Your Newborn Infant
After hospital discharge, please call the office to make an appointment for your newborn infant’s weight check and first well-baby visit. The weight check is at day 4-5 of age and then a well visit at two weeks of age.
Newborn Screening Fact Sheet for Providers & Families »
Well visits are scheduled every six weeks for the first six months, then every three months until the child is eighteen months of age. The next visit will be at two years old and annually thereafter.
Immunizations are given on a regular schedule during this well child period.
(DTaP, Hib, IPV)= PENTACEL*, Rotateq (oral), Prevnar -13
(DTaP, Hib, IPV)= PENTACEL,
4 1/2 months
Rotateq (oral), Prevnar-13,
(DTaP, Hib, IPV)= PENTACEL,
MMR, Hep A**
(DTaP, Hib, IPV)= PENTACEL
Hep A* & catch-up any missed
Urine (if able)
For years 5 and over, please click here to download our immunization schedule and well visit guidelines.
** Hepatitis A vaccine- now recommended for all children and adults in the USA.
Each newborn is an individual. Your baby probably looks different than what you expected. At birth the skin is covered with a thick, white, creamy substance called vernix. When the vernix is removed you will see a reddened, puffy curled-up being: your baby.
Your baby’s body may be covered with a fine, downy hair called lanugo. The amount, color, and areas covered may vary from child to child. The lanugo is shed naturally during the first weeks. The hands and feet may be bluish in color and cold due to immature circulation (acrocyanosis).
The skin may become flaky, dry, and wrinkled because of changes from the womb environment to the dry room air. It is not necessary to moisturize or put oil on these areas. It is better for the baby’s body to take of this naturally.
Many babies (40%) may have a rash during the first several weeks of life consisting of small, raised, white spots. These milia are present on the face and nose and signify the normal beginning of the function of oil and sweat glands. No treatment is needed for them and they will disappear on their own. Do not squeeze or pick at these spots.
Fifty percent of babies will have another rash that consists of small, red, raised bumps (erythema toxicum). This rash usually begins within the first few days of life and usually disappears within a week. The rash frequently occurs of the chest, abdomen, back, or bottom. No treatment is needed.
All babies are born with different amounts of hair, from thick full hair to bald scalp. The scalp hair may be rubbed off in patches as your baby shifts around and moves the head about. The hair color at birth is often different than the color of the hair regrowth and new hair.
The fingernails of a newborn are often long from growth in the womb. They should be carefully trimmed with a nail scissor or clipper or filed with an emery board to prevent scratches. Hand mitts may also be used.
The head will appear large in relation to the rest of your baby’s body. Because of the head’s weight, it needs to be supported when your baby is being handled. The head may be misshapen at birth due to the passage through the birth canal and the molding of the soft bones. This is normal and the skull will round out during the next year. This has no effect on the brain. If your baby prefers lying in one particular position, the head may flatten at that side of the skull. This often returns to normal as the bones mature. There are two soft spots (fontanelles) in the head where the brain is covered by a tough membrane until bone grows over them during the first year of life. There is no danger in touching, washing, or combing the skin and hair over these areas.
Eye color at birth will often change later on. Most newborns have bluish-gray eyes, or brown eyes if they are darker complected. Passage through the birth canal often causes considerable swelling in the eyelids, which will take several days to resolve. Coordination of the eye movement will develop slowly over the next year. Your baby may look cross-eyed, or not be able to focus on you for a while.
In some babies (boys and girls), the breasts will become swollen and enlarged due to the transmission of the maternal hormones prior to delivery. As those hormones wear off, the breast size will normalize over the period of a few weeks. Do not massage or squeeze the breasts.
The umbilical cord turns brown during the first days after it dries. If kept dry, it will fall off during the first few weeks. Some people wipe with alcohol to help aid in the drying process. At the time the cord stump falls off, it is normal to see a few little drops of blood on the clothing, diaper or skin. Continue to keep the raw area clean until it is well healed. If the area develops a bad odor, redness, or thick green drainage, contact your physician. Tub baths are permitted once the raw area is healed. Many babies will have a pouching out of the belly-button area (umbilical hernia) that is due to a gap in the muscles in the abdominal area. Most of these hernias will disappear on their own during the first years of life.
Often the genitals will appear large and swollen. Females may have a discharge that varies from white to brown or red. This is normal and is a result of the influence of the mother’s hormones and usually stops in the first days to weeks of life.
Males who have been circumcised will take several days to heal. Care should be taken to prevent irritation of the wound. A dab of petroleum jelly will help prevent sticking to the diaper. It is normal for erections to occur and frequently just prior to urination.
The arms and legs will often temporarily stay in a position similar to that in the womb. The legs may be bowed for the same reason. They may be turned at an odd angle. As your child matures, particularly after walking begins, the feet and legs will turn to a more normal position.
Your baby can perform the basic life functions of sucking, swallowing, breathing, keeping warm, and expelling waste. The normal breathing patterns may be quite irregular. Your child has the ability to see, hear, taste, smell and feel. Newborns have many involuntary reflexes that include: rooting (turning the head to suck when the cheek is touched), sucking, startling to sudden contact or noise (Moro), withdrawing of the limbs as a means of protection, grasping, blinking, yawning, gagging, coughing and sneezing. Hiccups or hiccoughs are another normal process and will stop on their own. The frequency and intensity of these behaviors are different for each individual newborn.
With all this activity and considerable growth, it is of no surprise that the average newborn sleeps 14-18 hours a day.
A mother’s milk has just the right amount of fat, sugar, water, and protein that is needed for a baby’s growth and development. Most babies find it easier to digest breast milk than they do formula. Breast milk has agents (called antibodies) in it to help protect infants from bacteria and viruses and to help them fight off infection and disease. Human milk straight from the breast is always sterile. Most mothers are capable of successfully breastfeeding with the right tools. It requires a positive attitude, relaxation, and a supportive environment.
When to Feed
You should nurse your baby soon after birth, if possible, when your baby is awake and the sucking instinct is strong. At first, your breasts contain a kind of milk called colostrum, which is thick and usually yellow or golden in color. Colostrum is gentle to your baby’s stomach and it is full of antibodies to protect your baby from disease. Your milk supply will increase and the color will change to a bluish-white color during the next few days after your baby’s birth.
During the colostrum period, your baby may not appear to feed well, but what the baby does get is rich and nutritious. When your “milk comes in,” your baby will begin to demand feedings more frequently (as often as every 1 to 2 hours). Then as a good milk supply is established, the routine will become more established, and he/she may feed less frequently. Most babies need 20 to 30 minutes of sucking time to complete a feeding. This may be accomplished by offering 10-15 minutes on each breast, or 5-10 on one breast and then switching to the other. In the first five minutes of nursing, 80% of the milk will be obtained.
Newborns need to nurse frequently, at least every two hours, and not on a strict schedule. This stimulates your breasts to produce plenty of milk. Since human milk is more easily digested than formula, breastfed babies eat more frequently than bottle-fed babies do. Babies nurse less frequently as they get older and start solid foods.
The supply of milk is controlled by your baby’s demand. To increase your production of milk, you need to increase the demand by feeding more frequently. Relaxation and adequate fluids (at least 6-10 cups a day) and calories are also important. This is not the time to diet. You need to have adequate protein in your diet to produce good milk. Remember that breastfeeding requires about an additional 500 calories a day. Ensure that you maintain a healthy, well-balanced diet. It is best to keep alcohol and caffeine to a minimum.
Signs that your baby is getting enough include:
- At least 5-6 wet diapers a day
- During the first month, stools as frequently as every feeding
- After the first month, stools once a day to every several days
- Weight gain – 4 to 7 ounces a weekWeight gain – 4 to 7 ounces a week
Caring for Yourself
In addition to the well balanced diet that is required, you need to get plenty of rest and try to be relaxed with nursing. The most challenging period is the first few weeks. Just take it one day at a time and try to avoid stress. Many women believe a glass of wine or beer is helpful in helping to reduce stress and induce relaxation. One glass is okay and will not be harmful to your baby. Be sure to check with your doctor about any prescription or non-prescription medications that you may be taking.
If your baby is solely breastfed, you are likely to experience an absence of menstrual periods and ovulation. There is still a small chance that you may be able to ovulate and get pregnant during this time. The more you supplement, the greater this chance becomes. If you do no desire to become pregnant during this time, discuss contraception with your doctor.
Expressing and Storage of Breast Milk
If you must return to work or would like to build a supply of milk for when you are away from baby, pumping milk is an option. You may purchase or rent a breast pump for this purpose. If you will be offering your baby expressed milk, it is best to ensure that your baby will accept a bottle. Around 4 weeks of age you may want to offer your baby a bottle or two a week just to remind him/her how to take an artificial nipple.
Some good times to pump for stockpiling of milk include:
- During the engorgement period, the early days when milk supply is over abundant
- On the opposite breast while your baby nurses
- 5-10 minutes after a feeding
- In the morning when milk supply is generally greatest
Human milk may be stored in hard-sided plastic or glass containers with well fitting lids or freezer milk bags designed for storage of human milk.
Milk may be stored:
- At room temperature for up to 10 hours
- In a refrigerator for up to 8 days
- In a freezer compartment of a single-door refrigerator for up to 2 weeks
- In a separate freezer compartment of a two-door refrigerator/freezer for up to 3 to 4 months
- In a deep freeze for up to 6 months or more
Thawing of Breastmilk
Frozen breastmilk may be thawed in refrigerator for 12 hours. For quicker thawing, you may hold the container under gradually warmed water until thawed and the correct temperature. Human milk should never be put in a microwave or in boiling water. Thawed milk may be stored in the refrigerator up to 24 hours. Thawed breastmilk should not be refrozen or reheated.
Bottle feeding should imitate natural feeding in providing close contact between parent and child. This contact is shown to be essential to your child’s social and emotional development.
When to Feed
Feed your baby when he/she is hungry. This is usually every 2 to 4 hours during the first months. There are usually 6 to 8 feedings per day. Try to remain flexible and remember that routines sometimes get disrupted. Many babies will sleep through the middle of the night around 8 to12 weeks. You may want to wake a baby who wants to sleep more than 4 hours during the day to allow for a better schedule at night.
The average child will vary the amount of formula taken at a feeding. At first your newborn will take 2 to 3 ounces frequently. As the baby gets older, the number of feedings will decrease and the amounts in each feeding will increase. After several months, 6 to 8 ounces will be taken at each feeding. The average consumption during the first 6 months is 24 to 32 ounces in a 24-hour period. A general rule of thumb is 2-2.5 ounces per pound per 24-hour period.
What Formula to Use
Most doctors recommend a commercially available cow’s milk formula such a Similac Advance. On occasion a soy protein formula like Isomil Advance is required. These specially formulated infant formulas will provide the necessary ingredient to assure proper growth through your baby’s first year of life. Be sure to follow the preparation instructions listed on the product exactly.
How to Prepare Formula
Infant formulas come in many different forms. Ready to feed formulas may be poured directly in the bottle and require no preparation. They generally come in 32 ounce bottles or cans and, must be refrigerated and used within 48 hours of opening. Concentrated formulas come in 13 ounce cans, generally, and must be mixed with water on a 1:1 basis (0ne ounce of formula per one ounce of water). Powder formulas are usually the least expensive and generally are prepared by using 2 ounces of water per scoop of formula. Be sure to only use the provided scoop to measure the formula, as different formulas use different scoop sizes.
If your tap water is provided by the city or the county and is deemed safe, there is no need to boil the water. Simply washing all bottles, nipples, and caps in a dishwasher or in hot soapy water, and rinsing and drying well is necessary. The formula may be prepared using tap water that has not been boiled.
If you have well water or unsafe water, boiling is required until your child is a month old. You will need to boil the bottles, nipples and caps, as well as the water for making formula.
You can sterilize all bottles, nipples, and caps and utensils by boiling for 5 to 10 minutes. Then you can boil the water for use with the formula for a minimum of 1, and not more than 5 minutes. Allow to cool, and then prepare formula in sterile bottles.
How to Feed Your Baby
You may serve the formula at room temperature, slightly warmed or even cool. Many babies prefer a slightly warmed bottle. Simply run warm tap water over the bottle for a few minutes and shake well. Check the temperature by shaking a few drops of formula onto your inner wrist. It should be no warmer than lukewarm. Do not use a microwave to heat your baby’s bottle. Also, check that the flow of the nipple is adequate. If no milk comes out, the hole in the nipple is too small or clogged. If milk runs out of the bottle, the hole may be too large and need to be replaced.
Feeding should take place where both you and your baby can be comfortable, relaxed, and uninterrupted. For bottle feeding, hold your baby in a position that keeps his or her head higher than the rest of the body. A good place to support the head is in the crook of your arm. Try to keep your baby’s head facing straight while feeding, as having the head turned back or sideways may make swallowing more difficult. To minimize air swallowing, tilt the bottle, allowing the milk to fill the nipple and the air to rise to the bottom of the bottle.
Remember that most babies will vary the amount at each feeding. They know when they’ve had enough. Avoid the temptation to try and force finishing off the bottle. If the baby has fallen asleep and is just doing a few “flutter sucks” for comfort, remove the bottle and allow the child to sleep.
Whether nursing or bottle feeding, your baby should be burped at least once during feeding and after feeding. This helps to relieve your baby of air swallowed during feeding. Hold the baby on your shoulder and rub or pat the back gently for several minutes. Another method is to sit the child upright in your lap let him/her lean over your arm. Gently rub or pat the back with the other hand. It is not always necessary to hear a burp. Remember – sometimes a baby will not burp. There is no need to “force” a burp.
Introduction of Solid Foods
Milk is the most important food for babies for the first year of life. Solids are not needed before 4 to 6 months of age. Here are some good reasons for waiting: baby’s intestines need to mature, babies have a natural extrusion reflex (spitting out of food), they have inability to chew, and increased likelihood of allergies. Baby cereal and foods should never be introduced in the bottle, unless your doctor advises you otherwise.
We recommend placing your baby on his/her back to sleep. Make sure to spread sheets smoothly and tuck them tightly beneath the mattress. You should have a crib mattress that is firm and conforms to safety standards. Check the space between the crib rails – they should be no more than 2 inches apart. Cribs made prior to 1979 may have wider spacing. Be sure the mattress fits the crib perfectly. If pushed all the way to one corner, there should be no more than 1½ inches between it and the side or the end of the crib.
Do not use any loose fitting plastic mattress covers or waterproof sheets as they may wrap around baby’s head or neck and cause suffocation. Do not place pillows or soft stuffed toys in the crib. Baby should not be allowed to sleep on soft surfaces such as waterbeds, beanbags, fluffy blankets or comforters.
Your baby should be dressed in clothing that you would feel comfortable in. The air/room temperature needs to be at a level that would be comfortable for anyone in that room. There is no need to dress baby warmer than you would dress, or give extra blankets. Simply dress according to the temperature. You may also want to accustom baby to sleep through ordinary household sounds. There is no need for silence when a baby is sleeping. Tip-toeing and whispering are not necessary, but do avoid sudden jarring noises and loud commotion.
Many infants have a polyphasic sleep pattern, which means short periods of sleep interspersed with even shorter periods of waking. The ability to sleep for a longer period of time comes with growth and maturity. Some may sleep for extended periods of time as early as 3 to 4 months. Some others may not until 10 to 15 months. Because of immaturity of the nervous system, an infant cannot be trained to sleep longer. Introducing solid foods at bedtime has never been shown to prolong the sleep period.
Crying is a normal and natural part of infancy. Babies cry when they want to inform you of something, such as a diaper needing to be changed, hunger, or, discomfort. Some babies just tend to have a fussy period, often occurring during the evening. Over-stimulation can sometimes make crying worse. When they have had lots of noise, movement, or playing during the day, sometimes it is difficult for them to settle down in the evening. This is similar to an adult who is exhausted lying down to go to sleep, but being unable to shut off their brain right away. When their neurological system becomes more developed, and with more set routines, this often improves spontaneously.
A crying baby can be very frustrating and upsetting for parents. It is helpful to try not to become to tense, as your baby can sense your feelings and may make things worse. Rest whenever you get the chance. If at all possible, find someone who can help you and take turns soothing the baby. You may try putting on some soothing music that you enjoy.
Babies who have colic, tend to have a high pitched cry, draw up their legs, and become red in the face. We do not know what causes colic, but it usually occurs about the same time every day, and is not usually helped by usual remedies. Colic can start as early as three weeks and last until the baby is three or four months of age. Some general measures to try include: rocking, walking, feeding, massage, music, a drive in the car, or a change in environment.
Just remember, it will get better. Often irritability, colic, and fussiness improve at about 12 weeks of age.
After your baby’s cord comes off, you may begin giving real baths. These can be done in any object that holds water and is convenient, such as a sink, bathtub, or baby bathtub. If you place a towel or washcloth in the bottom of the bath, it will be less slippery. Always test bath water for correct temperature. Use plain water or a mild soap and infant washcloth for bathing.
Since babies don’t do much to get too dirty, bathing twice a week (especially in the winter) is generally enough. Daily spot cleaning in areas that tend to get oily, sweaty, or dirty is helpful. Pay attention to behind the ears, in the neck folds, the crease of the groin, and the diaper area.
For shampooing, the same soap or mild detergent should be fine. Use only plain water on the face. Clean the ears with a washcloth. It is not necessary to clean the ear canals. Do not insert anything into the ear. Earwax is a natural product and is not dirt.
After bathing, pat dry with a soft towel. It is not necessary to use powder, oil, or lotions on your baby’s skin. These items can be an irritant and your baby’s skin may be sensitive to them.
Expect your newborn’s nails to grow very fast and don’t be afraid to cut them. This is best done using a blunt baby nails scissor, or nail clippers when the baby is asleep. Wait until the baby is in a deep sleep or very sleepy. You may file the nails with an emery board or clip the nails. Cut the nails in a straight line, not curved or angled at the corners. Angling the nails can contribute to ingrown nails. To avoid snipping the fingertip skin, depress the finger pad away from the nail during trimming. Drawing a drop of blood is part of the learning process. If this occurs, apply light pressure to the area and a dab of antibiotic ointment.
Because newborns wet frequently, it may be necessary to change 10-15 diapers a day in the beginning. The number and type of bowel movements will vary depending on your child’s diet. It is common for bowels to move after a feeding, since this stimulates the intestinal tract. Most infants will grunt and strain and turn red in the face when having a bowel movement. As long as the stool is soft, this is not an indication of constipation.
When diapering, find a sturdy surface. A floor or table is fine. If not on the floor, never leave the baby unattended and always have a hand on the baby. Have all of your materials prepared before starting your changing. You may use warm water on a soft cloth, or commercially available wipes to wipe your baby. For girls, always remember to wipe front to back. For boys make sure to get into the crevices when cleaning. You may want to place a cloth over his penis to avoid being squirted. Make sure your diapers have a snug fit, but are not too tight, especially around the legs.
Common Childhood Ailments
What does diaper rash look like?
Diaper rash usually causes mild redness and scaling where the diaper touches your baby’s skin. In bad cases, the rash can cause pimples, blisters and other sores. If your baby’s rash gets infected, the rash may be bright red and the skin may be swollen. Small red patches or spots may spread beyond the main part of the rash, even outside the diaper area.
What causes diaper rash?
Most diaper rashes are caused by skin irritation. Irritation can be caused by diapers that rub against the skin, fit too tightly or are left on for too long. Your baby’s skin can also be irritated by the soap used to wash cloth diapers, or by some brands of disposable diapers or baby wipes. Plastic pants that fit over diapers raise the temperature and moisture in the diaper area. Heat, moisture and irritated skin make it easier for diaper rash to start and for germs to grow.
How is diaper rash prevented and treated?
The key to preventing and treating diaper rash is to keep your baby’s diaper area clean, cool and dry. Change your baby’s diaper often, and let him or her go without a diaper when possible to let the air dry his or her skin. Try placing your baby on an open cloth diaper during nap time. Check the diaper shortly after your baby falls asleep and replace it if it’s wet. Babies often urinate right after falling asleep.
Tips for treating and preventing diaper rash:
- Check your baby’s diaper often and change it as soon as it’s wet or soiled.
- Carefully clean your baby’s bottom between diaper changes. Use plain warm (not hot) water with or without a very mild soap.
- Allow your baby’s skin to dry completely before putting on another diaper. Allow “air time” if possible.
- Use products that contain zinc oxide ointment (such as Desitin Ointment) or petrolatum (such as Vaseline) to protect your baby’s skin from moisture.
- Avoid using plastic pants.
- If diaper rash persists, change the type of wipes, diapers or soap you’re using.
Don’t use creams that contain boric acid, camphor, phenol, methyl salicylate or compound of benzoin tincture. These things can be harmful.
What if my baby has an infection?
If your baby also has an infection with the rash, the rash may not get better by following these tips alone. Your doctor might give you a prescription for a special cream to use on your baby’s rash.
What about powder?
Talcum powder and cornstarch aren’t recommended. Talcum powder can get in your baby’s lungs. Cornstarch may make a yeast infection worse.
Call or see your doctor if:
- Pimples and small ulcers form
- Your baby has a fever
- Your baby loses weight or isn’t eating as well as usual
- Large bumps or nodules appear
- The rash spreads to other areas, such as the arms, face or scalp
- The rash doesn’t get better after trying the tips on treating diaper rash for 1 week
Cradle Cap (Seborrheic Dermatitis)
What is seborrheic dermatitis?
Seborrheic dermatitis is a disease that causes flaking of the skin. It usually affects the scalp. In adolescents and adults, it is commonly called “dandruff.” In babies, it is known as “cradle cap.” Seborrheic dermatitis can also affect the skin on other parts of the body, such as the face and chest, and the creases of the arms, legs and groin. Seborrheic dermatitis usually causes the skin to look a little greasy and scaly or flaky.
How common is it?
Seborrheic dermatitis most often occurs in babies younger than 3 months of age and in adults from 30 to 60 years of age
What causes seborrheic dermatitis?
The exact cause isn’t known. The cause may be different in infants and adults. Seborrheic dermatitis may be related to hormones, because the disorder often appears in infancy and disappears before puberty. Or the cause might be a fungus, called malassezia. This organism is normally present on the skin in small numbers, but sometimes its numbers increase, resulting in skin problems.
How is seborrheic dermatitis treated?
Seborrheic dermatitis of the scalp in babies is treated with products that are not as strong as those used in adults. You might start with a mild, non-medicated baby shampoo. Brushing your baby’s scalp with a soft brush, like a toothbrush, can help loosen scales or flakes. But be gentle when massaging or brushing your baby’s scalp–a break in the skin makes it vulnerable to infection. If a non-medicated shampoo doesn’t work, talk to your doctor about switching to a shampoo that contains tar. Or your doctor may recommend a shampoo that contains ketoconazole (brand name: Nizoral).