CARE OF YOUR NEW BABY
Congratulations on your addition to the family! We are very pleased you have
chosen us to be your pediatricians. If your baby has been born at St. Vincent
Mercy Medical Center or The Toledo Hospital one of our physicians have
examined your baby following delivery. If your baby was born at another
hospital we will meet him/her at your initial visit in our office.
The instructions given here will help you meet the needs common to newborn
babies and will give you helpful hints on how to keep your baby healthy and
happy.
Your child is an individual from the day he/she is born. Adapt these instructions
to your baby. Do not depend on friends or relatives. We will always be happy
to give you guidance and answer your questions while you are in the hospital,
and later by phone and during your visits to the office.
Because medical care of infants and children is a 24 hour a day responsibility,
pediatric advice and attention will always be available to you.
YOUR BABY’S FIRST WEEK OF LIFE
During the first 3 to 5 days in the hospital it is normal for your baby to lose from
5 to 10% of his/her birth weight. Shortly thereafter feedings will go well and the
weight will be quickly regained.
Many babies are very sleepy the first 2 to 3 days and do not act the least bit
interested in feeding. Try to arouse your baby but do not worry if only ¼ or ½
ounce of feeding is taken during this period of time.
Many babies vomit on occasion during or shortly after the first few feedings.
This usually is caused by mucus in the stomach swallowed at birth—it is
common and no cause for concern.
We will watch your baby’s progress carefully while in the hospital and any
significant difficulty will be thoroughly discussed with you.
HOUSING
Your baby should have a sunny, well ventilated room. The temperature should
seem comfortable to you (70º-74º) day and night. The room should be aired
daily while the baby is in another room. The furnishings in the baby’s room
should be of the simplest type so they will not collect dust and may be easily
cleaned.
BEDDING
During the first six months your baby may sleep in a bassinet which should have
solid sides. A crib may be used from the beginning and should have slats placed
close enough that the baby’s head cannot get in between them. The mattress
should be firm, smooth, and waterproof. It should be covered with a cotton pad
and then a sheet. No pillow or top-sheet should be used. The baby should be
covered with one or two cotton blankets. Do not wrap the baby in blankets
because this interferes with freedom to kick. The Academy of Pediatrics has
recommended that you place your baby on his/her back for sleeping unless
otherwise recommended by one of us for medical reasons.
1
CLOTHING
A good rule of thumb when dressing your baby is to apply one layer greater than
yourself. Never should clothing be heavy enough to induce perspiration. There
is always a tendency to overdress infants and children. Clothing should be as
simple as possible, light in weight, soft in texture, and should fit quite loosely.
Some babies are allergic to certain materials, so watch for rashes in clothing
contact areas. Cotton is by far the best material for contact with baby’s skin.
CARE OF THE NAVEL
The umbilical cord falls off between 1 to 6 weeks of age. Keep it clean and dry.
A gauze square may be used. Apply alcohol by cotton tipped applicator if the
cord is oozing or foul smelling, otherwise leave the cord alone. Occasionally
after the cord falls off you may see drops of blood—this is no cause to worry. If
spotting of blood should continue for two or three days, then call to schedule an
appointment for us to examine. If you notice a persistent discharge and a
marked redness of the skin around the navel, call us as soon as possible. Only
sponge baths are to be given until the navel is completely healed, thereafter
baths are permissible.
CARE OF THE CIRCUMCISION
You may apply Vaseline to the circumcision until it is well healed. It is not
necessary to use any gauze. Infected circumcisions are rare, but if you should
notice swelling, bleeding or a discharge, please call us. The average urinary
stream for boys is from one to two feet long. Notify us if your baby just
dribbles.
CARE OF THE UNCIRCUMCISED
Care of the uncircumcised boy is quite easy: “Leave it alone” is good advice.
External washing and rinsing on a daily basis is all that is required. Do not
retract the foreskin in an infant, as it is almost always attached to the glans.
Forcing the foreskin back may harm the penis, causing pain, bleeding, and
possible adhesions. The natural separation of the foreskin from the glans may
take many years.
BATHING YOUR BABY
Bathe your baby at the time of day that is most convenient for you. Remember
that bathing can be very relaxing for your baby and may be done during a
“fussy” period or at bedtime. Bath instructions will be given to you during your
hospital stay.
The room where you bathe your baby should be comfortably warm. The bath
water should feel warm to the elbow and about three inches deep. Remember a
soapy baby is very slippery. We suggest that a mild soap be used such as Dove
or Johnson’s Baby Soap.
Wash the face with plain water and a soft washcloth. Use soap on the scalp and
rest of the body. Gently washing over the “soft spot” is perfectly safe. Clean
the eyelids and corners of the eyes with clean cotton and water. The ears and
nose may be cleaned with moist, cotton-tipped applicators. Do not attempt to
clean the inside of either the nose or the ears. Following the bath, rinse the skin
thoroughly and dry well with a soft towel.
2
If you note any persistent discharge from the eyes, call us. Fingernails and
toenails should be cut whenever they extend beyond the edge of the digit.
There is rarely a need to use commercial baby oils or lotions. New babies
frequently shed an outer layer of skin that appears scaly until it falls off. This is
not dry skin. Oils and lotions can cause skin irritations.
It is not necessary to give your baby a daily bath. Too frequent bathing can
wash the natural oils out of the baby’s skin, especially during the winter months.
For many babies, a two or three day interval between baths is quite acceptable.
STOOLS AND HYGIENE
Your baby may have a bowel movement after each feeding or may have one
stool a day. Breast-fed babies may have a stool every 5 days and bottle-fed
every 7 days, and be perfectly normal. Your baby may strain and cry when he
has a stool, but unless the stool is hard and pellet like, or contains blood, this is
normal. Stool consistency is the important distinction in babies. If stools are
excessively watery or contain mucus or blood, bring this to our attention. DO
NOT give your baby enemas or laxatives without talking with us. Do not give
your baby Karo syrup.
Change your baby’s diaper as soon as possible after each bowel movement or
wetting. After each bowel movement wash diaper area with a soft cloth and
soap and water. Rinse well with warm water. After each wetting rinse area well
with warm water and pat dry with a clean, soft cloth. Use a washcloth for the
first 2-3 weeks and then you may use wipes. If redness or irritation occurs,
switch back to using a washcloth.
If a mild diaper rash develops try to keep the diaper area as clean and dry as
possible. Following a thorough cleaning, wipe dry and then fan dry the area.
For additional drying effect, keep the diaper off and expose the bottom to air as
much as possible. Turn the baby on his/her stomach with a folded diaper
underneath. Should the diaper rash persist, Desitin or A & D ointment, applied
four to six times a day may be helpful. If you are unsuccessful in clearing a
severe diaper rash with home care, let us examine the baby in our office.
At times there is an irritation around the anus from stool—if this develops on
your baby then decrease fruit and fruit juice in his/her diet and apply an
ointment to the area two to three times a day.
CRYING
Crying is your baby’s way of saying, I’m hungry, I’m wet, I’m thirsty, I’m too
hot, I’m too cold, I have a stomachache, or I’m bored. You will gradually learn
to know what the baby means. Even a well baby will probably cry for a little
while each day and could cry for an hour or so without doing any harm.
All babies sneeze, belch, have hiccoughs, pass gas, and cry. They may
occasionally look cross-eyed. Sneezing is the only way in which a baby can
clean his/her nose of mucus, lint or milk curds. Hiccoughs are little spasms of
the diaphragm muscle. They may often be stopped by giving a few swallows of
warm water.
3
OUTDOORS
A fairly good rule to follow is to take your baby out whenever the weather is
pleasant. Good sense should dictate the amount of time the baby is outdoors as
well as the appropriate clothing. The baby’s exposure to direct sunlight should
be limited since the baby’s skin is easily burned.
EMERGENCIES
PLEASE DO NOT CALL OUR DOCTORS AFTER HOURS UNLESS
YOU HAVE A TRUE EMERGENCY. Should a medical emergency arise,
call 911, or our office at (419) 841-6202 during office hours. If you have an
urgent need after hours call our office number and an automated answering
system will direct you how to leave a message. Once a message is left the oncall doctor is notified and will respond. If you have not heard back from the oncall doctor within 20 minutes either re-page the doctor or proceed to the
emergency room.
If you must take your child to an emergency room we prefer either St. Vincent
Mercy Medical Center or The Toledo Hospital. Both hospitals are equipped to
handle pediatric patients. Your choice of hospitals is dependent on your
insurance, which is your responsibility to know. If your child has sustained a
serious medical problem, such as respiratory distress, and you choose not to call
911, you should go to the nearest emergency room.
REMEMBER…AFTER HOURS CALLS ARE ONLY IF YOU HAVE A
TRUE EMERGENCY.
VITAMINS
Vitamins will be prescribed for breast fed babies. They should be started at two
weeks of age and given daily until twelve months of age or until your baby is
eating a well-balanced diet. Vitamins can be purchased over-the-counter.
Formula fed babies do not require supplemental vitamins or fluoride unless your
water supply has inadequate fluoride. If your water does not have enough
fluoride, supplementation will begin at six months of age.
AT FEEDING TIME
Feeding is one of baby’s first pleasant experiences. The baby’s first love for its
parents arises primarily from the feeding situation. Both of you should be
comfortable. Hold your baby in your lap with the head slightly raised and
resting in the bend of your elbow. Whether breast feeding or bottle feeding,
hold your baby comfortably close.
BREAST FEEDING
To begin feeding, first place two fingers on each side of the nipple and press
slightly so the nipple sticks out, then gently stroke the baby’s cheek on the side
near the breast. This will cause the baby to turn the head in the right direction,
and to open his/her mouth for taking the breast (rooting reflex). You must be
sure the baby gets the nipple deep in his/her mouth because this is the only way
a baby can properly milk the breast. Help the baby breathe by depressing the
breast near his/her nose with your finger. The finger is again used to terminate
breast feeding by gently placing your finger in the corner of the baby’s mouth,
releasing the suction.
4
Some babies like to suck more than others just for the satisfaction of it. Thirty
minutes is a wise maximum for nursing, and much less time in the first week or
two to prevent cracked nipples.
Since you are unable to measure the exact amount of milk your baby is receiving
from the breast, you may fear the baby is not getting enough milk. If your baby
is content, and having at least 6 good wet diapers per day, after day 6 of life,
your milk supply is surely adequate.
The decision to offer one or both breasts at a feeding will be a compromise
between your feelings and the baby’s appetite. Nursing from both breasts at
each feeding is a good rule to follow, but it has special advantages during the
early weeks: the baby gets access to twice as much milk, the breasts are
stimulated to produce milk twice as often, and the baby’s sucking needs may be
satisfied without as much risk of nipple injury. If milk supply is ample, one
breast may suffice per feeding; then the other should be offered at the next
feeding.
We suggest that you do not use soap or any other drying agent on your nipples
to cleanse them. Rinsing off your nipples once each day with clear water is
sufficient. Allow the nipples to air dry after each nursing. Some mothers find
that lubrication of the nipples with lanolin or similar creams is beneficial.
The nursing mother should eat a well balanced diet which should include milk,
milk products and a moderate amount of meat and eggs. Additional vitamins
should be taken only if recommended by your obstetrician. Drink plenty of
fluids and avoid large quantities of highly spiced foods. Chocolate can be eaten
in moderation. Alcoholic beverages and smoking is not advisable. Rest is
important for the nursing mother, even if only for short periods during the day.
Avoidance of worry, fatigue and excitement will assure the continuation of an
adequate breast milk supply.
If you are having difficulty with any part of breast feeding, or have questions
you may contact a Lactation Consultant at the hospital where you delivered or
call our office to speak to a nurse.
You may pump your breasts to fill a bottle for your baby while you are out.
Keep this in the refrigerator and use within 24 hours. Breast milk may be frozen
for up to 30 days in a refrigerator freezer but may not be refrozen once thawed
for use. Breast milk may be stored in a deep freeze for up to six months.
Always feed stored breast milk in the order in which it was pumped.
BOTTLE FEEDING
Seated comfortably, and holding your baby with the head supported, tilt the
bottle so that the neck of the bottle and the nipple are always filled with formula.
This helps your baby to get formula, and prevents the baby from sucking and
swallowing air. Air in the stomach can give a baby a false sense of fullness and
may also cause discomfort.
Your baby has a strong, natural desire to suck, and for infants, sucking is part of
the pleasure of feeding time. Babies will suck on nipples even after they have
collapsed, so on occasion; take the nipple out of the mouth to prevent collapsing.
This also gives baby time to rest a bit.
Never prop up bottles and leave babies to feed themselves—the bottle can easily
slip into the wrong position. Remember too, babies need the security and
pleasure they receive by being held at feeding time.
5
USE A FLEXIBLE SCHEDULE
Your baby should be fed when he / she is hungry. This may be from every one
to four hours during the daytime. Most babies will require a 1:00 to 3:00 a.m.
feeding until they are four to six weeks of age. It is not necessary to wake the
baby for this feeding. If they are hungry and need the feeding, they will let you
know.
HOW MUCH FORMULA
The amount of formula your baby takes will vary. Babies have a right not to be
hungry sometimes, just as you and I, and you can’t make a baby want to eat.
Most babies feed for 15 to 20 minutes. You will probably find that sometimes
your baby will take his/her entire bottle and sometimes he/she won’t. Don’t
worry—this is normal.
When you go home from the hospital prepare each bottle with three ounces of
formula. As soon as your baby empties more than half of his/her bottle, add
another ounce to each bottle. It is good to have a little formula left in each bottle
after a feeding—then you are certain the baby has had all he/she desires.
BURPING
About halfway through a feeding you may notice that your baby tends to stiffen
out a bit. This is a good sign that it is burping time. You will soon find from
experience, how many times during the feeding it is necessary to burp your
baby.
There are three effective ways to handle burping, all of which may be tried to
see which one works best:
1. Over the shoulder—hold your baby in the usual upright carrying
position, supporting the back upward and gently pat the back with your
hand.
2. Face downward—place the baby in this position across your lap,
supporting the head, pat the back gently.
3. Sitting—in this position the baby is less likely to spit up. Seat the baby
on your lap, supporting head and back with one hand, head and front
with the other. Now gently move the infant back and forth as if
bowing, occasionally sitting the baby upright for a rest.
Remember, burping sometimes takes a while, and it is a good idea to cover your
shoulder or lap with a clean towel while doing so.
AFTER FEEDING
After you have fed and burped your baby, place the baby in bed. He / she
should be placed on his/her back to sleep. If you have a baby that tends to spit
up then keep him/her upright for 20 minutes after each feeding.
After bottle feeding, rinse bottles and nipples with cool water. This removes
milk before it forms a film and makes washing easier. Squeeze water through
the holes of the nipples as you rinse them. Washing can be done later, whenever
it’s convenient for you.
6
FORMULA PREPARATION
Present commercial formula preparations have made the sterilization of formula
unnecessary. City tap water is also pure and no longer requires boiling. Wellwater is usually pure, but as an added safety precaution, it should be boiled five
minutes before being used in a formula preparation.
We suggest that you thoroughly scrub and wash bottles and nipples in detergent
and water to remove formula residue. A dishwasher is acceptable after
preliminary cleansing. Adequate rinsing is important to remove traces of
detergent.
Because formula comes in different preparations—ready-to-feed, powder, and
concentrate, it is of utmost importance to read and follow the instructions on the
label.
Test the temperature of the formula by shaking a few drops onto your wrist. It
should feel warm, but not hot. We warm formula only because a baby prefers
warm formula. Formula at room temperature will not harm your baby.
You may prepare six to eight bottles of formula at a time. Formula is safely
stored in a refrigerator for twenty-four to forty-eight hours.
You may warm your formula in a microwave oven, but please remember the
core milk is hotter that the bottle feels. Shake the milk for a time and be certain
it is only lukewarm when fed to the baby.
Once your baby has taken part of the formula, the bottle should be discarded and
a fresh one used for the next feeding.
The average baby will take about 2 ½ ounces of formula per pound of baby
weight, per 24 hours. As the weight increases, your baby will gradually require
more formula. We do not recommend the use of “low iron”, or soy-based
formula unless specifically instructed by one of us.
BABY’S APPETITE
You may observe that during the first few months of life it seems difficult to
satisfy baby’s appetite. The baby may be “always hungry”. This is normal. At
no time in life is growth as rapid and caloric need as great as during the first few
months.
Breast milk or formula is the only food recommended for your baby during the
first four months. Cereal is not utilized by the baby for his nutritional needs
before four months of age. Cereal will not help your baby sleep through the
night.
All babies are different. Some little ones will omit the 2 a.m. feeding as early as
two weeks of age, other perfectly normal babies will be unable to miss this
feeding until older. This difference is a characteristic of the baby and not due to
the baby being breast or formula fed, or solid food intake.
PACIFIERS
Some newborn babies have a very strong sucking instinct during the first six
months of life. They will be discontent unless this sucking drive is satisfied.
These babies have a normal need for a pacifier.
7
Remember—a need may exist for the pacifier during the first six months only
and after that time it may become a habit. We recommend their use if your baby
needs it, but not if your baby has frequent ear infections (if so pacifiers should
be avoided).
Otherwise, the pacifier will cause no problem if it is taken away at six months of
age.
CHARGES
You will find our charges for medical services are moderate. Statements are
mailed once a month and payment is due within thirty days. You are welcome
to make cash payment at our office. If you have any questions about charges
please talk them over with us.
Co-pays are due at the time of service. If a co-pay is not collected within
twenty-four hours of service a $5.00 fee will be added to the account.
Failure to keep your scheduled appointment, or to cancel the appointment 24
hours prior to the visit, will result in the following charges according to the level
of service:
Follow-up Visit / Recheck -----------------------------$ 40.00
Sick Call / Office Visit-----------------------------------$ 50.00
Consultation / Medication Check-----------------------$ 75.00
Repeated offenses may result in discharge from our practice
OFFICE VISITS
We will usually see your baby in our office two to four days after discharge
from the hospital. Following this first office visit, we will see your baby for
well visits at 1 month, 2-4-6-9-12-15-18-24 months of age, and then yearly.
Your baby will receive his/her first immunization before being discharged from
the hospital. We will give your baby the required immunizations at his/her well
visits, as recommended by The American Academy of Pediatrics.
After your discharge from the hospital, call our office and make your baby’s
first appointment. If any problems arise before your first visit, feel free to call
us. It is best to call three to four weeks ahead for routine appointments. This
will enable our staff to arrange a convenient time to fit your schedule.
Please try to be 15 minutes early for your appointments and give us 24 hours
notice if you are unable to keep your appointment. We try to keep an accurate
appointment schedule, which necessitates being punctual for your appointment.
PHONE CALLS
We handle a tremendous number of calls each day. For routine questions please
call between 9:00a.m.-11:00a.m. and 1:00 p.m.-3p.m. Please avoid routine calls
after 3:00 p.m. The evening calls should be reserved for parents whose children
have become suddenly ill.
Please remember, when calling the office for information, or when anticipating
the physician’s return call, have this green book, pencil and paper available as
well as the telephone number of your pharmacy.
8
If your child has any chronic illness such as convulsions, diabetes, heart or
respiratory problems, etc…, or if he/she is allergic to any medication, be sure to
bring these facts to our attention. Obviously, these special situations may
influence the advice we give you over the phone.
SPECIAL TESTING
Your baby had a newborn screening done prior to discharge from the hospital.
Newborn screening is a simple blood test used to identify many life-threatening
genetic illnesses before any symptoms begin. The sample is usually taken on
the day of discharge and must be done after 24 hours of age. We will be notified
by the state lab and the results will be placed in your baby’s chart. In an effort
to identify hearing loss early, a simple hearing test will be done prior to
discharge. This is a standard procedure at many hospitals and you will have
results when the test is done.
We may order lead screening for your child yearly, beginning at 12 months of
age. We will ask you a few questions at your well exams that will help us
determine the necessity of a blood test to screen for lead poisoning. This is done
at a lab by either a finger or vein specimen. (? Done in our office)
IMMUNIZATIONS
AS A PRACTICE, WE STRONGLY ENDORSE THE AAP & ACIP ROUTINE
CHILDHOOD IMMUNIZATION SCHEDULE.
**IT HAS BEEN
DEFINITIVELY PROVEN THAT AUTISM IS NOT CAUSED BY
VACCINES. We do not support alternative vaccine schedules, which can be
harmful, lead to more side effects and cause less vaccine effectiveness.
Immunizations are an integral part of your child’s health. Thankfully we have
the ability to immunize children against deadly, preventable diseases. Your
child will receive most of his/her childhood immunizations before his/her
second birthday. Our immunization schedule is based on the recommendation
of The Academy of Pediatrics. Following is a brief summary of the diseases we
immunize against:
Hepatitis B: Infants and children who become infected with Hepatitis B are at
the highest risk of developing life-long infection, which often leads to death
from liver disease and liver cancer.
Polio: causes acute paralysis that can lead to permanent physical disability and
even death.
Haemophilus Influenzae Type b (HIB) meningitis: Previously the most
common cause of bacterial meningitis in the U.S. before the vaccine. It led to
deafness, seizures or mental retardation in those who survived the disease. This
illness is now rare thanks to the vaccine.
Streptococcal Pneumoniae: Is currently the leading cause of bacterial
meningitis, pneumoniae, and blood infections in children. This vaccine protects
against these deadly diseases.
Pertussis (whooping cough): Can lead to pneumonia, seizures, brain disease
and death in infants. Results in prolonged coughing that lasts for many weeks,
causing dehydration and vomiting.
Diphtheria: Caused by poison produced from the bacteria. It frequently causes
heart and nerve problems.
9
Tetanus (lock jaw): A severe, often fatal disease. Leads to stiffness and spasms
of the muscles. Can cause the throat to close, and spasms can cause fractures.
Rotavirus: This virus causes severe diarrhea, mostly in babies and young
children. It is often accompanied by vomiting and fever. Before rotavirus
vaccine was used, it was responsible for more than 400,000 doctor visits,
200,000 emergency room visits, 55-70,000 hospitalizations, and 20-60 deaths in
the United States each year. This vaccine has proven to be very effective.
Influenza (“flu”): Highly contagious virus spread by coughing, sneezing, or
nasal secretions. Anyone can get influenza, but rates of infection are highest
among children. Symptoms include fever/chills, cough, sore throat, headache,
fatigue, runny or stuffy nose. Young children and anyone with chronic health
conditions can get much sicker. Flu can cause high fever and pneumonia, and
make existing medical conditions worse. It can cause diarrhea and seizures in
children. Each year thousands of people die from influenza and even more
require hospitalization. It is recommended for all people 6 months of age and
older. It is either given by injection (all ages) or a nasal mist (2years and older if
appropriate).
Hepatitis A: This is a serious liver disease caused by the Hepatitis A virus. It
can cause flu-like symptoms, jaundice (yellow skin or eyes) and severe stomach
pains and diarrhea. This illness often requires hospitalization.
Varicella (chickenpox): Always present in the community and highly
contagious. Can be severe in some, leading to complications such as
dehydration, pneumonia, and shingles. Children miss a week or more of school
on average when infected with chickenpox. Chicken pox was responsible for
100 deaths each year before the vaccine was started in 1995.
Measles: Rash that can cause complications such as pneumonia, diarrhea or ear
infections in 9% of those infected. Some develop encephalitis, which results in
brain damage. It is one of the most infectious diseases in the world, and is
frequently imported into the U.S.
Mumps: Once a major cause of deafness in children. Can cause swelling of the
brain, nerves and spinal cord that can lead to paralysis, seizures and fluid in the
brain.
Rubella (german measles): Usually mild in children and adults, up to 90% of
infants born to infected mothers will develop congenital rubella syndrome,
resulting in heart defects, cataracts, mental retardation and deafness.
Note: Measles, Mumps, and Rubella are combined in one vaccine (MMR).
There is NOT a link between MMR and Autism.
Tetanus, Diphtheria, and Pertussis Booster (TdaP): Routinely given at the
11 year physical exam and needed for 7 th grade entry.
Meningococcal: This is a serious bacterial illness. It is a leading cause of
bacterial meningitis in children 2 through 18 years old in the U.S. College
freshmen who live in dormitories and teenagers 15-19 have an increased risk of
getting meningococcal disease.
10
Human Papillomavirus: HPV is the most common sexually transmitted virus
in the United States. It can cause cervical cancer which affects about 10,000
women every year and 3,700 die from it. It is the 2 nd leading cause of cancer
deaths among women around the world. HPV is associated with head and neck
cancer in males. The vaccine can also prevent vaginal and vulvar cancer in
females, and genital warts and anal cancer in both males and females. It is
recommended for both female and male patients.
At each office visit you will be instructed to read the vaccine information
statement for each immunization your child will receive, prior to the
administration. Each statement provides information for each vaccine along
with common responses and less common reactions. Please ask our staff for a
copy if desired.
We will be happy to answer any questions you have concerning immunization of
your baby/child. Also, please notify us of any unusual reactions you might have
noticed following a vaccine.
GROWTH AND DEVELOPMENT
Healthy development, in all forms, including social/emotional, communication,
and behavior will be monitored at each visit through questions and observations.
Little by little, step by step, your baby will grow, change, and develop
throughout the first years of life. As each month passes, you will witness her/his
constant change, and thrill to their first smiles, first words, and first steps.
There is a wide range of what is to be considered healthy or typical growth and
development. Babies will reach developmental milestones at different times and
it is important for parents to realize there is a range of typical development, and
there is tremendous variation and great opportunity for individual difference.
At each well visit you will be asked questions regarding your baby’s
development and you will have the opportunity to share your questions and any
concerns you may have. Following is a guide of developmental milestones for
your reference and to discuss at your well visits, preceding with …Does your
child? ...
At 1 month:
 Hear/see well?
 Have a social smile and cooing?
 Hold his/her head up while on abdomen?
 Have a tight grasp?
At 2 months:
 Hear/see well?
 Have a social smile and cooing?
 Hold his/her head up while on abdomen?
At 4 Months:
 Hear/see well?
 Coo and make different sounds?
 Roll over?
 Grasp for objects?
11
At 6 months:
 Hear/see well?
 Transfer objects from hand-to-hand and use a raking grasp?
 Babble and make different sounds?
 Roll over both ways?
 Sit with or without support?
At 9 months:
 Hear/see well?
 Sit unassisted?
 Have a pincer grasp?
 Say “ma-ma” or “da-da” non-specifically?
 Pull to stand, cruise around furniture or crawl/creep?
At 12 months:
 Hear/see well?
 Cruise or walk?
 Use a pincer grasp?
 Say “ma-ma” or “da-da” specifically?
 Say different words?
 Finger-feed self?
At 15 months:
 Walk well, run and climb?
 Follow one step commands?
 Say 4-5 words clearly?
 Scribble on a piece of paper with a crayon?
At 18 months:
 Say 8-10 words?
 Run and climb well?
 Know 5-8 body parts?
 Feed self, sometimes using a fork & spoon?
At 24 months:
 Walk, run and climb well?
 Speak in 2 word phrases and have a > 50 word vocabulary?
 Follow 2 step commands?
At 36 months:
 Draw circles?
 Throw a ball overhand?
 Peddle a tricycle?
 Walk up & down stairs alternating feet?
 Talk in 3 word sentences with a >250 word vocabulary?
 Dress/undress with assistance?
 Feed self completely?
12
NUTRITION
Making appropriate food choices for your baby during the first year of life are
very important. More growth occurs during the first year than at any other time
in your child’s life. It is important to feed your baby a variety of healthy foods
at the proper time. Starting good eating habits at this early stage will help set
healthy eating patterns for life. At each well visit we will review your child’s
diet and offer anticipatory guidance.
Solid foods should not be started before 4 months of age because: breast milk or
formula provides your baby all the nutrients that are needed to grow, your baby
is not physically developed enough to eat solid food from a spoon, starting your
baby on solid food too early increases the chance that the baby may develop a
food allergy, and feeding your baby solid food too early may lead to overfeeding
and being overweight.
Starting solid foods is a milestone in your baby’s experience. The swallowing
of even finely strained cereal depends upon new use of the tongue and throat
muscles. Be patient—never hurry. When starting solid foods, give your baby
one new food at a time, not mixtures. Give the new food for five to seven days
before adding another new foodthis way you can tell what foods your baby
may be allergic to or cannot tolerate. At first you should dilute the new foods
with breast milk or formula to make the taste and consistency more familiar.
We suggest that you introduce them in the following order:
1.
2.
3.
4.
Cereal
Vegetables
Fruits
Meats
Your baby’s/child’s nutrition will be discussed at each well exam. For your
convenience there is a feeding chart located in the back of the book that you can
use as a guide to starting new foods and the amount to be given, along with
sample menus for one and two year olds, and preschoolers.
SAFETY
Injuries are the number one cause of death for children and adolescents ages 1 to
21. There are important steps for parent, pediatricians, and communities to take
to keep injuries from happening. When an injury does occur, quick action to
give appropriate first aid can reduce the consequences of the injury. You will
receive anticipatory guidance at well visits related to the safety of your child.
The AAP has resources regarding a number of safety issues including: bicycle
safety, fire and burn prevention, choking prevention, hiring a babysitter, poison
prevention and treatment, water safety and drowning prevention, firearms injury
prevention, lawnmower safety, disaster preparation, and first aid guidance. We
encourage you to visit their website at www.healthychildren.org and search for
any topic to get detailed information that you can print from a computer.
If your child is exposed to a poison, by swallowing, breathing, or spilling on the
skin or in the eye call the Poison Help Line at 1-800-222-1222. A poison expert
is available 24 hours a day, seven days a week. Also call if you have a question
about a poison or about poison prevention. By visiting the above website you
can gather important information on prevention, treatment and other important
guides on poison protection. Make sure the phone number to the Poison Help
Line is by every phone in your house.
13
Of utmost importance is the use of car safety seats. Every state requires that
infants and children ride buckled up. More children die as passengers in car
crashes than from any other type of injury. Using a car seat correctly can help
prevent injuries to young children, so starting with your baby’s first ride home
from the hospital and every time he/she rides in a car you will help your child
form a lifelong habit of buckling up. You too should always use your own seat
belt. Current recommendations encourage the use of booster seats up to 8 years
of age and 80 pounds.
There are many manufacturers of car seats which necessitates the importance of
thoroughly reading the instructions and the child restraint section of your vehicle
owner’s manual carefully to be sure you are installing and using the car safety
seat correctly. Many local law enforcement agencies offer car seat checks
which can ensure proper placement of your car seat.
CARE OF THE TEETH
Good oral health is an important part of your child’s overall health. Good oral
hygiene and diet are imperative. You should begin to brush your child’s teeth as
soon as they erupt (twice daily, morning and evening) and floss between his/her
teeth once every day as soon as teeth contact one another. Use a child’s size
brush with a small head of soft bristles and a wide handle. The brush must be
small enough to reach all parts of his/her mouth. Brush with a fluoride
toothpaste that carries the seal of the American Dental Association.
Because sugar is the major cause of tooth decay, it should be held to a minimum
in a child’s diet. Avoid sticky sweets that cling to the teeth thereby prolonging
the acid attack. Especially avoid between-meal sweet snacks. After the eruption
of the first teeth, provide fruit juices (not to exceed 1 cup per day) during meals
only. Carbonated beverages should be excluded from your child’s diet. Infants
should not be placed in bed with a bottle so to prevent baby bottle tooth decay.
Ideally, infants should have their mouths cleansed with a damp cloth after
feedings.
Your baby should have an oral health examination by a dentist who provides
care for children by 24 months of age. Establishing a relationship with a dentist
at this young age provides an opportunity to implement preventive dental health
habits that meet each child’s unique needs and keep the child free from dental or
oral disease.
TOILET TRAINING
Bowel and bladder control is a necessary social skill. Teaching your child to use
the toilet takes time, understanding, and patience. The important thing to
remember is that you cannot rush your child into using the toilet.
There is not a set age at which you should begin toilet training. The right time
depends on your child’s physical and psychological development. Between 1824 months, children often start to show signs of being ready, but some children
may not be ready until 30 months or older.
Your child must be emotionally ready. He/she needs to be willing, not fighting
or showing signs of fear. If your child resists strongly, it is best to wait for a
while. It is best to be relaxed about toilet training and avoid becoming upset.
Try to avoid a power struggle. Children at the toilet-training age are becoming
aware of their individuality and they look for ways to test their limits. Some
children may do this by holding back bowel movements.
14
Look for any of the following signs that your child is ready:







He/she stays dry at least 2 hours at a time during the day or is dry after
naps.
Bowel movements become regular and predictable.
Facial expressions, posture, or words reveal that he/she is about to
urinate or have a bowel movement.
He/she can follow simple instructions.
He/she seems uncomfortable with soiled diapers and wants to be
changed.
He/she asks to use the toilet or potty chair.
He/she asks to wear grown-up underwear.
Soft, comfortable stools brought about by a well-balanced diet make training
easier for both your child and yourself. Trying too hard to toilet train before
he/she is ready can result in long-term problems with bowel movements.
Most children achieve bowel control and daytime urine control by 3-4 years of
age. It often takes longer for a child to recognize the need to urinate than the
need to have a bowel movement. Some children do not gain complete bladder
control for many months after they have learned to control bowel movements
whereas some children achieve bladder control first. Most, but not all, boys
learn to urinate sitting down first, and then change to standing up. Even after
your child is able to stay dry during the day, it may take months or years before
he/she achieves the same success at night. Most girls and more than 75% of
boys will be able to stay dry at night after age 5. If you have any concerns
regarding bed wetting please talk with us at your child’s next well exam.
In the beginning, many children will have a BM or will urinate right after being
taken off the toilet. It may take time for him/her to learn how to relax the
muscles that control the bowel and bladder. If these “accidents” happen a lot, it
may mean your child is not really ready for training. Sometimes your child will
ask for a diaper when a BM is expected and stand in a special place to defecate.
Consider this a good sign that your child is recognizing the bowel signals.
Suggest he/she have the BM in the bathroom and work toward sitting on the
potty without the diaper.
Teaching your child to use the toilet:
 Decide what words to use—carefully decide what words you use to
describe body parts, urine, and bowel movements. Remember that
other people outside your home will hear these words. Avoid using
negative terms (dirty, naughty, stinky), to describe waste products.
Treat bowel movements and urination in a simple, matter-of-fact
manner.
 Once your child is ready, you may want to purchase a potty chair.
 It is sometimes helpful to let children observe their parents in the
bathroom. Seeing grown-ups use the toilet makes children want to do
the same. Children can also learn these skills from older brothers and
sisters

Help him/her recognize signs of needing to use the potty—encourage
your child to tell you when he/she is about to urinate or have a bowel
movement. He/she will often tell you about a wet diaper or a bowel
movement after the fact. This is a sign that he/she is beginning to
recognize these bodily functions. Praise your child for telling you, and
suggest that “next time” he/she let you know in advance. Before have a
15




bowel movement, he/she may grunt or make other straining noises,
squat, or stop playing for a moment, and his/her face may turn red from
pushing. Explain that these signs mean that a bowel movement is
about to come, and it’s time to try the toilet.
Make trips to the potty routine—go to the potty when your child seems
to need to urinate or have a BM. Keep him/her seated on the potty for
only a few minutes at a time. Explain what you want to happen and be
cheerful and casual. If he/she protests strongly, don’t insist, it may
mean that it is not the right time to start training. It may be helpful to
make trips to the potty a regular part of his/her daily routine, such as
first thing in the morning when he/she wakes up, after meals, or before
naps. You may need to start with placing your child on the toilet once
an hour and then, as periods of dryness increase, the time in between
bathroom visits can be increased.
Some children are frightened by the flushing of the toilet. Give your
child a feeling of control, let him/her flush pieces of toilet paper in an
effort to lessen the fear of the sound of rushing water and the sight of
things disappearing.
Encourage use of underwear—once your child has repeated successes,
encourage the use of underpants. This moment will be special and your
child will feel proud of this sign of trust and growing up. However, be
prepared for “accidents.” It may take weeks, even months, before toilet
training is completed.
Teach your child proper hygiene habits. Show him/her how to wipe
carefully. Girls should wipe thoroughly from front to back. Make sure
both boys and girls learn to wash their hands well after urinating or a
BM.
Success at toilet training depends on teaching at a pace that suits your child.
You must support your child’s efforts. Do not try to force quick results.
Encourage your child with lots of hugs and praise when success occurs and
when a mistake happens, treat it lightly and try not to get upset. Punishment and
scolding will often make children feel bad and may make toilet training take
HOME CARE OF CHILDREN WITH
MINOR ILLNESSES
The Common Cold
The average baby may have from four to eight colds a year. Each cold can last
up to ten days and they may occur with or without fever. There are usually few,
if any complications. Colds are caused by viruses, and we have no specific
treatment for them. We can only try to relieve annoying symptoms.
Things To Do:
1. Do not force solid foods. The appetite is normally depressed during a
cold.
2. Encourage fluids of your child’s choice.
3. Clear the nasal passages by using nose drops fifteen minutes before
feeding and at bedtime. This will help your baby/child to breathe easier
while sucking. Nose drops can be prepared by mixing 1/8 tsp. salt in
four ounces of water. Saline nose drops (such as AYR) are available
over-the-counter for your convenience. Put one or two drops in each
nostril as frequently as ever 1-2 hours while awake. Do not us a bulb
syringe to suck it back out.
16
4.
5.
6.
7.
Cough due to colds is a normal body protective mechanism and helps
keep the airway clear.
**A cough that does not improve or worsens, along with any family
history of asthma, reactive airways disease, or bronchiolitis should be
evaluated in the office.
Often a headache, muscle aches and pains, and low grade fever
accompany a cold. Use Motrin (if over 6 mos. of age) or Tylenol to
relieve these symptoms. The dose is based on weight and can be found
on the label along with instructions for its use. call our office, during
regular office hours, for a dose if you are unsure.
It is helpful to moisturize the air with a vaporizer, especially during the
cold months of the year. A cool mist humidifier is usually more
efficient, and is safer. The wet air liquefies the mucus, enables the
child to be more comfortable, and makes it easier for mucus to be
removed. Do not add vapor medications. Studies have disproven the
usefulness of over-the-counter medications, in fact they may act as
an irritant to the baby/child.
If the baby/child is very active and does not feel sick enough to stay in
bed, don’t force the issue. Remember your child is sick and
uncomfortable. It is not easy on you, but he/she stills needs extra
attention, extra affection, and lots of patience.
Vomiting and Diarrhea
Vomiting and diarrhea are common infectious illnesses of infants and children.
It is usually caused by viruses and cannot be cured by antibiotics. It may last
one or two days or one or two weeks. It may improve for a few days, and then
severe symptoms may recur. Either the vomiting or the diarrhea may be mild or
severe.
The virus causes an irritation of the stomach and intestines. The infant or child
is often irritable and listless. Headaches, muscle ache, and abdominal cramping
are common. Mild cold symptoms may be present. The temperature can remain
normal or fluctuate between normal and 104 degrees. High temperature is not
necessarily a dangerous sign.
Important note: Infants or young children vomiting dark green or
fluorescent yellow need to be seen by a healthcare professional as soon as
possible.
The primary medical problem is to maintain proper hydration of the infant.
Dehydration, or loss of body fluids, can be dangerous. This usually does not
occur unless the diarrhea is extremely watery and frequent (10 to 15 movements
in 24 hours) and at the same time the vomiting is persistent with every feeding.
If fluid intake is good, dehydration is unlikely, even if the diarrhea is severe.
Dehydration is much more common in infants under 2 years of age than in older
children.
During the early course of this illness, the desire for both liquids and solids will
usually decrease. Gradually, as the illness progresses, the infant becomes thirsty
and his/her fluid intake will increase. You should always encourage fluids but
not force them. Give solids according to the wishes and tolerance of the baby.
Loss of appetite for solid foods is nature’s way of resting the gastrointestinal
system. Never force solids. As the infant recovers, he/she will automatically
correct his nutritional deficit.
17
If your baby is vomiting, use clear liquids only. We suggest Gerber Electrolyte
Rehydrating Solution or Pedialyte®, an electrolyte solution (both can be
purchased at most stores). As vomiting subsides gradually re-introduce his/her
normal fluids (formula, breast milk, or regular milk).
When vomiting stops but the diarrhea persists—you may offer the following
foods: baked potatoes, lean meats, sherbet, applesauce, bouillon or clear soup,
rice cereal, bananas, toast or soda crackers with jelly, cottage cheese, yogurt, or
jello.
What to do when your child begins to vomit:
1.
2.
3.
4.
5.
6.
When repeated vomiting first occurs, give nothing to eat or drink for
two to three hours. This rest period will help to settle the stomach.
Offer clear liquids frequently but in small amounts. Initially, only use
Gerber Electrolyte Rehydrating Solution or Pedialyte®. After vomiting
has ceased for at least twelve hours, you may then offer other clear
liquids or diluted formula. Small amounts given at one to two hour
intervals are less likely to upset the stomach.
When frequent vomiting has cleared for at least 16-24 hours, you may
then offer the solid foods that are listed above. As you advance the
diet, if frequent vomiting resumes, then once again use only Gerber
Electrolyte Rehydrating Solution or Pedialyte® for a twelve hour
period.
You may give Tylenol if he/she seems uncomfortable due to high fever.
Tylenol suppositories are available for babies who are vomiting and
unable to keep down oral Tylenol.
As the diarrhea improves gradually introduce regular formula or milk,
then regular solid foods. Return to the diarrhea diet if the bowels
become too loose or too frequent with regular foods.
Call our office for further instructions if the vomiting is uncontrollable,
if there is any blood or mucous in the stools. or if there is any sign of
dehydration (dry lips, no tears, lack of wet diapers (< 2 in a 24 hour
period), sunken eyes, etc…).
FEVER
Fever is the most common symptom of illness in infants and children. By itself,
it need not be a cause for worry or undue concern. Rarely does it constitute an
emergency situation unless it occurs in an infant younger than six months
without any other symptoms, like a runny nose. Fever in an infant without other
symptoms requires an immediate call to our office.
Fever is a symptom, not a disease. It represents the body’s response to fighting
an illness. More important than the fever itself is what other symptoms are
accompanying it? Is the child acting ill? Will he/she smile? Is he/she
extremely listless? Does he/she have a cough, difficulty breathing, excessive
vomiting or diarrhea, stomach ache, ear ache, etc…? These symptoms, together
with a fever deserve attention.
It is good to remember that the height of the temperature does not necessarily
correlate with the seriousness of the illness. Many common childhood viral
infections will commence with high fevers, run a short course of two to four
days, and will be unaccompanied by serious complaints. Kids will look ill
when feverish so it is important to gauge the severity of the illness by how
your child looks or acts when the fever is down.
18
Parents should also know that temperatures in the 103-105 degree range do not
cause brain damage and that convulsions due to fever rarely occur after a
temperature has been established for a number of hours. Also, high fever (103105 degrees) in an infant under two years of age calls for more prompt attention
than a similar fever in an older child.
Treatment of fever—easily handled in the home:
1. Place the child in a cool environment
2. Do not overdress—it is best to remove clothing to expose as much
body surface as possible.
3. Encourage your child to drink clear fluids, as much as possible.
4. You may sponge bathe infants and young children by placing them in a
bathtub with two or three inches of tepid water. If shivering occurs, the
water is too cool and it should be made warmer. The water should be
splashed over the child so that evaporation can occur. The child should
remain in the bathtub for at least fifteen minutes for optimal results. It
is best to bring fever down slowly and gradually. NEVER PUT
ALCOHOL IN THE BATH WATER.
5. Acetaminophen (Tylenol) is a very effective medication used to lower
fever and to relieve aches and pains. The appropriate dose, according
to your child’s weight, should be given every four to six hours as
needed.
6. Ibuprofen (Motrin) is also effective for fevers that are non-responsive
to Tylenol. DO NOT GIVE THIS TO BABIES LESS THAN 6
MONTHS OF AGE.
THE CORRECT DOSAGES FOR TYLENOL AND MOTRIN CAN BE
FOUND IN THE BACK OF THIS BOOKLET
The above treatment of fever will lower the temperature and will make your
child more comfortable, but it will not necessarily bring the temperature to
normal. A continued, normal temperature will not be attained until the illness
has run its course.
Please try to manage the child’s early fevers by referring to this instruction
sheet. Call us at the office if the fever persists for more than forty eight (48)
hours, or if the fever is accompanied by more than mild cold symptoms, mild
sore throat or mild diarrhea.
ALWAYS KEEP YOUR TYLENOL AND/OR MOTRIN OUT OF
CHILDREN’S REACH…for they are the most common poisonings in
children, and can be fatal.
Constipation
Firm and/or infrequent bowel movements are very common during the first year.
The toddler and pre-school child may also experience long, periodic episodes of
constipation. The stools may be hard, infrequent, and painful to move or even
cause bleeding from small anal fissures.
When dealing with constipation in an infant or small child try prune juice (1/2
ounce, undiluted, up to twice a day increasing by ½ ounce each day to a
maximum of 2 ounces twice a day) or brown sugar water (using 1-2 teaspoons
of brown sugar in 2-4 ounces of water, offering 1-2 ounces two times a day).
19
If your child has a tendency to have constipation:
Limit: milk, bananas, noodles/pasta, cheese, highly processed
foods.
Encourage: bran cereal, vegetables, drinking extra water, and
have him/her sit on the toilet or potty chair for ten minutes
after each meal. Make sure his/her feet can touch the floor or
a platform.
If you have followed the above recommendations and your child continues to
suffer from constipation contact the office.
Head Injuries
Head injuries are common in children and the great majority of these injuries are
not serous. However, following a head injury, children should be watched
closely for forty-eight hours. The following symptoms suggest the possibility of
a significant injury:
 Persistent change in behavior such as extreme irritability.
 Complaints of severe or persistent headache or stiff neck.
 Bleeding from the nose or ears.
 Increased sleepiness. Some sleepiness is normal after a head injury and
it is alright to let the child rest and sleepbut wake the child after one
hour to make sure he/she seems normal. Also, wake the child every
three hours during the night to be sure he/she can be aroused.
 Convulsions or seizures.
 Staggering when he/she walks.
 Weakness of one side of the body.
 Eye changes—blurred or double vision.
 Loss of consciousness.
 Severe nausea with persistent vomiting. (Some vomiting is common
even after minor head injuries)
In general—following an injury—let the child rest, give Tylenol for mild
discomfort, use an ice pack over any bump on the skull, and watch closely for
forty-eight hours. Call us if significant symptoms develop.
Croup
Croup is a spasm and swelling of the muscles around the larynx (voice box). It
is usually caused by a virus and most often comes on quite suddenly at night.
You might note very mild cold symptoms preceding the croup. It is most
common in children between two and six years of age.
The child will start making loud noises when he/she breathes. His/her voice will
be hoarse and his cough will sound like a seal’s bark. You might note his/her
chest pulls in while breathing, face is pale, and may look frightened.
First of allSTAY CALM. Most children will improve after they are up for
twenty or thirty minutes. Depending on the time of year and the temperature
outside it is best to take the child out into the cool night air. This is a quick and
easy treatment for croup. If the temperature outside is not cool then take the
child into the bathroom and close the door. Turn on the shower and hot water
faucets to make steam. Then sit with the child and let him breathe in the steam.
Have someone start a cold mist vaporizer in the child’s room. Cold mist is
preferred because it delivers a finer mist and is safer than boiling water. When
breathing is easier for the child, give him/her a popsicle or something cool to
drink. This helps to keep the throat moist. If the child has fever, treat it in the
usual manner.
20
Call us or take the child to an emergency room if the breathing difficulties are
progressive, if the child begins to drool or have difficulty swallowing or if the
child is extremely anxious and cannot be calmed down.
Burns
Never take burns lightly! Immediately rinse with cold, clean water. Never use
butter or other greasy substances. Dress the burn with an antibiotic ointment
and a clean bandage. Change the dressing one to two times a day. Do not break
any blisters that form. Large burns, burns on the face, hands or genitalia, or
electrical or chemical burns should always be cared for by a physician. Call our
office if the area has increased redness, drainage, or if your child becomes
feverish.
Teething
Teething usually begins about five months of age. Night crying, restlessness,
drooling, biting objects or lips/hands are the most common symptoms. Fever
has not been a proven association with teething.
If the discomfort seems severe, you may occasionally give Tylenol for pain.
Teething rings or products like baby Oragel may be beneficial.
Sunburn
Sunburn is due to overexposure of the skin to ultraviolet rays of the sun. the
child should be seen in the office if the burn is widespread, extremely painful,
severely blistered, or if the child has an unexplained fever over 102°.
Mild to moderate cases of sunburn may be treated at home: Give Tylenol for
pain. A cool bath given several times a day will relieve symptoms. Add two or
three tablespoons of baking soda to the bath water. Use a nonprescription ½ %
hydrocortisone cream on burned areaapply three times a day. Offer extra
fluids to drink during the first twenty-four to forty-eight hours.
Prevention is the key to avoiding sunburn. Infants and children should have
limited exposure to the sun. Cover skin with lightweight t-shirts, dress in light
colored clothes, and a use a hat when possible. There are good sunscreens on
the market that help to prevent sunburn. Use sunscreen with SPF of at least 30
or higher. Remember: sunburn can occur on overcast days and reapply
sunscreen frequently.
21