Breast-fed babies may feed every two to four hours for no more than 15 minutes per side. After 15 minutes the baby has emptied your breast as is sucking to soothe. They have “hungry days” when they are having a growth spurt. Nursing more often for several days will stimulate milk production to meet the baby’s needs. It can be hard to know the amount of milk the baby is getting. Stool and urination are good indirect ways to assess the amount the baby is getting. Once the baby starts having frequent small yellow stools, they are getting plenty of breast milk. After three weeks, a bottle of expressed breast milk or formula may be substituted for a nursing, one or more times a week as necessary, but no more than once a day. The late afternoon feeding is the best time for a bottle as less breast milk is produced at that time.
The AAP recommends vitamin D supplementation for all infants, children, and adolescents. After reviewing the literature, it certainly looks like many children may benefit from vitamin D, although not everyone necessarily needs it. Some children are more at risk for vitamin D deficiency than others. Risk factors for vitamin D deficiency include dark skin (African-americans, Indians, Hispanics), time spent indoors and not out in the sunlight (particularly in the winter months), low amount of milk consumption (less than 16 oz a day), and exclusively breastfed infants. The recommended dose is 400 IU (international units) once daily. This can be bought over the counter in either a single drop form, or with a larger dropper. Read the label carefully when dosing this to your child. Too much vitamin D can be harmful.
The usual feeding schedule for a bottle fed babies is every three to five hours. During the day, waken the baby if they sleep more than five hours. At night, let them sleep as long as they want.
No sterilization of bottles is necessary. Wash well, rinse and let drain. To prepare formula, follow the direction on the label. You do not need to boil the water unless you have well water. Refrigerate prepared formula until ready to feed. Warm the bottle in a pan on the stove. Microwave heating is not recommended because hot spots can burn the baby’s mouth. After a feeding, any formula left must be discarded. It is not necessary to start any solid food until they reach four to six months of age.
Babies should always sleep on their backs until six months of age or the baby is able to roll over both ways. Tummy time is important when the baby is awake for strengthening upper body and neck muscles and so that the back of the baby’s head is not flattened over time. Alternating the baby’s head position from one end of the crib to the other on a regular basis will also prevent a flattened head.
A sponge bath may be given two to three times a week using a minimal amount of mild, unscented baby soap or cetaphil body wash. Keep the diaper area clean. Use wipes sparingly, irritation occurs. If the skin becomes red and irritated around the anus, apply desitin cream or similar diaper cream with each diaper change. The umbilical cord will come off sometime in the first three or four weeks. Until then, wipe the cord with alcohol daily and try to keep it exposed to air. When the cord comes off, there may be some oozing and a little bleeding. Once the cord site is dry, tub baths may be substituted for sponge baths.
During the first four to six weeks, babies may have reddened areas or blotches on their skin, especially the face. These will clear. Do not use baby oil and avoid other baby lotions as well as these will often aggravate the skin rash. If your baby has been circumcised, cleanse the area gently with warm water only.
- limit contact of the baby to immediate family for the first three weeks, avoid anyone with a cold or other infectious disease. Any temperature greater than 100.4 F or 38 C or marked change in the baby’s behavior should be reported to us right away.
- babies frequently have swollen breasts due to your hormones. This will disappear. Girls may have heavy vaginal discharge or bleeding. This too will disappear within a week or two.
- the baby’s eyes may be swollen and have a little drainage in the first few days of life. Wipe with water.
- all babies sneeze occasionally to clear their noses. This does not mean they have a cold.
- babies have frequent hiccups, this is due to a full tummy and often occurs after nursing.
- most babies have a fussy time, often during the evening hours. The baby may have a sore tummy but this is a normal phase all babies go through. If they just fed, comfort them, offer a pacifier, put them down and let them fuss for five to ten minutes. Then pick them up and try to comfort them again.
- at first, breast fed babies have frequent loose mustard yellow bowel movements. Later on, the baby may go two or three days without having a bowel movement, this is normal and does not mean the baby is constipated.
- the circumcision ring will drop off in about five to eight days. If it has not, or you have questions about the healing call the office during regular hours.
SUPPLIES TO HAVE ON HAND
- acetaminophen drops (such as Tylenol), check with us before using. Doses are listed on our website.
- rectal thermometer, we do not recommend the use of an ear thermometer as they are inaccurate in the babies less then six months old. Measuring baby’s temperature with a digital thermometer in the rectum is safe and not uncomfortable for the baby. If you have any questions about how to take the temperature or read the thermometer, please ask one of our nurses at the first visit. They will be happy to show you.
- cool air humidifier
- a recommended car seat