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THE HOME CARE OF YOU AND YOUR BABY
The instructions given here are helpful hints on how to keep your new baby healthy and happy. Please read it carefully and refer to it frequently - as it will be very helpful now and in the next few weeks.
Your baby is an individual from the day he is born. Adapt these instructions to your baby. Do not depend on friends and relatives. Our doctors and nurses will be happy to give you guidance and answer your questions, while you are in the hospital and later by phone and during visits to the office, I will give you detailed instructions for your baby at frequent intervals throughout the year.
There should be few visitors the first few days you and your baby are at home. Both the new baby and new parents must adjust to a new situation. For this reason, do not expect the first 24-48 hours to be "smooth sailing." As a new mother, you need time for rest and extra care.
Breastfeeding is the natural way to feed your baby, with many benefits for both of you. The breastfed infant should have few infections and allergies. The nursing mother's body will return to normal more quickly and you will have the satisfaction of accomplishing something worthwhile for yourself and your baby. A full milk supply depends upon rest, extra fluids, and a good dietary intake. However, even with ideal conditions, it may take several weeks for this to develop. Do not be impatient. Since breast milk is so easily digested, your baby will probably nurse about every 1-3 hours. Practically all women can successfully breastfeed.
Do not be discouraged if your baby does not breast feed well at first, as both you and he need to learn the art. At first, you are giving him a protein-rich substance called colostrum. After 2-4 days, your milk will "come in." Alternate the breast that you start with and use both breasts at each feeding. Since the newborn may be sleepy for the first few days, some feedings may be more successful than others. The baby may fall asleep after nursing on one side. To wake him to finish the feeding, you may want to burp him between breasts, unwrap him slightly, sit him up and rub his back and/or change his diaper. You need to encourage your infant to take the breast every 2-3 hours to stimulate milk production and avoid engorgement as the milk begins to appear.
Avoid sore nipples with correct positioning and latch-on of the baby to the breast. When baby is finished nursing, place your finger in the corner of baby's mouth and pull out or press on the base of the nipple to release the suction so that baby can be removed without hurting the nipple. If engorgement occurs, use moist heat before nursing, and feed frequently around the clock to relieve the fullness. If the nipple and areola (dark area around nipple) are too swollen for baby to grasp easily, manually express or pump some milk out to soften. If you are still engorged after the feeding is over, you may need to express enough milk to soften the breasts and relieve the discomfort. Ice packs can also be used after the feeding.
Avoid excesses of any foods. Try to avoid medications or drugs, other than vitamins or iron without physician's approval. Avoid large amounts of caffeine and alcohol. Tobacco should be avoided.
Do not listen to "old wives tales" and criticisms from friends and relatives. Have confidence in yourself and call our doctors or our Lactation Consultant for help if questions or problems arise.
ADDITIONAL HINTS ABOUT BREAST FEEDING
1. Frequency of Feeding: If the baby is crying and you are sure he is dry and comfortable, he is probably hungry. At first, he may be hungry every 1-3 hours.
2. Milk Leaking: (This is normal.) Wear breast pads inside your bra. Be sure you change the pad frequently, so that your breasts don't stay wet.
3. Expressing Milk: There are several ways to empty your breasts of milk. When you are in the hospital after the birth of your baby, the nurses can demonstrate these methods. If you wish to use a breast pump, you may buy one of the pumps that are on the market. We recommend (1) Medela Pump, (2) Egnell Pumps. Electric breast pumps are also available.
4. Diet During Nursing: A balanced diet with a lot of liquids is best. If a mother is allergic to milk, high calcium foods or calcium supplements can be substituted. It is helpful to continue your prenatal vitamins while breastfeeding. Check with your doctor before taking any medicines, which might affect the baby, even over-the-counter preparations.
5. Storing Breast Milk: Pour the breast milk into a clean plastic bottle or bag. Label the bag with the time and date you expressed the milk. You may store it up to 72 hours in the refrigerator or up to 4 months in the freezer. DO NOT REFREEZE. Thaw the milk in the refrigerator or in lukewarm water just prior to use. DO NOT BOIL THE MILK OR LEAVE IT OUT ON A SHELF TO THAW.
6. Effective Nursing: To encourage effective caloric intake and to prevent "snacking," listen for the baby swallowing. Stimulate baby or switch breasts if swallows slow down or stop. Undressing the baby will encourage more productive eating.
A common position for nursing is the "cradle-hold," with the baby's head held in the crook of your elbow, using pillows for support. Some mothers prefer to nurse lying down and the "football hold" may be useful with a Cesarean delivery (have your nurse demonstrate). The baby should be lying completely on its side against your midriff. Hold the breast in a "C" position, with the thumb above the areola and fingers below, and move the breast slowly up and down to lightly tickle the baby's lower lip with your nipple. Continue tickling until baby's mouth is open wide (as with a yawn) and quickly pull the baby onto the breast. If baby's sucking causes soreness or pain, break the suction and begin the tickling process again. It may take several attempts, so be patient and repeat until nursing is comfortable. If soreness persists or cracked nipples occur, please call us or our Lactation Consultant. Soreness is not a normal part of nursing. A lazy, sleepy baby benefits from being switched from breast to breast every five minutes until the feeding is over, with burping in between, to keep awake. Switching breasts every five minutes may help produce more "letdowns" to satisfy the baby.
When breastfeeding is well established (usually by 3-4 weeks), you should substitute a bottle-feeding 2 times a week so that the baby will accept the bottle. Parents who have not practiced this may find that later on their baby refuses all bottles, which may create problems.
GETTING STARTED: How Often? How Much? How Long?
Many babies have a one to two hour period of alertness right after birth and then they become very sleepy for the next few days. For many babies, nursing is not a high priority in the first days of life. The substance first produced by the breast is called colostrum and is a thick yellowish fluid. It is important for the baby to receive this colostrum to get the anti-body protection it offers and it acts as a laxative to help the baby pass the meconium from the intestines. The act of suckling the colostrum from the breast on a regular basis will also encourage your milk to come in. Mother's milk usually comes in between the 2nd and 4th day postpartum.
Healthy full-term babies are born with a little extra fluid in their system to carry them over until mother's milk is in. Unless there is a special circumstance, baby should not need water if they are encouraged to nurse often.
In the first two days, nursing every two to four hours around the clock is sufficient. The most important thing in those first few days is to get comfortable positioning your baby correctly at the breast. On day three, you should start encouraging your baby to nurse at least every two to three hours. Eight to ten feedings in 24 hours is very common for the newborn that is not yet an efficient nurser (both baby and your breasts become more efficient over time). If you are nursing frequently during the day and especially into the evening, you can make that last feeding at around midnight then put your baby to bed and let him wake you for the next feeding if it is not later than 6 a.m. Feedings are always timed from the start of one feeding to the start of the next.
Remember most babies are used to being up at night. That is when they were awake and moving in utero. Many parents assume the extreme nighttime fussiness is related to breastfeeding dissatisfaction when it is usually just part of being a newborn. The first few nights home from the hospital are usually the worst. That is why resting during the day is essential!!
Once your milk starts to come in, frequent nursing will prevent and help decrease the discomfort from engorgement. Bottles given before breastfeeding is well established will not only confuse babies on how they should be sucking, but also can cause engorgement from missed feedings and eventually decrease the amount of milk you will have for your baby.
Newborns will usually take 30 to 60 minutes to complete a nursing period. Remember, this will improve over time. In order for you to encourage your baby to be as efficient as possible, you will need to start listening to your baby. What you will be listening for are his swallows at the breast.
When the baby goes to breast, get him deep onto the breast with his nose touching the breast. You will not need to push down on the breast to clear his airway if you keep his whole body tucked into yours. It will take 10 to 30 seconds of active suckling to stimulate your milk to let down. What you should hear is a soft exhalation with each swallow. Jaw motion on the breast doesn't count as eating time since babies can pacify on a breast for hours without actually eating. Listen for the swallows; they should be about one per second. When the swallows slow down or stop, rub the baby's back or feet without taking him off the breast. Each time he stops swallowing, give him a little encouragement to start swallowing again. If he won't start again, stick your finger in between his gums and remove him from the breast. Now sit him up on your lap and burp him and then put him on the other breast. Listen for swallows, encourage him when he stops and take him off that side when you cannot get him to swallow any more. Switching breasts will encourage your little one to get more milk in less nursing time. Watching your baby instead of a clock tends to promote a happier baby.
Most breastfed babies will begin to gain 1/2 oz. to 1 oz. per day once mom's milk is established and they will be back to birth weight by 2 weeks of age. In order to tell if your baby is getting enough, he should have several wet diapers in a 24-hour period and at least one stool. Many breastfed babies will stool with every feeding in the first few months.
Remember by starting out encouraging frequent and efficient feedings, your baby will gain weight faster and you both will be off to a great start in your nursing relationship.
Formula with iron is our recommendation. It can be found in the following forms:
#1 Concentrated Liquid .............................................................................
Dilute two ounces with two ounces of water (boiled or bottled)
As directed on the can
Convenient but expensive. No dilution required.
Offer two to 4 ounces on demand. Feed at least every 4 hours in the newborn.
Burp baby at least once during the feeding and at the end of feeding. Always hold your baby and the bottle, NEVER prop the bottle or use a bottle holder.
Test the nipple before feeding the baby. The hole should be large enough to permit the cool formula to drip freely out of the nipple when the bottle is held upside down without shaking the bottle. If the nipple hole is too small, enlarge it with a pin or needle to the proper size. The bottle cap should be loosened while baby is nursing so that large bubbles of air enter the bottle freely. If these small details are not observed the baby will tire before hunger is satisfied and baby will be eating too often.
It is NOT necessary to sterilize the formula. Bottles and nipples should be rinsed with very hot water. Use at ROOM TEMPERATURE.
When you start to use the room temperature formula, put another bottle outside the refrigerator, so it will be at room temperature for your baby's next feeding. We DO NOT encourage using the microwave to warm milk bottles. The milk may not be warmed evenly throughout the bottle.
HOW MUCH FORMULA
The amount of formula your baby takes will vary. Babies have a right to not be hungry sometimes, just as you and I. You can't make a baby want to eat. It is common for a newborn to be sleepy at and during feeding time, especially in the first few days. You can stimulate the baby to wake up by unwrapping him, changing his diapers and moving him around.
Feeding schedules are most satisfactory when roughly set and your baby is allowed to eat when he becomes hungry. Most babies will awaken for feeding every 3-5 hours. You will probably find that sometimes your baby will take his entire bottle and sometimes he won't. DON'T WORRY! This is normal. As your baby grows and gains weight, he will need more formula.
When your baby takes his entire bottle on a regular basis ... and sometimes cries for more ... increase the amount of formula in each bottle. Wake your baby every three hours during the day (8:00 a.m. to 8:00 p.m.) It is not necessary to feed this often, but the more your baby is awake during the day, the better he will sleep at night.
HOLDING YOUR BABY
All newborns are extremely sensitive to touch. You can convey feelings of warmth and protection by holding your infant close to you at every opportunity. A child takes delight and comfort in hearing the rhythm of mother's heartbeat. A parent's embrace can recreate for the baby the snug, secure world of the womb. By being attentive to your child's emotional and physical needs, you will provide the framework for healthy personality development. Talk to your baby and play with him sometime every day. Don't be afraid to give your newborn plenty of love and affection. You will not "spoil" your newborn by showing him affection or comforting him when he is fretful.
GETTING TO KNOW YOUR BABY
Some common concerns about new babies are the following:
CRYING: Crying is your baby's way of saying "I'm hungry," "I'm wet," "I'm thirsty," "I want to turn over," "I'm too hot," "I'm too cold," "I have a stomach ache," or "I'm bored." You will gradually learn to know what the baby means. Even well babies will probably cry for an hour or more occasionally without harming themselves. They tend to cry most in the late afternoon and evening.
SLEEPING: Most babies wake up several times a night in the first few weeks. Some babies wake up and cry, some babies merely wake up and look around and fall back asleep. The amount of time your baby stays awake and cries will change as the baby gets older. Some babies skip night feedings earlier than others.
HICCOUGHS-SNEEZING. ETC.: All babies yawn, have hiccoughs, pass gas, cough and cry. Sneezing is the only way in which a baby can clear his nose. Hiccoughs are normal. They are caused by the immaturity of the swallowing center in the brain. Burping, feeding or sucking usually helps.
SPITTING UP: Spitting up small amounts is very common. Often it will contain mucus, which lines the stomach. If the amounts are small and it does not bother the baby - do not worry. Forceful vomiting of large amounts of milk, or vomiting vile (green or gold liquid) is abnormal and should be checked out.
HEAD SHAPE/SOFT SPOT (fontanel): The newborn's head is made up of several bones, which have spaces between them. This allows flexibility of the skull in the birth canal and accounts for why the newborn's head is often cone-shaped, flattened or asymmetric. Natural reshaping to normal occurs over the first few days to weeks of life. There are areas on the head where the bones have not yet come together called the fontanels. Don't be afraid to touch or wash the soft spot - you won't hurt anything.
EYES/EARS/NOSE/MOUTH: The nose, ears, mouth and eyes do not have to be cleaned. It is O.K. to remove wax that comes out of the ear but don't poke anything into the ear canals. Loose mucus may be removed from the nose with a tissue. If there is a slight discharge from the eyes, wipe the lids off with a clean tissue, but don't put anything inside the eye itself.
Newborns often look cross-eyed. This is because they are unable to consistently focus their eyes. They should be able to focus well by 3 months of age.
SKIN: Peeling skin is normal in the first 2-3 weeks and does not require any special treatment.
At 1 -3 weeks of age, the infant may develop an ACNE-LIKE RASH on their face, which may extend to the scalp and chest. This rash is due to over activity of the sweat glands and will remain until 6-8 weeks of age. Lotions simply make the rash worse. Do not worry, simply wash gently with soap and water.
Diaper rash is most often due to heat and skin irritation from urine or stool. Frequent changing, rinsing well with water, careful drying (or leaving open to air) will help.
JAUNDICE: Babies frequently become jaundiced, in their first week of life. This is a yellow tint to the eyes and skin most often due to a temporary immaturity of the liver. This causes an accumulation of the yellow pigment, bilirubin, in the blood. If your baby becomes jaundiced your pediatrician will discuss this with you. If you are home and your baby becomes yellow, please contact us.
CORD CARE: Cleanse the base of the naval with a Q-tip dipped in rubbing alcohol several times a day until it has healed. No binders or pads are necessary. Some bleeding normally occurs as the cord detaches from the naval. Contact your doctor if there is any large amount of bleeding, or much redness around the navel.
CIRCUMCISION: If your baby has been circumcised, apply Vaseline to the tip of the penis until it has healed (usually one week). Notify your doctor if marked swelling or bleeding occurs. If a plastic ring has been used for the circumcision, no special care is needed. The ring may fall off in about a week.
BREAST SWELLING/VAGINAL DISCHARGE: Breast enlargement is quite common and perfectly normal both in baby boys and girls. The best treatment is to leave it alone. A small amount of white or pink-tinged discharge from the vagina is normal in baby girls during the first two weeks of life.
STOOLS: Your baby may have a bowel movement after each feeding or may have one or two stools a day. Some babies may go 48 hours or more without a stool and be normal. Your baby may strain when he has a stool, but unless the stool is hard or pellet like, this is perfectly normal. Stools may be watery for several weeks.
Breast-fed infants usually have more frequent stools than formula-fed infants. The character of the breast-fed infant's stools range from split pea soup to lemon custard with cottage cheese lumps.
Constipation is defined as hard, rock-like stools-sometimes stained with blood. If your baby has these often, then contact the office. DO NOT give your baby honey!
NAILS: Nails may be cut or filed at any time (this may be easier when your baby is asleep). A small amount redness or swelling around the nail of the big toe is common. This usually resolves on its own.
CARING FOR YOUR BABY
BATHS: Your new baby may peel all over. The baby has been suspended in amniotic fluid for nine months and thus has to shed multiple layers of old skin accumulated inside the uterus. The peeling is normal. Sponge baths may be given daily until the navel heals then a mild soap and tub bath may be used for the baby. Dry the skin by patting with a towel. In general oils, creams and lotions are not needed. Do NOT use baby powder.
CLOTHING/TEMPERATURE: Dress the baby with just enough clothes to keep him warm and comfortable. A T-shirt and diaper is often enough in warm weather. Do not use excessive clothes or coverings. Baby should be loosely wrapped in order to allow moderate freedom of movement. The body should be warm and dry, not clammy with perspiration. Baby's hands and feet are normally quite cool. A wrapping blanket usually makes your baby feel more "secure," even though not needed for warmth. Room temperature should be 68-70 degrees.
SLEEPING: Babies should be placed on their BACKS or their sides when sleeping. This American Academy of Pediatrics recommendation is based on careful examination of worldwide data suggesting a possible link between SIDS (crib death) and infants who sleep on their stomachs. Concerns about choking and aspiration have not been conĀfirmed. There are no reports that sleeping on the back is harmful to normal infants.
The baby's mattress should be flat and firm with a waterproof cover to protect it. No pillow should be used.
DIAPERS: The diaper area should be cleaned as often as the baby is wet or soiled with either plain water or a diaper wipe. Dry the skin of the diaper area thoroughly before reapplying a new diaper. Whether you use disposable diapers or cloth diapers is a matter of personal preference.
GOING OUT WITH BABY/VISITORS: There is nothing wrong with having the baby outside; just avoid crowded places like shopping malls and grocery stores where the chance of exposure to illness is greater. Friends and family may come to see your baby if they are well.
SIGNS OF POSSIBLE ILLNESS
1. Acts "sick," or unusually lethargic, drowsy, or irritable.
2. Refuses several feedings in a row.
3. Has labored or difficult breathing.
4. Has a fever of 100.4 or more in the first two months. (After 2 months of age, fever alone is not as serious a symptom.)
Provide yourself with a rectal thermometer and practice reading it. Electronic thermometers are acceptable; fever strips are not. Don't guess that the baby has a fever. Take his temperature and find out for sure. Lubricate the end with oil or Vaseline and insert into the rectum for three minutes. A reading of between 98.0 and 100.4 is normal. Clean the thermometer by wiping it off with alcohol.