This section will provide general information about care for your newborn. If you have specific needs or questions, talk to your nurse or healthcare provider.

The Kintzinger Women’s Health Center was made possible by a gift from John and Jewel Kintzinger.

Bathing
You will have an opportunity to watch a baby bath demonstration while you are in the hospital. Please feel free to ask the nurses questions. Once you are home, it is not necessary to bathe your baby every day. A bath every two to three days with mild soap is probably adequate. It is necessary to daily spot-clean areas such as baby’s chin and mouth, neck folds, diaper area, and creases of the groin.

It is a good idea to bathe baby before a feeding, then feed and let your baby fall asleep. Feeding prior to the bath may result in your baby’s spitting up or having a stool in the water.

Until the cord falls off in one to three weeks, you may sponge bath your baby.

Sponge bath guidelines:

• Choose a flat safe surface free of dangerous objects.
• Warm the room to 75 degrees.
• Organize everything you will need for bathing, drying, and dressing baby before you begin.
• Prepare two bowls of warm water, one for the soapy cloth and one for rinsing.
• Begin with the eyes. Use a clean, soft washcloth or cotton ball with water only.
• Start at the corner of the nose and wipe toward the outer portion of the eye. Use a clean cotton ball or clean area of your washcloth for each eye.
• Wash the rest of the face and ears. Never use cotton swabs (Q-Tips) to remove earwax because of the possibility of injury.
• Shampoo baby’s hair with a baby shampoo or mild soap, and rinse well. Gentle washing will not hurt the anterior fontanel (soft spot). It is well protected.
• From the head, work down baby’s body, washing, rinsing, and drying a part at a time to minimize chilling.
• Genitalia and buttocks are bathed last, washing from front to back.

Tub bath guidelines:

• Be sure the tub or sink is clean before bathing baby.
• Use one or two inches of warm water (95-100 degrees or warm to the back of your hand).
• A sponge or rubber mat on the bottom of the tub or sink will prevent baby from slipping.
• Never add more hot water while baby is in the tub since this could cause a burn to your baby.
• Never leave the baby alone in the tub—not even for a second.
• Never put baby under a hot water faucet that could be turned on accidentally.
• Support baby firmly when in the tub to provide a feeling of security. Remember: Baby is slippery when wet.
• Cleanse eyes, face, and hair as instructed for a sponge bath.
• Wash baby’s neck area, chest, stomach, arms, legs, and genitalia with a soapy cloth. Rinse well.
• Be sure to clean all skin creases and folds.

If you have a baby girl, you may note a clear or white mucous vaginal discharge. Occasionally the discharge will become pink or blood-tinged during the first week of life. This drainage is normal and a result of hormones that mother passed on to baby during pregnancy. Baby girls also have a white cottage cheese-appearing substance between the labia (lips), which is called vernix. This gradually disappears.

No special care is required except keeping the area clean. To cleanse, use a washcloth and warm water, gently separating the labia and wipe from front to back. If a noticeable discharge continues, be sure to tell your doctor. Cleanliness and avoidance of bubble baths can help prevent vaginal irritation and urinary tract infection.

If a baby boy is uncircumcised, clean the genitalia carefully with soap and water. It is not necessary to pull back the foreskin. The foreskin will gradually loosen on its own as the child gets older.

Skin and Nail Care
Your new baby has sensitive skin. After the bath, you may use lotion sparingly. Avoid using heavily perfumed lotions. Infants have a keener sense of smell than adults and may find lotions offensive. Avoid applying baby oil or greasy substances that block the sweat glands and may lead to pimples or heat rash. Avoid using talcum powder—breathing the particles may irritate your baby’s nose and lungs. It can also collect in baby’s skin creases, leading to irritation and rashes.

Your baby’s skin may also be sensitive to chemicals contained in new clothing. After laundering, rinse bedding and clothing twice to remove chemicals or accumulated soap. For the first few months wash infant clothes separately from other laundry that is heavily soiled. Fabric softeners should be avoided because their perfume content can cause irritation to baby’s skin and decrease diaper absorbency.

Trim baby’s nails with an emery board, baby nail clippers, or blunt-end scissors. Trim the nails in good lighting while the baby is asleep. Depress the fingertip away from the nail to avoid clipping the skin. Cut toenails straight across and round off fingernails to prevent scratching. You may need to trim fingernails once or twice weekly. Toenails grow much slower and require clipping only once or twice a month. As your baby gets older, nails will become harder and better defined.

Dressing
A good rule of thumb is to dress baby in one more layer of clothing than you are wearing. Make sure there are no loose strings in sleepers or booties that could cut off circulation to the toes.

It is a good idea to keep the temperature in your house at least 68-70 degrees. If the room temperature is over 75 degrees, reduce clothing to a single layer, but be sure to cover baby in air-conditioned rooms or in drafts. Baby can become very uncomfortable if overdressed or underdressed. Feel baby’s legs, arms, or back of the neck to see if baby is too warm or too cold. Overheating may contribute to SIDS (Sudden Infant Death Syndrome).

Your baby can be taken outdoors at any age. Just dress baby as warmly as you dress yourself. Often a hat or bonnet is necessary to prevent heat loss in cool weather or sunburn in warm weather. During the summer protect baby from direct sunlight, heat, and wind. Keep clothing to a minimum. Keep baby in the shade. Sunblock products are not recommended for infants under six months of age. For infants over six months of age, use a sunblock with an SPF of at least 15.

Cord Care
Don’t be alarmed by the appearance of your baby’s umbilical cord, it is very simple to care for. You will need to keep the cord clean and dry until it falls off in one to three weeks. Keep the diaper folded below the cord. As often as directed by your physician, use a cotton swab dipped in rubbing alcohol and apply to the base of the cord. Since there are no nerve endings in the cord, this does not hurt or sting the baby. Never pull the cord or loosen it. As it falls off you may notice a drop of blood. Continue with cord care for one week after the cord falls off. Notify your physician of any foul odor, discharge, or any red swelling around the umbilicus.

Circumcision Care
To cleanse use a cotton ball and plain water. A slight film of yellow drainage is normal. Vaseline or Bacitracin ointment may be applied until it is healed to prevent sticking to the diaper. Ask your doctor about retraction of the foreskin. The circumcision will heal in seven to 10 days, and then it will need only normal washing.

Some circumcisions will have a small clear plastic ring (plastibell) around them. This plastic ring falls off in five to eight days. If the ring should slip down over the shaft of the penis you will need to let your doctor know. Plastibell circumcisions require no special ointment!

Taking Baby’s Temperature
An infant’s temperature may be taken either axillary (under the arm) or rectally. A glass rectal thermometer has a short, round mercury bulb. These are considered to be a safety hazard due to possible mercury poisoning if they break. Please discard any of these located in your household. Digital thermometers are easy to read. Fever strips placed on the forehead and pacifier-type thermometers are not considered accurate.

Ear thermometers are not recommended until at least three to six months of age, when a baby’s ears are a little larger. At three to six months, if you use this type of thermometer, always read the directions for use very carefully. Be sure the thermometer is touching the inner portion of the ear all around and always retake the temperature to be sure of accuracy.

The axillary method for taking a baby’s temperature can be done as follows:

• Hold the thermometer securely under the arm with the tip directly into the armpit. Clothing should be removed so the thermometer touches only skin.
• A digital thermometer may beep when ready.
• Call your doctor if the axillary temperature is higher than 99.6 degrees F or 37.6 degrees C.

To take a rectal temperature use this procedure with a digital thermometer:

• Place a small amount of petroleum jelly on the end of the thermometer.
• Place baby tummy down on a flat surface such as a changing table or lay baby across your lap.
• Firmly hold baby’s lower back with the palm of your hand.
• Insert the thermometer one-half inch into the rectum and hold in place for two minutes. Hold thermometer between your fingers with your hand resting on baby’s bottom.
• If the rectal temperature is over 100.6 degrees F or 38.1 degrees C call your doctor.

Diaper Rash
Diaper rash is a skin irritation in the diaper area. The most common cause is leaving a wet or soiled diaper on too long. Other causes include over-cleansing with soap, sensitivity to diapers, and yeast infection.

Changing your baby’s wet diaper frequently is your best assurance against diaper rash. After a wet or soiled diaper is removed, wash baby’s bottom with a wet, warm washcloth, wet cotton ball, or baby wipe. Gently pat the diaper area dry. Cleanse the genitalia area by wiping from front to back.

Some babies are sensitive to baby wipes, so avoid those containing alcohol or perfume. Also avoid perfumed lotions or powder, which can irritate baby’s skin. Include in baby’s daily care the cleansing of the diaper area with soap and water. Give baby time to air out daily without a diaper. You may apply a thin layer of ointment, such as A&D Ointment for protection against wetness.

If diaper rash develops despite your best efforts, here are some steps you can take:

• Air dry baby’s bottom and change the diaper frequently.
• Increase circulation by using a loose-fitting diaper.
• Try a different type or brand of diaper.
• Gently cleanse the diaper area with warm water in a squirt bottle or place baby in a sink or tub of warm water several times a day.
• You may apply a cream such as zinc oxide (Desitin), which stays on longer than ointment.
• If the rash persists or worsens, notify your doctor.

Rash and Birthmarks
Your baby’s skin requires special care and attention because the outer layer of skin is thinner than an adult’s. Therefore, your baby is more prone to rashes, dehydration, sunburn, and infection.

The following information covers the most common rashes and birthmarks of newborn babies.

Erythema Toxicum (Newborn rash): This red blotchy rash has a small white bump in the center and looks like an insect bite. Over half of all babies develop this when they are two or three days old. This rash can occur anywhere on the body and disappears usually by the second week. If you suspect true blisters or pimples, especially on the scalp, during the first month of life, call your doctor.

Milia: About 40 percent of newborns have tiny white bumps on their faces, called milia. These are blocked skin pores, which eventually open up by one to two months of age. Do not try to open them. Avoid using ointments or creams.

Mongolian Spots: A bluish-gray flat birthmark is called a Mongolian spot. These occur mostly over the back and buttocks in more than 90 percent of Asian, Hispanic, Native American, and African American babies. They may vary in shape and size and fade away by two or three years of age.

Stork Bites (hemangiomas): These flat red or pink birthmarks occur on the eyelids, bridge of the nose and back of neck in more than 50 percent of newborns. The facial marks clear completely by one to two years of age. About 25 percent of marks on the neck can persist into adult life.

Heat Rash: During hot, humid weather babies may develop a fine pinpoint reddish rash. This is seen mostly around the neck (front or back) and other body areas where clothes are rubbing. Remove most of the clothing, wiping baby’s skin with a cool, moist cloth. Then dry the skin thoroughly and apply a very small amount of baby powder to your hands (away from baby’s face,) then to baby’s skin.

Newborn Acne: About one-third of all babies develop small red bumps on the face. This may begin at three to four weeks and last until four to six months. Newborn acne is temporary and no treatment is necessary. Applying oil or ointment will generally make it worse.

Drooling Rash: Occasionally, a rash may develop on the cheeks or chin. This is a result of baby spitting up feedings. Gently cleanse baby’s face with a warm moist cloth after feedings and place a clean cloth diaper under baby’s head during naptime.

Color: Your baby’s skin may have looked purplish-red at birth, but within hours, the palms of your little one’s hands and soles of his/her feet should be the only part that may look slightly blue. If you should notice your baby’s lips, tongue, or face looking blue, notify your nurse or baby’s doctor right away.

Jaundice
Jaundice occurs in most newborns, whether they are bottle-fed or breastfed. Jaundice in the newborn presents itself as a yellow color to the skin or eyes. It usually appears after 24 hours of age, peaks in three to five days, and usually disappears by seven to 10 days. Jaundice is caused by a yellow pigment—bilirubin—in your baby’s system from the breakdown of extra red blood cells. This bilirubin is released during the breakdown process and is filtered through the liver. In some babies, their little liver is just too immature to handle the extra work. The bilirubin therefore builds up in the blood stream, and then gets deposited in the skin, giving it a yellowish color. Your baby’s liver continues to work to get rid of this extra bilirubin by excreting it in the baby’s stool.

First noticed on baby’s face, jaundice may gradually progress down to the chest, legs, and feet. Parents will want to look at baby’s true skin color during daylight hours. Some babies are not able to get rid of this excess bilirubin on their own and the blood level becomes too high. This can cause problems for the baby. If you notice some of the following symptoms call your doctor:

• Increased yellow skin color of baby’s entire body
• A yellow coloring of the whites of the eyes
• Increased sleepiness
• Poor feeding, not interested in sucking, falls asleep with feedings
• Fewer wet diapers

Your doctor may want to do a blood test called a bilirubin level.

Since much of the bilirubin is passed in the baby’s stool, it is important that you feed your baby frequently to encourage stools. If you are bottle-feeding, feed your baby formula at least eight times in a 24-hour period.

If you are breastfeeding, the colostrum and frequent nursing will act as a natural laxative in passing stools. When jaundice is present, your baby may be sleepy. Awaken your baby to nurse every two to three hours. If baby refuses to nurse for a complete feeding, pump after the nursing attempt and feed baby this pumped breast milk.

Elimination
Normal stool patterns: Baby’s first stool is a black, sticky, odorless substance called meconium. This is the end product of digested amniotic fluid. The next stool is a greenish color and is called a transitional stool. It may be somewhat loose or watery.

Breast Fed Stool: Within the first week the breast fed baby’s stool will become yellow, mushy, seedy looking or soft-formed. The baby may have a bowel movement as frequently as every feeding in the first few days. After one to two months, babies have less frequent bowel movements. Well-nourished breastfed babies older than eight weeks may go several days without a bowel movement.

Bottle-Fed Stool: The bottle fed baby’s stool will be soft and yellowish-tan. It may have the consistency of toothpaste. The stools may be as often as every diaper change or as little as one or two a day.

Constipation: Constipation is not defined by how many times an infant has a bowel movement, but by what the stool looks like. A constipated baby will have a hard-formed pebble-like stool. Any stool like this should be brought to the physician’s attention.

Diarrhea: Diarrhea consists of frequent (more than eight per day), watery, mucous, stools that are green in color and have a foul odor. The stools may even be tinged with blood. If you think your baby has diarrhea, call your baby’s doctor.

Urination: Your baby should have six to eight wet diapers a day and should have urinated and had a bowel movement at least once during the first 24 hours after delivery. If you go home within the first 24 hours after delivery and your baby does not urinate or have a bowel movement by 25 hours of age, notify your baby’s doctor. Also, call the doctor if the urine looks dark yellowish-orange. You may notice a pinkish granular stain on the diaper. These are urate crystals, a harmless substance in the urine that will go away by itself in a few days. If your baby is a girl, you may notice a pink to red vaginal discharge. This is normal in the first few days of your infant’s life.

Physical Characteristics
During the first few days of life, many changes take place inside your baby’s body enabling him or her to adjust to life outside your uterus. It is important, therefore, to observe your baby closely. Observe his or her overall appearance, temperature, breathing, and patterns of eating and number of wet or dirty diapers. Abnormalities in one or more of these areas may be the first indications of a problem. Please discuss any questions you might have with your nurse or physician.

After your baby was born, did you find yourself startled by his or her physical appearance? Don’t worry, you are not the only who has felt this way. Most newborns weigh between 5.5 and 10 pounds and are 18 to 22 inches long. Compared to adults, they have a large head and long trunk and they keep their arms and legs folded up. They like to return to the position they held inside of their mother’s uterus. They have a large rounded abdomen and a face that may appear flat and some have a receding chin. Their skin may be dry, loose, or wrinkled, sometimes giving a “little old man” appearance. This is your amazing newborn! Let’s look at your little one more closely…

Head: Looking at your baby, or others in the nursery, you may notice how many have slightly misshapen heads. This is moulding and occurs normally as the baby’s head shapes to fit through the mother’s birth canal. Moulding usually resolves by itself in a few days. There are two “soft spots,” or fontanels, one at the top and one at the back of the head. They are covered by tough membranes, so don’t be afraid to touch them. The one at the back of the head closes at around two months of age and the one at the top of the head closes at about 12 to 18 months. The amount and color of your baby’s hair now has little bearing on what it will be like later on. All of his/her hair will be replaced at about four months of age, so don’t be alarmed if you find your baby’s hair rubbing off.

Eyes: Being born is a hard process to go through, and all babies respond to it differently. You may notice that your baby’s eyelids appear swollen or red. This may have been caused by the pressure of birth or by the antibiotic ointment that was put into his/her eyes after birth to protect against infection. You may also notice one or more red spots on the white part of one or both of his eyes. These are just small, broken, blood vessels caused by the pressure of birth and will resolve on their own in a short time.

Newborns can focus at approximately eight to 12 inches, and can see in color. Your baby will especially like bright or patterned objects. Make eye contact with him/her and talk to him/her as you care for him/her. You may also notice that his/her eyes cross or wander at times. This is normal for a newborn and will usually correct itself within a few months.

What color are my baby’s eyes? This is a question many parents ask. The eyes of white babies are usually blue or gray while those of non-white infants are generally darker. You won’t see the true color of your baby’s eyes until about six months of age. A newborn will seldom have tears during the first two weeks of life.

Breathing: The normal respiratory rate (breathing rate) for newborn babies is 40 to 60 breaths per minute on the first two days and 30 to 40 thereafter. It is normal for your baby’s breathing to be irregular, but it should not appear labored. The respiratory rate may increase if baby is having trouble breathing. You can count baby’s rate of breathing by watching the chest as it rises when baby is quiet. Count the breaths for one minute. This gives you the baby’s rate of breathing per minute. If your baby has some mucous in his/her nose or throat, your baby’s breathing may sound noisy. It may help to suction his/her nose and mouth with a bulb syringe. Don’t worry if you hear your baby sneezing periodically. This is normal. Sneezing is your baby’s way of clearing his/her airways, and does not mean your baby has a cold.

Call your physician if you notice your baby wheezing, having a hard time breathing with a respiratory rate of over 60 breaths per minute, or blueness of the lips, tongue, or face. If you are still in the hospital, and you notice this, bring it to the immediate attention of one of the nurses.

Shaken Baby Syndrome
Never handle baby roughly. Never toss or shake a baby or small child. Always support the baby’s head. It can be very frustrating when your baby keeps crying, when you have tried different ways to comfort baby. This feeling can lead some people to shake the baby.

This can cause “Shaken Baby Syndrome,” a brain injury that can cause permanent brain damage or death. It is important to warn those caring for your baby that babies can be seriously injured by rough handling or shaking.

If your baby won’t stop crying, put the baby in the crib, shut the door, and go to another room in the house. When you have had time to calm yourself, then you can try again to comfort your baby.

If you have tried everything and are losing your patience, you may call the Kintzinger Women’s’ Health Center at 236-2324 or the Grinnell Regional Medical Center Emergency Room at 236-2380 to talk to someone who can help you.

Infant Stimulation
Infant stimulation is pleasing play and learning activities that you can use to help your baby’s physical, emotional, and mental development. When playing with your baby, it is always important to watch for cues that tell you if baby is enjoying the play.

Stimulation (activity and play) is most effective when your baby is quiet and awake. Try to spend 10 to 15 minutes a few times a day stimulating your baby. Watch to see if baby is paying attention. Most babies will turn their heads or stretch their fingers and toes toward the object you are showing them. Often, babies become less active if they are intent on listening and watching. Smiling, gurgling, and squealing also lets you know that baby is thoroughly enjoying your time together.

You know that your baby is not ready for play when baby is very active, irritable, or fussy. When you are playing and baby turns away from you or the toy you have provided, baby may need a short break or rest from play. It is possible to over-stimulate, causing baby to tune you out. Always try to respect your baby’s cues and postpone play to a later time.

During the first six months of life, babies primarily learn through their senses; what they can see, hear, taste, smell, and feel. We know there are certain sights, sounds, and smells that babies particularly enjoy and which benefit them. Following is a list of some activities you and your baby will enjoy.

Touching and Holding: Babies feel more secure when they are touched and cuddled. They learn about their world through touch.

• Cuddle your baby and hold him or her frequently.
• Gently massage baby’s skin to encourage relaxation.
• As your baby gets older, introduce baby to different textures such as soft, silky, smooth, rough, fuzzy.

Seeing: Babies learn much from what they see. They especially enjoy very dark or light colors (such as black and white).

• Provide black and white toys. As babies grow from three to six months, they prefer colors like deep reds and blues.
• Let your baby watch your eyes and facial expressions. They may imitate you.
• Move objects for your baby to follow. Move the objects first so that baby can follow with his or her eyes. Then move the object so your baby can follow by turning his or head. Adjust the distances you are moving these objects as your baby matures. At birth, babies see well at about nine to 13 inches. This gradually increases and by three months they can see well across a room.

Hearing: Talking makes baby more social. Babies will smile and talk more if you talk to them.

• Talk to your baby with a higher pitched voice during play times.
• Imitate your baby’s noises.
• Record yourself singing a lullaby and play the tape to your baby.
• Provide soothing music (classical or lullabies) for your baby to listen to.
• Loud noises or loud music can damage your baby’s hearing.
• Read to your baby. Even newborns like a brief reading time.

Moving: This is important for your baby to develop coordination.

• Rock your baby and carry baby frequently.
• Use a cloth baby carrier around the house.
• Place safe toys within baby’s reach.
• Allow baby time to play on his or her tummy when you are present. Using swings or infant seats too much can delay development of baby’s head control, rolling, crawling, and walking.
  The American Academy of Pediatrics advises against the use of walkers because of the high number of injuries associated with their use.

Tasting and Smelling: Babies can recognize and identify with their parents just by their body odor.

• Use only very mild colognes or perfumes around baby. Consider using the same one so baby learns to recognize it.
• Let baby be around the everyday smells of cooking.
• Allow baby to suck for comfort. Sucking even when not feeding is a pleasurable experience for babies.

Baby’s Growth and Development
Birth to 12 Months
No two babies grow and develop at the same rate. Even brothers and sisters who have the same biological parents and are raised in the same environment can be as different as night and day. Each baby is unique, but all babies need a warm, loving, secure environment that will allow them to grow and develop to their maximum potential.

Physical Growth
Generally birth weight is doubled by five months and tripled by one year of age. However, the rate of growth is more important than the actual height and weight. Your child’s height and weight will be recorded on a growth chart at each doctor check-up.

Development
For the individual child, no area of development—motor, social, language—follows a smooth upward path. Developmental growth often occurs in spurts followed by periods of leveling off. Many times baby may be making several changes in one area of development while other areas may not be changing. An example of this would be a 10-month-old who is making advances in motor development (crawling, pulling to stand, and walking around furniture) but has stopped saying a word, such as “dada,” which was frequently heard between seven and eight months. Babies need your time and patience while they develop at their own pace.

General patterns of development are described here. Again, keep in mind the individual differences of each child and take into consideration if they were born prematurely.

One Month
Social Development
• Looks into parent’s face
• Maintains eye contact briefly
• Early smile
• Holds head up

Fine Motor Development
• Grasp reflex—will hold object placed in hands
• Visually may follow objects briefly
• Prefers human faces to inanimate objects
• Also shows preference for toys and pictures with light–dark contrast

Motor
• Lifts head up when placed on tummy
• Moves arms and legs

Language
• Notices sounds
• Startles or cries in response to loud noises
• Makes small throaty noises

Three Months
Social Development
• More responsive
• Smiles in response to familiar face

Fine Motor Development
• Grasp reflex fades
• Begins to swipe or bat at toy or mobile
• Beginning to follow objects with more intensity

Motor
• Pushes up on arms
• Holds head up

Language
• Watches your face as you speak
• Smiles and coos
• Comforted by your voice
• Cries differently for hunger, discomfort, fatigue

Six Months
Social Development
• Attentive
• Expresses pleasure, laughs
• Beginning to imitate behaviors and sounds

Fine Motor Development
• Grasps toys and brings to mouth
• Uses both hands to pick up toy
• Follows 180 degrees

Motor
• Sits with support
• Holds head up
• Straight back
• Rolls over

Language
• Turns head, looks to source of sound
• Begins to babble (“ba ba, da da, ma ma”)
• Vocalizes pleasure and displeasure

Nine Months
Social Development
• Prefers primary caregiver
• Wary of strangers
• Communicates likes and dislikes
• Enjoys looking at self in mirror
• Likes peek-a-boo

Fine Motor Development
• Transfers objects from hand to hand
• Has purposeful grasp, can pick up small objects
• Puts everything in mouth
• Watches objects drop from line of vision

Motor
• Sits without support
• Arms free to reach and grasp
• Moves around by rolling and crawling

Language
• Stops activity on hearing “no” or own name
• Recognizes familiar words and family names
• “Talks” to toys

Twelve Months
Social Development
• Likes games (patty cake, how big is baby, this little piggy)
• Waves bye-bye
• Exploring more
• Indicates wants vocally, reaching, or going after

Fine Motor Development
• Puts everything in mouth
• Examines objects—picks up, holds, and bangs together
• Likes to fill and dump toys in container

Motor
• Pulls to stand
• Cruises around furniture

Language
• May say “ma ma” or “da da” plus one or two other words
• Jabbers
• Understands single words

Newborns
Newborn Behavior
It becomes immediately apparent to the nurse in the nursery, that no two babies are alike. From the moment they are born, each one has a unique personality. Each one is an individual.

Some babies are easy to care for; they are quiet, alert, and very content. Others need more attention. Try not to compare your baby with others. Take time to get to know him/her and learn to recognize his/her needs. You are the one who must meet these needs. Well-meaning friends and relatives may bombard you with “helpful hints” on how to care for your baby. Just remember that what worked for one, may not work for another. Just use your common sense.

Most newborns have their own patterns. So parents, for a time, may have to adjust their schedule to fit that of their baby’s. Newborns should be fed on demand and for the first few days will sleep when they want. Most babies will be awake much of the night for the first two to three days at home. After the first few weeks, parents can affect their baby’s schedule slightly by trying to get more feedings in during the day and fewer at night. By the time babies are six months old, most will have a schedule if encouraged by their parents, although you will notice that illness or growth spurts may affect even a well-established schedule.

Crying
Some babies cry a lot and some don’t. Remember, crying is one of the most important ways your baby communicates with you. Babies cry if they are hungry, lonely, wet, cold, hot, uncomfortable, tired, have gas, are sick, over stimulated, or are just bored. They need to know that someone will respond to them. It is not a good idea to leave a newborn baby crying for more than 10 to 15 minutes. It is not possible to “spoil” a newborn baby by responding to his or her cries. Remember, crying means a baby needs something, even if only to be held and talked to. If your baby seems to be crying excessively, please call your physician’s office

Soothing a Fussy Baby
Remember, crying is the only way your baby has to communicate with you. As the days go by, you will begin to notice that different cries express different needs. Your baby depends on you to figure out what his/her cry means and what needs to be done. Time is on your side, and before you know it, you’ll learn! Take time to simply watch your baby, asleep, awake, quiet, and crying hard. As with any other relationship, the better you know each other, the better you will communicate.

When your baby cries, think about what he/she may need and be creative. Use different soothing techniques to calm him/her down. Just remember no two babies are alike. What one mom does to soothe her baby may not work to calm yours. Here are some suggestions you might try:

• First, check to see if your baby is hungry, cold, hot, wet, tired, or needs to burp.
• Pick baby up and talk to him/her.
• Hold your baby closely, so your baby can hear your heartbeat. Try walking with your baby in this position.
• Try rocking your baby gently.
• Sing to baby or put him/her near some soothing music.
• Give baby something stimulating to look at.
• Try bundling baby tightly in blankets or change baby’s position.
• Some babies need to suck at times other than feeding times, try a pacifier or his/her fingers.
• Some babies enjoy low rhythmic sounds such as a clock ticking or radio static.
• A ride in the car often lulls a baby to sleep.

At times you will be able to comfort your baby quite easily and at other times nothing will work. Then you can cry together, or you may need to hand the baby to a different pair of arms and walk away for a few minutes. If the cries continue for long periods of time call your healthcare provider.

Colic
No one knows the exact cause of colic and it is frequently difficult to confirm. You may suspect colic, however, if your baby cries inconsolably at about the same time every day. The infant draws his knees up in pain and screams loudly for two to 20 minutes; then the crying stops, only to resume later. The baby may pass gas from the rectum. Despite the apparent discomfort, colicky babies seem to thrive.

Try comforting the baby by trying the ideas listed in soothing a fussy baby.

Also maintain a tension-free atmosphere as much as possible. This may mean getting away from a colicky baby for a while. Swaddle, hold close, or put the baby in a front pack. Lay the baby on his/her back and try bicycling his/her legs for few minutes.

Talk to your caregiver to determine whether food sensitivities might be contributing to the problem.

Use a comfort hold that provides pressure against his or her abdomen, lying on his abdomen across your lap or lying on your arm looking away from you.

The colicky period is very stressful for families. It may seem impossible to maintain a calm atmosphere. Try to keep in mind that colic does not produce any lasting harmful effects and it usually disappears by the third or fourth month. Consult your doctor if constant crying is associated with vomiting, a cold, fever, or hard stools.

Newborn Safety and Health
Sudden Infant Death Syndrome
SIDS, also referred to as “Crib Death,” is defined as the sudden unexplained death of an infant less than one year of age. It is the leading cause of death in children between the ages of one month and one year. It claims the lives of approximately 7,000 infants annually. Though the cause of SIDS is still unclear, medical research has uncovered factors that may reduce the risk of SIDS death.

Every baby is at risk for SIDS. Help reduce the risks for those babies you love…

• DO PLACE them down for sleep ONLY on their back until they are one year of age. This is different from what your mother or grandmother did!
• DO PUT them on a firm mattress in a crib. (If you do not have a crib, place the baby on a clean, safe area of the floor to sleep!)
• DO NOT use pillows, crib bumper pads, blankets, or quilts (especially adult blankets) over or under the baby.
• DO KEEP the baby’s room cool (less than 65 degrees) when he or she is sleeping.
• DO NOT overdress your baby.
• DO NOT smoke around your baby or let anyone else smoke around your baby.
• DO NOT smoke when you are pregnant or afterward around your baby and do not take your baby into smoke-filled environments.
• DO breastfeed your baby, unless you are a heavy smoker
• DO NOT overdress or over heat your baby especially if he or she is ill.
• DO seek medical care for your baby when he or she becomes ill.
• DO NOT let babies share a sleep surface with another child or with an adult.
• DO NOT put babies in an adult bed or on a sofa to sleep.
• DO tell other care givers of the baby (such as aunts, uncles, day care providers, babysitters) to follow these simple rules, too!

Immunizations
Immunizations protect your child against serious life-threatening diseases. Every child should be protected against the following serious diseases: polio, measles, rubella, diphtheria, pertussis (whooping cough), tetanus, mumps, H. influenza type b, hepatitis B, and varicella (chickenpox). Keep a record of all immunizations and take it with you when you visit healthcare professionals. Be sure to ask whether your child’s immunizations are up-to date. Regular check-ups for your baby at the doctor’s office or clinic are important. Immunizations are available through your local doctor or at Grinnell Regional Public Health at 641-236-2385. You will be given a public health immunization schedule during your hospital stay. Costs for immunizations are by donation. If you have Title 19, please bring your card with you along with your child’s social security number.

Recommended Vaccine Schedule for Infants and Children

• Birth Hepatitis B
• 1 month of age Hepatitis B
• 2 months of age DTaP/HIB, IPV
• 4 months of age DTaP/HIB, IPV
• 6 months of age DTaP/HIB, Hep B
  (Hep B given depending on when first dose was administered—at two months or at birth)
• 12 months of age Varicella & MMR
  
• 15 months of age DTaP/HIB, IPV
• 4-6 years of age DTaP/IPV, MMR
• Every 10 years Td (tetanus)

Prevnar vaccine for pneumococcal infections is now available for infants and toddlers.
Hepatitis B series available at no cost to children up to age 18 years.

For more information regarding immunizations for your child call 641-236-2385.

Safe Choices In Baby Items
During the first three years, children have little sense of danger. They are totally dependent on adults to make sure they are safe. Accidents often happen because parents are not aware of what their children can do. Safety is an important responsibility in the care of your newborn.

In the Car
Automobile accidents are the leading cause of death in young children. Car seats decrease the likelihood of death by 90 percent and serious injury by 70 percent. Every state now has a law requiring that infants and children ride in an approved car seat. In Iowa, from birth to three years of age, children must ride in an approved car seat. Three- to six-year-olds must be in approved car or booster seats or a seat belt.

Holding a baby in your arms does not provide protection in a car accident. Children who ride without a restraint are more likely to behave in a way that will distract the driver. When we start letting children ride unprotected “just around the block,” they are likely to begin resisting the use of a car seat. If you always use a car seat your baby will accept it.

Babies under a year old are best protected in a rear-facing infant seat because their necks and spines are immature and still developing strength. Children older than one year, up to 40 pounds, should ride in a car seat that faces forward.

Car seats must meet federal safety standards. Check the car seat certification label to ensure it meets or exceeds Federal Motor Vehicle Safety Standard 213. Always read and follow the instruction manual carefully both for proper placement of the child in the seat, and also for proper placement of the seat in the car. The car seat must hold the child in, but the seat belt must hold the car seat in.

It is not recommended to use a car seat that is more than five years old. The plastic begins to harden and if the harness straps are dirty, twisted, or worn they do not slide easily, stay tight, or catch properly to protect your child in an accident. It is not a good idea to purchase a used car seat. There is no way of knowing if it has been involved in a crash and often the manual is missing or incomplete. If you have an older car seat, look at the label to make sure it was made after January 1,1981. Car seats made earlier do not meet the same strict crash standards.

If your car has a front seat passenger air bag, your baby’s car seat should ONLY be belted into the back seat. An infant or child could be injured or killed by the force of an inflated air bag. NEVER place child safety car seats in the side jump seat of an extended cab pick-up truck. These are not safe.

Usually the safest place for a car seat is in the middle of the back seat. Sometimes the middle seat is too small for a car seat, and then sideboards (side seats) need to be used. Once the seat is mounted, check for movement. If the seat can be moved significantly from side to side, it is not properly mounted.

Six common car seat mistakes:

1. The instruction manual for the car seat was not used. Every car seat is different. Keep the manual in your car for use as the child gets older. The vehicle owner manual may also be helpful.
2. The reclining angle is not correct. The baby should sit at a 45-degree angle in the seat when it faces the rear of the car.
3. Wrong size seat for the child’s size. For the best possible fit and safety for your newborn, you should use a rear-facing infant car seat that fits children five to 20 pounds. When your child is one-year-old you may use one of the larger convertible infant seats that face forward. These are appropriate for children over one-year-old and between 20 and 40 pounds but not for infants. Premature babies often do not fit in regular car seats. What about seats for preemies? A baby born earlier than 37 weeks may need to use a car bed if he or she has any possibility of breathing problems when sitting semi-reclined. Ask your baby’s doctor if your baby needs to be tested before discharge for breathing problems. Use a seat with the shortest distances from seat to harness strap slots, and from back to crotch strap. Use rolled blankets to keep the baby’s head from slumping. Never place any extra cushioning under or behind the baby.
4. Harness is not snug. The shoulder harness straps should by placed through the slots that will position the straps at or below the infant’s shoulders with a rear-facing car seat. Properly secure the harness in the back of the car seat with the bar or metal slide according to your instruction manual. When infants are fastened in their car seats, place your fingers between the infant and the harness at the top of the shoulder or at the collarbone area. You should be able to place one or two fingers between baby and harness for proper fit. Any more or less space is incorrect. Do not wrap baby in a blanket before placing in a car seat. Using blankets allows the harness to slip off the shoulders and does not allow the child to sit deep enough or be fastened tight enough into the car seat. Dress the baby in an outfit and place extra blankets over top if needed.
5. Improper harness tie position (retainer clip). The harness tie must be used at all times to properly restrain your baby in the car seat. Place it at the level of the child’s armpits. Some seats have cross bars or T-bars. These work best for children over 20 pounds.
6. Seat belt not snug on car seat. Rear-facing and front-facing seats have different paths for the seat belt. Make sure the proper path is followed. There should be no more that an inch of movement from side to side when the car seat or base is properly installed. Many car seats do NOT fit tight enough in cars with deep seats, dips, or humps in the seats. They also cannot be tightened adequately in cars with seat belts that are forward anchored (belts that begin forward or where the upper or lower seat cushion meet) or seat belts with stiff stalks. When using a combination seat and shoulder harness to hold the car seat in, you must know if you have self-locking belts or not. Belts that stay loose during normal use need locking clips. These may need to be purchased from your car dealer. Refer to your car seat instruction manual and car manual for information on the use and need for locking clips. Car seats CANNOT be used with seat shoulder belts connected to the doors or on a track. Your auto dealership can install the proper seat belts when needed.

If you experience difficulty with properly installing your car seat due to the types, lengths, or placement of your seat belts, type of seats, etc., reread your instructions for possible suggestions or contact your car dealership or police department, or Grinnell Regional Medical Center’s obstetrics department at 641-236-2324.

Always be sure to send in your car seat registration card so the company can notify you of any problems or recalls. For questions about car seat safety or recalls, call the Auto Safety Hotline in Washington, D.C., at 1-800-424-9393.

Help your child form a lifelong habit of buckling up by setting a good example of always buckling up yourself.

Infant Seats
If you decide to use an infant seat, buy one with a safety strap and always keep baby strapped in. Don’t substitute it for a car seat or set it on high places like tables. Infant seats can tip over easily once your baby reaches three to four months of age.

Cribs and Playpens
Federal safety standards require that all cribs and play pens built after 1974 have spaces between the crib bars of 2-3/8” (6 cm) or less, to keep the baby’s head from getting caught between the slats. If you have an older crib or playpen, check the distance between the slats. Also check for any loosened crib bars or latches.

The mattress should be the same in size as the crib so there are no gaps to trap arms and legs. If you can fit two fingers between the mattress and the side of the crib, do not use the crib. Keep the mattress in the lowest position because babies move more than you expect.

If you have an older crib, check for cracked or peeling paint. Remove any paint you are uncertain of and repaint with lead-free products designed for nursery furniture.

Suffocations occur in babies who are placed face down on a soft surface that they can sink into. When putting baby down to sleep, do not use waterbeds, sheepskin, pillows, or soft mattresses, or any beanbags. The American Academy of Pediatrics recommends babies be positioned on their backs for sleep.

Changing Tables
Changing tables should include straps to prevent falls and drawers or shelves that can be easily reached while you’re changing the baby. Babies will wiggle, move and push against things. These very first movements can result in a fall. Never leave your baby alone on a changing table or other high places.

Strollers, High Chairs, and Automatic Swings
Strollers, high chairs, and automatic swings should have a sturdy wide base that prevents tipping. Always use the safety straps and never leave your baby alone even for a moment.

Most strollers come with a brake. Use it each time you stop the stroller.

High chair trays need to have a good safety latch. The tray should also have adjustable positions to adapt to your child’s growth. Always use the strap between the legs to prevent baby from slipping down and out of the high chair. This can cause serious injury to baby.

Gates
Any open stairway must be protected by a child-safe gate. The strongest gates are spring-loaded. Avoid criss-crossed wooden gates because babies can get their head stuck in these.

Baby Walker
A baby walker can be harmful item. Over 40 percent of children who use walkers have an accident requiring medical attention. Most of the serious walker-related injuries result from falling down a stairway. The American Academy of Pediatrics recommends you do NOT USE BABY WALKERS. Walkers can delay both crawling and walking if used more than two hours a day. If you decide to purchase a walker, it should be one of the newer stationery walkers that do not roll around. There have been reports that even some of these may tip.

Childproofing Your Home
You should childproof your home by the time your baby is four months old. Many babies are getting ready to crawl at this age. Childproofing works. No one can watch a child 24 hours a day and accidents may happen. Ninety percent of accidental injuries can be prevented. Begin by getting down on your hands and knees and looking through each room for possible hazards. Check the kitchen and bathroom very carefully, since these are the most dangerous rooms in the house for small children. Post emergency phone numbers by your telephone. This includes 911, your address, hospital, doctor, and poison control center’s number (1-800-352-2222).

Kitchen: Hot liquids, poisonous substances, and sharp utensils are among the hazards found in the kitchen.

• To avoid accidental spills or burning, never drink anything hot while holding your baby.
• Turn pot handles toward the center of the stove and cook on the back burners. You may want to consider buying burner protective guards.
• Don’t leave your hot oven door open for even a few seconds.
• Place a fire extinguisher within reach of adults only.
• Use safety latches on all cabinets and drawers. Use safe equipment. Look for the JPMA (Juvenile Products Manufactures Association) Safety label.
• Store all household products in original containers. (In case of accidental poisoning, you will need to report the exact list of ingredients.)
• Put sharp knives or any poisons, such as dishwashing soaps, cleaners, or other chemicals in high cupboards, out of baby’s reach. Occasionally, safety latches fail to keep baby out.
• Use trash resistant covers on all trash containers.
• Keep pet food dishes out of reach of very young children.
• Secure or fold tablecloths so they cannot be pulled down.

Bathroom: To prevent drowning: Remember, children can drown in as little as one inch of water.

• Never leave your child unattended near toilets, baths, tubs, showers, diaper pails, swimming pools, or wading pools. Always watch your child near water such as a lake, river, or stream.
• Never leave standing water in the bathtub. Never leave a bucket or pail with even a small amount of water in it. Babies can fall into the bucket headfirst and not be able to get out.
• Use a lock on the toilet seat to keep it closed.
• Keep the bathroom door shut.

To prevent burns: A steam vaporizer can cause severe burns if a child overturns it or puts his or her face too close to it. Use cool humidifiers, not hot steam vaporizers.

• Set your water heater at 120 degrees F or below.
• Don’t let a young child touch faucet handles.
• Consider anti-scald devices that slow water to a trickle if it reaches a critical temperature on tub spouts and showerheads.
• Keep electrical appliances unplugged when not in use and stored out of reach of children. Keep appliances away from all sources of water.

To prevent falls:

• Use a non-skid mat in the bathtub and on the bathroom floor.
• Use protective padding on the faucet and tub spout.

To prevent poisoning:
• Keep cosmetics, cleaning supplies, and medicines with child-resistant caps stored in the original containers in a locked cabinet high out of children’s reach.
• Keep shampoos and soaps, including those stored in showers, out of children’s reach.
• Don’t leave toilet bowl cleaner or the brush with residue next to the toilet.
• Have syrup of ipecac on hand in case of accidental poisoning. (Note: administer only on the advice of your doctor or poison control center).

General living area:
To prevent choking:

• Babies and young children will put everything into their mouths. From the time you baby is a few months old, don’t leave anything small on the floor, in baby’s crib, or near your baby. Be sure that small pieces of siblings’ toys are not left where a baby could reach them.
• Babies and young children choke on food. Hot dogs, straws, carrots, ice cubes, raisins, peanut butter, grapes, nuts, popcorn, and hard candies are common choking hazards.
• A rubber balloon is the leading cause of choking death from objects other than food. Most incidents occur while children are chewing on a deflated balloon and suddenly inhale it. Chewing on an inflated balloon is also dangerous because it could burst. Keep rubber balloons away from babies.
• Pacifiers should not be hung around a child’s neck on a cord or string because it could strangle the baby. To prevent choking, the pacifier’s shield should be at least 11/2 inches in diameter and the pacifier shield should be a single piece.
• Keep strings, cords, or other materials out of baby’s crib. These could get wrapped around your baby’s neck. Take all strings off of babies clothing.
• It is a good idea to take the heartsaver baby class. One of the topics covered is what to do if your baby chokes. For more information on this class call 641-236-2596.

To prevent burns:

• Use flame-resistant sleepwear (be sure to follow manufacturer’s laundering instructions to preserve flame-resistance).
• Never leave your child alone near a barbecue grill, space heater, or hot fireplace.
• Keep screens and safety rails on fireplaces and heaters.
• Clean and check smoke detectors monthly; change batteries every year.
• Cover unused electrical outlets with safety caps.
• Keep electric cords out of children’s reach and out of walkways.
• Never run an electric cord under a rug.
• Replace electric cords that are worn out or frayed.
• Keep light bulbs in all fixtures (even if the light isn’t used).
• Dispose of smoked cigarettes safely. Cigarettes are the most common cause of house fires. Cigarettes are poisonous if swallowed.
• Keep flammable liquids, matches, and lighters up high, out of children’s reach.
• Before placing a child in a car seat, check the temperature. Hot straps or buckles have caused second-degree burns. When possible, take baby’s car seat indoors or cover the car seat with a towel or sheet.

To prevent falls:

• Keep doors to stairs or outside areas closed.
• Keep spring-loaded gates securely in place with open stairways.
• Keep furniture with hard edges or sharp corners out of heavy traffic areas. Apply cushioned corner and edge protectors or tape foam strips over corners.
• To avoid tripping on stairs, keep stairway well lit and free of clutter.
• Secure carpet or rubber mats on stairs to avoid slipping.
• Use slip-resistant area rugs.
• If you live on an upper floor of a building, install window locks or guards.

Other dangers around the home:

• Keep houseplants out of children’s reach. Some are poisonous.
• Keep plastic wrap, dry cleaning bags, and garbage bags away from children to reduce the risk of suffocation.
• Don’t keep loaded guns in your home. If you have guns, store the guns and ammunition in a separate locked area.
• Keep knives, scissors, and other sharp objects such as tools stored out of children’s reach.

Smoke-Free Environment
A new baby in the house is the best possible reason for parents to quit smoking. When a baby is exposed to smoke, the nicotine, carbon monoxide, and other substances pass into baby’s blood. The byproducts of nicotine are found in baby’s urine and saliva.

The incidence of Sudden Infant Death Syndrome is increased when babies are exposed to cigarette smoke. Babies under two years of age are at greatest risk to the harmful effects of cigarette smoke. They may be especially sensitive because their lungs are immature and their immunity to infections is not well developed. The greater the exposure to tobacco smoke, the greater the harm. In fact, hospital admissions for bronchitis, pneumonia, and other related illnesses can be twice as frequent for babies whose parents smoke.

Follow these simple rules to protect your baby:

• Never ever smoke while holding, bathing, or feeding your baby.
• Never bring a cigarette into the area where the baby is.
• Don’t smoke when the baby is with you.
• Don’t allow smoking in your home or car. The smoke filters to all areas of the house, even if you close the doors. If you or others must smoke, go outside.
• Insist on no-smoking areas when you visit public places with your baby.
• Decrease or quit smoking yourself. Talk to your doctor about new products on the market to help you quit.

If you are interested in a smoking cessation program, call GRMC at 641-236-2411.

Lead Poisoning
Lead is a common metal found throughout the environment. It is in lead-based paint, car exhaust, air, soil, household dust, food, magnets, and certain types of pottery, porcelain, pewter, and water. Lead can pose a significant risk to your health if too much of it enters your body. The greatest risk is to young children and pregnant women. Small amounts of lead can slow down normal mental and physical development of children’s growing bodies. This is referred to as lead poisoning.

The primary source of lead poisoning is lead-based paint, though magnets and some types of pottery have been found to contain higher amounts of lead. Lead-based paint is found in homes built before 1960 or furniture or items painted before that time. Children may chew or teethe on furniture, pick up and eat lead-based paint chips or breathe in dust from paint being removed. They may put dirty hands or dusty toys containing lead into their mouths.

Many children with lead poisoning show no signs of illness. Others may be easily excited, not able to pay attention, have stomachaches, be more tired than normal, or have learning and behavior problems as they grow older.

The only way to tell if your child has lead poisoning is to have his or her blood tested at your doctor’s office or public health clinic. Call Grinnell Regional Public Health at 641-236-2385 or click here for more information.

Lead in drinking water, although rarely the sole cause of lead poisoning, can increase a person’s total lead exposure. Babies who drink formula and concentrated juices mixed with water are at a greater risk. To find out whether you need to take action in your home, have your drinking water tested. You cannot see, taste, or smell lead in drinking water.

If a lead test shows that drinking water drawn from your tap contains lead above 15ppb, take these precautions:

• Anytime the water in a faucet has not been used for more than six hours, let the water run from the tap about 15-30 seconds before using it for drinking water or cooking.
• Use only cold water for cooking and drinking.

For more information call the Iowa State Department of Public Health at 1-800-972-2026. They can advise you on where to have your water tested in your community.

When To Call Your Doctor
Knowing when to have your child checked is not always clear. If your child does not seem too ill, your doctor’s office nurse can help you decide whether to take your child into the office. If you feel it is important to consult your doctor after office hours, you can reach the answering service by dialing the office number. The service will put you in touch with your doctor or another doctor he or she has designated. The hospital emergency room is the most costly way to seek healthcare. Avoid using it except for critical situations or emergencies.

In general, the younger the child, the sooner you should call your doctor. With a newborn, nearly every illness needs to be checked. Be aware that a child’s illness can change quickly. For example, your child may seem to have just a cold, but when checked in the doctor’s office several hours later, has developed other complications.

Caring for an ill child may be frightening and frustrating. Get as many facts together as you can before taking your baby to the doctor’s office or calling in. Write important facts down to save time. Have a pencil ready to write down instructions. Repeat instructions to be certain you understand them correctly.

Information to have on hand:

• Your child’s name, age, weight, allergies, current medications, and the pharmacy you use.
• Signs and symptoms. Observe your child. Does the throat look red? Is there a rash? Is it raised? Where is it? Has there been a change in baby’s eating, sleeping, or behavior? Has there been a change in urination or stools?
• Baby’s temperature. What is it? When was it taken? How was it taken? (rectal, axillary, or in the ear) Was it taken before or after Tylenol (acetaminophen)?
• Sequence of events. How long has the child been sick? Is anyone else in your family or neighborhood sick?

Just describe the symptoms. Don’t put a label on them. Loose stools are not always diarrhea. Fussiness is not always colic.

Don’t hesitate to call your doctor back if you continue to be concerned about your baby.

Fever and General Signs of Illness
There are some symptoms that you may see with a variety of your baby’s illnesses. Many children eat less, sleep more, are less active, and have a fever in times of illness. Usually the more severe the illness, the more intense these symptoms will be.

With a minor illness, some decrease in food intake is normal and not harmful as long as you make sure the baby is taking in plenty of fluids. If your baby is less then two months old, you should call your doctor if there is a noticeable decrease in food intake. For any baby, you should call if you have not changed a wet diaper in more than eight hours.

Most babies sleep several extra hours a day and are less active when they are sick. It helps them to fight the illness and speed up recovery. Call your doctor if there are other symptoms that worry you or if your baby is unusually difficult to waken for feedings.

Fever is defined as a rectal temperature over 100.6 degrees F or axillary (armpit) temperature over 99.6 degrees. A baby’s body temperature will fluctuate throughout the day. Mild elevations of up to 101 degrees F can be caused by excessive clothing or hot weather. If you question a mild temperature rise, take away the possible cause of the fever and retake the baby’s temperature in 30 minutes.

Fever is a symptom, not a disease. Fever is the body’s normal response to infection. It turns on the body’s immune system to fight infection. For babies less than two months old, fever should be reported to your doctor immediately. For infants two to six months old, even if they are not acting very sick, you should call within 24 hours for fevers over 101 degrees F. For older children, many fevers can be watched or treated at home, especially when the cause of the fever is obvious as from a cold.

Any fever should be reported immediately if the baby has inconsolable crying, a convulsion, crying with touch or movement or a temperature over 104 degrees F. Also report a fever immediately if your baby is difficult to awaken or is acting very sick.

Acetaminophen is the drug of choice for reducing fever. DO NOT use aspirin (acetylsalicylic acid) for fevers from illness or flu as it is associated with Reye’s Syndrome in children. For older babies, the liquid form of acetaminophen can be given for fevers over 102 degrees F. It is best not to give medications for lower fevers because the fever is helping your baby fight the infection. Medications should be given according to the product instructions or doctor’s recommendation, not more than every four to six hours. Make sure a baby has on light clothing and offer fluids frequently during a fever.

Giving Medications
Every child at some time will be given medication for some sort of illness. The following tips may help.

• Always give your child antibiotic medication until the bottle is empty, even if your child seems better in two to three days. It takes many days of antibiotics to completely kill the bacteria.
• Give medications at the recommended times.
• Give the correct amount (dose) for your child. Read the directions on the label carefully. You may want to try different medicine helpers, such as:
  • A plastic medicine spoon that is marked gives a more accurate dose than a teaspoon.
  • Marked medicine droppers or medicine syringes are available from your pharmacist.
  • Put the medicine in one of baby’s nipples and your baby’s reflex will cause him or her to suck and swallow the medicine.
• 1 teaspoon = 5 ml.= 5 cc.
• Slightly raise the baby’s head, open the mouth, and place the dropper or syringe to the side of the cheek and release the medication slowly, allowing the infant to swallow.
• Watch expiration dates. Does it need to be refrigerated? Always keep medicine out of the reach of children.
• Understand the reason for the medication.
• Be aware of the side effects.
• Be sure new medications can be taken safely with the ones your child may already be taking.
• If the medication is one that can be taken with food, you may give a small amount of formula or juice to wash the medicine down.
• Call your doctor if your baby becomes so sick that he or she cannot keep the medicine down.
• Drug stores have many medicines for stuffy noses, coughs, etc. It is always best to check with your doctor before you give your baby any of the over-the-counter medications.

Common Illnesses and Conditions
Teething: Teething is not an illness. Teething is the normal process of new teeth working their way through the gums. You may see your baby drooling and having a desire to chew on things. It occasionally causes mild gum pain, but should not be enough to keep your baby awake. Cold compresses or gum massages may be helpful in soothing swollen gums. Some babies enjoy chewing on solid teething rings or cold liquid-filled teething rings. Be sure the liquid-filled rings are filled with purified water. Avoid teething gels and lotions. Many of them contain benzocaine, which can cause a drug reaction or choking because it numbs the baby’s throat.

When teeth first appear, around six to seven months of age, dentists recommend cleaning baby’s gums. A baby washcloth wrapped around your finger makes a good first “toothbrush.” Toothpaste is not necessary and could cause staining of the developing teeth if too much is used. A soft bristled brush may be used after the first tooth appears.

Colds: A cold is a viral infection of the nose and throat. Cold viruses are spread from one person to another by the mouth (kissing) or hands. Cold viruses can live on toys, phones, doorknobs, toilet handles, tables, and other surfaces for up to three hours. Common signs of a cold are runny or stuffy nose, fever with a sore throat, cough, hoarseness, red eyes, and swollen lymphnodes in the neck. Colds usually cause more symptoms and last longer in babies. In young babies, a blocked nose can make it difficult for your baby to suck. Use a bulb syringe to clear your baby’s nose. Call your doctor immediately if your baby’s breathing continues to be difficult. Also, call your doctor if your baby acts or looks very sick and fever is present.

Croup: Croup is an infection of the vocal cords often caused by a virus. It sometimes occurs with cold. Symptoms include hoarseness, a result of swelling of the vocal cords and a cough that sounds tight, like a barking seal. If your baby has these symptoms, call your doctor. They may suggest a warm mist (like you’d find in a steamy bathroom) or other treatment.

If croup becomes more severe, you may hear a harsh, raspy vibrating sound when your baby inhales. This sound is called stridor and occurs with crying and coughing. CALL your doctor IMMEDIATELY if your baby has stridor, difficulty breathing or swallowing, or bluish lips. Be sure to call the doctor if your baby is constantly uncomfortable, unable to sleep, or looks and acts very sick.

Thrush: Thrush is a yeast infection that grows rapidly on the lining of the mouth or diaper area. It can occur from scratches caused by a pacifier or prolonged sucking (as when a baby sleeps with a bottle or pacifier.) Antibiotics also put a child at risk for developing thrush by decreasing the body’s normal bacteria.

You may see white patches that coat the inside of the mouth and sometimes the tongue. These white patches are attached to the mouth and cannot be washed away or wiped off easily like milk curds. In the diaper area thrush appears as a red sore diaper rash that does not heal with the usual management.

This is not an emergency situation, but your baby should be seen by a doctor for treatment with a prescription medication. If you are breastfeeding, you will need to have your nipples treated also. You can continue to breastfeed.

Anything baby has been sucking or chewing on, such as pacifiers, bottle nipples, or teething toys must be boiled for 15 minutes or put through the dishwasher once or twice a day (wash and dry cycle). If this is not possible, the items should be discarded halfway through the thrush treatment because they can harbor the yeast fungus and re-infect the baby.

Ear Infections: Ear infections are common in babies and young children. Infections of the middle ear are commonly referred to as otitis media. Fluid collects in the middle ear space, increases pressure, and causes your baby ear discomfort. When fluid gets trapped it becomes a good place for germs to grow. Ear infections are common with upper respiratory infections (colds) because germs can travel from the nose, mouth, and throat up the eustachian tube to the middle ear space.

Signs and symptoms of ear infection may include:

• Fever
• Pulling at the ears
• Irritability
• Fussiness with eating
• Changes in sleep patterns
• Pus-like drainage from the ears

Call your doctor if you notice any of these symptoms.

Common Sense About the Spread of Infections
The following actions can help decrease the spread of disease within your household.

• Encourage hand washing. Hand washing helps prevent the spread of infections more than anything else.
• Discourage habits of touching the mouth and nose.
• Don’t smoke around your children.
• Discourage the kissing of pets.
• If possible, consider a small daycare home over a large daycare center.
• Don’t share cups or towels.
• Use a mild antibacterial dishwashing detergent to clean toys, pacifiers, and bulb syringes.
• Use disinfectants to clean the diaper changing area, crib, stroller, or other baby equipment.

Herpes Simplex Virus
A disease that is especially dangerous to newborns is herpes simplex virus. Infants can be exposed to this from other people with herpes lesions such as cold sores or genital herpes. It can cause serious illness for the newborn or even death. Keep visitors with herpes lesions away from your newborn. If you have herpes lesions, you must wash your hands thoroughly every time before you hold or touch your newborn. Cover lesions with a Band-Aid, mask or clean covering, and avoid touching active lesions with your hands. Never kiss or nuzzle your infant if you have sores on your face or lips. Do not place your infant on furniture or bedding where a person with herpes lesions has been.

Emergencies
Emergencies can happen at any time. Infant CPR classes are available at GRMC. To register, or to get more information, call 641-236-2596.

Post emergency phone numbers, addresses, and have these supplies on hand:

• Liquid children’s acetaminophen
• Thermometer
• Rubber bulb syringe