Newborn Care

Caring for Your Newborn

New Parents and Baby

Your baby is unique. As parents, the people most closely involved, you will come to know your baby best. Trust yourself. Most new parents are unsure of their parenting skills. These worries will soon disappear with experience. You will see that you can provide the proper nutrition and the love, warmth, and attention your baby needs. Our staff is here to answer your questions and address your concerns as you build your confidence.

All babies sneeze, yawn, burp, have hiccups, pass gas, cough, cry, and get fussy. These are normal behaviors. Sneezing is the only way babies can clear their nose of lint, dust, and mucus. Hiccups are common little muscle spasms, but not painful. Crying is a baby's way of saying, "I'm tired," "I'm wet," "I want to be held," "I'm too hot," "I'm hungry." Gradually, you will learn what your baby means when she cries.

Because a baby's resistance is not very good in the first few months of life, it is a good idea to make an effort to minimize exposure to infection. This can be best done by not exposing your baby to anyone you know who has a contagious disease (including a cold or flu virus), restricting visitors to a select group of special family and friends, and asking that everyone who is going to touch the baby to first wash their hands thoroughly. Other friends and relatives can visit you and the baby later.

Regular Visits to Our Office

There is a recommended schedule of "well baby" visits to which you should bring your baby. These visits will give us a chance to check on your baby's growth and development, to talk with you about the care of your baby, and to offer guidance as your baby grows. Immunizations against a wide variety of important childhood illnesses are generally given at these well-baby visits/ During these visits, our staff will also discuss with you our recommendations for handling many common childhood illnesses and problems.


The kinds of injuries a baby may experience change with age, so you need to consider and adjust your safety efforts continuously. No one can protect a baby from all hazards, but there is a lot you can do, starting the day your baby comes home from the hospital.

Car Safety

Always use a government-approved, rear-facing car safety seat in the back of your car. In an accident, a baby held in a passenger's arms can strike parts of the inside of the car or be thrown from it. Make sure that there is NO air bag protecting the seat where your baby is placed. Ask us for information to help you buy, rent, or borrow an approved car seat.

Be sure your dashboard and back seat shelf are free of all objects that could fly off if you hit the breaks suddenly. Never leave your baby alone in a vehicle. Keep the vehicle at a comfortable temperature and well ventilated. On hot days, check the car seat surface before placing your baby in the seat. Cover a leather or plastic seat with a towel to avoid burning the baby. On cold days, bring an extra blanket to cover your baby.

Crib, Bassinet, Carriage, Playpen, Changing Table

The crib for your baby must have slats or bars no more than 3 - 3/8 inches apart, no unsafe design features, and a snug-fitting mattress. To avoid blocking your baby's breathing, do not have pillows, large and fluffy toys, blankets, or loose plastic sheeting in the crib, bassinet, carriage, or playpen. Cover the mattress with a waterproof cover, quilted pad, and well-fitting, soft baby sheet. Healthy infants should be placed on their back when put to sleep. Always be with your baby while he is on a flat surface above the floor unprotected by side rails, to avoid injury from falls. Keep one hand on your baby while he is on the changing table.


A baby's delicate skin burns easily. When you take the baby outside, shade him from the hot rays of the sun. Set your water heater no higher than 120°F (48.8°C). Always test the temperature of your baby's bath water to be sure it's not too hot. Smoking cigarettes while feeding or playing with your baby is harmful to his lungs. It is also dangerous because hot ashes could fall on your baby. Also, don't hold the baby while cooking or drinking hot liquids. Hot food could splatter on the baby, he could touch hot pans or their contents, or hot liquids could spill onto your baby.


As your baby grows, keep small objects such as buttons, pins, and toys with small parts our of the baby's reach so he cannot pick them up and swallow them. If you offer a pacifier, use only a commercially made one that meets safety standards and doesn't have a long cord that could wrap around his neck and cause choking.

Never leave your baby alone with a person you don't know. Never let a stranger take your baby from you, no matter what the excuse. Don't leave your baby alone with a pet, no matter how "friendly" the pet has been. Don't leave your baby alone with any young child.


Daily bathing of newborns may dry their skin and is unnecessary. Newborn babies don't get very dirty, except for the diaper area, which you can clean at each diaper change. Until the umbilical cord stump has fallen off, only a sponge bath is needed. After that, two or three baths a week are plenty.

It's a good idea to have a regular time for bathing your baby. The room should be warm, with no drafts. Keep bathing supplies together to save steps. You can bathe your baby in a small tub containing comfortably warm water no more than 3 inches deep. Check the water temperature with your elbow before placing the baby in it. NEVER turn your back for even an instant while your baby is in the tub.

Wash the baby's face with plain, warm water and a soft cloth. Do not use soap. To clean around the eyes, use cotton dipped in cool water. Wipe from the bridge of the nose to the ears. Do not try to clean either the inside of the nose or ears, but clean outer areas with a moist washcloth or cotton ball.

Wash your baby's head with a mild shampoo. Work from front to back, to keep suds out of his eyes. Clean carefully over the soft spots. We should be notified if there is greasy scaling (cradle scalp).

Use a mild soap and warm water to wash the baby's body. Be sure to wash in the folds of skin. Rinse well. Pat him dry. Powders and lotions are not necessary for routine skin care. Powders, in particular, should be avoided as babies have been injured by accidentally inhaling baby powder.

Trim your baby's fingernails carefully with a nail clipper. This may be necessary several times a week.


Wet diapers and frequent feedings are signs that your baby is getting enough to drink. Sometimes it is difficult to determine if a diaper is wet. It is common, during the first 4 to 5 days after birth, to find a pink-colored stain in your baby's wet diapers. This results from normal crystals in the urine and is not a problem.

Preventing Diaper Rash

Change your baby's diaper frequently. Let her bottom air-dry as long as possible at each diaper change. You may use a zinc oxide cream or petroleum jelly to protect the skin. Do not use powder.

Changing You Son's Diaper

If your son is circumcised, gently rinse the area at each diaper change. It is important to keep the area as clean as possible. The gauze wrap on the penis will usually fall off within 24 hours following circumcision. We recommend applying petroleum jelly or an antibiotic ointment to prevent the penis from sticking to the diaper.

Changing Your Daughter's Diaper

Using a wet cloth, wipe from front to back. Gently clean between all creases of skin. A little blood-tinged mucus from her vagina is normal at first. If this condition continues, becomes more frequent or heavier, call us.

Bowel Movements

Bowel movements of newborn babies vary considerably in size, color, consistency, and frequency. A baby may have several bowel movements daily, or none for a few days. Frequent bowel movements in a breast fed newborn are a good indication that he is getting enough breast milk. Stools may be yellow, brown, or green - firm, loose, or pasty. Your baby's first stools are black-green, tarry, and sticky. They are called meconium. By day 2 or 3, the stool will probably become brown to green and seedy. A breast fed baby's stools are generally yellow, loose and seedy once past the meconium stage. The stools of a bottle-fed baby may be yellow, green, or brown and may be loose to well-formed.

Change your baby's diaper as soon as possible after each bowel movement or wetting. Clean the diaper area and wipe it gently with a cotton washcloth or a non-sensitizing diaper wipe.

General Feeding Information

At Feeding Time

Feeding is one of your baby's (and your) most pleasant experiences. At feeding time, your baby receives nourishment and a feeling of security from your loving care. The food helps you baby grow healthy and strong. Loving helps your baby develop a sense of security and stability.

Both you and your baby should be comfortable at feeding time. Choose a position that will help you relax as you feed your baby and that your child is warm and dry.

A Schedule With Flexibility

A feeding schedule should be flexible, allowing your baby to eat when she becomes hungry. Very young babies usually need to be fed every 2 to 3 hours, but older babies may wait for 4 or 5 hours between feedings. Although crying is the only way a young baby can complain of hunger, crying may mean other things as well. If your baby cries within 2 hours after a feeding, check for other causes such as an uncomfortable position or wet diaper before feeding her again.

Burping Your Baby

Try to burp your baby during and after breastfeeding and bottle-feeding. It's also a good idea to try burping your baby halfway through a feeding. Burping helps remove swallowed air. To burp, hold the baby in an upright position so that her head is directly above her stomach. Sometimes a baby will not be able to burp, so don't try to force one. Don't be alarmed if your baby spits up a few drops of her feeding when being burped.

Feeding Your Baby Other Foods

According to the American Academy of Pediatrics, there is no need to begin feeding a baby solid foods or liquids other than breast milk or formula before 4 to 6 months of age. When that time is near, we will discuss with you the addition of new foods. When solid foods are introduced, generally one new food is begun every several days. When fruit juices are given, they should be limited to a total of no more than 4 - 6 ounces per day. Water supplementation is unnecessary for both formula fed and breast fed infants. Whole cow's milk should not be given before one year of age.

Don't give your baby honey before her first birthday. Certain bacteria that are sometimes found in honey may cause a serious disease called infant botulism in your baby. Older children don't get the disease, so feeding them honey is not dangerous.

Vitamin Supplements

The need to supplement an infant's diet with vitamins or fluoride is individualized, based on what diet your infant is being fed and where you live. Breast fed babies will likely need a vitamin D supplement, starting in the first two months. We will discuss this with you at your first visit and, if indicated, prescribe accordingly.


Feeding Your Baby

Breastfeeding is the optimal way to feed your baby. Just as a mother is capable of nourishing her baby for months in the womb, she is also completely capable of completely nourishing her baby at the breast. Breast milk is the ideal food for your baby.

Your breast milk is suited to our baby. It is always available at the right temperature, doesn't need any mixing or equipment, and costs very little. By choosing to breast feed, you are helping protect your baby from common early childhood illnesses such as colds, ear infections, and diarrhea, especially during the early weeks and months of her life.

The ideal goal is to breast feed for at least the first year, but your baby will benefit from whatever amount of breast milk she receives.

Keep in mind that you should breast feed without introducing a bottle or pacifier for at least 3 to 4 weeks to assure that breastfeeding is well established. We recommend that you continue to breast feed your baby for as long as you can. If possible, continue to feed your baby your breast milk until her first birthday.

Techniques for the Breastfeeding Mother

The way your baby "latches on," or attaches to your breast, is one of the most important things to master for successful breastfeeding. Making sure your baby correctly latches on will help prevent or minimize sore nipples. Gently lift and support your breast, with your fingers below the breast and your thumb above, well away from the areola (the dark area around your nipple). Gently stroke your baby's bottom lip with your nipple in a downward motion several times. Pause to see if he will open his mouth. Repeat this until your baby opens his mouth very wide. Then quickly pull him onto your breast so that his nose, cheeks, and chin are all touching the breast. Most of your areola should be in the baby's mouth. If your nipples become sore as the feeding continues, remove your baby from your breast, after breaking the suction, and try reattaching him. You should call our staff if you develop sore nipples.

When you breast feed in the sitting position, hold your baby on his side facing your breast, with the baby's lower arm tucked around your waist. Your baby's face, tummy, and knees should be facing you, in a snug tummy-to-tummy position. If his nose is blocked, pull his bottom upward and closer to you so his head will move back slightly.

Alternate the breast offered first at each feeding. Babies should be offered both breasts at each feeding. When your baby loses interest in the first breast, stop and burp him. Then offer the second breast for as long as you both want. Generally, most newborns should feed for at least 10 minutes and they should be able to complete a feeding in about 60 minutes or less. To change breasts, put your finger into the corner of the baby's mouth between the gums, and he will open his mouth, releasing the suction. Let your breast completely air-dry after nursing.

Check the information below for signs that your baby is getting enough breast milk. Please call our office if you are concerned that your baby is not feeding well, or if you are feeling overwhelmed, anxious or just unsure about the breastfeeding process. Getting help early will often prevent problems from developing.

If you need to be separated from your baby at a feeding time, once breastfeeding is well established, you can leave behind a bottle of milk that you express from your breasts. You can express breast milk by hand, or by using a breast pump (see information later in this section). If one is needed, my staff can refer you to a lactation consultant for assistance in selecting and renting or purchasing a breast pump.

Signs Your Baby Is Getting Enough Breast Milk

A healthy, full-term newborn who is breastfeeding well at least eight times a day should need no feedings other than mother's milk. Your baby is most likely getting enough milk if:

  • Your milk "comes in" (increases in amount) - making youth breasts feel firm and full - between the second and fourth days of breastfeeding.
  • Your breasts feel full before a feeding and softer afterward.
  • Your baby has no difficulty latching on.
  • She is breastfeeding every two to three hours - at least eight times in a 24-hour period.
  • She usually breast feeds for 10 minutes or more and no longer than 60 minutes at each feeding. Let your baby, and not the clock, determine how long a feeding lasts.
  • She gives you signs that she is ready to be fed. She may lick and smack with her lips and tongue, clench her fists and put her hand to her mouth, or flex her arms and legs.
  • You can hear a rhythm of suck/pause/suck during feedings.
  • Your baby usually breast feeds at both breasts
  • She appears satisfied and no longer hungry after feedings.
  • She has at least one wet diaper the first day of life and three on days 2 and 3. Look for more wet diapers on das 4 and 5. Your baby should wet at least six diapers every day after about 6 days of life with a clear, colorless urine.
  • Your baby is passing yellow, seedy runny stools, starting on day 3 or 4. If she is not passing any stools, or is still passing meconium (thick and black or dark green stools), contact our office.

Expressing and Storing Your Breast Milk

Your situation will likely dictate which method of expression you use. For example, if you need to be away from your baby for full-time work or school, or if your baby is premature or sick and unable to breast feed, it is recommended that you rent an electric breast pump. Select one with a double pumping kit so you can pump both breasts at once and cut the time in half that you will need for expressing milk. If you need to be separated from your baby only occasionally, a hand pump or hand expression may suit your needs.

Expressing Your Milk by Hand

Wash your hands thoroughly with soap and water. Place one hand at the edge of the areola of one breast, with your thumb above and fingers below the areola and the nipple in the center. Your fingers and thumb should not move on the skin, as this leads to pinching off the nipple. Pull back toward your chest, press your thumb and fingers together to squeeze the breast, and then roll them forward toward your nipple. Hold your thumb and fingers in this squeezing position as long as milk comes out. Then let go. Do the same thing again. Continue to do this "milking" action in a rhythm. Move your hand around the areola to reach all parts of each breast. Alternate between breasts, continuing until enough milk has been expressed. Remember, hand expression is like any other manual skill: it takes practice before you become good at it.

Using a Breast Pump

Several different types of breast pumps are available:

  • Hospital grade electric pumps produce the closest imitation of both the pressure and rhythm of a baby's sucking action. They are the most appropriate choice when breastfeeding is going to be delayed for a considerable time (as with a premature baby) and the most convenient is you will be away from your baby for long periods on a regular basis (as when returning to work or school).
  • A double pump set-up permits pumping both breasts at once. The advantages are that it takes half the time to pump and can increase the level of prolactin, the hormone that tells your body to make milk. WIth a double pump, it usually takes 10 to 15 minutes to express your milk. If you do one side at a time, it will take 10 to 15 minutes per side. These pumps are expensive to purchase, but they are available for rent on a weekly, monthly, or longer basis. They usually can be rented from hospitals or medical supply companies. Check with our office for information on how you can obtain these pumps.
  • Small hand-held battery or electric pumps are used to collect milk from one side at a time. They vary in type and quality, from good to ineffective. Before purchasing one, talk to someone who has used a hand-held pump successfully or ask a certified lactation consultant or our office for advice on which type to choose. This kind of pump is probably most appropriate for a limited amount of pumping, as when you collect for an occasional separation from your baby. With practice, expressing your milk should take no longer than about 30 minutes. Follow the manufacturer's instructions for using and cleaning the pump.

Resolving Challenges When Expressing Your Milk

If you have difficulty expressing your milk, don't panic. This does not necessarily mean your milk supply is low. Some of the following tips may help you:

  • Relax. For about 5 minutes before beginning to express, sit or lie in a comfortable, quiet place and close your eyes. Take several slow, deep breaths for the first few minutes. When you feel yourself relaxing, picture in your mind either your baby breast feeding well at your breast or your milk flowing freely from your breasts as you express.
  • Get into a "pumping routine" by always pumping in the same location(s), and keep a picture of your baby, or one of her toys or blankets to look at while you pump.
  • Try putting warm compresses on your breasts for a few minutes before expressing.
  • Massaging, stroking, and gently shaking your breasts can help your milk let down before and between episodes of expressing.

Storing and Handling Your Breast Milk

The following are basic procedures for storing and handling your milk:

  • Wash your hands before touching your breasts, any of the breast-pump parts, or your expressed milk.
  • Transfer your expressed milk into a clean glass or rigid plastic, food-safe container or heavy-duty breast milk bag for storage.
  • Label the container with the date and time the milk is collected so you can be sure to use the oldest milk first. You may also want to mark the amount of milk you collect.
  • Freshly expressed milk contains antibacterial factors that enable it to be kept at room temperature for up to 4 hours. But to be on the safe side, place your milk in a cooler or refrigerator as soon as possible.
  • If you intend to store your breast milk for longer periods of time, freezing your breast milk is preferred. Freeze your milk within 24 hours after it has been expressed. Refrigerated breast milk should be used within 24 hours if possible.
  • Freeze your milk in small (2- to 4-fluid-ounce) portions so they will thaw fairly quickly.
  • Wash all the pump parts that come in contact with your breast milk in hot, soapy water after each use; rinse well in hot water. Follow the manufacturer's suggestions about putting pump parts in the dishwasher. Milk storage containers should be washed in the same manner if they are to be reused.


If you choose to supplement your breast milk with an infant formula, talk to us first. Infant formulas provide a safe and nutritionally complete alternative to breast milk, but do not offer the same benefits as your breast milk. The American Academy of Pediatrics recommends an iron-fortified infant formula as the only acceptable alternative to breast milk for the first 12 months of life. Whole cow's milk and low-iron infant formulas should not be fed during a baby's first year. Even if you choose to use infant formula for some feedings, you can still continue to breast feed. Many mothers find that a combination of breast feeding and formula feeding works best for themselves and their baby.

If your situation requires that you be away from your baby at feeding time, on a regular basis, and you will be unable to express your milk while away, you may want to start the conversion to formula a few weeks ahead of time. This will allow your breasts to reduce the amount of milk that is made for less frequent breastfeeding and your baby to adjust to the bottle of formula. For example, if you will be missing two breast feedings every day, start to introduce bottle feedings about 2 weeks before being away. During the first week, give your baby one bottle feeding each day at the time you expect to be away. Express only enough milk from your breasts at this missed feeding to relieve any discomfort. The next week, give him two supplemental feedings each day. Again, express only enough milk for relief. The law of supply and demand is at work here: The need to express your milk when you are away will decrease over time.

Formula Feeding

Feeding Your Baby

Deciding how and what to feed your baby is a personal choice only you can make. Breast milk is the optimal feeding for a baby. For that reason, we recommend that you breast feed, and for as long as possible during your baby's first year. In addition to supplying proper nutrition, breast feeding helps protect your baby from disease.

If you have chosen not to breast feed, if you need to supplement your breast milk, or if you stop breast feeding before your baby is a year old, we will recommend that you use an iron-fortified infant formula. The American Academy of Pediatrics recommends an iron-fortified formula as the only acceptable alternative to breast milk during the first year. Whole cow's milk and low-iron formulas should not be fed during a baby's first year. Do not change formula unless you talk to our office first.

Choosing the Right Infant Formula for Your Baby

Nutrition will never be more important for your baby than during the first year. Your baby will grow more and develop faster that during any other period in her life. You can be confident that infant formulas are both safe and nutritionally complete, and will provide your baby all the nutrition she needs for proper growth and development.

Your Baby's Delicate System

As a new mom, you may find it comforting to know that more than half of babies spit up to some extent. Occasional spit-up is normal for both breast fed and formula-fed babies. Usually, the most sensible course is to continue feeding the same brand of formula, and not make changes that could further upset your baby's system.

It is important to remember that your newborn's digestive system needs time to fully develop. Most babies gain weight despite spitting up. A change in formula is just one more thing that can confuse the situation and is usually not necessary. But if symptoms persist, we may recommend a soy formula. Soy formulas are milk-free and lactose-free, and provides balanced nutrition for the full first year.

Tips for Preparing Formula

  • Always follow the instructions on the label.
  • Wash your hands and all supplies carefully before preparing formula.
  • Always test the temperature of the heated formula before feeding by shaking a few drops on your wrist.
  • Never use a microwave oven to warm formula, this can result in hot spots that can burn your baby.
  • Throw out any formula left in the bottle after feeding.

Techniques for the Bottle-Feeding Family

When you feed your baby, she should be in a semi-upright position with her head higher than her body. Hold the bottle so the nipple is always filled with formula. This helps your baby receive formula instead of air. Air in the baby's stomach may give a false sense of being full and may cause discomfort.

Sucking is part of a baby's pleasure at feeding time. A baby may continue to suck on a nipple even when it has collapsed. Therefore, take the nipple out of your baby's mouth occasionally to make sure it hasn't collapsed.

Never prop a bottle or leave your baby alone to drink. Remember your baby needs the security and pleasure of being held at feeding time. Face-to-face contact is very important for your baby. Sometimes, your baby will take every drop in the bottle, and sometimes not. Don't worry this is normal. You can usually tell when your baby has had enough when he stops sucking, frequently turns away, or falls asleep. You should never force your baby to finish a bottle. Throw out any formula left in the bottle.

When your baby regularly finishes every drop at each feeding and sometimes cries for more, it may be time to increase the amount of formula in the bottle at each feeding. Your baby will need larger amounts as he grows.

Choosing the Formula That's Best

Different babies and their parents have different needs. That's why infant formulas come in three forms:

  • Ready To Feed requires no measuring or mixing. It is convenient for everyday use and especially for your day-care or travel needs.
  • Concentrated Liquid is easy to mix and convenient for preparing several bottles in advance.
  • Powder is handy for making one feeding at a time and can be used for up to one month after opening.

You can mix Powder or Concentrated Liquid with sterilized water (water that has been brought to a rolling boil for one minute, then cooled to room temperature), with tap water from the cold-water faucet, or with bottled water. Our staff will tell you which to use. If you have non-chlorinated water or well water, it is especially important to sterilize the water for your baby's formula. Do not add water to Ready to Feed Formula.

Choosing the Right Nipple

There is no "correct" nipple shape; however, different babies are likely to have a different preference for one shape over another. Try different ones until you find the nipple your baby likes.

Another thing to consider when choosing a nipple is the size of the hole. The hole should be large enough so your baby doesn't have to work too hard to get the milk out, but not so big that the milk flows too fast causing your baby to gulp or choke. Repeated use may distort nipple size. Make sure you examine the bottle nipples frequently and discard at the first sign of wear.

Cleaning Bottles

After feeding time, scrub bottles, nipples, caps and rings with a bottlebrush in soap and hot water. Or, put them in the top rack or basket of the dishwasher. Squeeze water through the nipple hole during washing and rinsing, to keep it from clogging. Rinse everything well in hot water. Test nipples regularly to be sure the holes are the right size and there are no signs of wear.

Changing Formulas

Continue feeding the formula we have recommended until at least the baby's first birthday. If you have reason to believe that your baby's chosen formula is causing any problems, please discuss the concern with us. Please be sure to check with our office before making any feeding changes.

Your Sleeping Baby

Newborns do not have the same sleeping patterns as adults. Regular sleep patterns develop as your baby gets older. Newborns usually sleep 16 - 18 hours a day. They sleep 2 - 3 hours, wake up, eat, and go to sleep again. They often seem to have no real pattern and no regard for whether it's day or night. At about 6 weeks old, their sleep and wake pattern begins to become established. By 16 weeks, many will have settled into a regular schedule.

When putting your baby to bed, the American Academy of Pediatrics recommends that healthy infants sleep on their backs to reduce the risk of SIDS (sudden infant death syndrome). SIDS is a term used to describe the unexpected death of babies in their sleep for no known reason.

Six Steps to Reduce the Risk of SIDS

  1. Put your baby on his back to sleep in an appropriate, safe infant crib with a firm mattress.
  2. Do not put your baby to sleep in a bed shared with any other person (including yourself), on a couch, sofa, waterbed or any soft mattress.
  3. Do not let him sleep on soft things like cushions, pillows, blankets, sheepskins, or foam pads. Keep your baby's crib free of extra fluffy blankets and stuffed animals.
  4. Smoking during pregnancy has been associated with a higher risk of SIDS. Do not smoke near your baby. Do not let others smoke near your baby.
  5. Do not let your baby get too hot. Dress him in as much or as little as you would wear. Do not wrap your baby in lots of blankets or clothes. If your baby is sweating, has damp hair, or is developing a heat rash, he may be too hot.
  6. If possible, breast feed your baby. Breast feeding has been shown to be healthier for your baby and may reduce the risk of SIDS.


Your baby will require certain immunizations for protection against childhood diseases. If your child has had a reaction to a previous immunization, please let us know.


The following immunizations are recommended for all children. During routine office visits, we will tell you at what age each immunizations should be given:

  • Hepatitis B
  • Rotavirus
  • DTaP (Diphtheria, Tetanus, Pertussis [Whooping Cough])
  • Influenza Type B (Hib)
  • Inactivated Polio Virus (IPV)
  • Influenza
  • MMR (Measles, Mumps, Rubella [German Measles])
  • Varicella (Chicken Pox)
  • Hepatitis A
  • Meningococcal (MPSV4)

If you would like to see an immunization schedule, click here

If the following reactions occur with an immunization given in our office, contact us immediately: baby's temperature higher than 102°F (38.8°C), uncontrollable screaming, excessive sleepiness, limpness, paleness, or a convulsion.


Certain tests are a part of routine well-child care. These screenings may include tests for the following:

  • Anemia
  • High Cholesterol Levels (depending on family history)
  • Blood Pressure
  • Lead Poisoning
  • Vision Problems
  • Hearing Problems

Newborn Screening

All newborn babies are required by law to be tested, or screened, for certain rate inherited diseases. These diseases, if untreated, can seriously interfere with a baby's development. For screening, a few drops of blood are usually taken from the baby's heel. Although all babies are screened in the hospital, sometimes babies have to be screened again after they have gone home. In certain situations, the screening may not detect the disorder the first time. We will tell you if your baby needs to be screened a second time for these rare but serious diseases.

Common Concerns

Choking and CPR

We recommend you take an infant-child CPR course so that you can receive proper training to handle these potentially life-threatening problems.


Constipation in infants less than one year of age can be a source of concern for parents. Sometimes your baby is not really constipated, but must be given time to set his own schedule for having a bowel movement. Remember that some grunting and straining is normal. Generally, an infant's stool is soft and easily passed. Irregular bowel movements do not necessarily mean a baby is constipated. If your baby is having large and very hard bowel movements or seems to struggle painfully when having them, please discuss with us.

Treatment for Constipation:

  • If your baby is old enough to eat strained foods, you may give him fruits and vegetables.
  • If your baby is not eating jarred baby food yet, we may recommend fruit juices (prune, pear, cherry or apple). If his stools become too loose, just give him less juice.
  • If your baby is eating rice cereal, it may help to switch to oatmeal or barley cereal. Rice cereal can cause constipation.
  • Do not give your baby enemas, laxatives, or suppositories unless we direct you to do so.


One of the most common illnesses among infants and young children is diarrhea. The most common cause of diarrhea in infants is an intestinal virus. It may be accompanied by fever and/or vomiting. A child may have several large watery stools or more frequent (more than 5 or 6 in 24 hours) loose stools. Usually, diarrhea lasts only a few days and can be managed at home. Our staff will discuss with you the routine management of diarrhea.

During diarrhea, babies lose fluid and important minerals from their bodies. Excessive fluid loss caused by diarrhea can lead quickly to a serious condition called dehydration, especially if the baby is also vomiting. Dehydration may become severe enough to require a baby to be hospitalized to have fluid replaced.

It is important that extra fluids be given to replace the fluids being lost during bouts of diarrhea, and to replace the nutrients (electrolytes) also lost in these stools. DIscuss with us the need to keep on hand an oral electrolyte maintenance solution and instructions for its use. An oral electrolyte solution is the best way to replace the fluids and minerals your child is losing.

You may have heard that sports drinks, fruit juices, weak tea, and soft drinks containing sugar are good to give your baby during diarrhea. However, these liquids are not best for your baby. They do not have enough sodium and proper balance of electrolytes to replace what is lost during diarrhea. Most of these fluids also contain too much sugar. Too much sugar can draw water into the intestine and away from the rest of the body and make diarrhea worse. The best fluid to give your baby is an electrolyte maintenance solution.

Know the signs of diarrhea-more frequent, watery stools, often a change in color and odor. Follow our instructions for dealing with diarrhea. Be sure to call if your baby has persistent vomiting or you note any of the following signs of dehydration:

  • Less frequent urination (fewer wet diapers)
  • Dry mouth
  • Few tears
  • Overly sleepy or overly fussy
  • Sunken eyes



Fever in a newborn is a concern to us. If your baby is 2 months or younger, and has a rectal temperature above 100.2 degrees Fahrenheit, call us immediately.

Older Infants

Fever in infants older than 2 months of age is commonly associated with infectious illnesses and can be treated with acetaminophen or ibuprofen. If your baby's fever is very high or associated with unusual sleepiness or irritability, please call us.

Spitting Up

Spitting up is when some of the baby's stomach contents spill out of her mouth. This usually involves only small amounts of liquid, although it is often seems like a lot. Spitting up generally occur shortly after feedings, beginning in the few weeks of life. More than half of all babies spit up to some extent after they have been fed. Occasional spit-up is normal for both breast fed and formula-fed babies.

In many cases, spit-up is thought to be due to an immature muscle in the base of the esophagus, the tube connecting the throat to the stomach, which allows the stomach contents to back up into the mouth. This is often referred to as "GE reflux" (gastroesophageal reflux) and goes away as the baby matures. Though spit-up may be messy, it's usually not a cause for concern. Most babies gain weight well despite "spit-up." If an infant is frequently in distress, is not gaining weight as he should or has other symptoms, we may need to do some further evaluation.

Spit-up happens. If your baby spits up occasionally, here are several things you can do to help keep meals down:

  • Avoid feeding your baby when he is lying down and keep him upright for about 30 minutes after feeding in a front carrier, a back carrier, or in your arms.
  • Avoid placing him in an infant seat, which can increase pressure on the abdomen.
  • Avoid vigorous play and jostling after feeding your baby. Excess activity can aggravate an already delicate system.
  • Control the amounts you are feeding. If your baby gets an overly full stomach, it is more likely to overflow. Give more frequent, smaller meals to see if that helps.
  • Burp your baby often and control the amount of air and liquid he takes in. Check the nipple-holes size. If the hole is too small (which may increase the gulping of air) or too large (and the formula flows too fast), your baby may spit up more.
  • Try to feed your baby before she is overly hungry. Gulping formula too fast may lead to spit-up problems.


Vomiting occurs when the stomach contents are ejected through the mouth with force. It usually is a cause of great distress for baby and family. When vomiting occurs, it usually involves more than just a few mouthfuls. Call our office right away if you notice any of the following:

  • Frequent, repeated vomiting
  • Crying (with legs pulled up) that cannot be soothed
  • Fever
  • Blood in vomit
  • Green vomit
  • Can't keep fluids down
  • Repeatedly refuses feedings
  • Any signs of dehydration
//All information comes from "Caring for Your Newborn," ©2009 Abbott Laboratories Inc.