General Newborn Care

Baby’s First Visit

Your baby
should have his first office visit when he is several days old; unless,
he needs my attention before then. For your convenience, please call our
office as early as possible to schedule your baby’s routine well visit
at 2 weeks, and 1 and 2 months. During the routine visits, we will want
to discuss your baby’s growth and development and the many interesting
things you can expect your baby to do within the next few months. Experience
has shown that most parents have many questions regarding their babies,
but it is common to forget them while in the office. We encourage you
to write down anything you want to know before you come, even if you think
it is trivial.

Newborn Period

B vaccine: The American Academy of Pediatrics and the Center for Disease
Control, in reviewing the marked increase in the incidence of Hepatitis
B, has made a policy statement that all newborns in the United States
be vaccinated before they leave the hospital.

Hepatitis B vaccine is a totally synthetic and very safe vaccine that has been available
since 1981. The vaccine has been safely and widely utilized since 1981
in all health care workers and families where there has been a carrier.
We did not offer the vaccine to the general public because we did not
see the cost-benefit ratio to be favorable. Previously, the incidence
of Hepatitis B in the United States was low and confined to high risk
populations such as prostitutes, IV drug abusers, and homosexuals. Unfortunately,
this disease has shown a dramatic increase in its prevalence and has spread
throughout all socioeconomic groups and life styles. There is no longer
any way to prevent the disease except through universal vaccination.

We know that the vaccine is very safe or we could not administer it to newborns. We
have used it since 1981 with an excellent track record. All the information
we presently have indicates that your child will have life long immunity
to Hepatitis B upon completion of the series of three doses.


How Much Formula

During the
first month, increases in formula will be necessary. The amount of formula
your baby takes will vary, but will usually not exceed six ounces per
feeding. Babies have a right not to be hungry sometimes, just as you and
I. Most babies feed for 15 to 20 minutes. You will probably find that
sometimes your baby will take all his bottle and sometimes he will not.
Do not worry. This is normal. As your baby grows and gains weight, he
will need more formula. When your baby takes all of his bottle pretty
regularly and sometimes cries for more, it is time to increase the amount
of his daily formula. By 8 weeks of age, most infants are taking 6 to
8 ounces every 3 to 4 hours. Call if your infant refuses several feedings
in a row.

Special Instructions

All babies
lose weight the first 7 to 10 days of life. Most lose 6 to 10 ounces,
and it is not uncommon for a baby to lose up to 10 percent of his birth
weight. The larger the baby, the greater the weight loss. The baby does
not usually regain his birth weight until 14 days. There is a reason for
this. The first 3 to 4 days of life nature has set aside for rest – not
work. The change from a parasite in the womb to a truly independent being
is a traumatic one. Nature allows for this and gives each baby an extra
amount of liquid that he can use in the first few days so he does not
have to worry about eating.

When is it time for the newborn to start eating? If the baby were intended to begin
taking nourishment immediately after birth, the mother’s milk would be
“in” and ready for him. The milk, however, does not come in
for 3 or 4 days.

Interestingly, that is usually the time the baby really becomes interested in sucking
and eating.

For the first few days, most babies take no interest in the breast. When placed at the
breast, their sucking is erratic and poor. During this time, however,
they do stimulate the production of milk by their sucking. They receive
colostrum, which is a very thin, yellow initial breast secretion known
to be very high in antibodies that help fight infection. During these
first few days, the baby should not be FORCED to take the breast.

Keeping the
same philosophy and psychology in mind, consider the baby who is fed by
bottle rather than breast. Just because he has milk ready to go at the
first feeding is no reason to think the bottle baby will be ready to eat
any sooner. Remember, do not be concerned about your baby’s feeding habits
for the first few days. OFFER but DO NOT FORCE. If he is hungry, he will



Water is not
necessary. You may offer your baby water in a nursing bottle once or twice
daily, but not within an hour before the next feeding. Some babies do
not like water, and your baby may refuse it. It is a good idea to offer
it in warm weather when the baby may perspire more. Do NOT use honey or
Karo syrup to sweeten. Tap water may be used – no need to boil.

Smoking and Your Child

Passive smoking
has clearly been demonstrated to harm infants and children. Studies have
proven that children exposed to smoke have significantly more respiratory
illnesses and ear infections. All smoking should be done outside the home
and car.

Spitting Up

Many normal
babies spit up frequently. This is because babies have a weak “valve”
between their stomach and esophagus (the tube leading to the mouth). This
valve tends to tighten after the first year of life. Spitting up is normal
unless your child has “projectile” vomiting (extremely forceful),
or if your baby is failing to gain weight. Spitting up is decreased by
sitting the baby upright for 30 minutes after feedings and by thickening
formula with rice cereal (2 tablespoons per 4 ounces formula). Call me
if symptoms persist or worsen. Make sure to enlarge the nipple holes if
you add cereal to the bottle. Enfamil AR formula may be used instead.


Care and regularity in feeding your baby will promote health and lay the foundation of eating
habits for future years. Do not confuse the word regularity (meaning here
simplicity and similarity) with schedules. Feeding schedules are not necessary
for either breast-fed or bottle-fed babies. Generally, your baby should
be fed on a DEMAND SCHEDULE (i.e., WHEN HE IS HUNGRY). The demand schedule
recognizes the infant’s own rhythms and allows him to eat whenever he
chooses and the amount he chooses. Ultimately, the babies put themselves
on a fairly regular schedule. The demand schedule produces happier and
more secure infants, more relaxed parents, and also helps to prevent future
feeding problems. Both of you should be comfortable – you should have
a comfortable chair, and the baby should be warm and dry.

Keeping Utensils Clean

All utensils used in preparing formula must be clean. Scrub bottles, nipples, and caps
with hot, soapy water and a bottle brush, squeezing water through the
nipple holes. A detergent removes scum better than soap. Rinse well with
hot water. Protect bottles by putting them upside down on a rack or clean
towel. Put nipples and caps in a clean jar. The saucepan, measuring pitcher,
can opener, and other articles used should be washed, rinsed, and kept
protected until time to use them. Automatic dishwashers are fine for bottles
also. Boiling bottles and nipples is unnecessary.


It is of utmost importance that you maintain an adequate, balanced diet and drink plenty
of fluids. Do not become overly tired. Keep breasts well supported, clean,
and dry at all times. Wash your breasts with soap and water; rinse with
water before nursing.

Cradle your baby in your arms, and gently raise the baby so the cheek next to you
touches your breast. Do not attempt to push the baby’s mouth toward the
breast by pressing the opposite cheek; this causes the baby to turn toward
your hand.

Since most milk is obtained in the first five minutes or so, you should not nurse
more than 10 to 15 minutes on each breast. Alternate which breast is nursed
first from feeding to feeding. Your milk will regulate to the needs of
the baby; as he requires more, his sucking will stimulate you to produce
more milk. The consistency of breast milk will appear watery in contrast
to cow’s milk. This has nothing to do with the nutritional value of your

The nursing schedule should be on demand. Babies know when they are hungry better
than we do. Most newborns nurse every 3 to 4 hours, but between the 5th
and 10th day many demand more frequent feedings; perhaps as many as 12
feedings in 24 hours. By the end of the second week, the infant will settle
down to a 6 to 8 feeding per day schedule.

Once breast-feeding is established and the milk supply is fully in, a bottle with breast milk
or formula may be given in place of a feeding. This is especially acceptable
at 2 a.m. so the mother can get an occasional full night’s rest, or at
dinner time when a mother’s milk supply can be diminished. Usually breast-fed
infants prefer the Playtex nurser nipple or Avent. Maternal dietary restrictions
are generally unnecessary. Mothers can eat chocolate, but should not eat
a pound or a full box at a sitting. Smoking does decrease milk production
and should not be done around the infant. Alcohol in modest amounts increases
milk production, especially if it is associated with a period of relaxation
prior to feeding. Mothers can diet in moderation to lose weight and still
nurse. Harsh laxatives should be avoided while breast-feeding. Anything
you take will be in your milk in approximately 2 – 4 hours.

If your baby does not seem satisfied, and you earnestly want to breast-feed, it is
best to try resting more and increasing your fluid intake. Try more frequent
feedings before you resort to supplementing him with formula. It is easier
for the baby to suck the bottle, and formula is sweeter than breast milk;
the less the baby sucks from the mother, the less she will produce. Call
our office if the above measures do not seem to be working. Also, there
are lactation counselors at Medical Center of Plano who will give advice
by phone.

Try to continue to breast-feed your infant until he is at least 6 – 10 months old. By
12 months, it is time to consider stopping. With breast babies, I would
suggest offering formula from a cup at 6 months; once the baby is taking
10 to 12 ounces of formula from the cup daily, the breast may be discontinued if desired.
There is no need to use a bottle at all. NO COW’S MILK UNTIL AGE 12 MONTHS.


Test Nipples Regularly

Nipple holes should be the right size to help your baby suck easily. When nipple holes
are the right size, milk should drip as rapidly as possible without forming
a stream (approximately one drop per second). If nipple holes are too
small, your baby may tire of sucking before he gets all the formula he
needs. If holes are too large, then he gets too much formula too fast
and may not get enough sucking to be satisfying. He may also choke or
gag. If nipple holes are too large, the nipple is worn out and should
be thrown away. Enlarge holes that are too small by pushing a hot needle
through them.

Bottle Feeding

Some mothers simply do not feel comfortable breast-feeding. Today’s infant formulas
are excellent and complete foods for the first 3 to 6 months of life.
Be seated comfortably and hold the baby at an angle. Hold the bottle so
that the neck of the bottle and the nipple are always filled with formula.
This helps your baby get formula instead of sucking and swallowing air.
Air in his stomach may give a false sense of fullness and may also make
him uncomfortable.

Your baby has a strong, natural desire to suck. For him, sucking is part of the
pleasure of feeding time. Babies will keep sucking on nipples even when
they have collapsed, so take the nipple out of the baby’s mouth occasionally
to keep the nipple from collapsing. This makes it easier for him to suck
and lets him rest a bit.

Never prop the bottle and leave baby to feed himself; the bottle can easily slip
into the wrong position. Remember, your baby needs the security and pleasure
it gives him to be held at feeding time. It is a time for your baby and
you to relax and enjoy each other.


Baby Foods

There is no set time when a baby will need to begin with foods. Most will not want any until
between 4 to 6 months of age. In general, the later the better. NEVER begin before 4
months of age. Solid foods are not necessary until age 4 to 6 months. Most
breast-fed babies are completely satisfied with only the breast until
6 months. If your child is feeding at 4-hour intervals and somewhat longer at night,
then he needs no additional foods. If he begins waking between 2 and 3
hours, wakes more than once during the night, or is taking at least 34
ounces of formula per day (if bottle-fed), then starting rice cereal is
recommended after 4 months of age.

At age 6 months, bananas, plums, peaches, and applesauce may be given with cereal. Add
these one at a time to your baby’s diet. Bananas and applesauce cause
the stools to be more formed, so if your baby is constipated, limit use
of these two fruits. If the stools are liquid, these 2 fruits may firm
them up.

Non-citrus juices may also be added at 6 months. Any adult juices may be used and
do not need to be diluted. Orange (citrus) juice causes a high incidence
of allergic reactions with babies and should not be used until 12
months of age. Also, at 4 months, add vegetables one at a time, beginning
with yellow, then orange. Between 5 and 6 months begin 3 meals a day and
green vegetables.

At 6 months, meats may be added. Begin with poultry, veal and lamb, then beef and beef
products, and ham. You may want to mix some fruit with meat to make it
tastier. Also, at 6 months, you may start egg yolk. Withhold egg white

General Rules

1. Because your infant may be sensitive to certain foods, begin one new food every
3 to 4 days and use it each day during that time. Begin with just a
small amount and gradually increase it.

2. Use only individual strained foods and not any combination until your baby has
had these foods separately.

3. The vegetable and meat dinners are actually a soup and should not be used as a meat;
use either strained meat and a vegetable or a high-meat dinner.

4. Junior foods may be started at about 5 months as tolerated by the baby.

5. Do not force foods on your baby. If he rejects a certain food, stop it and
try it again in about a week.

6. Most babies take 24 to 32 ounces of formula a day from 2 – 8 months. Formula
intake decreases thereafter.

7. If you have a blender, at about 5 or 6 months, you may put table foods in the
blender, add a little formula or water thereby making your own junior
foods. This is much tastier, just as nutritious, and much cheaper than


Formula Preparation

1. Enfamil Lipil ready to feed with iron (no mixing)

2. Enfamil Lipil concentrate with iron (mix 13 ounces formula with 13 ounces of water)

3. Enfamil Lipil powder with iron (1 scoop of powder to 2 ounces of water)

on the container unless told to do otherwise. Usually a 24 hour supply
of formula is prepared at one time, but if refrigeration is good, any
amount of formula up to a 48 hour supply can be prepared safely. Drinking
water may be used directly from the tap without boiling. Bottled or filtered
water does not have fluoride, necessary for strong teeth.


Infant Diet Guidelines



Burping your baby helps remove swallowed air. Burp or bubble him by holding him upright
over your shoulder and patting his back gently, or place him face down
over your lap and gently rub his back. He can also be burped by holding
him in a sitting position (baby leaning slightly forward) on your lap,
with your hand supporting his trunk and neck. Gentle bouncing may help
in this position. Three minutes of trying is long enough.


Vitamins are generally not necessary for bottle-fed infants. Bottle-fed infants receive
fluoride from the tap water used in formula preparation. To provide extra
vitamins to be sure of proper nutrition, Vi-Daylin or Poly Vi Sol are
good choices. Breast-fed babies need 1cc of vitamins per day to receive
enough Vitamin D: Vi-Daylin drops one dropper full daily or Poly Vi Sol
one dropper full daily.

When you give
vitamin drops, fill the dropper to the FULL mark. Place the dropper between
your baby’s gums and cheek almost half-way back in the mouth, and slowly
squeeze out contents.


A Schedule with Flexibility

Feeding schedules are usually most satisfactory if the hours are set roughly, and the baby
is allowed to eat when he becomes hungry; for example, any time between
3 and 5 hours after the last feeding. In the first few days of life, he
may take very little formula; sometimes as little as a half ounce per
feeding. This will gradually increase day by day. New babies usually need
to be fed about every 3 hours, but may often go 4 to 5 hours between feedings.
It is better not to wake the baby for feeding during the day unless he
goes longer than 4 hours. It is not necessary to wake him at night. Should
he occasionally wake up and cry after only 2 hours, the amount of formula
he is receiving may be insufficient.



All babies need iron for the formation of red blood cells and proper brain development.
Breast-fed babies need no supplement. Bottle-fed babies should be started
on iron (usually in their formula) right away. I recommend that all children
start on vitamins with iron after they go off the breast or formula at
12 months of age, especially with “picky” eaters.


Almost all babies have fussy periods. These may occur regularly, perhaps in the late
afternoon or evening. When babies cry for over an hour for no apparent reason,
some people call this colic. Doctor’s don’t know exactly what causes colic,
but theories include gas, constipation, “cramping colon”, nervous parents,
and mixed up days and nights. None of these theories explain all cases of
colic. There are many treatments for colic, none of which work all the time.
The following ideas may be helpful. If you are breast-feeding, avoid dairy
products and caffeine. Milk in your diet may cause the “colicky” infant.
If you bottle-feed, try an non-milk based formula such as Enfamil soy. If
you try Enfamil soy for 10 days without improvement, a 7 to 10 day trial
of a special formula like Nutramigen may be indicated. Nutramigen is expensive,
but well worth the expense if it relieves crying. Other remedies include
Mylicon drops (available without a prescription), one dropper full (0.6
ml) four times per day for gas. If these ideas don’t help, let me know.
We’ll work together to help you and the baby work through this difficult
time. Remember:

It’s not your fault – babies with colic are born with the tendency.

All babies outgrow colic by age 3 to 4 months. Soon this will be a distance memory,
and you will have a healthy, happy child.


Post Partum Depression

The most common complication of childbirth is Post
Partum Depression. One out of eight moms experience some form of Post Partum Depression. However, some mothers
and fathers feel completely overwhelmed with their new responsibility. Sleep deprivation adds to the problem.
If you suspect Post Partum Depression in yourself or a loved one, seek help immediately. The phone number is
1-800-944-4773 and the website is

The material on this website is for informative purposes only. If you need specific medical advice,
please contact our office for an appointment.