Congratulations! Thank you for choosing West End Pediatrics. Here are some questions that we are frequently asked about newborns.

Q: When should I bring my baby to the office?
A: Unless one of our doctors has told you otherwise, we would generally like to see your new family member for a first “well-child” visit at about 5 days of age if your child was a vaginal delivery and 1-2 weeks of age if you had a Caesarean section.

Q: How often should I feed the baby?
A: Immediately after birth most babies are alert for about 8-16 hours. Babies typically then become lethargic and less interested in feeding for a day or two until just about the time that your breast milk comes in. Use this time to get some rest. It is normal for your baby to lose about 5%-10%% of their birth weight during this period. By 2 weeks of age your child should be back to birth weight.

Regardless of whether you baby is breast- or bottle- fed, they will most likely want to eat about every 2-4 hours (6-12 times per day). We recommend that you try to feed your baby about every 2-3 hours during the day, even it means waking the baby. Let them sleep longer at night to encourage them to move into our time zone. Keep your baby unwrapped during feeding in order to increase wakefulness. Once your milk is in, usually not a subtle event, try not to supplement breast feeding more than once a day. If you are bottle feeding, please discuss the appropriate formula for your child with us.

Q: How long should each feeding take?
A: If you are breast feeding, allow your baby to suckle for about 5 minutes at each breast per feeding on the first day and then increase the length of feeding by about 1-2 minutes every other feeding until you have reached 15 minutes per breast per feeding.. Feedings (breast or bottle) should take about 30-40 minutes. Breast fed babies will generally empty the breast in 5-7 minutes or good sucking, so 15 minutes should be plenty of time. Feeding for longer periods of time can result in unnecessary soreness at the breast. The strongest signal to make more breast milk is how often the breast is emptied, not how long the baby suckles. If your baby still wants to suckle after going 15 minutes at each breast, offer them a clean pinky or pacifier.

Q: How do I know that my baby is getting enough?
A: You should see at least 6 wet diapers a day and your baby’s gums should feel slippery like a fish and not tacky like scotch tape. If you find your baby consistently wants to eat more often than every 2 hours, or you are not getting enough wet diapers, or you are just worried, then make an appointment with us to check your baby’s weight. How do I burp my baby? Try to burp your baby by patting them lightly over the middle and left side of their mid-back. You can do this with the baby over your shoulder or sitting on your lap facing sideways while you support your child underneath the jaw. If you want to do the sideways burp, please ask us to show you how to position your baby. You should try to burp your baby once or twice during a feeding and then again at the end. If you don’t get a burp after 2 minutes, stop and try again 5 minutes later. If you still don’t get a burp then give up. Your baby may just not have swallowed any air.

Q: How many times a day should my baby make a stool?
A: Babies usually have a reflex that causes them to stool after or during most feedings. However, there is a lot of variation and stooling patterns can vary from once a day to 12 times a day. Newborn stools are initially dark and tarry and then tend to transition to a green (bottle fed) or yellow (breast fed) color. Stools can be orange, yellow, green, brown, seedy, mucusy, pasty, or watery. You should only worry about the stool if there is blood in it.

Q: I saw some reddish stains in the diaper and I am wondering if I need to worry?
A: Baby girls often have a slight bloody discharge from the vagina at about a week of age. This is from withdrawal of the mother’s hormones and is very normal. You may also occasionally see orange or pink stains in the diaper. These are usually uric acid crystals and not blood. However, they may indicate that your baby is not sufficiently hydrated nad if you see them you should call our office.

Q: I am a new Mom and I don’t know very much about how to care for my son’s genitals. What should I watch out for?
A: The only penile care that is necessary for uncircumcised boys is gentle cleansing of the penis and foreskin. Do not attempt to retract the foreskin. For circumcised boys apply Vaseline or Bacitracin to the penis for 3-5 days after the circumcision. Sometimes the circumcised penis will develop a yellowish membrane during healing process. This is normal and needs no specialized treatment.

Q: My baby has pimples – does this mean that he will always have bad skin?
A: Those pimples are usually what is called “newborn acne” and they are really not pimples at all. They do not indicate an increased risk of teenage acne. They may come and go for up to 3 months. Talk to your doctor if the skin is severely irritated or dry.

Q: What is newborn jaundice?
A: Babies often become a bit jaundiced (yellow) at 3-5 days of age. A yellowish tinge to the baby’s eyes, face, and even the upper chest is not unusual. However, if they yellow extends farther than the upper chest then your baby should be seen in our office. Jaundice occurs because liver is initially unable to adequately metabolize bilirubin, which is breakdown product of the hemoglobin in red blood cells. This is a job that the mother’s liver has done throughout gestation. The newborn liver usually begins to clear the bilirubin faster around 6 or 7 days of age. Sometimes breast milk will contain some antibodies that actually slow the removal of bilirubin and babies can remain a bit jaundiced for weeks. This is called breast milk jaundice and is not something to worry about once your doctor has assured you that the bilirubin level is not of concern.

Q: How do I care for the baby’s umbilical cord?
A: The remnant of the umbilical cord is usually a hard scab by the time you leave the hospital. Make sure that diaper band falls below the cord so that the cord does not rub up against the infant’s abdomen. Newborn diapers usually have an indentation in the waistband to take care of this. When the cord is about to fall off, it may look yellow and disgusting. Only worry about the cord if it is foul-smelling or has a red rash at the base. Give only sponge baths until the cord falls off and the umbilicus is dry. After that, you can begin tub baths and some skin moisturizing soap. Some doctors recommend going around the base of the umbilical cord with some alcohol on a cotton ball 2-3 times per day until the cord falls off. This is fine, but it is not clear whether or not this really has a beneficial effect.

Q: How do I care for my baby’s bottom?
A: Always wipe your baby’s bottom from front to back to avoid bringing stool in the baby’s vagina or penis. Diapers are so absorbent, that wiping is usually only needed after a stool, not a urination. During first 4 weeks use a light towelette with some water to wipe the baby. As far as diaper creams go, you might want to wait to see how sensitive your baby’s skin is. If you do need a cream, A&D ointment or Vaseline are good barriers to prevent diaper rash, while Balmex, Desitin, or other zinc oxide containing creams are better for treating an actual diaper rash.

Q: It seems like my baby’s skin is just peeling off – do I need to worry?
A: Most babies will shed their outer layer of skin over the first few weeks of life. This is not surprising when one considers that have essentially spent the previous 9 months in a hot tub. This peeling usually begins on the feet and hands. Some skin moisturizer helps a bit, especially if the skin becomes raw around the neck elbows, armpits, ankles, or backs of the knees.

Q: My baby feels warm a lot of the time – how do I know if it is a fever?
A: Babies have a low surface to volume ratio and so they naturally feel warm. You should take your baby’s temperature a few times with a rectal thermometer to see what the temperature is when your baby feels warm. In general, if you find your newborn has a temperature of 100.4oF (38oC) or higher then you should let the doctor know immediately. Babies sometimes run a temperature or feel warm because they are a bit dehydrated or overwrapped. Before checking your baby’s temperature, keep them unwrapped while you feed them to make sure that any fever you detect is real.

Q: My mother in law wants to bring all her friends over to meet the baby. Is this okay?
A: Every sight, sound, and smell is a new experience to your baby. We suggest limiting visitors to your closest friends and relatives to avoid overstimulation during your child’s first two weeks. Anyone who has been outside should wash their hands before touching the baby. We also recommend that, to reduce the risk of infection, no one under the age of 7 years except for brothers and sisters should hand handle the newbornfor 6-8 weeks. You should not feel that you have any social responsibilities other than taking care of the baby. We suggest that you change the message on your answering machine to announce the name, birthdate, and birthweight of the baby and that you will return the call when you can. Your friends can wish you all the best and you can avoid any hosting or telephone responsibilities until you are ready. Just let your closest friends and relatives visit—and let them feed you!