Frequently Asked Questions 

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DISCLAIMER: Information in the Children's Medical Associates of Northern Virginia (CMA) website is for informational and educational purposes only.  The information is not intended to replace professional advice. By accessing the CMA website, you agree to the terms and conditions contained in its disclaimer. Please read the full disclaimer before continuing.

 

 

FEVER	ACETAMINOPHEN (TYLENOL)DOSE
DIARRHEA and/or VOMITING
COLD SYMPTOMS (URI)	IBUPROFEN (MOTRIN/ADVIL) DOSE
EMERGENCY PHONE NUMBERS

 

 

 

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) This is a tremendous source of information about many diseases and conditions.  Be sure to check it out.

 

 

 

Baby Sitter Information
Bathing
Bowel Movements
Circumcision
Clothing and Temperature

Constipation
Cord Care
Crying/ Colic

Eye Care

Feeding Your Baby

Feeding Your Infant: Starting Solid Foods
Hiccups
Jaundice
Metabolic Screening Tests
Prevention of Accidents and Poisoning
Rashes
Shaken Baby Syndrome
Sneezing and Nasal Congestion
Sleep
Spitting Up/ Vomiting/ Reflux
Teething
The Soft Spot
Things to Remember
Well Child Visits & Immunizations 
When to Call the Doctor
Suggested Reading

 

 

Baby Sitter Information

When a baby sitter cares for your children in your home, he or she should be provided with basic emergency information as well as information about your child: where you are going, what time to expect you back, and how to reach you by phone. Post the numbers for your pediatrician's office, Poison Control (1-800-222-1222), 911 for Police, Fire or Rescue Squad, both parents' work numbers, and a nearest friend or relative and emergency instructions. Go over this list with your sitter before you leave.

If a child is to be given medication, go over the name, amount and time to be given. Tell the sitter where other medications and cleaning supplies are kept so that he or she can keep your child away from these things. Point out the location of smoke alarms, fire exits and children's bedrooms.
 

Bathing

Sponge bathe your baby with a mild soap and water until approximately one week after the cord falls off. Then you may start a regular tub bath as needed. This may be as often as daily or as infrequently as weekly. However, beginning the first week at home, wash the baby's face daily with soap and water and his head with baby shampoo two or three times a week to minimize "cradle cap". We advise leaving your baby as natural as possible by avoiding the use of oils, powders, and lotions. Do not put Q-tips in the baby's ears or nose as this may cause injury. Clean the external genital folds of a baby girl with a soft washcloth or cotton ball by wiping from front to back. A little blood tinged mucous discharge from the vaginal area is normal during the first month .
 

Bowel Movements

The first stool passed by a newborn baby is called "meconium." It is a thick black tar-like substance. After a few days the stool becomes green in color and is more loose. This is called a "transitional stool." If the baby is breast fed, the stools tend to remain loose but become yellow in color and contain a number of small seed-like particles. Stools of a bottle fed infant are more firm and often darker in color. Once the newborn is getting adequate nutrition after the first few days of life, it's typical for the baby to have bowel movements almost as often as the baby is fed.

Prior to a bowel movement, a baby might grunt, push, and get red in the face. This is normal. As long as the stool is of a normal consistency for your baby, no treatment is necessary.

Over the first two months of life, the baby's bowel movements become less frequent and more "pasty". By two months of age, baby may have a bowel movement every two to three days. Provided the stools are soft and the baby is not fussy, this is normal.
 
 

Feeding Your Baby

Introduction

Babies can be successfully fed from either mother's breast or from a bottle using one of the available commercial infant formulas. We encourage you to breast feed your baby because your milk is especially designed by nature to provide the best nutrition for your newborn baby. Many authorities feel that there are definite psychological benefits for mother and baby gained by a successful nursing experience. Although there are psychological and possibly nutritional advantages to breast feeding, how you feel about your baby is far more important than how you feed him. A baby raised in a secure loving environment will grow up to be a healthy individual no matter how he receives nourishment.

Your baby will have about 1,200 meals during the first year of life. Try to make the meals relaxed, pleasant, and a good guide for future eating habits.

The American Academy of Pediatrics strongly recommends breast feeding or using a commercially available formula for the first several months of life. Infant formulas are scientifically formulated to supply nutrients at optimal levels to insure proper growth. Considering these facts, please do not discontinue breast feeding or formula until 12 months of life.

In bottle feeding, hold your baby as well as the bottle. Avoid laying the baby on his back and propping the bottle up. Under no circumstances should you allow the baby to fall asleep and continue sucking on either the bottle or the breast.

Advice about vitamins, iron, fluoride, and the introduction of solids will be discussed during the various well baby visits. Current recommendations advise parents to hold off solid foods until 6 months of life.  At that time, cereals, vegetables and fruits may be started.  Infants should never be given honey. Cereals, when given, should be given by spoon and not in a bottle.

Breast Feeding

The two most important requirements for successful breast feeding are a sincere desire on the part of the mother to do so and strong support from the family. With these advantages, nearly all healthy full term babies can be successfully breast fed.

When the conditions of both mother and baby allow, the infant's first experience at the breast will occur in the delivery suite. This initial maternal infant contact will be encouraged unless medical considerations make it impossible.

There are a number of different approaches to the art of breastfeeding. Different methods work for different people. Breastfeeding is a learned task for mother and baby. Some babies may nurse beautifully right from the start, others may take a longer time to learn the process, and still others may want to do nothing but sleep the first few days.

We recommend about 5 minutes of nursing time per breast the first few times. If baby wants to nurse longer, he should gradually be allowed to do so. If baby is positioned correctly on the breast, nipple soreness should be kept to a minimum. Make sure the baby takes into his mouth not only the nipple, but as much as possible of the dark areas around the nipple (areola).

The more the baby nurses the first few days, the sooner the true milk will come in. Nursing time at the breast should gradually increase to meet baby's needs. The breast is usually emptied of milk after 20 minutes of nursing, but your baby will have received the majority of milk after 5 minutes of nursing at each breast. Be sure to begin each feeding on alternate breasts. When removing the breast from the baby's mouth, break the suction by gently inserting your finger into baby's mouth, along one side of the nipple. Burp the baby after finishing at each breast. It is important to remember that not all babies will burp, or burp a lot, with every feeding. Most breastfed babies will feed 8 - 12 times a day. The more you nurse your baby the more milk you will have. So, frequency of feeding is what helps establish milk supply. The exact timing of the feedings varies from baby to baby and from day to day. Your infant will establish his own schedule in due time. Unless specified otherwise it is best to let the baby tell you when he wants to eat. It is recommended, however, that you not let baby sleep longer than 3 to 4 hour stretches during the day and night for the first two weeks of life. If baby sleeps longer stretches in the nighttime hours after two weeks of age, let him (and yourself) sleep.

For the first few days colostrum will nourish your baby. It has a thick yellow appearance and is produced by your breast the last trimester of pregnancy and during the first few days of life. Your "true" milk supply should come in within several days after giving birth. This milk is tailor-made to meet your baby's nutritional needs. The average mother reports a 48 to 55 hour period between the time her baby is born and the time she feels that her milk has come in.

During these early days, your baby's requirement for fluid is quite low. Remember, a healthy, normal baby might lose up to 10% of his birth weight in the first week of life. Call your pediatrician if you are concerned about this issue.

In the early days and weeks of breastfeeding, it is especially important that your baby not be supplemented with formula! Your baby needs to learn how to properly express milk from the breast, and even an occasional introduction of formula in a bottle might interfere with the learning process. Most babies do not need to be offered water after the breast.

While nursing you should avoid undue fatigue and tension. It is important to drink plenty of fluids, although milk is not mandatory if you do not like it. In addition, a well balanced diet is necessary. You should continue your prenatal vitamins. Discuss any additional questions which you might have about caloric or calcium requirements with your obstetrician.

There are many myths about diet and medications taken by the mother during her nursing experience. There are no specific foods that must be avoided but careful observation of your baby may allow you to notice that one or more particular foods in your diet may make him less interested in nursing or make him fussy several hours after a feeding. If this occurs, you may want to eliminate that food from your diet, although an occasional taste will not do your baby any harm. (Milk, coffee, tea, colas, onions, garlic, chocolate, hot spicy foods, some green leafy vegetables, tomatoes, large quantities of citrus, and even melons in mother's diet have been suspected to produce colic in some babies.) In general, foods that you eat will appear in your breast milk about 6 hours later and can affect your baby for 12 - 24 hours.

One must be careful of all medications, as virtually all pass into the breast milk in various quantities. It is best to check with your pediatrician before taking any medications.

For more information about or help with breastfeeding, please check out our Lactation Services.

 

Bottle Feeding    

Mothers who choose to bottle feed their babies can choose a number of available formulas. Various preparations are available: powder, liquid concentrate, and ready to feed. Most find the powder convenient and economical. Always check the instructions on the can as to mixing. The standard dilution for powder is two scoops to 4 ounces of water. Offer a bottle about every 3 - 4 hours at the beginning, but allow the baby considerable flexibility in the feeding schedule. You should have enough formula in the bottle to allow for increased intake as the baby grows. Do not feel that you have to restrict the baby to any particular amount of formula in the bottle. Let the baby take the amount he desires as his appetite will vary from feeding to feeding. Babies will generally take 1 - 2 ounces per feeding in the hospital and up to 4 - 5 ounces per feeding by one month of life.

If bottle feeding, it is not necessary to sterilize your baby's water, bottles, or nipples. Washing them in hot, soapy water and rinsing them thoroughly is adequate, as is a dishwasher.

In general, babies should have no more that 32 - 40 ounces of formula in any 24 hour period.

You will rarely overfeed your baby if you stop feeding him at the first sign of willingness to stop eating.

 

Introducing Solid Foods To Your Infant

When:

The ideal time to introduce solids is generally at 6 months of age, but may be started as early as 4 months old if necessary.  Some of the signs your baby will give you that he/she is ready for solid food include the ability to sit with support, an interest in others eating and distractibility while breast or bottle feeding.  If your family has a strong history of allergies, many sources recommend delaying the introduction of solids until 6 months old.

How:   

            Mix one tablespoon of rice cereal with formula or breast milk to produce a thick soup.  Introduce the rice cereal to your baby with a spoon at one feeding in the day.  Make sure that the baby is hungry, otherwise he/she might not be interested enough to try the cereal (i.e. if your baby feeds every 3 hours, introduce the rice cereal at the 3 hour mark).  If he/she does well, the next day, you may increase the amount of rice cereal you provide.

            When your baby is eating 1-1½ ounces of rice cereal at one feeding, you may either introduce cereal to a second feeding, or introduce a new item.  New items may include other cereals, vegetables and fruits.  Some sources recommend starting vegetables before fruits as some infants may resist the consumption of vegetables if tempted with the sweetness of fruits (but most babies do well regardless of which item you introduce first).  There is no real science to introducing new foods to an infant. 

However, the following are some helpful guidelines: 

1-Introduce only one new item every 3-4 days so that if an allergic reaction occurs, the culprit is readily identified. 

2-Remember to use your baby’s cues as to how much to feed.

3-By the age of 1, your child should be eating 2-3 solid food meals a day and drinking no more than 24 ounces (16-24 ounces) of milk.  Whichever way you work up to that goal is fine.  It has to fit your schedule and lifestyle.

4-Certain foods should be avoided to minimize allergies and to protect your infant from certain adverse effects.

a)      avoid meats until 7 or 8 months of age

b)      avoid honey, eggs, fish, citrus and whole milk until 1 year of age

c)      avoid shellfish and peanuts/nuts until about 18-24 months of age

          or later if there is a family history of food allergies

d)      beware of “choking foods” (i.e. hard, spherical, crunchy)

Mealtime is a social experience.  Your baby will eat better if fed with the family.  So, have fun and Bon Appétit.

 

Circumcision

K-Y Jelly, antibiotic ointment, or Vaseline can be applied to the circumcised penis with each diaper change, until it has healed in three to five days. A non- oozing yellow discoloration at the circumcision site is part of the normal healing process.
 

Clothing and Temperature

Many people tend to overdress a baby. A full term baby's temperature regulating abilities are the same as yours. He gets just as hot and cold as you do so dress him like you dress yourself. A baby who is overheated is hot, irritable  , and subject to rash. Clothing should be loose and as simple as possible. On warm days a diaper and t-shirt are sufficient. Keep the house temperature at a comfortable level for the whole family and dress the baby accordingly.

Babies sunburn more easily than adults. We encourage the use of sun- blocks for older infants, but your newborn is safest if kept in the shade, or if he wears a hat and long, light clothing. Be aware of the dangers of reflections off water and sand and remember that harmful sun rays can filter through shaded areas. Also, air may be poorly circulated in a carriage, and the temperature may be higher than the ambient temperature.
 

Cold Symptoms/URI

Colds, or viral upper respiratory infections, are extremely common in infants and children. The average number of colds per year is from 3-10, each lasting up to 14 days for a possible total of 140 days per year with cold symptoms. Symptoms include:

 

Nasal discharge (often yellow or green)

Nasal congestion

Scratchy/sore throat

Tiredness and aches

Post nasal drip

Headache

Cough

Sneezing

Decreased appetite

Fever (greater than 100.5)

Irritability

Decreased sleep

Slight eye discharge without redness

Hoarseness 

COLDS ARE MOST COMMONLY SPREAD FROM NASAL SECRETIONS.

WASH YOUR HANDS OFTEN!!

The common cold completes its natural course in 10-14 days and management is focused on relief of symptoms.  Best therapies include humidified air, saline nasal drops (and bulb suctioning, if needed), positioning with the head elevated, and increased fluid intake.

In adolescents and adults, decongestants occasionally help symptoms; in infants and toddler, studies show cold preparations are no better than placebo (nothing). These products will not prevent ear infections.

If cold preparations are used, single ingredient products are recommended to decrease the risk of both adverse effects and overdose. (Data from the 2000 annual report of the American Association of Poison Control Centers indicate there were 61,034 overdoses in children younger than 6 years of age due to cough and cold preparations.) This includes not using cough/cold preparations that contain acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).  If your child has a fever or is uncomfortable, then give acetaminophen or ibuprofen separately.

Adapted from Pediatrics in Review, April, 2004

 

Constipation

"Constipation" is defined by physicians as stools that are "rock-like" in appearance and consistency. Such stools virtually never occur in breast fed babies. Such stools can occur in formula fed babies and require an adjustment in the formula feeding.

Another version of "constipation" is infrequent stools, regardless of the fact that the stools are loose to pasty in consistency. In the first few weeks of life, this may be the result of insufficient milk intake. Or the milk intake is sufficient, but the baby "holds on to" the stool from an inability to relax the rectal muscle. This is do to a temporary neurologic immaturity.

Regardless of the cause, "constipation" can aggravate crying/ colic and deserves appropriate attention. Call your doctor's office for advice.
 

Cord Care

Although many hospitals and pediatricians still recommend using rubbing alcohol to clean the cord, new studies showed that it does not speed up the drying process of the cord. Keep the cord dry and clean, you can use water and soap to clean the cord and navel few times a day until the cord falls off (usually between 7 - 14 days of age). Clean the area under the "stump" where the cord meets the normal skin of the umbilicus. Manipulation of the stump will not hurt the baby.

Oozing or minimal bleeding at the cord site is commonly observed for up to a week after the cord falls off and can be regarded as normal. The diaper should be kept "bikini" style, low on the baby's abdomen. Fold the plastic away from the baby's skin.

You should be aware of possible warning signs of a cord infection. Call your pediatrician if you notice an odor, discharge, or rash on the abdomen around or near the cord.
 

Crying / Colic 

All babies have periods of fussiness. The average two week old baby will cry about 1 3/4 hours a day. A six week old will cry 2 3/4 hours. After six weeks, the duration of crying steadily decreases. As a parent, you will develop an instinctive ability to "read" your baby's cries. You will learn the "hungry" cry, the "tired" cry, the "pick me up I want to play" cry, and the "something hurts" cry.

Some babies cry for lack of anything better to do.

The most common cause for the "something hurts" cry in the first few months of life is the baby's normal sensitivity to his own gastrointestinal ("peristaltic") contractions. The intensity of these contractions vary from baby to baby, with the result that some babies tend to grunt and whimper only on occasion, while other babies appear to be in almost constant pain.

Because bowel contractions, a necessary part of the digestive process, are responsible for the baby's pain, most traditional remedies for this problem, while worth trying, are usually useless: e.g. changing the mother's diet, changing the formula, "colic drops", chamomile tea, grippe water.

Some non-medical approaches to this problem: Mild colic is relieved by distraction such as carrying the baby, offering a pacifier, using an automatic rocker or the old fashioned rocking chair, taking a stroll, going for a ride in the car, taking a bath. Gentle warmth to the baby's abdomen may help: use a warm water bottle or have the baby lie on your stomach.

If the baby is having constipation , relieving this problem will relieve the intensity of the cramps. If the baby is experiencing spitting up/ vomiting/ reflux follow appropriate measures to address this problem.

If your non-medical problems fail, an office visit for a complete medical evaluation is warranted. Be assured that measures to relieve even severe colic are available and effective.

A severely colicky baby cannot be consoled by carrying and it would be reasonable to leave such a baby in the crib, provided the remedies above have been attempted. A baby who is crying because he is over tired should be left in the crib.

Babies who are crying from hunger, a full diaper, or the human need for loving, deserve immediate attention. The baby cannot be spoiled by responding rapidly to his appropriate needs. Usually, A child rapidly attended to while crying will be more easily consoled and will cry for a shorter period of time than a child left to fuss. In addition, these children tend to become more independent, less whinny, and less clingy as older infants and toddlers. The time you spend consoling your infant in early months may reap rewards later in childhood.
 

Diarrhea / Vomiting

 

GASTROENTERITIS GUIDE

 

Vomiting and diarrheal illnesses are very common in children but are usually managed at home with no medications needed. These illnesses infect the intestines which may include the following symptoms:

            Watery non-bloody diarrhea

            Abdominal cramps and pain

            Nausea, vomiting, or both

            Occasional muscle aches or headache

            Fever ( greater than 100.4 )

 

Depending on the cause of the illness, the infection can range from mild to severe, lasting a day or 2 or as long as 10 days. There’s often no specific medical treatment for gastroenteritis because antibiotics are not effective against viruses. To keep more comfortable and prevent dehydration:

            Let the stomach settle and wait 1 hour after vomiting before trying liquids

Older children may suck on ice chips or take small sips of clear liquids

Pedialyte is the drink of choice in small children

Pedialyte popsicles for small children and popsicles for older children also deliver fluids slowly

            Ease back into eating solids

            Do not use Ibuprofen,  and use Tylenol sparingly

            Avoid Aspirin

            If no vomiting, may offer regular diet (including milk products) as desired by the child

 

 Call the doctors office if any of the following are present:

            Temperature higher than 104 degrees

            Is unusually sleepy, difficult to arouse, or irritable

            Has bloody diarrhea

            Has a dry mouth or cries without tears

            No urine output for 12 hours

            Is in a lot of discomfort or pain

            Any  other worrisome symptoms

 

Remember: The best defense against the spread of intestinal infections is FREQUENT AND THOROUGH WASHING OF HANDS.         

Compiled in part from The Mayo Clinic

 

Emergency Phone Numbers

Police, Fire, Ambulance 911

Poison Control (202) 625-3333 or (800) 222-1222

Children's National Medical Center Emergency Room (202) 476-5203 or (202) 476-5433

INOVA Alexandria Hospital Emergency Room (703) 504-3065

INOVA Fairfax Hospital Emergency Room (703) 776-3154

INOVA Mt. Vernon Hospital Emergency Room (703) 664-7111

Virginia Hospital Center (Arlington Hospital) Emergency Room (703) 558-6161
 

Eye Care

Your baby will have drops put into his eyes shortly after birth. These drops prevent what was once one of the most common causes of blindness in newborns. Many babies will develop a mild swelling of the eyelids and/or a small amount of discharge from the eyes. You can gently wipe the exudate away with a clean washcloth and water. It will resolve without any damage to your baby's eyes. If excessive tearing or mucous persists, bring it to your doctor's attention.
 

Fever 

FEVER GUIDE
 
When children have a fever, parents worry about doing the right thing- knowing when to act and when to let nature take its course. Children’s Medical Associates care for  children with fever who may or may not need medications for the elevated temperature. To help demystify fever, CMA has compiled a fever guide for parents.
  What is fever?
Fever is the body’s normal way of fighting infection. Fever lets us know that something is going on and alerts us to keep an extra watch on how a child is acting. Normal temperature variation throughout the day is between 97 degrees and 100.4 degrees F. Your child has a fever if his or her temperature is greater than 38.5 C or 100.4 F with a rectal or ear thermometer. The best way to take a temperature of a child under 3 years of age is rectally. Using a digital thermometer is the quickest and safest. Mercury glass thermometers are NO LONGER recommended. Taking a temperature under the arm, with a forehead strip or with a pacifier thermometer is unreliable and NOT recommended.
  Putting the fever in perspective
Fevers between 100.5 and 105 F are common with many illnesses in children. The height of the fever does not necessarily correlate with severity of illness. We treat children with fever reducing medication to make them more comfortable. Never wake your child just to take a temperature or to give fever reducing medication. Fevers are not dangerous until they are over 108 F. Children under 2 months of age with a rectal temperature over 100.4 F should see a doctor.
  What to do?
If you think your child has a fever, dress him or her lightly and encourage fluid intake. Avoid bundling your child in heavy blankets. SPONGE AND COOL BATHS ARE USUALLY NOT NEEDED AND MAY MAKE YOUR CHILD MORE UNCOMFORTABLE. ALCOHOL BATHS OR RUBS ARE DEFINITELY NOT RECOMMENDED AND MAY BE HARMFUL.

If you choose to use a fever reducing medication, we recommend either acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). We do not recommend alternating these medications or giving them at the same time. These medications will reduce the temperature 1-2 degrees and last several hours. Reducing a temperature to normal is not necessary, because a little fever can be beneficial in helping your child fight infection.
 

Contact your doctor’s office if your child is:

Very irritable
Not drinking or urinating
Looking and acting very sick or seems confused
Feverish for longer than 3 days
Having difficulty breathing
Unable to swallow
Very sleepy and hard to wake up
Or if you have any concerns

Compiled in part from the Children’s Hospital of Eastern Ontario
 
 
 

Hiccups

Hiccups are most common in the first few weeks of life and generally subside in frequency by two to three months of age. No treatment is necessary, but burping the baby or offering warm tap water are two measures which might help.
 

Jaundice

Many babies develop a yellowish color to their skin and sometimes the white of their eyes during the first week of life. This is called "jaundice" and is caused by the accumulation of a pigment called "bilirubin" in the blood stream as a result of the immaturity of the newborn liver. Jaundice usually reaches its peak on the third to fifth day of life and then resolves over the next two weeks. It is not an illness and only a temporary condition. A blood sample may be taken from the baby's heel to determine the bilirubin level. In most cases jaundice is mild and requires no treatment. Occasionally a baby may be placed under special "bili lites" to reduce the elevated level. It is not unusual to make several visits to the doctor's office, during the first week home, to follow the jaundice level.
 
 

Metabolic Screening Tests

Prior to discharge from the hospital and again at the first office visit, your baby will have a blood test done by heel stick to check for the presence of "PKU," thyroid abnormalities, and a number of other metabolic disorders. These diseases can cause mental retardation if not detected early which can be prevented if treated promptly.
 

Prevention of Accidents and Poisoning

Accidents and poisonings are by far the most frequent causes of death and crippling among children. It is your responsibility to provide a safe environment for your child. Read the following instructions carefully. Do not wait until your child has already been hurt before you make your home safe.

 

1. When traveling, a car seat (or safety belt for older children) must always be used. The younger your baby, the more he needs to be protected. A child is safest when riding rear-facing until twelve months of age and 20 pounds. Secure the car seat properly into the car's seat belts and strap your child into the car seat. We recommend the use of car seats until a child reaches a minimum weight of 45 pounds.  The AAP recommends that children remain in booster seats until they reach a height of 57 inches.

2. The sides and ends of your baby's crib should be protected to prevent your baby from getting caught between the bars. The slats should be less than 2 3/ 8 inches apart. Corner posts should be less than 5/8 of an inch high. See that the sides of your crib are up and latched whenever you turn away from your baby. Blankets should be light and loose, mattresses should be firm and snugly fitted. There should be a minimum of 26 inches from the top rail to the mattress, with the mattress set at the lowest point. There should be no sharp edges or lead paint. Pillows are not recommended.

3. Always stay with your baby when he is in the bath. Always grab a wrist or ankle firmly if you must turn away, even for a moment!

4. Keep him away from faucet handles - babies have been burned by hot water. Turn your hot water heater down so that your hot water temperature is 120 to 125 degrees maximum.

5. Hot coffee, either from a cup or a percolator, is the leading cause of burns. Immediate application of cold running water over the burn area is the best initial first aid you can give.

6. Your baby should not be left alone on any thing from which he might fall. Do not turn away, even for a moment, even at two weeks of age. This advice applies even to babies restrained in infant carriers or infant seats.

7. Your baby should be given only safe toys. Rattles should be unbreakable. Toys should have no sharp points and no small parts which might break off and choke him.

8. Keep plastic bags, safety pins, and other small objects out of your baby's reach.

9. Children should not have anything tied around their neck. Cords, pacifiers, and necklaces used in this fashion have been known to result in strangulation.

10. Toddlers and early school age children are prone to the ingestion of poisons, either in the form of medicines, cleaning compounds, toxic plants, insecticides, or alcohol. If ingestion occurs, call Poison Control immediately at (202) 625-3333 or (800) 222-1222 or go straight to the nearest Emergency Room. 

11. Head injury from bicycle accidents is a leading cause of serious injury in children. Small children riding in bicycle seats and older children and teenagers riding their own bicycles should wear an approved safety helmet. Helmets bearing a sticker from ANSI (American National Standards Institute) or the Snell Memorial Foundation indicates that strict safety standards have been met.

12. To prevent unnecessary risks in bicycle riding, avoid buying a bike that a child must grow into. A beginning cyclist should have a standard or three gear bicycle with pedal brakes. The child should be able to place the balls of both feet on the ground when sitting on the seat, stand straddling the crossbar (if there is one) with one inch clearance between the crossbar and crotch, and apply pedal brakes or hand brakes without difficulty and with enough force to stop quickly.

13. Falls are common in toddlers and active children. Let your doctor know if there is a deep cut or if your child has difficulty or pain in moving his arms or legs. Bumps on the head are frequent. If your child gets up right away and seems fine, there is probably nothing seriously wrong. If he is tired, let him go to sleep, but check him every 3 - 4 hours to make sure he stirs as in a normal sleep. If there is a loss of consciousness, vomiting, change in coordination or behavior, or he "just doesn't act right" call the office.

14. Knowledge of cardiopulmonary resuscitation (CPR) is highly recommended for parents and sitters. Contact the local Red Cross or your community hospital for class information.

Rashes

Babies are prone to rashes. A sunburn-like peeling of the superficial layers of the skin, especially on the hands and feet, is almost universal in the first two weeks of life. This phenomenon is normal and requires no treatment. Another common skin condition in the first two weeks usually noticed on the first or second day, is the appearance of scattered hive-like bumps which change location almost hourly. This rash, which resembles insect bites, causes the baby no discomfort and disappears by two weeks of age.

At two to four weeks of age many babies develop acne-like pimples on the cheeks and chin which may be associated with a rash in the scalp that consists of fine red bumps with a yellowish crust. These rashes go by the popular names of "infant acne" and "cradle cap" and by the technical name of "seborrheic dermatitis." The daily use of a mild soap and water on the face and the every other day use of a baby shampoo on the scalp will usually keep this rash under control. If not, your doctor's office will recommend additional measures. Seborrheic dermatitis is felt to be a developmental phenomenon related to hormonal changes taking place in the baby. Even untreated, it usually resolves by two to four months of age.

Other rashes are due to the baby's sensitive skin, which is easily irritated by moisture. Since babies usually do some "spitting up," change the crib sheet frequently to prevent chafing of baby's cheeks. The diaper area is almost always exposed to moisture, and keeping that area clean and dry is the key to rash control. Clean the area with a warm wet washcloth, and dry well before re-diapering. Pre-moistened towelettes can be irritating to newborns and might be reserved for times when soap and water are not available.

In the presence of rash on your baby's skin, a food newly introduced to the diet, a new laundry detergent, or fabric softener should be viewed with suspicion. Any rash which fails to respond to standard remedies within 2 - 3 days deserves a call and perhaps a visit to the doctor's office.
 

Shaken Baby Syndrome

Although parents and sitters can often times be frustrated with a crying baby/ child, it is important never to shake the baby/child for this could result in serious harm. If you ever have overwhelming feelings of frustration or anger, you should contact your pediatrician. Your concerns should be met compassionately.
 

Sneezing and Nasal Congestion

A small amount of sneezing is normal in all babies and is useful to clear the nose of mucous and dust. Nasal congestion is also common. For occasional congestion, one or two drops of saline solution in each nostril may be administered every four hours. Saline nose drops may be purchased over the counter in a drug store: Nasal, Ocean and Ayr are several name brands. A cool mist vaporizer or humidifier in the baby's room may relieve sneezing and nasal congestion by preventing irritation of the nasal membranes from dryness. A very congested baby may be experiencing an upper respiratory infection or allergy problems. Please call if the baby is having trouble breathing or you are concerned.

Sleep

It has previously been thought that babies are generally most comfortable and safest if they sleep on their abdomen or side. However, since October of 1994, the American Academy of Pediatrics has recommended that babies should be placed on their sides or backs, not stomachs. This recommendation was based on many studies that demonstrated a decreased incidence of Sudden Infant Death Syndrome in babies who do not sleep on their stomachs. In fact, since the introduction of the back-or-side sleep position in the United States, the incidence of Sudden Infant Death Syndrome has dropped in half!

Although some parents prefer to have their newborns sleep in bassinets in their room, we encourage putting babies in their own room within the first few weeks of life. Everyone rests better. Be assured that you will hear your baby if he needs you. The sooner you allow the baby to sleep in his own room, the sooner you will all sleep through the night.

A normal baby will sleep 18 - 20 hours a day during the first several weeks of life. They awaken when they are hungry, wet, or otherwise uncomfortable. Many babies are more active during the night than the day in this early period. By 3 - 4 months, most babies will sleep through the night, omitting the night feeding. This will finally provide you with some additional needed rest.

There is no need to "tip-toe" around your house when a new baby has joined the family. He will easily acclimate to your normal noise levels and learn to sleep through the running of a vacuum cleaner in the same room or a football game on TV.
 

  Spitting Up/ Vomiting/ Reflux

Babies seldom "spit up" in the first few weeks of life because the milk intake at each feeding is small. It's typical for the baby to begin "spitting up" at two to four weeks of age. Effortless regurgitation of small amounts of milk is normal. Forceful vomiting ("projectile vomiting") is abnormal and requires a call to the pediatrician and possibly further evaluation.

Some babies raise milk from the stomach to the esophagus or the throat and then reswallow the milk. The is referred to as "gastroesophageal reflux" . Mild reflux is normal and of no concern. Reflux which appears to pain the baby or causes frequent gagging requires a medical evaluation and possibly medical treatment (usually medication).
 
 

Teething

Babies generally begin to drool and chew from teething around age two to four months, although the teeth do not usually erupt before four to seven months of age. For several weeks before a tooth breaks through the gums, the baby may experience discomfort. Irritability, poor sleep, reluctance to suck, and an increase in the frequency of bowel movements are symptoms associated with dental eruption. You may give acetaminophen drops every four hours as needed for temporary relief. If the baby's symptoms are disturbing, call the doctor's office to discuss the problem. We are careful not to attribute symptoms to teething which might be due to other problems.

Baby teeth usually erupt as follows:

Central incisors 6 - 12 months

Lateral incisors 9 -14 months

Canine (eye teeth) 16 - 22 months

First year molar 13 - 17 months

Second year molar 24 - 30 months

The time to start cleaning a baby's mouth is shortly after birth. The gums can be gently wiped daily with a soft cloth. This routine gets the child used to having the mouth touched by the parent's fingers. When the first teeth do erupt, the cloth may be used to clean them. A toothbrush is generally introduced when the baby has about 8 teeth (no later than age 2 years old).

The Soft Spot

There is an area at the top of the head where the bones of the skull are separated leaving a soft diamond shaped opening called the "anterior fontanel". The "posterior fontanel" represents a smaller soft spot at the back of the head. Despite the absence of a bone cover, these areas are well protected by a firm membrane beneath the skin. It is safe to shampoo these areas; indeed the failure to do so might aggravate a scaling condition of the scalp known as "cradle cap" or seborrhea. The posterior fontanel usually closes by two months of age, the anterior by fifteen to eighteen months.
 
 
 

  Things to Remember

1. A healthy baby cries several times a day.

2. A healthy baby may sleep 18 - 20 hours a day.

3. Puffy eyes with mucous in the first 2 - 4 days of life are the result of drops or ointment put into the eyes at birth to prevent eye infections. This is temporary and harmless .

4. A red bruise on the cheeks of an infant delivered by forceps is normal. It may be followed by a lump under the skin in this area. The lump will shrink away in about one month.

5. Occasional spitting up, straining to have bowel movements, hiccups, and sneezing are normal.

6. Mild to moderately swollen baby breasts are normal. Do not massage or rub them. They will shrink by themselves.

7. Occasional bloody mucous from the vaginal area the first month of life is normal. It is due to the effect of hormones from your body to which the baby was exposed during development. It will stop by itself in 2 - 4 days.

8. There is no need to give your baby extra water. The water in the formula or breast is plenty.

9. A healthy newborn might lose up to 10% of his body weight during the first week or so of life. Do not feel that this represents an inadequate intake.

 

Well Child Visits

Well Child Visits serve as a forum to review your baby's growth, nutrition, day to day activities and development.  During these visits we often also administer the recommended vaccinations and obtain the recommended tests.  The Well Child Visits are generally conducted at:

    -4-5 days old

    -2 weeks old

    -2 months old

    -4 months old

    -6 months old

    -9 months old

    -12 months old

    -15 months old

    -18 months old

    -2 years old and once a year thereafter. 

Our schedule of well child visits coincides with the present recommendations of the American Academy of Pediatrics.  If and when these recommendations change, we will alter our visit and immunization schedule accordingly.
 

Click on this link to view the 2008 Recommended Childhood Vaccine Schedule. 

Click on this link to view the 2008 Recommended Adolescent Vaccine Schedule.

When to Call the Doctor

Suggested Reading

BREASTFEEDING

 

-Dr. Mom’s Guide to Breastfeeding by Dr. Marianne Neifert

-Breastfeeding-A Parent’s Guide by Amy Spangler

-The Nursing Mother’s Companion by Kathleen Huggins, RN

-Nursing Mother, Working Mother by Gayle Pryor

-AAP New Mother’s Guide to Breastfeeding by JY Meek,MD

 

CHILD DEVELOPMENT

 

-Infants and Mothers, revised edition by T. Berry Brazelton, MD

-Your Child at Play: One to Two Years by Marilyn Segal

-AAP Caring for Your Baby and Young Child, Birth to age Five, 2004 by Steven Shelov MD et al

-AAP Guide to Your Child’s Symptom, Edition 1 by Donald Schiff MD et al

-Between Parent and Child. Revised edition by Ginott et al.

-How to Talk so your Kids will Listen and Listen so your Kids will Talk by Faber and Mazlish

-Touchpoints by T.Berry Brazelton

 

ADVICE BOOKS

 

-Siblings Without Rivalry by Elaine Mazlish

-Food Fights by Eagan

-Feed Me I’m Yours by Vicky Lansky

-Raising Positive Kids in a Negative World by Zig Ziglar

-How to Talk so your Kids will Listen and Listen so your Kids will Talk by Faber and Mazlish

-Solve Your Child’s Sleep Problems by Richard Ferber,MD

-Living with Children by Gerald Patterson

 

 

PROBLEM SOLVING

 

-The Kazdin Method for Parenting the Defiant Child by Alan Kazdin Ph.D.

-Effective Parenting for the Hard to Manage Child by Degangi and Kendall

-The Magic Years: Understanding and Handling the Problems of Early Childhood by Selma Fraiberg

-Why can’t you catch me being good? by Edyth Denkin, Ph.D

-The Difficult Child by Scott Turecki, MD

-The Challenging Child by Stanley Greenspan, MD

-Answers to Distraction by Edward Hallowell, MD

-From Chaos to Calm: effective Parenting for Challenging Children with ADHD and other Behavior Problems by Sharon Weiss

-Freeing your Child from Anxiety by Tamar Chansky

-Helping your Anxious Child by Rapee and Spence

-Your Spirited Child, a guide for parents whose child is more intense, sensitive, perceptive, persistent, and energetic by Mary Sheedy Kurcinka

 

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