Care of the Newborn Infant

The various tests included in the newborn screen differ slightly from state to state. To see a list of diseases screened in Florida, click here.

The results of the screen will come back to the hospital or our office within several weeks. Generally, you are notified by letter from the state of Florida of any abnormality; if you receive such notification, please contact the office.

Introduction:

We welcome you and your child to our practice and are honored that you have chosen our doctors as your child's pediatricians. One of the most rewarding and exciting times in your life is beginning and we will be available to guide you through the journey. Understandably, the first few months at home with your baby can be times of insecurity and uncertainty in a parent's life.

As you may have found with your pregnancy, some people will offer unsolicited but well-meaning advice about the care of your baby. Some of this advice can be conflicting. If you have questions about your feelings or instincts about caring for your baby, contact our office.

The information presented here is intended to assist you with the needs of your newborn.

Newborn Characteristics and Care:

Head: Molding of the head coming through the birth canal results in the "conehead" shape at birth. This returns to a normal shape after several days. The head may also appear asymmetrical for the same reason. The "soft spot" in reality has a tough fibrous covering. It normally closes between 9 and 18 months of age.

Eyes: The eyelids may be swollen at birth. This resolves in a few days. The eyes may also have a slight mucousy discharge at birth which is usually of no concern. A small, red flame-like hemorrhage may be present on the sclerae (white part) of the eye. This also is very common and will resolve in 2 to 3 weeks. The eye color is usually a slate blue at birth. The permanent eye color appears usually by 5 to 6 months of age, but it can change until 1 year of age. Infants eyes may wander from time-to-time, especially when they are tired, but most babies outgrow this intermittent strabismus by 3 months of age.

Mouth: The under-surface of the tongue may contain a short tight band that connects the tongue to the floor of the mouth. This tongue tie is common, and rarely causes any problems. It usually stretches later in life. Anterior tongue tie only requires medical intervention if it is causing feeding problems early on for breast fed babies.

Legs: Bowing of the legs is common in infants because of intrauterine positioning. If your baby pushes up while held in a standing position it will not cause the bowing to worsen.

Feet: The feet may also be turned inward. As long as the feet are flexible, they will straighten out as the child grows. The toenails of newborns are often very soft and may curl over the end of the toe, or may curve upward. The nails will become firm and straighten later in life.

Behaviors: Newborns have a variety of behaviors that frequently cause concern in new parents. A few of these include: hiccuping, sneezing, yawning and trembling of the chin or lower lip. Your baby may also stare or jerk suddenly in response to sounds or movement. All of these behaviors are usually normal and will decrease as the infant becomes older and his neurological system matures.

Bowel Movements: Many babies during the first few weeks will have bowel movements whenever they eat, and also one will be noticed upon their awakening. This may add up to quite a large number of bowel movements. These may be very explosive, loud, and watery. Breast-fed babies can have watery bowel movements with yellow curds in them, while the stools of formula fed babies tend to be more formed. Pure water and hard pebble-like bowel movements are abnormal. The number of stools can range from 10-12 per day to one every 4-5 days. Babies frequently strain to stool but are not constipated unless the stools are hard or firm.

Vomiting: A small amount of spitting up after eating is normal in infants. If this pattern becomes progressive with more frequent spitting up, larger amounts of spit up, or more forceful vomiting the infant should be seen for evaluation.

Umbilical Cord: Your newborn should not be immersed in water until the cord has fallen off and the navel healed. This should occur within a few weeks. Occasionally a small amount of blood will appear when the cord separates. This is not of any concern unless the bleeding is substantial or prolonged. Do not attempt to remove the cord yourself.

Skin: The skin is often dry and flaky and subject to many nonspecific rashes that come and go over the first few months of life. Erythema Toxicum is a common rash in the newborn period that appears as small yellow bumps surrounded by a red area about the size of a dime. The rash looks similar to an insect bite but is harmless and goes away by itself. Milia are small white bumps over the nose and may appear elsewhere on the face. They are unopened skin pores, and will resolve in 1 to 2 months. We do not usually recommend using a lot of creams or lotions on a newborn's skin. These agents usually cause more irritation to the sensitive skin of the newborn. No special treatment is necessary. "Stork bites" are flat pink birthmarks appearing on the forehead, upper lip, eyelids, and the back of the neck. The vast majority of these birthmarks disappear by themselves within two years. Mongolian spots occur on the lower back as a bluish-gray flat area varying greatly in size in infants with a darker complexion. Most fade away by 2 to 3 years of age.

Jaundice: Yellowing of the skin or the eyes is common and usually a harmless condition in newborn infants. Normal jaundice usually appears on the second or third day of life in healthy, full term infants. It can occur in both breast-fed and formula fed babies. A few babies require a blood test and/or examination by the doctor to determine the cause of jaundice. In most cases, jaundice can be treated at home. Please call during office hours if you think your baby has jaundice.

Colic: Colic is common during the first three months of the infants life. An Infant with colic frequently has unexplained periods of crying. Call our office for advice if your infant is having frequent crying episodes. The nurse may be able to offer phone advice, but if the problem continues call the office to schedule an appointment.

Visitors:

We recommend not exposing your newborn to friends and neighbors for the first two months of life. Until the immune system matures, a newborn has very limited defenses when exposed to illness, and consequently can became ill very quickly. If you are concerned your infant is ill, it is important to take the temperature rectally. An infant is considered to have a fever under two months of age if the temperature is 100.4 degrees or higher rectally. It is important to notify the office immediately should your infant have a fever at two months of age or less.

Environmental Conditions:

In general a baby will enjoy whatever temperature the parents find comfortable. As long as the child is dressed correctly he/she should be able to adapt to variations in temperature. Avoid exposure to wind, rain or excess heat or cold. It is especially important not to leave your baby in sunlight because he/she can sunburn very easily, even if not directly in the sun. Sunblock is not recommended prior to six months of age.

The Care of Infants in the Crib:

• The infant should never be left alone when the side rails are down.
• The mattress should be lowered before the baby can sit unassisted and set at the lowest position as soon as the baby can stand.
• No toys or other articles should be left in the crib that can be used as steps for climbing out.
• The crib should be placed away from windows and from other furniture that could be used to climb out. Be sure no draw cords of curtains, blinds, or mobiles are hanging within reach of your child once they are able to grasp objects. These things pose a choking hazard.
• Babies should be placed on their backs to sleep to help prevent sudden infant death (SIDS).
• To help prevent SIDS/suffocation your baby needs to sleep in their own crib/bassinet that has a firm and flat mattress.
• No pillows or bumpers should be used.

Methods of Feeding:

Breastfeeding: Experts agree that breastfeeding is best for both the mother and the baby. The reasons for this recommendation are as follows: Breast milk is the ideal food for babies, containing all the nutrients they need for the first 4 to 6 months. It is easily digested. The American Academy of Pediatrics recommends to exclusively breastfeed for the first 6 months of life, and even after solids are introduced to continue to breastfeed for the first year of life. Breast milk contains substances that help protect babies against illness. Breast milk also seems to delay the onset of food allergies. Nursing gives the mother a chance to show her special love and provides her with much emotional satisfaction. Nursing is convenient as it is not necessary to shop for formula and prepare bottles. Breastfeeding helps the uterus get back to its normal size. Hormones are released during breastfeeding that contract the muscles of the uterus making it smaller and firmer. Until your milk supply is well established avoid formula supplements, unless medically needed to make sure baby is getting enough nutrition. If your milk supply seems inadequate or you suspect your baby is not gaining weight, notify the office. Sometimes it is difficult to know whether the baby is getting enough breast milk. One indication of inadequate intake is the lack of bowel movements. Once your breast milk has come in and your supply is adequate, the baby should have several loose yellow stools a day. Some infants have a gastrocolic reflex and will stool with every feeding. The American Academy of Pediatrics recommends supplementing exclusively breastfed babies with Vitamin D 400 IU once a day. One such supplement, D-vi-Sol can be purchased over the counter. Check the package of the product you buy for dosing instructions.

Bottle Feeding: A variety of fine formulations are available. These are packaged as powder, liquid concentrate, and ready-to-feed. Two general types of bottles are available: solid glass or hard plastic with or without disposable sterile bag units. Prepare only a 24-hour supply of formula. Keep it refrigerated. Infant formula does not need to be warmed, but if you would like to warm the bottle you can do it by placing the bottle upright in a pan of hot tap water or using a bottle warmer. Make sure to always check the temperature of the milk before giving it to the baby to make sure it is not hot. Shake or squirt a few drops of formula on the back of your hand to test the temperature before offering it to the baby. Do not warm the bottle in the microwave. This can be dangerous due to uneven heating, as well as the denaturing of the milk protein by the microwave heating process. The American Academy of Pediatrics recommends for formula fed babies who are getting less than 32 oz. of formula per day to get Vitamin D 400 IU once a day. One such supplement, D-vi-Sol, can be purchased over the counter. Check the package of the product you buy for dosing instructions.

Feeding Schedule for Both Breast and Bottle Feeding: Extremes of rigidity or laxity are best avoided when setting a schedule for feeding. Breastfed newborns feed every 2-3 hours and formula fed newborns feed every 3-4 hours. Don't let your baby sleep past his 4 hour feeding time during your awake hours. Always offer a feeding just before you retire for the night. Once a baby weighs 12 lbs or more they can sleep through the night without being woken up to feed. If necessary, especially during the first few weeks, arouse the baby into activity at feeding time by briskly rubbing the soles of the feet with your thumb. Crying does not always signify hunger. An upset infant will often take a few swallows of milk. Unless he takes several ounces he/she may not be crying from hunger. Frequently babies may initially eat every two hours, especially breastfed babies.

Newborn Behavior FAQs

Q: Is it normal for babies to hiccup so much?

A: Yes. Many newborns hiccup several times daily, often associated around feeding or burping times. They last about 10 minutes regardless of what you do. It usually lasts for the first few weeks or so.

Q: Is my baby getting a cold? He sneezes a lot.

A: Sneezing is the normal way that babies clear the mucus production we all have. Sometimes they sound congested before they sneeze. If the baby is feeding well, and seems to be breathing okay it should be okay. Any baby younger than 2 months with cold symptoms, poor feeding, or a fever of 100.4 or greater should be seen by a physician. If you are unsure, call and speak to a triage nurse.

Q: My baby breathes funny. Sometimes she breathes fast and other times she seems to hold her breath for a few seconds. Is this normal?

A: This is a normal breathing pattern for a newborn and young infant. Call the office if the fast breathing continues and is more than 60 breaths in one minute, the baby is sucking in the muscles between the ribs and the ribs appear to stick out, the nose is flaring with the breaths, you hear a grunting sound as she breathes, or there is a persistent blue color to the skin. Any of these symptoms needs to be medically evaluated.

Q: How long does it take for the umbilical cord to fall off?

A: Usually within the first 2 weeks. Sometimes you will see a few spots of blood before and shortly after it comes off. Your healthcare provider will need to see the baby if it continues to ooze or has a foul smell.

Q: Why does my baby seem to "jump out of his skin" when he hears a loud noise or somebody bumps him?

A: This is the normal and expected Moro reflex. They often cry at the same time. This usually diminishes over the first month. You didn't do anything wrong or hurt the baby in any way when this happens. In fact, at the well child exams, we check to see if the Moro reflex is present.

Q: I think my baby has diarrhea. The stools (poops) are yellow and watery. She is stooling during or after every feeding. What is normal?

A: Infants fed breastmilk often have very watery, yellow stools. Formula fed infants also have yellow stools, but they are often more mushy. The number of stools should be about 4 (or a total of about 4 tablespoons) daily during the first 1 1/2 weeks. Around day 9, babies start through their first growth spurt and stooling slows down. Formula fed infants usually continue stooling daily, however breastfed infants can go several days between dirty diapers. Many parents consider this to be constipation. Constipation is not defined by how long the infant goes between stooling, but by the consistency of the stool. Constipated stools are very hard and often like little rocks. A mushy stool every 2-3 days can be a normal pattern for some babies. All babies grunt, strain, and have red faces from time to time.

Q: Most of the time, my baby's stool is yellowish, but the last few have been green. He acts okay and is feeding normally. Should I be worried?

A: If everything else is normal, greenish stools for a few days are okay. This is a normal occurrence and can vary from feeding to feeding. If the stools remain greenish or don't seem normal to you in other ways (mucus, unusually foul smelling, baby seems to have stomach ache), call the triage nurse and she will help you decide if the infant needs to be seen.

Q: My baby has so much gas!

A: Most babies are gassy during the first few months. They can get gas by the normal digestion process and taking in air as they feed or cry. Make sure that they aren't sucking in air when they feed by keeping air out of the bottle nipple or making sure the lips form a seal at the breast. Keeping the baby upright at about a 45 degree angle during the feeding should help too. Also, don't shake the bottle before you offer it. This incorporates bubbles within the liquid. Mix the formula or expressed breastmilk by stirring it or rolling the bottle in your hands. Many babies respond well to gentle abdominal massages, a warm moist cloth on the abdomen, or gently pressing the knees toward the abdomen. Try not to over feed the baby. This usually causes more discomfort rather than relief.

Q: How do I know if I am overfeeding my baby?

A: A hungry baby has folded arms and legs, and is looking for something to suck, and often cries. An overfed baby has folded arms and legs, is desperately looking for something to suck, and is crying as if in distress. These similar behaviors can be very confusing to parents. The difference is in the timing of the behavior. A satisfied baby comes off of the bottle or breast and is fairly content, often drifting off to sleep or is quietly alert. The overfed baby seems content for about 10-15 minutes then starts fussing, desperately sucking at the fist, grunts and strains. I call these the Thanksgiving babies. They feel like they ate the whole turkey at the Thanksgiving feast! Overfeeding is thought by some to be a contributor to the behavior called colic. However, not all babies with colic are overfed.

Q: My baby was eating every 2-3 hours, but for the last day or so, she has wanted to eat every hour! How often should I feed my baby?

A: During the first 2-3 weeks as you get to know your baby, feed on demand. For the first few days, the baby is sleepy and often doesn't awaken to feed. They should be awakened to feed every 2-3 hours. By day 4, they are more alert and will suckle at their fist or start sucking at their lips or tongue. These are the first cues of hunger. Crying is a late sign of hunger. Between days 9-14, they go through the first growth spurt and will want to feed very frequently for a few feedings in a row. This usually lasts 3-5 days and will happen again around 3 weeks. A growth spurt can be identified by frequent feeding, decreased stooling, grunting and straining. This is normal infant behavior.

Q: How do I wake up my baby to feed her? She sleeps so soundly.

A: Babies go through cycles of deep sleep and light (REM) sleep. The deep sleep is usually cycled in 30-40 minute segments. It is difficult to awaken a baby during this sleep pattern. During the light sleep, they will make cute little facial expressions and the eyes will move. This is when you attempt to awaken them for feeding if necessary.

Q: How much formula should I feed my baby?

A: Simple math.

Feeding Rule #1: Double and triple the rounded off weight in pounds and this gives the range of formula for 24 hours. Example: 6 lbs x 2 = 12 ounces / 24 hrs or 6 lbs x 3 = 18 ounces / 24 hrs

Therefore, a 6 pound baby needs between 12-18 ounces per day. A 7 pound baby needs 14-21 ounces per day, and so forth.

These estimates are based on the caloric need of the quickly growing infant. Don't force the baby to take the larger number. This guideline is true for the first 2 months or until the higher number is 32. When they are taking 32-36 ounces per day, they are usually ready to start solids.

Feeding Rule # 2: During the growth spurts when the infant is cluster feeding (normal behavior for breast and bottle fed infants around 2 and 3 weeks), match the hours and the ounces for infants over 6 pounds. For example, if they go 2 hours between feeding, offer 2 ounces. If they request to eat in 1½ hours, offer 1½ ounces. This will keep them from over feeding while getting the extra calories they need during a growth spurt. Smaller babies will take a little less than this estimated amount.

Q: If I choose to give formula to my baby, does it matter what formula?

A: Not really. The important thing is to choose one and stick to it so the diet is consistent. Most of the choices are as follows:

• Milk based (ex: Enfamil, Similac, Good Start, store brand): these are modified cow milk and lactose which is the natural sugar of milk
• Soy based (Prosobee, Isomil, Alsoy, store brand): these are soy protein and often corn syrup
• Special formulas (Nutramigen, Alimentum)
• Milk based without lactose (Lacto Free): the natural milk sugar has been replaced by corn syrup but the protein is milk based

The hospitals usually receive equal supplies from the makers of Enfamil and Similac. If your baby is bottle fed, he will probably be sent home with either one of these. It is not recommended that breastfed infants receive formula from the hospital at discharge. You also probably have samples from these companies from other sources. It is best to discuss the choices with the baby's doctor to help decide what is best for your baby. The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first 6 months of life.

Q: What is colic? How do I know if my baby has it?

A: This question is difficult to answer, in that colic still remains somewhat of a mystery. The American Academy of Pediatrics answers it in the following way:

"Does your infant have a regular fussy period each day when it seems you can do nothing to comfort him? This is quite common, particularly between 6:00 P.M. and midnight - just when you, too, are feeling tired from the day's trials and tribulations. These periods of crankiness may feel like torture, especially if you have other demanding children or work to do, but fortunately they don't last long. The length of this fussing usually peaks at about three hours a day by six weeks, and then declines to one or two hours a day by three months. As long as the baby calms within a few hours and is relatively peaceful the rest of the day, there's no reason for alarm. If the crying does not stop, but intensifies and persists throughout the day or night, it may be caused by colic. About one fifth of all babies develop colic, usually between the second and fourth weeks. They cry inconsolably, often screaming, extending or pulling up their legs, and passing gas. Their stomachs may be enlarged or distended with gas. The crying spells can occur around the clock, though they often become worse in the early evening.Unfortunately, there is no definite explanation for why this happens.

Most often, colic means simply that the child is unusually sensitive to stimulation. As he matures, it will decrease, and generally it stops by three months...." (Shelov, Steven P. M.D. Caring for Your Baby and Young Child: Birth to Age 5. pp. 139-140. Bantam Books, 1993)

If the above behavior describes what you and your baby are going through, the infant needs to been seen medically to rule out other possible causes of this crying. Colic is difficult for everyone involved. Patience and understanding that "this too shall pass" is needed by parents, grandparents and healthcare workers. Much has been written about ways to sooth the infant with colic. Ask for a handout on colic at your next appointment.

Q: Why is breastfeeding so painful?

A: In the first week or two, this is usually due to poor positioning/latch. The following three guidelines can be helpful:

• Alignment. The infant must have ear, shoulder, and hip in one straight line when placed at the breast. This applies for any position the mom chooses.
• Bring infant to the breast. When the breast is taken to the baby, the baby latches onto the nipple rather that the areola and "nipple feeds" rather than breastfeeds. (A toe curling "ouch!")
• Chin and nose must touch the breast during the feeding. This is what keeps he nipple to the back of the infant's mouth (the soft part of the mouth).

Q: My milk has just "come in" and my breasts are so hard. What do I do?

A: Feed the baby. You may need to express some of the milk so that the breast can become soft enough for the infant to latch onto. Cold compresses on the breast for about 20 minutes several time daily will help also. Warm compresses make it worse. "Engorgement" usually occurs if the breast isn't being relieved of the newly produced milk. Early and frequent feeding at the breast is the best way to prevent engorgement. It usually last 24-48 hours. Speak to a triage nurse if you need help.

Q: Should I limit the time I feed my baby on the breast? How do I know when to feed from both breasts or just one side?

A: Lactation guidance no longer recommends that infants limit feedings to a certain number of minutes. Watch the baby, not the clock. As long as the infant is swallowing while breastfeeding, keep her on that breast. When she stops swallowing or comes off naturally, offer a burp and then the other breast if she acts hungry. If she is hungry, she will take the second breast. If not, she will act uninterested. 

Q: What foods should a breastfeeding mother avoid?

A: Very little in the mother's diet actually causes problems. Foods such as onion, broccoli, cabbage, and Italian spices can change the flavor and smell of the milk and some babies acknowledge this change. They might not form a complete seal at the breast due to this change, therefore causing more air intake during feeding. Some babies react to cow's milk protein that can pass into mother's milk. If the infant seems to be in distress after feeding, a trial elimination of cow's milk products can be tried for a couple of weeks. If you do this, be sure and get your dietary calcium through another source. Caffeine may affect the infant, so limit this until you get to know your baby better and can judge if this is the case in your baby. Also, don't force liquids. Drink to thirst or if your urine appears concentrated.

Q: My baby has been breastfeeding well, but recently it has become painful. What's happening?

A: The most common cause after 2 weeks if painless feeding has been established is a yeast infection. You may feel burning as the infant feeds and breast can remain painful to touch after the feeding. Call our office or your physician's office for guidance. The infant needs to be evaluated for thrush and both of you may need to be treated with an antifungal medication. If your nipple is cracking and possibly bleeding, it may also be a bacterial infection and your physician needs to be consulted.

Q: How do I know if I have mastitis?

A: Mastitis is an infection of the tissue of the breast. Symptoms include fever, soreness, redness and firmness of part of the breast, and flu-like symptoms. Call your physician for treatment. It is okay that you continue to fed the infant while you have mastitis - in fact, it is important that you do so. The milk needs to flow to prevent further infection or damage to the breast.

Q: My breasts aren't red and I don't have fever, but they have a sore lump. What should I do?

A: Lactating breasts often have lumps even as far as up under the arms. They are not usually sore. Soreness may be a blocked milk duct. Warm compresses over the lump and massages above the lump toward the nipple usually works. They usually resolve in 24-48 hours. If not, seek medical help.

Q: I have a painful white blister on my nipple. It hurts to feed. What's up?

A: This is similar to the above question but the blockage is at the point of exit for the milk. Again, warm moist compresses and expressing the milk to unplug the opening. Seek medical help if it persist greater than a day or so.

Q: I think my milk supply is less than it should be. How do I build it back up?

A: It's a "take and make" process. Offer the breast more often so that your body is encouraged to increase the supply. If this is not possible, pump for about 10 minutes after the infant breastfeeds. This should communicate with your body that more milk is needed. Have you started on a birth control pill lately? This often decreases milk supply. Discuss this with your physician. Other options can be discussed over the phone in an attempt to find what is best for you.

Q: How long can I store milk - at room temperature, in the refrigerator, or in the freezer?

A: There are many numbers floating around regarding milk storage, but to make it simple and be within safe limits you can use the following guidelines:

• 3 HOURS at room temperature
• 3 DAYS in the refrigerator
• 3 MONTHS in the freezer

As with formula however, any time the infant takes milk from a bottle, he must complete that bottle within an hour. Once he has gotten saliva into the milk, it cannot safely be saved for later use.

Q: When can I offer a bottle? What bottle nipple should I use? What about a pacifier?

A: If breastfeeding is well established (usually after 3 weeks), it really doesn't matter. Most babies go back and forth easily at this age. This will be governed by your lifestyle. It is important that moms who plan on returning to work soon establish an alternative feeding method for the babysitter to use. Whatever type nipple the baby uses is best for that baby. In most cases, infants do best with a nipple that has a wide base and long nipple. Choices include Nuk and Avent, but there are many other types. Buy one of each and see what works best. The same is true with a pacifier. Most breastfed infants spit the pacifier out initially.

Q: My 2 month old baby used to take 20 minutes or longer to feed. Lately he has shortened the time to10 minutes or less. Is there something wrong with my milk?

A: It is normal that the more proficient the infant is at obtaining the milk, the shorter the feeding. If the infant is gaining well and acts happy and content, all is well. Welcome to the wonderful world of breastfeeding!

The following is helpful information for breastfeeding education and support. Interlachen Pediatrics recommends you take advantage of the opportunity to work with a lactation consultant while still in the hospital with your infant. One of our board certified Nurse Practitioners, Heather Bryant, provides lactation consultations in our office. We can also refer you to lactation resources in the community.

Why Should I Breastfeed

There are many recognized benefits to breastfeeding. Aside from the obvious time spent bonding with your newborn, the health benefits are truly amazing. Breastfed babies are shown to have decreased rates of diarrhea, less risk of obesity, less rates of pneumonia, and lower insulin levels just to name a few.

Studies have shown that breastfeeding decreases the rates of diarrhea. The pH of the breastfed baby's gut is more acidic. The iron in breast milk is readily available, so the iron content in the gut is lower which leads to less growth of unhealthy organisms. There are increased levels of gastrin and cholecystokinin, which causes increased digestion, storage of energy, and sedation.

Breastfed babies tend to sleep more and are less fussy. Mothers that breastfeed tend to have lower rates of depression, lower incidence of breast/ovarian cancer, lower risk for type 2 diabetes, and decreased risk for developing metabolic syndrome.

How do I Breastfeed

Breastfeeding is natural, not an instinct. It has been found to be most beneficial to have skin-to-skin contact with your baby directly after delivery. The baby will root and "crawl" and smell its way to the breast. Typically finding the nipple and latching on with little help on the mother's part. This is OK and with some patience and support babies will learn to latch on correctly and breastfeeding can be enjoyable for both the mother and newborn.

Feeding Cues

Learning your baby's feeding cues is the first step to successful breastfeeding. The first signs that a baby is hungry actually begin while they are still asleep.

REM (Rapid Eye Movement)

While your baby is still sleeping you will notice subtle movements of the body and the eyes moving quickly back and forth. This is the very first sign that your baby is getting hungry; this is the best time to initiate a feeding. After this stage passes, they will move into the quiet alert stage.

Quiet Alert

Eyes are open, body is still; this is still a good stage to begin a feeding. The next stage is active alert.

Active Alert

The infant will begin to smack his lips and have little sucking motions, bring his hand to his mouth, flex his arms and legs, and root; this stage is going to be a little more difficult to get feeding started.

Crying

If the baby is crying attempting a feeding will be frustrating for both mother and baby. This would be a good time to revert back to skin-to-skin contact to help your baby settle back into one of the previous stages and then try latching at that time.

The Latch

• Nose-to-Nipple:Your baby should be held so that his head is supported at the base. His ears, shoulders and hips should align and his belly should be to your belly. His hands should be on either side of the breast. Place your infant in front of the breast, nose-to-nipple.
• The head tilt and gape: Your infant will smell the breast milk and tilt her head back with a wide open mouth (gape). When you see the mouth open gently bring the baby on to the breast. The chin and lower lip should reach the breast first and the upper lip should reach last. The nose and chin should be close to the breast and there should be more of the lower breast/areola drawn in then the top.
• Lips flanged: The upper and lower lips should be turned out, not sucked in.
• Rounded cheek line: The cheeks should not have breaks or dimples in the curve. If enough breast is drawn in and the lips are flanged the cheeks should be full and rounded.
• Suck/swallow: The baby should have bursts of feeding - suck, swallow, suck, suck, suck, swallow. If your infant is feeding like Maggie Simpson sucks on her pacifier, she is likely nipple feeding and is not latched well.

At the end of a successful feeding the infant should release the nipple and have a relaxed body tone and relaxed hands. The mother's nipple should not have changed shape and no pain should have been involved.

Frequently Asked Questions

How Do I Know If I Am Making Enough Milk?

By the fourth day of life your baby should be having at least 3-4 yellow seedy bowel movements per day, as well as 3-5 wet diapers. Some newborns will want to eat every 30 minutes and others will be content feeding every 3 hours. Regardless of what group your newborn falls into, as long as they are having stools and gaining weight they are getting enough. If concerned, you may make an appointment for a weight check and we can discuss this further.

What Is The Best Breast Pump?

There is not one pump that is best for everyone. You have to find the one that suits your needs.

How Can I Increase My Milk Supply?

There is not a "magic pill" per say. Your body makes milk based on the demands of your baby. You can trick your body into thinking you need more milk by stimulating your breasts and pumping. Some women find that feeding on one breast and pumping on the other helps. You can "power pump." This is done by pumping for 5 minutes, stopping for 5-10 minutes and then pump again for 5 minutes etc. This tricks your body and increases the level of prolactin. Prolactin is the hormone that is responsible for milk production. If you have higher levels you will make more milk, lower levels lead to less milk.

Are There Any Herbs/Medications That I Can Take To Increase My Milk Supply?

There are not any that are recommended. Talk to your healthcare provider prior to initiating any treatments.

Can I Have An Alcoholic Beverage While Breastfeeding?

The Institute of Medicine says: "If alcohol is used advise the lactating mother to limit her intake to no more than 0.5 g of alcohol per every 2.2 lbs of body weight. For a 132 lb. woman, 0.5 g of alcohol per 2.2 lbs of body weight corresponds to approximately 2-2.5 oz. of liquor, 8 oz. of table wine or 2 cans of beer." - (IOM, 1991, p.104) Infants tend to eat less after a mother has consumed alcohol.

Does Caffeine Have Any Effect On My Baby?

According to the Healthy Children Project, "Caffeine consumption during pregnancy and by nursing mothers has no consequences for infant sleep." It may accumulate in premature and very newborn infants so be sure to speak with your child's doctor if your child has been prescribed caffeine.

Do I Have To Feed On Both Breasts Every Time?

The decision to feed on both breasts is driven by your infant. If your baby comes off on one breast and still appears hungry then feed on the other. It is not necessary though if your baby is content after one breast.

How Long Should I Breastfeed For?

There is no one set time. Once you have a good breastfeeding relationship with your baby and you find that your feeding is taking longer than 20 minutes or less than 5, you may want to speak with a lactation consultant to ensure there are not any problems.

Resources:

• Winnie Palmer Hospital  Breastfeeding Education Center Helpline: 321-843-2229
• Florida Hospital Breastfeeding Support Line: 407-303-7650
• National Breastfeeding Hotline (M-F 9am - 6pm): 800-994-9662
• Healthy Children's Center for Breastfeeding
• La Leche League of Central Florida
• LactMed: Provides information regarding drugs/medications and their interaction with breast milk
• InfantRisk: Provides information on risks for mother and baby associated with taking medications during pregnancy and lactation

Circumcision involves removal of the foreskin of the penis. The only true benefit is that it makes the penis easier to clean. There have been no definitive medical studies that prove the medical necessity of circumcision. We feel that this procedure is a personal decision that should be made by you and your family. If you plan to have your son circumcised, it is best done during the first week of life, preferably in the hospital. If your infant is not circumcised in the hospital or at a birthing center, and you wish to have him circumcised in the office, tell the appointment desk when you schedule your appointment with the physician. This will ensure that adequate time will be scheduled for the physician to perform the circumcision.

The circumcised penis may still have a Vaseline dressing in place when the baby is discharged from the hospital. This may be removed the day following discharge. If the dressing is adherent to the penis, soak the gauze for a few minutes with warm water and gently remove the gauze. After the dressing is off, the simple application of Vaseline at each diaper change is adequate. While healing, a yellow appearing material sometimes forms over the head of the penis. The circumcision is usually well healed in about 7-10 days. When washing the penis do not forcibly pull the foreskin back.

Choosing your child's car safety seat is a very important job, but how do you know which one to choose and what safety features to invest in? Here is some helpful information about how to find the right car seat for your little one.