NEWBORN BOOKLET Cook Children s Pediatrics Burleson

Transcription

1 NEWBORN BOOKLET Cook Children s Pediatrics Burleson CONGRATULATIONS! Thank you for choosing our office for your newborn s care. We are here to help you through these first few weeks of your baby s life. This booklet is designed to help. Please read through it carefully and make note of any questions. A doctor will be by each day that you are in the hospital to examine your baby, provide instructions for your baby s care, and answer any questions that you have. Sometimes friends and family are eager to share information with you, or you may read some information on the internet, and while well-meaning, sometimes their advice is out of date or inaccurate. Our physicians and nursing staff will be happy to answer any questions and give you guidance by phone and at your office visits after you leave the hospital. This booklet is a good place to start for basic questions about your baby s care. Keep this booklet to use as a reference as your baby gets older.

2 FEEDINGS Breastfeeding Of all of the issues we can help you with in your child s early life, feeding may be the most important. We encourage you to breastfeed exclusively for the first 6 months of life. The benefits of breastfeeding are numerous and well-studied: better bonding between mother and child, improved immunity to various infections, decreased incidence of childhood obesity by as much as 32%, decreased incidence of diabetes, ear infections, diarrhea, lower respiratory tract infections, asthma, and childhood leukemia. If those advantages were not enough, breastfeeding decreases your risk of breast and ovarian cancer as well as post-partum depression. To improve your chances of successfully breastfeeding, do skin to skin time right after delivery and try to breastfeed within the first hour of life. Avoid formula or water. Giving formula in the first few days of life is the major cause of unsuccessful breastfeeding. (If the baby needs milk for medical reasons, there is usually donor breast milk available.) We recommend avoiding artificial nipples and pacifiers. However, if you have questions about using a pacifier please ask. Once your milk supply is well established by 2-4 weeks of age then introducing a pacifier is allowed. Have your baby room-in at night so that you can nurse when the baby is interested. Utilizing support groups in the community can help as well. (See the list at the end of the booklet). Getting started Directly after delivery, infants have an awake and alert phase which is the perfect time to breastfeed for the first time. After that, babies often are sleepy for several days, so during that time we recommend watching for your baby s interested cues. The best time to feed is when the baby is quiet and alert, or when he is smacking his lips or sucking on his hands and opening his mouth. When babies get hungrier they squirm and root actively, arch their back, or eventually cry moving their head back and forth. Even when they are interested, during the first few days of life they can latch on and suck a few times and fall back asleep. Don t be alarmed if a feeding or two doesn t go exactly as planned. This is a learning experience for both of you. Other times they latch on and don t want to come off or they suck a little, stop, and then suck a little more. It may be frustrating, but having the baby suckle does stimulate your milk supply and orients the baby to the whole process. If the baby is sleeping soundly, leave him alone. Avoid nursing too long with each feeding as this can make your nipples sore. You also can get sleepy during a long session which may put your baby at risk of falling or suffocating. Generally no more than 30 minutes of actual sucking is recommended per feeding.

3 Remember that it takes 3-5 days for your milk to come in but your baby will be getting your colostrum which is concentrated, energy rich and full of nutrients. Your baby will not starve before your milk comes in. Breastfeeding is a learned skill, so don t worry if it feels awkward at first. If you are having problems in the hospital ask for help from the nursing staff and the lactation consultants, or ask the doctor during daily rounds. Once you have gone home you may call the office for advice. Our nurses are specially trained in breastfeeding and have direct access to your baby s doctor. Don t give up. Everything gets much easier when your milk comes in. Remember, friends and relatives and the nurse next door all have good intentions but rarely have the experience of our trained staff. Breastfeeding positions There are many positions to choose from, so experiment and find the position which works best for both of you. There is no right or wrong position if it works. The sidelying position is good right after delivery, especially after a C-Section, where you lie on your side with the baby lying on his side facing you. This position removes the weight of the baby from your arms, back and neck. There is the traditional cradle hold where you sit in a chair with arm rests and your feet propped up or in a bed supported with pillows. Your baby s head is in the crook of your arm feeding from the same side breast. The cross cradle hold is where your baby is nursing and you use the same side hand to support your breast in a U hold while you support your baby with the opposite hand by holding the baby s head in the webbing between the thumb and index fingers with the palm between your baby s shoulder blades. There is also the football hold where the baby is tucked under your arm and the baby s head and neck are supported by the same arm. You can use the opposite hand to support the breast. Pillows help to get the baby to the correct height. Latching Make sure that your baby is latching on correctly with his nose aligned to the nipple and his mouth wide open and around the areola. If the baby only latches onto the nipple or if the latch is uncomfortable, detach the baby by putting your finger in his mouth, breaking the seal to avoid trauma to your nipple. Touching the baby s cheek with the nipple can stimulate him to root so that he opens his mouth and turns toward the breast. Feeding schedule Once your milk comes in (usually 3-4 days after delivery) try to encourage your baby to eat about every 2-3 hours during the day. Start to associate waking with eating, not going to sleep with eating. Alternate which breast you offer first with each feeding. Often babies prefer one breast over the other, but this improves once your milk comes in. We recommend no more than 30 minutes of feeding total, whether that is 15 minutes a side or 30 minutes on one breast. If you feed longer than 30 minutes the baby will probably just fall asleep. Allowing him to use you as a pacifier

4 won t help. Try to burp the baby after the first 5 minutes, between breasts, and at the end of the feeding. Once your milk is in, let your baby work a little bit for a night time feeding. Let him wake and cry (5 minutes) before feeding, and don t interrupt the baby s sleep just because you think it s time. At night they often make a lot of noise and if we immediately get up and try to feed, they often just take a few sucks and fall back asleep. So we want to encourage day time feedings and discourage the night time feedings, just a little. The more milk that your baby demands the more milk you will make. If you feel that your baby is not being satisfied with your breast milk call the office before introducing supplemental formula which would greatly affect your milk supply. The American Academy of Pediatrics recommends breastfeeding exclusively for 6 months, before we introduce baby foods. We encourage you to breastfeed your baby through the first year of life. Pumping If you are planning on pumping your breasts in order to store milk for future use, we recommend using an electric pump such as the Medela type breast pumps. Hand pumps can work but they are harder to use and can be time consuming. To maintain your supply we would suggest pumping after you breastfeed. This completely empties your breasts, stimulates more milk production, and ensures that the pumping doesn t decrease the amount of milk available to your baby. When you are with your baby always try to breast feed and only use your pumped breast milk when you are not together. When you are away from your baby for extended periods of time, like when you start back to work, try to pump as often as you can to maintain your milk supply. Breast milk storage We recommend that you use glass or Bisphenol A (BPA) free plastic containers with tight lids, or special freezer bags. Do not use bottle liner bags that tear easily. Store the milk in 2-4 oz portions to avoid wasting milk. Cool freshly pumped milk before adding it to already frozen milk. Leave at least 1 at the top of the container when freezing. Do not refreeze once milk is thawed. Date the bags of breast milk and store them at the back of the freezer where it is colder. Expressed breast milk can stay at room temperature for up to 6-8 hrs (in a covered container), and in an insulated cooler bag for up to 24 hours. Breast milk can be stored in the refrigerator for 5 days and in the freezer compartment for 3-6 months. If you have a chest or upright freezer you can store the milk for 6-12 months. Thaw milk by leaving it in the refrigerator for 4 hours, or by placing it in cool running water until it starts to thaw and then run warm water to finish thawing. To warm already thawed breast milk, put it very warm water and never use a microwave which does not heat evenly.

5 Breast care Wear a good nursing bra that supports your breasts and has snaps in the front so you can expose one breast at a time without having to undress. Buttoned dresses or shirts are most convenient. A cloth nursing cover that snaps around your neck or a baby blanket can make it more discreet while you nurse in public. Keep your nipples dry and clean. Wipe off your nipples after feeding and put a clean cloth or pad inside your nursing bra to keep your nipples dry. You can keep your breasts exposed for a while after feeding to let your nipples air dry. A little soreness is to be expected initially, but if the soreness lasts the whole feeding or it gets worse instead of better over time, please contact us before stopping breastfeeding. There may be a problem that we can help with and preserve your milk supply. COMMON BREASTFEEDING PROBLEMS Engorgement Engorgement typically happens between 3-7 days after delivery. It can also happen when milk is not removed from the breast regularly, or at times when you are away from your baby. When your breasts are engorged your nipple can flatten and the baby can have a hard time latching on. If this happens, pump your breasts before trying to have your baby latch on and try to nurse a little more frequently. Pumping after feedings can help empty your breasts and it will have a positive impact on your milk supply. Using a warm compress before nursing and a cold compress after feeding can help with the discomfort. You can also take an over the counter pain reliever. Nipple soreness Poor positioning or improper attachment at the breast is often a cause of nipple soreness. Make sure that your baby s mouth is wide open and that he is getting a good portion of your areola in his mouth when he latches on. When a baby sucks on artificial nipples he uses a more superficial sucking pattern. If your baby uses this sucking pattern when he breastfeeds, it can lead to frictional trauma of the nipples and soreness. This can also be seen with the use of nipple shields and breast pumps. Try to correct the latch and avoid using pacifiers until breastfeeding is well established by 2-4 weeks of age. Treat your breasts with purified lanolin cream or Hydrogel pads and breast shells to keep clothing away from sensitive skin. Yeast infections Nursing mothers can also get Candida infections (yeast infections) which require a prescription to treat. Your doctor can help you with this problem. When yeast infects a baby s mouth, it is called thrush. Thrush appears as a white plaque on the inside of

6 the cheeks and on the tongue and lips. Boil any bottle nipples or pacifiers for 10 minutes a day to prevent an infection in the baby s mouth. If you feel that your baby has developed thrush, give the office a call. Plugged ducts Plugged ducts appear as almost pimple like lesions on your nipple or areola that may be red and tender. If you feel that the openings of the ducts on your nipple are plugged, feed frequently on the affected side and change positions during the feeding. Also massage breasts towards the nipple and soak your breasts in warm water. Mastitis Mastitis is a bacterial infection of your breast tissue and causes pain and flu like symptom and there can also be redness and streaking of your breasts. This condition requires antibiotics so contact your doctor. Other things to help with mastitis are to nurse frequently, use warm and cold packs and over the counter pain medications. General tips When you are nursing, try to eat a healthy diet and continue your prenatal vitamins. It is recommended to take a calcium supplement. Take your calcium and your prenatal vitamins and any iron supplements at different times to better absorb the iron. Your baby will need a vitamin D supplement as well: give 1 ml or 400 IU a day to promote healthy bone growth. Consult your doctor before taking any medications. If you drink alcohol, do so in moderation and wait 2 hours before breastfeeding your infant. FORMULA Formula feeding Although we advocate breastfeeding and will do all that we can to encourage and support breastfeeding, we do understand there are medical or personal circumstances that may not allow breastfeeding to be an option for you or your baby. We understand that you have made this important and sometimes difficult decision after considering all of the facts and looking at your personal situation, and you have decided that formula feeding is the best choice for you and your family. We would like to assure you that the formulas available are safe and nutritious. Your baby will still thrive, and develop normally. Formula In general, we do not recommend one particular brand of formula over another, but we do recommend a cow s milk-based formula as the best option. There is really no

7 difference between powder, concentrate, or ready-made formulas of the same brand except for convenience and price. Generic and store-brand formulas offer the same nutrition as brand-name formulas and can be significantly less expensive. Organic formulas do not offer any nutritional advantage, but we will not discourage you from using one if you wish. When using a powder or concentrate, use tap water so your baby will get fluoride to promote strong teeth. There is no need to boil tap water before mixing the formula. Ready-made formulas do not contain fluoride so you may need to give a fluoride supplement. Bottles There are also many types of bottle and feeding systems to choose from. Again, we do not endorse any particular brand or system. Generally your baby will adapt to whatever method that you choose to use. All of the components should be dishwasher safe. When preparing formula always follow the mixing directions on the can. Never dilute the formula to save money as this can be dangerous for your baby. You may prepare formula one bottle at a time, or up to a 24 hour supply. Discard any unused prepared formula after 24 hours. Store prepared formula in the refrigerator until you use it. If your baby doesn t finish a bottle within 1 hour discard it and get a fresh bottle when he is ready to eat again. You may offer formula warm or cold. Cold formula does not cause colic. Never use a microwave to warm formula as microwaves do not heat uniformly and a hot spot may injure your baby. Nipples Test the nipples by making sure that milk can drip out rapidly without forming a stream. The nipple holes should be the right size to help your baby suck easily. If the holes are too small, the baby can tire out before getting all the formula that he needs. If the holes are too large, the formula can come out too quickly and overwhelm the baby s ability to swallow and they can gag or choke. Feeding schedule Offer formula around every 3 hours or so during the day, but do let him wake up and cry a few minutes (5 minutes) before you get up to get the bottle ready at night. If you hop right up to fix the bottle, often the baby is already back asleep when you return with the bottle. Formula changes If at some point you feel that your baby is having a problem that requires a formula change, call the office so we can evaluate the problem and best advise you on whether a formula change is necessary and what type of formula would likely fix the problem.

8 Sleeping routines Early on we want to establish a good wake, eat, play and sleep routine. Initially, to maximize night time sleeping, we want to encourage day time feedings and discourage night time feedings, just a little. Never wake your baby at night for a feeding, unless instructed to do so for medical reasons. Even at the very newborn stage, try to associate waking with eating rather than going to sleep with eating. When your baby wakes, try to feed him, burp him, and change his diaper. Then play and have fun interacting with him, but when your baby starts showing tired cues (yawning, droopy eyes and fussiness are common), lay him down on his back in the bassinet or the crib while he is still awake. Putting your baby in the crib content but still awake is the most important step towards having your baby sleep well. If your baby only goes to sleep in your arms or at your breast, he will learn he can only sleep with you. If your plan is not to have your baby sleep with you, but for him sleep by himself in the crib, you have to train him to go to sleep by himself in the crib. That means that you have to lay him down awake. Of course in the beginning when you lay your baby down awake he is going to cry, but crying is normal for babies and does not hurt them. Just check on him every 5-10 minutes, without picking him up and he will go to sleep and when he wakes up, feed him, burp him, and start the whole process over again. During the first month it is ok to swaddle your baby before laying him down awake (make sure that it is not too tight around hips and thighs). Discontinue swaddling by 1 month as babies can wiggle out making the blanket a SIDS risk. Instead, dress him in a warm night-time outfit and encourage him to learn to go to sleep without a swaddle. Fussiness Initially newborn babies are not awake very long after a feeding, so sometimes it is hard to lay him down awake. By 3-4 weeks of age they tolerate being awake about an hour. Watch carefully and when he starts to look tired, lay him down. Newborns rarely tolerate being awake more than 2 hours. Also be aware that fussiness almost always gets worse after 2 weeks of age, especially in the afternoon and early evening. This is due to the increasing stimulation he is experiencing through the day. Parents often misinterpret this as gas pains or stomach aches and naturally want to help. Bouncing, rocking, swinging and singing simply over stimulate the baby more and he can scream all night long. So, as soon as he starts to get fussy, lay him down. Limit rocking When you routinely rock your baby to sleep, he often wakes up when you put him down. It is better to lay him down awake and let him learn to go to sleep on his own. In general your baby needs to sleep in between feedings.

9 Night-time Put your baby down awake at night at a time that will eventually work for your schedule. In the middle of the night it is ok to let your baby wake and cry (5 minutes) before getting up to feed him. This makes sure that he is awake and hungry. You will receive a DVD called Period of Purple Crying. Watch it carefully and it may help to explain about your baby s crying. The most important message we want you to hear about your baby s sleep health is that you must teach your baby to self-sooth and to go to sleep on his own. You achieve this by putting him down while he is still awake. This is the best investment that you can make to earn a good night s sleep for the whole family. ROUTINE CARE Bathing The room should be warm. Gather your supplies before you begin so you do not have to leave the baby unattended. Sponge baths are recommended until your baby s circumcision has healed and the cord has fallen off (around 2-4 weeks of age). Wash the face with plain water and clean the eyes with a soft wet cloth. Do not use a Q tip to clean inside the ears. For the rest of the body use a mild soap such as Cetaphil Skin Cleanser or Dove. If your baby develops dry skin, use a regular moisturizer such as Eucerin or Cetaphil. Traditional baby lotion may smell nice, but may not be a very effective moisturizer. Do not use baby oils because it makes babies very slippery. In between baths, clean the diaper area with a wet washcloth or alcohol free wipes. If a diaper rash develops, use a barrier cream such as A&D, Desitin, or Dr. Smith s. Please do not use powders, which can aerosolize and be inhaled by your baby and cause health problems. Cord care Keep the cord clean and dry until it falls off between 2-4 weeks of age. Check the cord during diaper changes and if it looks wet or sticky where it attaches to the skin, dab on some rubbing alcohol with a cotton ball or a cotton tipped swab. It is normal for the cord to bleed slightly as it separates. After the cord is off, you can begin tub bathing. Circumcision For Plastibel circumcisions the Plastibel should fall off by 2 weeks of age. Keeping it dry will speed up the process. Use a wet washcloth if it needs cleaning, but avoid baby wipes until the circumcision has healed. For Gomco circumcisions replace the gauze with Vaseline over the head of the penis at every diaper change for about a week, or until the area has healed completely.

10 Vaginal care Newborn girls can have a thick white discharge, which can, on occasion, contain small traces of blood. This is due to stimulation by maternal hormones. The thick yellow covering sometimes seen in the vaginal folds has a protective role and will eventually disappear with normal washing. There is no need to remove this substance with vigorous cleaning. If stool gets into the vaginal folds, wipe the area with a soft cloth or Q tip to remove the stool. After the cord has fallen off a normal tub bath is adequate to clean the vaginal area Pee and poop Newborns on average only urinate 1-3 times a day until Mother s milk comes in. After the baby starts getting more milk, the number of wet diapers will increase. Babies have meconium stool that has a thick tarry consistency for the first 3-4 days after delivery. They become greener during the transition period and then the watery mustard color, typical of breastfed baby stools. Formula fed babies have more formed stools which can look seedy at times. In infants, the consistency of the stool is more important than the number of stools. If your baby s stools became hard balls or very thick and pasty (like dried out peanut butter) then your baby is constipated. If you think that your baby is constipated call the office during the day for advice. Diapers What type of diapers you use is a personal decision. There are many different brands of disposable diapers, and once again, we don t endorse any particular brand. Cost, the quality of the fit, and the lack of any skin irritation, are some of the things to look for in a disposable diaper. Cloth diapers are cheaper and better for the environment, but are not as convenient as disposable diapers. If you decide to use cloth diapers, buy at least 3 dozen diapers and prewash them in Dreft soap. Use the Velcro diaper covers or covers with snaps. Do not use pins or plastic diaper covers. There are diaper services available. Some families decide to use a combination of cloth during the day and disposable diapers at night. Pacifiers Sucking is a very strong reflex in newborns and it does bring a feeling of comfort and security. Using a pacifier can help calm fussy infants; however evidence has shown that offering a pacifier early on in breastfed babies can interfere with breastfeeding. The technique for sucking on a pacifier and holding it in the mouth is very different from the sucking motion that an infant needs to use to successfully breastfeed. For breastfed babies it is better to wait until nursing is well established (2-4 weeks of age) to introduce a pacifier. Once your baby is breastfeeding well, feel free to offer the pacifier. Every baby s needs are different and there are some babies that sucking is comforting and nipple confusion will not be an issue. If you are wondering if your baby would benefit from the use of a pacifier without it interfering with the establishment of breastfeeding, please discuss it with your doctor. Don t be

11 surprised if your baby prefers skin and does not accept a pacifier. These infants can eventually find their thumbs and fingers to suck on. Because the sucking motion used on the nipple of a bottle is similar to that of a pacifier, the bottle fed infant can be introduced to the pacifier at any time. External temperature At home set the thermostat so it is comfortable for you. If you like it cool, make sure that your infant is dressed warmly enough, but not overdressed. Hot infants are flushed and sweaty while cold infants are pale and mottled with their skin cool to the touch. You may take your baby outside when the temperature is pleasant after one week of age. We do not recommend exposure to direct sunlight until your baby is 2 months old. After that it is alright to use sunscreen, but we still recommend limiting direct sunlight. A sun-burned baby is a miserable baby. SIDS Sudden Infant Death Syndrome is mainly caused by suffocation. To prevent SIDS, we recommend lying your baby down awake on his back in a bassinet or crib with just a plain flat sheet covering the mattress. The mattress should have a waterproof cover, and it should be firm and fit the crib exactly without any gaps along the sides. You may swaddle the baby for the first month, but after that, no blankets should be placed in the crib. Instead, dress your baby in a blanket sleeper, or pajamas with feet so they stay covered and warm at night. Avoid using bumper pads or piling in toys or stuffed animals. Do not ever have the baby sleep with you in bed or on the couch. Multiple SIDS cases have occurred when the baby became wedged between the cushions of the couch, the parent and the mattress, or between the mattress and the wall or headboard, which results in infant suffocation. Postpartum depression A large percentage of women experience baby blues soon after delivery because of rapid hormonal shifts. The baby blues usually only last a few days and do not persist beyond 3 weeks postpartum. Postpartum depression is the most common complication of pregnancy and it affects 10-20% of mothers within the first year. There is also a 25-50% recurrence rate with subsequent pregnancies, and it is more common when other stressors are present. The symptoms are similar to depressive symptoms in general, but they are compounded by worries about the baby and about being a good parent. Some of the symptoms include: loss of enjoyment in previously pleasurable activities, loss of self-esteem and confidence, loss of appetite and weight, broken sleep irrespective of the baby, a sense of hopelessness, suicidal thoughts or ideas, panic attacks and an overwhelming fear for the baby s overall safety and well-being. We will be screening you for postpartum depression, but if you experience any of the symptoms contact your obstetrician. The benefits of treatment usually outweigh any potential risks of the medication on the baby, and are very effective in controlling the symptoms of postpartum depression.

12 NORMAL BABY BEHAVIORS AND CHARACTERISTICS. Common symptoms Sneezing, coughing and congestion are normal in newborns, especially after they first wake up. These are not symptoms of allergies or a cold. If the congestion is interfering with the baby s eating or sleeping, or if you see a lot of mucus in the baby s nostrils, you may use some saline nasal drops and suction out the mucus with the blue bulb syringe or a Nose Frida. Hiccups Newborns hiccup a lot due to small spasms of their diaphragm. They are normal and do not usually bother the baby or require treatment. Passing gas Babies swallow a large amount of air while they are learning to coordinate sucking, swallowing and breathing. This will improve with experience and as the baby learns to burp more effectively. Do not be surprised about how much gas your baby can pass. Also passing gas does not hurt, so when your baby is fussy it is not necessarily due to gas. Often it is due to the baby being tired. Irregular bowel movements Many babies will strain, turn red in the face, and occasionally cry when they are passing a stool, all of which is normal. Early on, some babies will have a stool with every feeding, and then change to having a large blow out once a week. Both patterns are normal. Unless the baby s stool is hard, the baby is not constipated and no treatment is necessary. If the baby s stool is hard, even if they have a small stool several times a day, call the office to discuss what to do. Irregular breathing Sometimes babies will alternate between very rapid and very slow breathing. This is a normal pattern and no cause for alarm unless the baby shows a color change, appears to be in distress, or has other symptoms indicating that he might be ill. Rashes During the first week, your baby may develop a hormonal rash that looks a little like mosquito bites. It usually resolves within the first week. They often develop baby acne which mostly occurs on their face, scalp and upper chest and back. This rash can come and go over the first 3 months of life and does not require treatment. If your baby s skin feels dry, apply moisturizers, especially right after bath time.

13 Illness If your baby feels very hot to you even undressed, take a rectal temperature. If it is more than degrees, please call the office. Temperatures taken under the arm or in the ear tend to be inaccurate. Other symptoms to watch out for are persistent, forceful vomiting (not just the typical spitting up that infants do after feedings), indifference to their surroundings, excessive/ inconsolable crying, refusing several feedings in a row, or a sudden change in the stool pattern, including possible blood in the stool. If you see any of these signs or symptoms, contact the office immediately. If your baby is under 2 months with a fever, or is overly fussy, DO NOT give Tylenol, or ibuprofen unless instructed to do so by our office. Molded head The skull of a newborn is flexible in order to pass thru the birth canal. After delivery, the skull is frequently irregularly shaped and asymmetrical. It will assume a more normal shape within the first hours. Frequent tummy time, while awake, during the first 6 months of life can help in reshaping the head and preventing your baby s skull from becoming flat on one side. Tummy time also helps strengthen your baby s back and neck. Curved feet and legs The uterus is not a very big place. Part of your baby s adaptation to this is having legs and feet that curve and bend to help them fit inside. Most often the lower legs and feet fold and curve inward to some degree. This resolves over time and is normal. Birth marks Most areas of redness or pigmentation present at birth will disappear within the first year or two of life. Red splotches are very common on the upper eyelids (angel kisses) and the back of the neck (stork bites). These are collections of capillaries that are close to the top of the skin and will fade as the baby s skin thickens. AFTER DISCHARGE First appointment Please call our office when you get home to schedule your first follow up appointment. The first appointment is usually 2-3 days after leaving the hospital to screen your baby for jaundice. There will be a second visit at 2 weeks of age to make sure that your baby is back to birth weight. The regular checkup schedule is 1, 2, 4, 6, 9 and 12 months. In the second year they will be seen at 15, 18, and 24

14 months. After 2 yrs of age, we see them once a year through college (after that they need to move to an adult doctor). During the checkups we will discuss your baby s feedings, growth, development and behavior. We will be happy to discuss any concerns that you may have during this visit as well. Some of the visits will include immunizations, routine blood work, or other testing / procedures if these are deemed necessary during our visit. Please choose a pharmacy and give the information to our receptionists so we can have it in our records. You can change your pharmacy choice at any time. Insurance Another reminder to add your baby to your insurance on the first business day after your baby is born. Most babies are covered during the first 30 days of life on mother s insurance, but it is important to check your individual policy so that you do not miss an important deadline. Visitors Friends and family will want to hold and love on your new baby, which is only natural. Unfortunately, most illnesses are spread through close contact and you may not know who has a cold, or a sore throat or some other infectious disease. Allow visitors to look at your baby without actually handling him, or make sure that they wash their hands thoroughly before touching your baby. In general, we strongly recommend that you avoid places or gatherings that would expose your baby to large groups of people. These can include public, or private nurseries (church or gym), church/ worship services, large family celebrations, and airports. It is better to wait until after your baby has received his first set of immunizations at his 2 month checkup.

15 THANK YOU We are honored that you have chosen us to be part of this exciting time in your lives. Please call on us at any time. There is no perfect manual. It is hands on learning, but we are here to educate you, to reassure you and to support you as you start on this exciting and ever-changing journey. RESOURCES American Academy of Pediatrics ( Breast Milk Counts ( La Leche League ( International Lactation Consultant Association ( ) Kelly Mom ( Breastfeeding INC ( Lactation Consultants at Andrews Women s Hospital ( ) Rocking Mommas Breastfeeding Support a mother to mother support group ( Cook Children s web site (