Author Archives: foxtrot
In July 2014 Timothy Perl, MD, F.A.A.P., also a Board Certified American Academy of Pediatric Pediatrician, joined Carroll Pediatric Center as a full time Pediatrician. Having Dr. Tim Perl join our group has allowed us to increase our regular evening and weekend office hours in addition to having him in the office every weekday. Tim Perl, MD, the son of Edward Perl, MD, received his Bachelors of Science degree from Tulane University before receiving his M.D. Degree from St. George’s University School of Medicine. He completed his Pediatric Residency at SUNY Downstate Medical Center in New York in June 2014.
Tim is an extremely bright, dedicated, personable and gentle physician, and we are sure you will appreciate the superior care he will provide to your family. In June 2014 he moved back to Maryland with his wife, Sarah, who is an RN graduate from Johns Hopkins and a Pediatric Nurse Practitioner graduate from NYU. Sarah is a Pediatric Nurse Practitioner at Kennedy Kreiger at Johns Hopkins. Tim and Sarah have two delightful children.
Edward Perl, MD and Cathy Reifman, MD will continue to maintain their current office hours and grow their practices.
Carroll Pediatric Center has been serving Carroll and the surrounding counties for 39 years. We are available for our patients 24/7 and continue to accept just about all insurances. We look forward to providing superior prompt care to your family for many more years and generations.
TICKS IN MARYLAND
Ticks in our area are either:
- The DOG TICK is about 1/8″ diameter and brownish black, and can enlarge up to 1/4″ when engorged with blood. It then becomes pale whitish in color. This tick can carry a germ that causes Rocky Mountain Spotted Fever and other tick borne illnesses.
- The DEER TICK is dark in color and is the size of a pencil dot. This tick can carry the germ that causes Lyme Disease.
MOST TICKS DO NOT CARRY THESE DISEASES.
TICKS USUALLY WALK AROUND ON YOUR BODY FOR 24-72 HOURS BEFORE THEY BITE INTO THE SKIN AND INJECT THEIR SALIVA. FOR THIS REASON, CHECK FOR TICKS TWICE A DAY.
Do NOT try to burn the tick with a match or other hot object.
Do NOT twist or squeeze the tick when pulling it out. This can cause the release of more saliva.
Do NOT try to kill, smother, or lubricate the tick with oil, alcohol, Vaseline, or similar material. This can cause the tick to dig in deeper.
If a tick is attached to you or your child:
1. Grasp the tick close to its head or mouth with a paper towel. Do not use your bare fingers.
2. Pull it straight out with a slow and steady motion. Avoid squeezing or crushing the tick. Be careful not to leave the head embedded in the skin.
3. Clean the area thoroughly with soap and water. Also wash your hands thoroughly.
4. Save the dead tick in a jar or sealed plastic bag.
5. If all parts of the tick cannot be removed, it is not an emergency; but call the office to discuss removing the remaining parts. Bring the tick in the jar or plastic bag to your doctor’s appointment.
Wear long pants and long sleeves when walking through heavy brush, tall grass, and densely wooded areas.
Pull your socks over the outside of your pants to prevent ticks from crawling up inside.
Keep your shirt tucked into your pants.
Wear light-colored clothes so the ticks can be spotted easily.
Spray your clothes with insect repellant.
Check your clothes and skin frequently while in the woods.
After returning home:
Remove your clothes and thoroughly inspect all skin surface areas, including your scalp. Ticks can quickly climb up the length of your body.
Some ticks are large and easy to locate. Other ticks can be quite small, so carefully evaluate all black or brown spots on the skin.
If possible ask someone to help you examine your body for ticks.
An adult should examine children carefully.
GUIDELINES FOR NEWBORN CARE
This handbook is designed to help you through the first days and weeks with your new baby by answering some of the most commonly asked questions. All babies are individuals from the day they are born and therefore you will find variations from child to child. You are going to have many questions about your baby. Write them down so you will remember them when you see or talk with us at the office. Be cautious of the advice you may receive from well-meaning friends and relatives.
All new parents are unsure of themselves at first.Hopefully, through the advice provided in this handbook and by our office, you will be relieved of some of the initial anxieties and thus be able to relax and enjoy your new child.
The decision of whether to breast or formula feed your baby is an individual one and there are advantages and disadvantages to both. However, it is clear from a health viewpoint that breast milk is better for the baby, as well as providing some health benefits for the mother. Breast-fed babies have fewer problems with digestion and a lower rate of infections and allergies. However, you need to choose the technique of feeding that makes you most comfortable since anxiety and frustration can interfere with either form of feeding. If you are unsure of which method of feeding to use, talk with your doctor. If still undecided, it is probably worth giving breast-feeding a try since you can change more easily from breast to formula feeding than the reverse. If breast-feeding does not work out for you, you can always change to formula feeding – either totally or as a supplement to breast-feeding.
Before starting to feed your baby, always make sure that you are relaxed and comfortable. Anxiety and physical discomfort can affect the success of the feedings. The very first time you feed the baby by breast, you may need to have one of the nurses help you to position the baby properly. (Most hospital nurseries have lactation specialists available to help you. They can answer almost all of your breast-feeding questions and concerns. They are a good resource and we recommend using them during your hospital stay.)
Start the feeding by guiding your nipple into the baby’s mouth. Usually the baby will instinctively open his/her mouth and grab hold of the nipple. Allow the baby to draw the nipple and breast far back into his/her mouth because, in addition to sucking, the baby obtains milk by a chewing motion. Avoid pressing the baby’s face firmly against your breast since this can interfere with breathing through the nose. If your baby needs some encouragement to suck, try gently stroking the cheek nearest the breast or pressing upward on the jaw.
The first feeding should be three minutes on each side, gradually working up to ten minutes on each side during the next several days. If after twenty minutes of nursing the baby still seems hungry, you can breast feed the baby an additional 5 minutes on each breast until the baby is satisfied. At each feeding start with the opposite starting breast from the last feed. Burp the baby between each breast and again at the end of the feeding.
Sore nipples are a problem many nursing mothers have when first starting to breast-feed. Do not use any alcohol or soap on your nipples since this can cause drying and cracking. After nursing, you may find it helpful to let your nipples air dry since the baby’s saliva will be soothing. If this doesn’t relieve the soreness or cracking you can use lanolin on your nipples.
It can take up to 7 days for your milk supply to come in completely. The more often you put the baby to breast, the faster your milk will come in. During the first several days of nursing, the baby gets a substance called colostrum from your breast. This substance usually provides the baby with adequate fluid until the milk comes in. You can assume your baby is getting enough liquid if she/he urinates at least four times a day and has a wet mouth. Consult your doctor if the baby is urinating less than four times a day or you are worried about possible dehydration.
The first week, do not let the baby go longer than 4 or 5 hours without nursing. Small or premature babies should not go longer than 3 hours without feeding. Most babies will need to be fed every 2 ½ to 3 hours. After breast-feeding is well established and the baby has documented good weight gain, it is no longer necessary to wake the baby for feedings. Many babies need 10 to 12 feedings in 24 hours but most of these hopefully will take place during the day with less frequent feedings at night. In general try to space out the feeds at least 2 to 2 ½ hours; however you may find that in the early evening the baby my want to feed a little more frequently.
It is recommended that breast-fed babies take vitamins while exclusively breast-feeding. Breast milk does not contain adequate vitamin D. This can be supplemented in the form of drops that also contain needed iron and vitamins A and C.
As a nursing mother, make sure you drink plenty of liquids, eat a balanced diet, get proper rest, and consult your doctor before taking any medications. Make sure you are in a comfortable and relaxed setting when nursing the baby.
Many nursing mothers want to give their baby a supplemental bottle of previously pumped breast milk or formula once or twice a day. It is probably best if you don’t start this until after your milk is well established. After about two weeks, if your baby is nursing well and has demonstrated good weight gain on breast milk, it is fine to give a bottle occasionally. It usually requires at least four breast-feedings a day to provide enough stimulation to maintain an adequate milk supply.
If you or your baby has problems with breast-feeding, consult our office or the lactation specialist.
There are many baby formulas available in either ready-to-feed, powdered, or concentrated liquid form. If you have well water at your house, make sure the water has been checked by the County Health Department before using a concentrated formula or powdered formula. Boiling well water can destroy most germs; but certain chemicals, such as nitrates, cannot be destroyed by boiling or removed by filtering. Therefore, if you depend on well water, use ready-to-feed formula (no water needs to be added) until you have your water approved by the Health Department. Discuss with your doctor which type of formula would be best for your baby.
Before starting to feed your baby always make sure that you are relaxed and comfortable. Anxiety and frustration can be easily transmitted to a feeding baby. The first time you feed the baby you may need to have one of the nurses help you to position the baby properly. You want to be sure that the nipple is tilted downward and full of formula so the baby does not suck a lot of air.
Try burping the baby every ½ ounce. You may have to try different positions to find the one that is most successful and comfortable. Some babies are easier to burp than others. If you can’t burp after each ½ ounce, try after each ounce.
Never prop the bottle and leave the baby to self feed as this can be very dangerous and uncomfortable for the baby. Also, you should never leave a bottle in the baby’s crib.
By the time the baby is several days old and ready for discharge from the hospital, he/she should be taking anywhere from 1 ½ to 4 ounces at every feeding. Allow the baby to take as much formula as she/he wants at each feeding, but try not to feed him/her more frequently than every 2 to 3 hours.
The first week don’t let the baby go more than 4 to 5 hours during the daytime and 6 hours at night without a feeding. Small or premature babies should not go longer than 3 hours without feeding. After the first week, you can let the baby go longer between feedings, as long as she/he receives at least six feedings a day for the first month. After this the baby should receive at least four feedings a day.
Always have more formula in the bottle than you expect the baby to take. If your baby usually drinks 5 to 6 ounces, you should always put 6 ½ to 7 ounces of formula in each bottle so that she/he will not empty the bottle and suck in a lot of air. Your baby will stop eating when he/she has eaten enough; therefore, do not force the baby to drink a particular amount.
It is not necessary to heat the bottle before feeding the baby. Room temperature or slightly warm formula is adequate. If the bottle has been in the refrigerator you can run some hot water over it until it is warmed to room temperature. NEVER MICROWAVE FORMULA. Formula that has been sitting at room temperature for over one hour should not be used. Also, once a baby drinks from a bottle, the liquid in that bottle must be used within one hour, after which it should be discarded.
The hole in the nipple should be the right size for your baby to suck easily; that is, the formula should drip as rapidly as possible without forming a continuous stream. If the hole is too small, you can enlarge it by pushing a red-hot needle or nail through the already existing hole. If your baby is not sucking easily, try a different brand of bottle and/or nipple.
The amount of formula the baby takes at each feeding will vary throughout the day. Don’t worry if your baby has one or two feedings during the day at which he/she takes only a small amount. However, if the baby is consistently feeding poorly or is consistently taking more than 32 ounces of formula a day, you should consult our office.
OTHER FOODS, VITAMINS & WATER
A baby on breast milk does not usually need any solid foods until six months of age. Formula fed babies may need solid foods somewhere between 4 – 6 months of age. Most babies can grow perfectly well on only breast or formula for the first six months. However, physicians differ on their recommendations about when to introduce solid foods; so if you feel your baby may need some solid foods before four months of age, consult your doctor.
Full-term babies taking formula do not require any vitamin supplements since an adequate amount of vitamins is provided in the formula. However, a very small or premature baby may require some additional vitamins or iron. Thus, if your baby is more than two or three weeks early or weighs less than 5½ pounds, ask your doctor if vitamins are needed.
It is recommended that breast-fed babies take vitamins while exclusively breast-feeding. Breast milk does not contain adequate vitamin D. This can be supplemented in the form of drops that also contain needed iron and vitamins A and C.
Fluoride helps strengthen the baby’s developing teeth. After the age of six months, a rice grain size of fluoride toothpaste twice a day or fluoride drops once a day should be given to your baby unless you are preparing the formula with water that has fluoride added to it. Well water in Maryland does not contain adequate fluoride.
Supplemental water is not recommended for breast or bottle-fed babies. They get all the fluid they need from the breast milk, formula or in solid foods. If you have well water at your house, make sure the water has been checked by the County Health Department before using a concentrated formula, powdered formula or adding to solid foods. Boiling well water can destroy most germs; but certain chemicals, such as nitrates, cannot be destroyed by boiling or removed by filtering. Therefore, if you depend on well water, use ready-to-feed formula (no water needs to be added) or add bottled water to foods or formula until you have your water approved by the Health Department.
Spitting is very common with all babies. When a baby is just born he/she often spits up mucus during the first several days. Later on, you may see some milk come up after burping the baby or laying the baby down after a feeding. Some babies spit with every feeding and others may rarely spit up.
There is no clear-cut way to differentiate “spitting-up” from “vomiting.” In general, spitting-up involves a small amount of milk that seems to roll out of the baby’s mouth. Vomiting usually refers to a larger amount of milk that comes out with significant force and may project out several inches to several feet. If vomiting occurs and is persistent, you should call your doctor.
Some babies are “spitters” and spit-up with every feed. If your baby is spitting excessively, you should contact your doctor. Most babies who are “spitters” grow normally, remain well hydrated, and have no problems from spitting. If a baby is not growing adequately or develops other symptoms from excessive spitting, there are medications and other interventions that can be used to treat them.
Burping the baby helps to get rid of any air swallowed during the feeding. Some babies are “good burpers” and others have more difficulty burping. Breast-fed babies should be burped between each breast and again at the end of the feeding. Bottle-fed babies should be burped after each one-half to one ounce of formula.
There are many positions you can hold the baby to get him/her to burp. The most common positions are up against the shoulder or sitting up on your lap with one hand supporting the chest and abdomen. Another popular position is face down lying across your lap. While holding the baby in one of these positions rub or pat the baby gently on the back until he burps. Too vigorous patting or rubbing is very ineffective and upsetting.
Some babies will burp as soon as you change their position, while others may require 5 to 10 minutes of rubbing or patting. If your baby is difficult to burp, try different positions. If you still can’t get the baby to burp, perhaps the baby doesn’t have any air to expel and the best thing you can do is to go on with the feeding. After several days of feeding your baby, you will learn the baby’s burping habits and the position to use for most effective burping.
SNEEZING, HICCUPS, & “RATTLING IN THE CHEST”
Most babies do some sneezing the first few days. This is usually normal and does not require any treatment. This is how a baby may remove some of the mucous in the nose that is left over from delivery. Overuse of a nasal aspirator (blue bulb syringe) can be irritating, cause nasal bleeding and produce more mucous. Hiccups are usually normal the first few days or weeks and will gradually go away. There is nothing you can do to make the hiccups go away. If it seems to significantly affect the baby’s feedings or is accompanied by vomiting, consult our office. Just about all babies will have periods when they produce a “rattling” sound in the back of their throats which often sounds like it is coming from the chest. This is an “in and/or out” gurgling sound which is often loud. The sound is usually caused by saliva or mucous sitting in the back of the throat. With this sound the baby does not cough, choke or seem upset. This sound can usually be eliminated temporarily by changing the baby’s position or giving a sip or two of water. (This is not “wheezing” which is a high pitched whistling sound. Wheezing is usually hard to hear without a stethoscope and is usually accompanied by a lot of coughing.)
Stools (Bowel Movements)
A baby should have his first bowel movement within 24 hours of birth. The first stool is a thick black tarry stool called “meconium.” These meconium stools may continue for several days before gradually changing to a looser greenish stool referred to as “transitional stools.”Transitional stools can also last for several days. The type of bowel movements your baby has after the first three to seven days will then depend on what you are feeding the baby.
Breast-fed babies may have bowel movements as infrequently as every fifth day or as often as 12-15 times a day. These bowel movements are usually loose, seedy or pasty and yellow or brown in color. Sometimes the stools may be dark green, especially if the baby is taking vitamins. The stools of breast-fed babies are usually odorless or have a sweetish smell.
Formula fed babies may have bowel movements as infrequently as every other day or as frequently as 6 to 8 times a day. The appearance and consistency of these stools will depend on which type of formula you are using and whether or not it contains iron. In general the stools should be mushy or pasty with the color varying from a yellow-tan to green or brown.
No baby should consistently have hard or formed bowel movements during the first several months. This can lead to constipation and can cause the baby pain and difficulty when trying to have a bowel movement. If this is a problem with your baby, and you have made sure that you are preparing the formula properly, then consult our office.
Whether or not your baby is constipated or having diarrhea, can best be determined if you know the baby’s usual bowel habits. For example, if your baby usually has one pasty stool each day and suddenly changes to eight loose stools a day, then the baby has diarrhea. For another baby, eight loose stools a day may be normal. Thus, significant changes in your baby’s usual bowel habits are the best indication of a possible constipation or diarrhea problem.
There are many causes of diarrhea and constipation. If your baby suffers from either of these problems you should consult your doctor for some suggestions on how to deal with the problem.The
type of treatment suggested will usually depend on the duration and severity of the problem, the age of the baby, and the diet you have been giving the baby.
If the number of bowel movements reduces significantly or become very hard and is accompanied by a decreased urine output, there could be a hydration or nutrition problem. If the baby looks skinnier with the skin appearing more wrinkled, there could be a hydration or nutrition problem. If the baby has a consistently weaker cry and a dry mouth with or without sunken appearing eyes, there could be a hydration or nutrition problem.
Urine can vary in color from clear to yellow. The more yellow the urine, the stronger the odor and the more concentrated the urine. Usually the first urine in the morning is the most concentrated with the strongest odor, especially if the baby is sleeping through the night and thus not taking any fluids.
Signs of possible problems with the urine or the bladder are varied. A male infant should have one strong stream when voiding – often shooting out a distance of several feet if left with the diaper off. Neither a male nor a female infant should be constantly dripping urine. Babies should urinate when their bladders are full and then remain dry for a period of time. Newborn babies may urinate as frequently as every hour or go up to 6 to 8 hours without voiding at all.
Urine of any color except clear or yellow could indicate a problem and your doctor should be contacted.
Urine is produced from the fluid your baby takes with feedings. If the amount of urine your baby passes decreases it means he/she is taking less fluid. If your baby urinates only twice in 24 hours, she/he may be dehydrating and your doctor should be called.
There is no need to routinely use lotion or powder in the diaper area unless a rash or redness appears. If your baby seems a little red in this area, use a small amount of a barrier cream such as Balmex or A and D Ointment. You may also use a small amount of baby powder for very mild rashes but be careful that the baby does not breathe in the powder. Too much powder “cakes-up” in the creases and is irritating.
The most important way to prevent diaper rashes is to change the diapers frequently. The diaper should be changed as soon as you realize that the baby has urinated or has had a bowel movement. When changing the diaper, clean the area with disposable wipes made for this purpose, or use a soft cloth with a gentle soap and water followed by rinsing with plain water. Do not use paper towels as they irritate, tear and crumble too easily. Make sure the diaper area is dry before putting on another diaper. You should contact your doctor if your baby develops a diaper rash that becomes severe or persists longer than a few days.
If you have a baby boy you may elect to have him circumcised. Usually your obstetrician does the circumcision and will tell you how to care for the penis. Clean the area with plain water when bathing the baby; and if the baby gets some stool on the circumcision, wipe it away with a damp cloth. Never use alcohol on the circumcision.
Regardless of whether your child is circumcised or not, you should clean the penis daily with plain water by pushing the foreskin back over the tip of the penis until the ridge can be seen. If the foreskin does not move easily over the tip of the penis, do not force it and be sure to draw this to the attention of the baby’s doctor at his next regular check-up.
Most newborn girls have a discharge from their vagina during the first several weeks. This discharge may be white or clear and may even be streaked with blood. This is a normal result of the mother’s hormones that are still in the baby.
You can clean the vaginal area by gently spreading apart the labia and wiping gently with a disposable wipe or washcloth dampened with warm water. Do this daily and whenever any stool gets into the vaginal area after a bowel movement.
The umbilical cord, or navel, is soft and moist when the baby is first born. Over the next few days the cord will dry up and shrink. There are frequently changing recommendations on cord care, but the current suggestion is to do nothing to a normal appearing cord. After one or two weeks the cord will dry up and fall off. There may be some mild bleeding for a day or two before or after the cord falls off. Abdominal binders or “belly bands” serve no purpose and should not be used. Until the navel falls off and the entire area is healed, only sponge-bathe the baby. Usually by the time the baby is three weeks old the entire area is healed.
Call the office if the cord area has thick or continuous drainage, a foul odor, or excessive redness of the surrounding skin.
Newborn babies should only be sponge bathed until the umbilical cord falls off and completely heals over. This usually takes two to three weeks. The reason for this is to avoid getting the umbilical cord soaking wet. The baby should be bathed every day or two with warm water and a soft terry cloth. A mild soap should be used.
After the umbilical cord completely heals over you can bathe the baby in a small basin. Using the sink to bathe the baby can be dangerous since the baby may accidentally turn on the hot water.NEVER LEAVE THE BABY ALONE DURING A BATH!
A baby’s hair should be shampooed about twice a week with a mild shampoo. Sometimes the baby’s scalp becomes dry and flaky and may develop a thick yellow crust. This thick crust is called “cradle cap” and can be treated with twice weekly use of a mild dandruff shampoo.Always try to avoid getting shampoo in the baby’s eyes; but if this occurs, immediately wash the eyes with clear water. If the scalp looks red or irritated after using a shampoo, stop using it and contact our office.
There is no reason to use baby oil or Vaseline on the baby’s skin or scalp. If the baby has dry, flaky or cracked areas of skin, use a mild unscented moisturizer.
Do not use Q tips to clean the baby’s ears. There are little hairs in the ear which usually move the wax to the outside where you can remove the wax with a wash cloth. If your baby has problems with wax accumulating in the ear canal, your doctor will suggest the best methods of removal.
Frequently a newborn baby will have long fingernails. This is more common in a baby born after the due date. You may dress the baby in a shirt with sleeves that cover her/his nails in order to prevent the baby from scratching the face. If you want to cut the nails, a clipper is easier to use than a scissors. It is best to cut straight across without rounding the corners. You can remove sharp corners with an emery board. Fingernails may require cutting twice a week. Toenails need cutting much less frequently. Another suggestion is to file the baby’s nails while your baby is sleeping.
The sleeping habits of babies differ drastically from individual to individual. Some babies will sleep through the night from the start and others need to be trained to sleep through the night. Daytime naps will also vary greatly with each baby. During the first six months you should do things to encourage sleeping at night such as making nighttime feedings boring and quiet, keeping the lights down low and not talking or playing with your baby very much during these feedings. After six months, if your baby is still not sleeping through the night, you should discuss with your doctor at the baby’s check-up ways to encourage the baby to sleep through the night. A baby should sleep on her/his back on a firm mattress without pillows, stuffed animals or thick blankets in the crib. It may be helpful to give the baby a pacifier to help the baby get to sleep, but do not replace it if it falls out later in the night. A baby should never have a bottle in the crib.This encourages bad habits and can cause severe damage to the teeth. A baby should not share a bed with the parents. It is best if the baby has his/her own crib or bassinet.
CRYING & COLIC
Babies cry for many reasons. They may be hungry, cold, hot, wet, overtired, uncomfortable, or just anxious to be held. When the baby cries, new parents may feel very frustrated trying to figure out what the problem is. Usually after a few days or weeks, you will learn to understand the different cries of your baby.Colic is a frequent problem with babies, usually starting around two weeks of life and gradually ending around two to three months of age. A “colicky” baby is simply one that cries more than the average baby for no known reason. They are usually very fussy during the evening hours after acting perfectly normal all day. During these “attacks” the baby will act like he/she is having stomach cramps, drawing up the legs and may pass a lot of gas. It can be very frustrating to try to find something that makes the baby comfortable. You can try feeding, rocking or cuddling the baby. If the colic or crying seems severe or persists, then discuss with your doctor.
Always wash any new clothes before putting them on the baby for the first time. Use a mild detergent and never use bleach or fabric softener. All clothes should be “fire-safe.” The first month, a baby may require one more layer than you would put on yourself. After the first month, for a full term growing baby, the baby does not require any more clothing than an adult.Therefore, dress your baby according to the temperature, and do not overdress. Before dressing, check the feet of sleepers and socks for hairs or threads that could wrap around toes and cut off circulation. When changing a diaper for a boy check for hairs or threads that could wrap around the penis and cut off circulation.
A newborn baby’s room should be kept between 68-73 degrees Fahrenheit. If for some reason the room temperature varies from this range, be sure to adjust the clothing accordingly until this temperature variability is corrected. The baby should never be kept in a direct draft from a window, fan, air conditioner or heater. Kerosene heaters and other gas space heaters can be dangerous and give off toxic gases. Never heat an area with a gas oven. All houses and apartments should have the proper number of functioning smoke-detectors. Consult your local fire department for recommendations. There should be no smoking anywhere in the house. Exposure to second-hand smoke greatly increases the chances of the baby developing asthma, ear infections, colds, pneumonia and other lung diseases.
There should be very few visitors the first few days at home. It takes at least several days for the baby and the parents to get used to each other and the changed surroundings. After things settle down and a schedule is established, a few visitors can be allowed for short visits. Nobody with colds, stomach viruses, or other contagious illnesses should be allowed anywhere near the baby. People should wash their hands before handling the baby. Discourage visitors from putting their face very close to the baby’s face and they should avoid kissing the baby or touching the baby on the mouth. There should be no smoking allowed anywhere in the house.
GOING OUTDOORS & CAR TRAVEL
You can take the baby outside if the weather is pleasant. On very cold days or extremely hot days avoid taking the baby out unnecessarily. If you must travel, make sure the car is comfortably heated or cooled and adequately ventilated. There should be no smoking in a car where the baby will be riding. Never leave a baby or child unattended in a vehicle. Indirect sunshine is good for the baby, but the direct rays of the sun should be avoided. Babies sunburn very easily and direct sunlight can hurt their eyes. Only a few minutes of direct or reflected sunlight can cause second degree burns. Many people feel that a newborn should not go out for a few weeks in order to avoid exposure to illness. Though you don’t have to isolate your baby during the first weeks, it is in his best interest not to be exposed to people with colds or other illnesses for at least the first two months. Thus, it is probably best to avoid stores and other public places where strangers may cough or sneeze around the baby. If you plan to visit relatives or friends, make sure they are in good health. Always use a car seat when traveling with your baby. The best location is in the center position in the back seat. Babies and children should not be in the front seat. Infants should be rear facing until 1 year old and 20 pounds. After that they should remain in a forward facing car seat until they are about 4 years old and 40 pounds.Subsequently, they should use a booster seat until they fit into regular seat belts appropriately, which usually isn’t until they are at least 8 years old.
WHAT A NEWBORN LOOKS LIKE
Most babies that are delivered vaginally will have molding of their heads to help them pass easily through the birth canal. This molding, which often causes a flat sloping forehead or an asymmetrical shape to the head, is usually temporary and disappears gradually during the first week. Babies delivered by C-section usually do not have molding since they do not pass through the birth canal. However, molding may occur in a C-section baby if the mother has been in labor or if the baby was in a certain position in the uterus during the last part of pregnancy. All babies have a soft spot called the “fontanel” at the center of the top of their heads where the bones of the skull have not yet grown together. The size of the fontanel varies with each individual and differences are usually of no significance. With time, the bones grow together and the fontanel gradually closes, usually by 18 months of age. There is no reason to be afraid of touching or washing this area.
The shape of the face can also be affected temporarily by molding. The forehead may be sloping, the nose may be flattened, or the face may be asymmetrical.
Frequently, small pinpoint white or red bumps will be noted on the face or across the bridge of the nose. These are blocked sweat or sebaceous glands called milia or miliaria. This is normal and will gradually resolve during the first few weeks.
The eyelids are frequently puffy during the first few days. This can be caused by the trauma of the delivery or the ointment placed in the baby’s eyes soon after birth to prevent infections. This puffiness gradually decreases during the first several days.
Many babies are born with blue eyes. If the baby is destined to have brown eyes, this will become apparent by six months of age. It is usually impossible to predict the baby’s final eye color during the newborn period.
Most babies have flat pink marks noticed on their face or neck during the first few days. These marks are called salmon patches and can vary in size from very small to several inches. The most common places to note salmon patches are the eyelids, central forehead, bridge of the nose, between the nose and the upper lip, and on the back of the neck. The patches that occur on the face will fade gradually and usually disappear completely by the first birthday. The patches on the back of the neck will be permanent about 10 percent of the time, but because they usually occur above the hairline, are rarely noticed.
Some babies, especially those of Asian or African descent, have faint blue flat marks on their skin. These are called “Mongolian Spots.” They are usually located on the lower back or on the extremities and may be confused with bruises by the inexperienced observer. They usually fade with time and have no significance to the baby’s health.
Jaundice is a yellow discoloration of the skin that commonly occurs in newborn babies. It is caused by a substance called bilirubin which accumulates in the bloodstream. Jaundice is not harmful to the baby unless the bilirubin level gets too high. If your baby becomes jaundiced, your doctor may monitor it with blood tests to measure the bilirubin level. If the level is rising very rapidly or getting too high, it can be treated with a special light therapy called phototherapy.This can be done in the hospital or at home depending on the severity of the jaundice. The bilirubin usually peaks around the fifth to seventh day of life and then starts to decrease and gradually resolves after seven to ten days.
It is best to check for jaundice by a sunny window or under a white fluorescent light. It is usually most noticeable on the face but is often seen on other areas of the body. If while you are in the hospital the baby looks yellow, orange, or golden colored or someone tells you the baby looks jaundiced, make sure the people caring for the baby check the bilirubin level. Before you leave the hospital, if there is any jaundice noted, there should be a plan developed with your pediatrician to follow the jaundice.
Sometimes the jaundice will not appear until after you get home. If you suspect jaundice, contact our office.
This should be a wonderful time in your life. Our office is available to help you and your baby.
Head injuries are a common occurrence in children. Fortunately, most of the time they are mild and do not cause serious injury to the brain. They often result in trauma to the scalp which can be frightening but does not usually lead to significant complications. The hard skull does an admirable job of protecting the delicate brain. The most common causes of head injury in children are falls, followed by sports-related trauma, car accidents, bicycle accidents, and child abuse.
There is a low risk of brain injury in low force injuries such as falls from a short distance. Conversely, a greater risk of brain injury is evident in high speed auto accidents, falls from great heights, certain sports related injuries, being hit by heavy or sharp objects and intentional abuse.
The common signs and symptoms seen after a head injury include:
- A “knot” or large swelling on the head – This develops because there are many blood vessels in the scalp which can bleed or leak fluid under the skin.
- Scalp laceration – Breaks in the skin often bleed profusely, even from small cuts.
- Headache – About 20% of children complain of headache after head trauma. In infants or toddlers this may manifest as irritability.
- Vomiting – One episode of vomiting does not necessarily indicate serious injury but could indicate a concussion.
- Seizures – A seizure occurs in less than 1% of children immediately following head trauma.
- Loss of consciousness – Rarely, a child will briefly pass out after hitting their head.
It is not always necessary for every child to be evaluated by a doctor after an episode of head trauma. Parents should call the doctor to discuss the situation if they are concerned, but can generally trust their instincts if the child is alert and behaving normally. The following scenarios may indicate a more serious injury and should prompt a doctor’s evaluation of the child – either over the phone, in the office or in the emergency room:
- An infant less than 6 months old
- Persistent vomiting (One episode of vomiting with a headache could indicate a concussion.)
- A seizure or loss consciousness
- A headache that is worsening – If your child has a headache and other physical or emotional symptoms, at least a phone conversation with the doctor is indicated.
- A significantly depressed area on the skull
- Clear or bloody fluid running from the ear
- Persistent clear fluid running from nose
- Abnormal behavior, difficulty walking, slurred speech or confusion
- Obviously becoming less alert or responsive
- Dizziness that persists or recurs
- Eye pupils of unequal size – they can both be large or both be small, but they should both be the same size
- Bleeding that does not stop after applying pressure
- A history of a high force injury
The past few years, there has become a greater awareness of CONCUSSIONS, especially during sporting activities, but they can occur from many types of trauma. Any injury could cause a concussion if it results in a persistent headache or any alteration in behavior, alertness, or memory. The child should be immediately evaluated “field side” and should not return to play if there is any suspicion of an injury or a concussion.The severity should determine the promptness and level of care sought, but your physician should be notified at some point if your child has a suspected concussion. In addition, the child should not return to activity until cleared by your physician. There are well defined guidelines for coaches, parents and physicians to follow for assessing and managing suspected concussions. Concussions can have long term affects on your child, therefore careful management is very important.
Most children with head injury can be managed at home. If there is swelling, an ice pack may be applied to the site. It should be wrapped in a thin cloth to prevent cold damage to the skin. A bag of frozen peas is often helpful for this purpose and is less threatening to young children. Tylenol may be given for headache; however, the child should be evaluated if the headache is severe or worsening. If the child is alert and acting normally and looks well to the parent, it is not necessary to keep the child awake or to wake them from sleep; but if you are unsure of the child’s well-being, check on the child periodically while asleep. Children often have a good, hard cry after an injury and then want to take a nap. As long as they are consolable and subsequently have normal behavior, it is fine to let them sleep. You should observe your child for at least 24 hours for the development of any of the above symptoms of a more serious injury and call if you see any of these signs. After a head injury, children may have a headache and be a little tired for quite a few days. This could be a concussion, thus your physician should be consulted. The headache and degree of alertness should not be getting worse. All sports and strenuous and risk activities (climbing, swimming, etc.) should be restricted while any symptoms exist, and activities should be gradually resumed when better.
If you are uncomfortable with your child’s condition, please feel free to call at any time.
Fever (temperature of 100.4 or higher) is often scary for parents. Fever in infants and children indicates something is not completely normal, but learning what causes fever and how to treat it should help make you less anxious and better informed how to handle the situation.
It is only natural to be concerned when your child has a fever, especially if it is going up, but not all fevers are a cause for worry. Some fevers don’t need treatment. Fevers activate your child’s immune system and by doing this can actually shorten the illness. Everyone has their own internal ‘thermostat’ that regulates body temperature. Normal temperature is not a specific number. It usually ranges from 97 degrees to 100.4 degrees, but can also vary according to time of day, age, and physical activity.
When your body detects an infection or inflammation, the body responds by raising the temperature to help fight the infection. How ill someone is acting is a better indicator of the severity of illness than the height of the temperature. A child with 103 temperature who is playing and maybe just a little out of sorts is usually not as much of a concern as a child who is “out-of-it” or not very responsive regardless of the temperature.
A person usually has chills when their temperature is going up rapidly, and sweats when it is coming down. Treatment is rarely required for a child older than three months who has a mild fever and no other symptoms. If other significant symptoms appear with the fever or if the child is younger than three months of age with a fever of 100.4 or higher, you should call our office.
You should call our office when your child has a temperature of 100.4 or higher if:
- Your child is younger than 4 months
- Your child is lethargic, unresponsive, refuses to drink, has a rash, is in pain, or is having difficulty breathing
- You see signs of dehydration, such as dry mouth, significantly fewer wet diapers.
- The fever lasts more than a few days
- If your child experiences a seizure
(Most of these symptoms would require our attention even without a fever.)
The best way to tell if your child has a fever is to take their temperature. A fever can’t always be detected by feeling a child’s forehead. The best way is to use a rectal thermometer for an infant and an oral one for a child. This way is still the most accurate.
Use a digital rectal thermometer, clean the tip with rubbing alcohol, lubricate the tip with a water-soluble lubricant, place baby on stomach or accross a firm surface, or on his/her back with legs lifted, slowly insert the thermometer into the anal opening, about 1/2 inch. Hold the thermometer with one hand and hold baby with the other hand and then wait for the reading of the thermometer.
Althought not every fever needs to be treated, there are some things you can do to try to make your child more comfortable. You can give acetaminophen or ibuprofen to reduce the fever. Make sure you give the appropiate dose. Our office does not recommend alternating acetaminophen and ibuprofen because of the risk of overdosing your child in a situation where the risks outweight the benefits. Don’t overdress your child with a fever, and offer a lot of fluids to keep him/her from getting dehydrated. Remember, if you have questions or are just not sure, call our office.
A quick note about febrile seizures. A febrile seizure is a relatively common and harmless side effect of fevers in young children. It looks like a full-body seizure where your child might be unresponsive, look strange, twitch, stiffen or roll his/her eyes. If this happens, you should try to remain calm, move him/her to a safe place where he/she can’t hurt themselves. Do not try to put anything in his/her mouth. The febrile seizures usually last less than one minute (they can last as long as 15 minutes). If the seizure lasts longer than a few minutes, you should call 911. Follow-up with our office for all febrile seizures.