We are excited that you are considering Wake Internal Medicine and Pediatrics in Raleigh, NC as your new born child’s medical source. Congratulations on the birth of your baby! You are embarking on an amazing journey that is full of wonders and probably seems a little scary, too. The day you bring your newborn home is exciting but may have you asking many questions along the way. While each child is different and your parenting style will be your own and very unique, this booklet will contain a lot of newborn information that may help answer some of the questions.We work hard to make sure you have a direct line of communication to our staff and physicians. We look forward to answering all of your questions and concerns and we are excited to join you on this amazing journey with your newborn child.
Newborn Pediatric Schedules
Throughout the years of your child’s growth and development, he/she will be coming to our pediatric office for regular checkups and immunizations. Wake Internal Medicine and Pediatrics believes that immunizations are a vital component to your baby’s health and development. We follow the American Academy of Pediatrics and the Centers for Disease Control and Prevention’s recommendations for immunizations. You may have questions and concerns about immunizations and we encourage you to discuss these with your doctor.
We encourage all of our families to frequent our website for information and updates. On our website you will find a wealth of information on newborn checkup schedules, immunizations schedules and any special updates that will be vital to your child. You will also be able to find forms, contact numbers and links to important sites that will be helpful in answering some of the questions you may have. Our staff can help you set up a newborn immunization schedule with all recommended immunizations. For any other questions or for more information about our services, contact us at our Raleigh, NC office.
Please click one of the below items, to view more information about newborn pediatric care.
To ensure a more stress free beginning for you and your child, make sure you have the following on hand:
– Approved infant car seat. You will not be able to leave the hospital without one.
– Blankets – for swaddling
– Diapers – disposable or cloth. If using disposable, begin with the infant diapers but keep the next size handy.
– Clothing – T-shirts and onesies, sleepers, booties and socks, receiving blankets, sweaters or other warm clothing
– Bath supplies – soft washcloths, hooded towels, mild soap (non-perfumed), small tub
– Medicine cabinet supplies – infant thermometer, diaper rash ointment, bulb syringe for suctioning the mouth or nose.
– Laundry detergent – Dreft is recommended since it is mild for baby’s delicate skin.
Each baby is unique and as you begin to get to know your newborn, you will quickly discover his likes and dislikes and his own personality will begin to quickly emerge. Enjoy this special time as you and your family gets to know your baby. There is no such thing to a newborn as too much love or attention.
You will notice that babies make lots of sounds! Sneezing, coughing, passing gas, hiccups and spitting up are all normal behaviors. If you think your newborn breathes loudly, do not fear; it is very normal as is alternate rapid and slow breathing. They startle easily and loud noises can make them cry. Make yourself known as you approach your baby so they don’t become alarmed.
You will also notice that your baby has many involuntary reflexes. When he is startled, he will stretch out all limbs. When you touch the palm of his hand, he will grasp firmly. When you rub his lower lip, he will turn his head and open his mouth. This is called rooting. Most of these reflexes will disappear within a few months.
In short, crying is the best way your baby has to communicate. While some newborns cry two to three hours per day, some cry even more. When your baby cries or fusses, check for one of these possible causes:
– Dirty diaper
– Diaper rash
– Gas…you may need to burp them.
– A need to suck on something. Try a clean finger, baby thumb or pacifier.
– Is he too cold or too hot?
– Colic (more on this later)
If none of these seem to be the problem, try rocking, singing, playing soothing music or going for a walk or ride in the car. If you become frustrated, that is very normal. If you have checked off all the obvious issues and your baby is still crying, it is perfectly fine to place your baby in a crib or safe place and leave the room for a few minutes. That may be what both of you need to calm frustration, especially if you are exhausted. If you need a longer break, ask someone you trust to watch the baby for a while so that you can regain your composure. If questions about your baby’s crying persist, please call your physician to talk further.
You may feel that for the first few weeks all your baby does is sleep. Eventually your baby will begin to spend more time awake and discovering his surroundings. Newborns have no regular sleep pattern but will become more predictable with age. At the beginning, let your baby call the shots as to when and how much he sleeps and then you can begin forming a nighttime routine that will help with a regular schedule. After feeding your baby in the evening, sing or read or rock him each night. Keep this feeding quiet and low-key. Turn down the lights and help your baby learn the difference between night and day.
Feeding is one of the most pleasant experiences for your baby and for you. It gives you and your baby a unique chance to bond with each other.
We feel that breastfeeding is your baby’s best source of nutrition and while we recommend you do breastfeed, there are many reasons why people may choose bottle feeding. Breastfeeding is the most inexpensive, natural and convenient form of feeding. It also will protect against infections. Your breast milk can change constantly based on what you eat. In the first few days after delivery, you will have a yellowish color to your breast milk. This is called colostrum and it is filled with immunoglobulins for your baby. Your breast milk can vary in color. It may be thick and yellow or thin and bluish-white. At the start we suggest feeding for 10-15 minutes on each breast. This will allow your baby to receive the rich hind milk at the end of the feeding. Make sure your diet is balanced and healthy and be mindful that some medications can be excreted in the breast milk. Check with your doctor if you are taking any medications to ensure they are not transferred to your baby in the feedings. Avoid alcohol because that can excrete through breast milk, too.
If you choose to bottle feed, talk to your doctor about the choices for commercial formulas. There are many liquids and powders available. Make sure you carefully follow the directions on the package. While your baby may prefer his formula heated, it is not necessary. If you do want to heat the bottle, place it in a pan of warm water. Never microwave the bottle because it could lead to uneven heat that can burn your baby’s mouth. Throw away any formula that has not been used after the feeding. After the first few days, newborns will usually take two to three ounces of formula every three to four hours. The first few days, your baby will probably eat very little. That is perfectly normal. Make sure you wash all bottles, nipples or any other items used to prepare the formula in hot, soapy water. You may need to adjust the nipple size for your baby because the amount coming out may be too slow or too fast for your newborn. Always hold your baby while feeding the bottle. Do not prop him up or lay him on a bed with a bottle.
After the feeding you will need to always burp your baby to help remove any swallowed air. Hold the baby upright over your shoulder or face down on your lap. Pat or rub his back gently. Your baby may spit up and that is perfectly normal as is the possibility that no burp will result every time.
Bath time is another one of those wonderful times for bonding with your infant. Newborns do not need to be bathed daily. A bath every two to three days is fine. You can bath your newborn in a small plastic tub or in the sink which should be clean and lined with a towel. Use warm water and test the temperature of the water with your elbow before putting the baby into it. You can use a soapy washcloth to clean your baby’s body but wash his face without soap. To wash the hair, apply a small amount of very gentle soap and warm water. Tilt the baby’s head back gently and pour clean water over his head to rinse. Make sure the room is warm when bathing the baby. When you have finished, wrap your baby in the towel and make sure that you dry around the folds and creases of the skin.
A few words of caution: Never leave your baby unattended around any water at all. Turn your water heater down to 120 degrees Fahrenheit and gather all your supplies before bath time so that you do not have to carry the baby around while looking for things.
The stump of the umbilical cord attached to the baby’s navel should fall off in one to three weeks. In the meantime, cleaning and care is necessary. Use a soft clean cloth to clean around the cord during the baby’s bath and during diaper changes. If the area does become irritated, pus develops or you notice a strong foul odor, please call your doctor. Do not be alarmed if when the cord does fall off, it bleeds slightly or there is a small discharge from the navel. Simply keep it clean and dry. Fold the diaper down over the cord to avoid irritation.
If your son has not been circumcised, no special care of the penis is required. Simply wash the penis with soap and warm water and do not attempt to retract the foreskin because it will retract naturally in a few years. If your baby has been circumcised, the tip of the penis may appear inflamed, yellowish or swollen. For the first 24 hours after the procedure, the penis should be covered with gauze dressing with petroleum jelly. The jelly will prevent the gauze from sticking. Change the gauze dressing every diaper change. After that initial 24 hours, you can use the petroleum jelly alone to prevent the diaper from sticking to the penis. Some obstetricians will use the PlastiBell circumcision method which leaves a plastic ring on the tip of the penis. This takes the place of the gauze and petroleum jelly dressing. The ring usually will drop off within five to eight days. Once it does, gently retract the foreskin and wash away any white secretions.
It is quite common for baby girls to have a thick, creamy discharge for the first few weeks. This is not a cause for alarm. Remove this discharge by gently wiping from front to back with a baby wipe or warm washcloth.
You will be needing roughly 70 or more diapers per week. If you are using cloth diapers, you will also need diaper wraps or plastic pants. Steer clear of powder because it could irritate their lungs. Changing diapers frequently will help prevent diaper rash, as will allowing their bottom to air dry as much as possible. Clean the diaper area with baby wipes and make sure if you have a little girl you are wiping from front to back. This will avoid infection.
If redness occurs, apply a thick coat of diaper rash ointment. Babies are also prone to yeast infections. If you notice an inflamed red rash or white cheesy film, consult your doctor who will instruct you to use an over-the-counter anti-fungal cream that should take care of the problem.
Newborn skin often peels, particularly on the hands and feet. This is totally normal and does not require any special skin care.
You will need to keep your baby’s nails well-trimmed to prevent scratching himself. Use a soft emery board and file them gently. The nails are very soft so be careful not to file the tip of the finger or toe.
Swaddling is a wonderful way to make your newborn feel safe and relaxed. Ask your maternity nurse to give you instructions on swaddling (wrapping) your baby snugly in a soft blanket. And, layering your baby’s clothing will help you to add or remove layers according to room or outdoor temperatures. Never overdress your baby because then you will have one very unhappy little camper. Because babies have large heads in relation to the rest of their bodies, they tend to lose a lot of body heat from that area. Keeping a hat on the baby, particularly in cold weather, will help maintain his body temperature.
The birth process can be traumatic for newborns and it can cause them to have an odd shaped head. Don’t be alarmed…their head will regain its smooth and rounded look within weeks. Also be aware that babies are born with two soft spots on their heads. One is on the top and one is in the back. These areas are where the skull has not yet grown together. These spots will close by the time your child is 18 months old. It is not dangerous to touch these spots but be gentle when shampooing or brushing their hair.
A combination of the birth process and the medication they are given to fight infection may cause your newborn’s eyes to appear puffy. This will improve within a few days. And, as the muscle in their eyes strengthen, any occurrence of crossed eyes will diminish also.
Your baby’s scalp may develop what is called cradle cap. These scaly flakes can be removed by gently scrubbing the scalp with a mild shampoo and soft brush every few days. Ask your physician for a suggestion as to what shampoo will work best. These flakes will disappear within days.
Do not be alarmed if you notice white, cottage cheese-like patches in your newborn’s mouth. This is a yeast infection called thrush and it is quite common but can also be painful. If you are breastfeeding you may need treatment also. Please call your doctor as soon as you notice this condition so that it can be treated.
Spitting up is a very normal situation for newborns. It is no cause for concern unless the amount being spit up is a very large amount. If your baby has a green or yellow vomit or is projectile vomiting, please call your doctor. Gagging and the appearance of choking is also quite normal. You can use a baby bulb syringe to gently suck out the mucus. Place the tip of the bulb inside the baby’s cheek on the side and towards the back of the mouth. Gently use the suction. Do not suction your baby’s nose unless mucus is visible to avoid swelling inside the nose.
Every parent lives in terror of the dreaded colic showing up with their newborn. Rest assured that colic only affects about 10-15 percent of newborns. The cause of colic is still unknown but a colicky baby can sometimes be soothed by motion, riding in a car, warmth, sucking on a pacifier, being massaged or taking a warm bath. Crying spells generally last a couple of hours. Colic typically develops in the second or third week of life and disappears by three months of age. If the methods above do not help your baby get over the crying spells, call your doctor if you notice any of the following signs:
– The cry appears painful
– The crying lasts for more than three hours
– The colic begins after one month of age
– Diarrhea, vomiting or constipation are present
– Your baby is inconsolable
Colic is an extremely frustrating situation for both the baby and the entire family. Once you have taken care of all your baby’s needs, it is okay to put him down somewhere very safe and walk away for a few minutes. If you become overly exhausted and frustrated, call your doctor and we will try to give you more guidance and assistance.
During the first few days of life, your baby will pass a dark, sticky substance called meconium. As the days wear on, that color will become a yellow, green or brown color. Breastfed babies tend to have loose and seedy stools up to 10 times per day. Bottle-fed babies’ stools will appear pasty and be less frequent. As your baby ages, stools will become fewer. As long as the stool is soft and your baby is not straining, this is normal. You will notice your baby grunting and even turning red while having a bowel movement.
If you bottle feed your baby, constipation is more normal than for a breast-fed baby. Signs of constipation are abdominal pain and pebbly stools. Conversely, if your baby has frequent, watery stools accompanied by a foul odor, he is suffering from diarrhea. Either one of these situations warrant a call to the doctor for treatment.
Newborn babies commonly have skin problems. Most will disappear in time and are of no concern.
Milia: small white spots on the face. This condition is due to blocked sweat and oil glands.
Baby acne: red and pimply rash
Newborn rash: small, yellow spots surrounded by red blotches. These will disappear within days.
Stork bites: visible blood vessels close to the skin on the eyelids, forehead and back of the neck
Mongolian spots: Most common for newborns with dark skin; this appears a greenish-blue coloring on the lower back.
If you feel a concern about a skin problem that does not sound like one of the above, call your doctor and we will check to make sure it is not heat rash or any other skin condition.
Lanugo is fine, downy-like hair that covers the back, shoulders, forehead, ears and face. This is more common in premature babies and will disappear within days.
You will be informed if your baby has jaundice in the hospital. It is quite common and your doctor will go over the methods of treatment.
Newborns should be watched more carefully if they get sick over the first several months of their life. Please call us immediately if you notice any of the following:
If you take your baby’s temperature rectally and it is 100.4 degrees or higher
– Any strange rash that appears uncommon
– Your baby is listless
– Your baby is crying inconsolably
– There is severe vomiting after several feedings in a row
– Loose or more frequent bowel movements
Please do not give your baby medication unless talking to the doctor first. It can be very upsetting to you when your newborn appears ill but make sure you are calm and have pen and paper handy for instructions. We can best serve you if you are able to relate the problem to us calmly and as detailed as possible.