always support your baby’s head and neck when moving the body.
WHAT ABOUT THE 1001 OTHER QUESTIONS YOU NEED ANSWERED?
That’s what being a parent is all about! Make sure to take time out for yourself and time for the family!
Dr. Benefield is a phone call away and lots more topics will be discussed at the 1-2 week, and 2 month check-ups!
Again…
GOOD LUCK & CONGRATULATIONS!
