• Introduction
• Newborn Care: Getting to Know Your Baby
• Newborn Care: Breastfeeding
• Newborn Care: Formula Feeding
• Newborn Care: Pacifiers
• Newborn Care: Sleep
• Safety Issues

One important thing to remember: no one knows your baby better than you do. You may hear lots of advice from friends, relatives, and even complete strangers. They all mean well, and much of the advice is very helpful. If someone gives you some advise that doesn't seem quite right or if seems to make you feel bad or guilty, take it with a grain of salt. All babies are different, all families are different, and there are lots of right ways to raise a child. There are just a few absolutes in child rearing, and I'll tell you what they are (look for the ALL CAPITALIZATION TYPE). Feel free to call if you need help with too much advice.

We are open from 9 to 5 Monday through Friday, and 9 to 12 on Saturday. We try to schedule all new baby appointments first thing in the morning. This is so we can spend the time with you that you need, and that there haven't been a lot of sick kids marching though the clinic yet! We ask that you come a few minutes early so we can get you to fill out some paper work and get your chart established. In order to save a few minutes, you may want to drop by and fill out the new patient paperwork before yournext appointment.

When you go home from the hospital, your doctor will pick the best time for your baby to be seen. Sometimes it's as long as 2 weeks away. Many times its sooner. You may be asked to go by the lab at the hospital for some labwork before being seen. Remember to allow at least an hour before your appointment for this. Whenever you are scheduled to be followed up, there is a specific REASON for being seen then, which is determined to be in the best interests of your baby.

All children must have an appointment to be seen. If you child is sick, we can work you in, but you will need to call and talk to a nurse first. Please be honest with the staff member when making your appointment. For instance, working in for a small rash then later asking to do a four-month-old checkup with shots isn't fair to the people who have appointments after you. If you must cancel your appointment, please call at least 24 hours in advance. You may be asked to reschedule if you are late for your appointment. We make sure that all children and families are given the attention they require, so please understand if someone before you is delaying the doctor for your time. We will give your baby the same extra time if it is needed.

The Emergency Room is available for you at your local hospital. Don't hesitate to go to the emergency room in the case of a true emergency. However, for mild illnesses or concerns, the ER may not be the best place to take your baby. We are available to answer your questions if you are not sure if your baby needs to go to the ER. The clinic is also open 6 days per week, and a doctor or nurse is always available by phone. Dr. Gaudet can see patients at either Wesley Medical Center or Forrest General Hospital. Some insurance companies require the primary care provider to approve or disapprove visits at outside facilities. Please be aware that unnecissary usage of the ER or urgent care clinics may get billed to you in full by the outside facility. Know your insurance company's rules and follow them.

We understand that mothers have many questions about their baby's care. Our nurses handle telephone calls. You will find them to be a friendly and helpful resource. When you call, please leave a message and one of the nurses will call you back soon. If your call is not answered within 2 hours, please call back and let us know. If a nurse decides that your question cannot be handled easily over the phone, you may get a call from the doctor, or be asked to schedule an appointment. Please limit routine baby questions to office hours. Phone calls can only offer advice, and are not substitutes for hands-on medical care.

Payment is expected at the time of service. This includes copayments and coinsurance. The rules of copayments are set by insurance companies and are mandatory. We cannot bill you for your copay. We strive to offer the best pediatric care available at reasonable prices. We can continue to do this if all of our patients follow the guidelines set by their insurance companies. Our staff cannot possibly know what benefits are offered by all of the various insurance plans, as there are literally thousands of companies out there. We ask that you read your policy and know what your benefits include (especially wellness check-ups and immunizations), copays, and hospitalization.

We can offer immunizations to you whether your insurance covers them or not. We are enrolled in a state program that allows us to administer vaccines to babies who have insurance, but immunizations are not included in the coverage. We provide this service to you for your convenience, but we need you to tell us what your coverage is before you can be included in this program. If your policy does cover immunizations, just let us know and we can bill your insurance company. Vaccines are too important to miss just because of an insurance problem!

If you are having financial problems, please notify one of our staff members promptly, so we can help you make arrangements. Our greatest concern is the same as yours, the health and welfare of your baby. Don't be hesitant to seek care for your child if he is ill because you are not able to pay right then.

If your insurance changes, or you have a new address or phone number please notify one of our staff members as soon as possible. If your are going out of town, make sure that the person caring for your child has written and notarized permission to seek care for your child in your absence.

Very little in life can compare with the first time you see your newborn baby, whether it is your first or fifth! Along with that great joy and awe, many parents experience uncertainty and anxiety at the awesome responsibility of caring for their newborn. Do not feel discouraged, as these feelings are perfectly natural. During the coming days and weeks, as you get to know each other better, you will begin to feel more relaxed and confident in your parenting role. As long as your baby is loved, well fed, warm and comfortable, you are already doing all the right things. You really do know more than you think you know!

All babies have a unique personality from the day they are born. Some are active and alert, some kick and fuss, and some are quite passive. Well meaning friends and relatives may tell you to do certain things that worked on their babies. Remember that you know your baby best, and what is right for her.

Her EYES may be puffy and have a discharge for a few days. This is due to being squeezed through the birth canal, and having medicines placed in the eyes at birth to prevent infection. Some babies have a mild greenish eye discharge for several weeks. This is due to a blocked tear duct, and will resolve on its own by just some mildly warm compresses to the eyes, and gentle massaging to the corner of the eye near the nose. Some babies have 'blood spots' in the whites of their eyes at birth. This is like a bruise, and is caused by being born. They will go away by themselves. Babies can see about 12 inches from their face. He especially enjoys looking at YOU. Let her spend some time observing your face and listening to your voice. Also, many babies look 'cross-eyed' at birth, but really are not. This is due to an extra fold of skin across the bridge of the nose. This will correct itself with time.

His HEAD may be a little odd shaped. Again, the birth canal molds head into a cone-shape. This will even out with time (the cranial bones are not yet fused together, and can even bump up against each other forming ridges). You will notice the soft spots on the front and the back of the head, which are present to allow 'growing room.' Don't be afraid to touch or wash gently in these areas. These spots (fontanels) go away by 9 or 12 months of age. You may notice a collection of fluid (blood) underneath the scalp called a cephalohematoma. This is caused by pushing against the mother's pelvis, and will go away in several months. It may turn hard and feel like bone before it goes away. There may be some soft swelling at the crown of the head called caput. This is also due to squeezing in the birth canal, and will go away in a few days.

Babies are obligate nasal breathers, meaning they only breathe through their noses. The NASAL passageways are tiny. Babies protect this airway by sneezing (so sneezing doesn't mean that they have a cold or allergies). Sometimes they sound stuffy, but they are not. If you notice a lot of stuffiness, especially associated with difficulty feeding, just suction a few drops or squirts of nasal saline (Pediamist, Ayr, Little Noses) with a bulb syringe. Don't do this too much, because you can cause some swelling in the nose that makes it worse.

The SKIN will have a variety of changes after birth. It may be very dry, and peel a lot. It may be oily and look like a teenager's acne. Both of these extremes are normal. The peeling is necessary, so don't try to 'treat' it with ointments. The acne is due to maternal hormones that passed through the placenta, so that will clear with time as well. The best way to care for baby's skin is to wash gently about three times per week with a gentle soap (i.e. Dove). Sponge bathe until the cord is completely healed. Ointments, creams, and salves tend to irritate the skin and aren't recommended (especially if they smell sweet: perfumed creams just contain chemicals that can irritate the skin). Remember that she was underwater for nine months, so her skin may look a little strange for a few days!

JAUNDICE is the yellow coloration of the skin that occurs in some newborns. Breast-fed babies are at the greatest risk for this. It's not always serious, and will resolve on its own in most cases. Call our office if you see the following symptoms: the baby is floppy and lethargic, won't feed very well, and has fewer than four wet diapers in a 24 hour period, and is having fewer than two stools in a 24 hour period. If the stools are beige or cream colored, instead of yellow or green. We may need to check her for jaundice if you see these symptoms. Jaundice is the deposition of the pigment bilirubin into the skin. Bilirubin is a by-product of the breakdown of extra red blood cells after birth. If you see signs of jaundice in the first 36 hours of life, please give us a call. Sometimes we ask parents to take their baby to the lab to get bilirubin determinations after they've gone home from the hospital. These tests are very important! The reason we do these is to catch worsening jaundice in the early stages, and to prevent side effects that can occur if jaundice is untreated, like hearing loss and kernicterus (a type of brain damage). The typical treatment program involves home phototherapy (light). Bilirubin is normally removed from the body through the bile, which is excreted in bowel movements. If your baby is feeding well, wetting plenty of diapers, and having several yellow/green/brown bowel movements every day, then he is doing a pretty good job of getting rid of the jaundice himself.

You may also notice a few BIRTHMARKS on your child. Most will go away with time. Stork's bite is red splotchy areas on the neck or eyelids. Mongolian spot is a bluish discoloration on the lower back and buttock of people of Asian, African, or Mediterranean decent. This will clear over several years' time. Milia are white pearly bumps that occur on the bridge of the nose. These will clear over the next several weeks. Boys and girls may develop little firm enlargements of the breast tissue underneath the nipple. This is just from maternal hormones, and will clear with time.

The CORD may intimidate some people. It must be cleaned to prevent infection and to help it fall off. Alcohol is the best method, Don't be afraid to pull the hard part up a little, and wipe the alcohol swab underneath where it's soft. There are no nerves in this area, so she can't feel it. The alcohol may be a little cold on the surrounding skin, though, so expect a little fussing. It is not even part of your baby's body anymore, so don't be afraid of it. If you see a lot of redness, swelling, or bad smelling discharge, call the doctor.

The GENITALS also require a little extra attention. Boys who were circumcised may have a plastic ring around the tip of the penis, or they may not. In either case, keep the sensitive skin at the head of the penis lubricated with some white petrolatum or KY jelly to prevent it from sticking to the diaper. This will also help the ring fall off faster if there is one. Expect the circumcised penis to get a little greenish discharge around the rim. That will clear with time. Please call the office if you see redness and swelling of the circumcision such that it obstructs the flow of urine (boys should be able to get a nice high arc if you are in mid-diaper change!). If he is uncircumcised, you should not try to pull back the foreskin. Give that a few years before it can be retracted.

Little girls may look swollen in the genital area. This is more pronounced in premature girls, and girls who were breech. You also may notice a little milky vaginal discharge as well. This is from maternal hormones that passed through the placenta. Given a few days, this will clear up. The Vernix (whitish cheesy substance) that coated her body will be stuck down in the crevices of her genitals. Just gently wipe with a plain-water wash rag daily until this material wears off.

ARMS and LEGS may be a little crooked at first, due to intrauterine positioning. They will straighten with time. Hands and feet may turn a little purple when she's cold so keep them covered if its cool. Fingernails and toenails may grow fast, so keep an eye on them. You don't want him to scratch his face up with them. Clip while he's asleep, and just nip the very tip off, in a straight cut, don't try to round any corners down. Her toenails may be soft and curve upward, but this doesn't indicate an ingrown toenail.

Breast milk is the ideal food for babies. It contains literally everything they need. Breastfeeding also provides infection-fighting proteins called immunoglobulins that help prevent illnesses. It also increases the bond of intimacy and warmth between mother and baby. Many people think that breast milk looks 'weak' when compared to cow-milk based formula. This is simply because the human milk is made for humans, and is utilized more efficiently. Breast-fed babies stools are smaller and softer than cow-milk formula stools. Try to start breastfeeding as early after birth as you can. At this time, you are producing a substance called colostrum, which contains important protein and immune factors. Try to feed at least every three hours initially. Term babies are born with a 'camel hump' of extra fluid and calories to get them thought the initial period of poor breast milk production. You may be tempted to supplement him with formula in those first few days until your milk comes in. This may actually make breast feeding harder later on. There are some unusual circumstances where supplementation is medically necessary, but discuss it with your doctor before deciding to supplement.

In the first day or so, keep nursing periods short and frequent, to prevent sore nipples. Alternate sides upon which you start feeding to keep up your milk production. You should be able to tell by her sucking and swallowing sounds how well the feeding is going. Frequent bowel movements and wet diapers are also a good indicator of successful feedings. Call our office if she has fewer than 4 wet diapers in a 24-hour period, or if you are worried about how the feedings age going. If it seems that he is slowing down, and not actively feeding anymore, its OK to break the suction (with your little finger working into the side of his mouth) and stop feeding. Take care of your nipples by cleansing and drying them, and treating the sore areas with a lanolin based breast ointment.

If your are breastfeeding, continue to take your prenatal vitamins. Make sure your doctor knows you have decided to breastfeed, and inform anyone who prescribes you medications. It's important that you get a balanced diet, and plenty of fluids. There are many myths about what you should, and shouldn't eat. Most of what you should avoid include alcohol, nicotine and caffeine. If you notice a certain food making your baby fussy 6 hours later, then it should be avoided. Keep a positive attitude, stay relaxed and confident, and your breast-feeding will be successful.

If you have chosen not to breast feed, you may feel overwhelmed by the choices of infant formula before you. We want you to use our office as a resource in selecting a formula for your baby. Try not to be swayed by things like advertising, commercials, and coupons when choosing your formula. All babies and families have different needs and concerns, and we can guide you though this. I also discourage parents from giving up on a formula and changing it too quickly. Many feeding problems are actually worsened from getting on the 'formula-merry-go-round.' Also, many feeding problems are actually not caused by the formula itself, so changing it wouldn't help. Remember that iron is an essential nutrient and prevents anemia helps in brain growth and development. Babies don't get constipated or have stomach aches just from dietary iron. Low-iron formulas are like a medicine used in certain iron- overload diseases, so call the office if you considering switching to a low iron formula.

City water can be used in clean bottles for formula preparation, but well water should be boiled for the first six weeks of life. Bottles and nipples should be washed and cleaned regularly, soon after use. If your child doesn't finish a bottle, then discard the remainder. Store open cans of formula in the refrigerator, and discard after 48 hours. Never reheat a bottle in the microwave oven. This creates dangerous 'hot spots' and destroys essential vitamins and nutrients.

Cow Milk should not be given in the first year of life. Its proteins are harder to digest and can be associated with gastrointestinal bleeding and anemia. This includes foods prepared with whole milk like ice cream.

Solid foods should not be given to newborns. They don't contain the right nutrients. They also contribute to obesity, and contain too much salt for the baby's system. Research has shown that early introduction of solid foods leads to food allergies later in life. The earliest we recommend introducing solids is around the four- month birthday. There are certain medical conditions where we introduce cereals earlier, but we will discuss this with you if it is needed.

DON'T PROP BOTTLES

WATER can be given after the first few weeks of the baby's life. Initially, it is not needed. Breast milk and formula contain all of the water your baby needs. After about one month of age, it is fine to give a few ounces of water per day, if she wants something to suck on, but she's not hungry. It is also helpful if the weather is very warm. It should not be given to the exclusion of breast milk or formula.

SCHEDULING the baby's feeding should be individualized. Smaller, littler babies require smaller, more frequent feedings. There are no universal truths to baby feeding. In as much as you are becoming 'babywise,' your baby is becoming 'mamma-wise' and 'daddy-wise.' It's important for you to get to know your baby's signals for hunger. Rooting, crying, fist sucking and lip smacking are reflex behaviors, and don't always indicate hunger. Many parents take these cues to mean hunger, and if they aren't really hungry, the baby can become cranky, gassy, and overfed. If he's fussing and it doesn't seem like its time to eat, he may just want to be held, walk around, swing, or interact with you in some way. A few good burps mid-feeding will prevent a lot of spit-ups and gas problems later. She should be held in a semi-upright position to feed, which will help swallowed air to be expelled easily. Don't be surprised to see some milk come up with a burp. A small amount of spit-up is expected. Remember; don't feed him every time he cries.

CRYING is a baby's job. It is her only form of communication. It may indicate 'I'm hungry' or 'I'm wet' or 'I'm tired' or 'I'm cold' or 'leave me alone for a while.' Sometimes babies cry for no apparent reason. Consider these episodes as simply exercise. Most babies have several hours of crying daily. You usually can't tell by the sound of the cry why she is doing it. When she cries, go and run down a checklist. Look at her diaper, her position, her temperature, and the room environment, consider if she's hungry or even over fed. Look at fingers and toes for anything that may have gotten wrapped around them (i.e. hair). If everything checks out OK, then it's all right to let her cry. Allowing a child to cry is NOT child neglect.

Most stories about colic are anxiety producing. Colic has no medical cause. It is not due to gas, or iron in the formula, or bellyache. It is crying for no known reason. Walking, holding, rocking, patting, feeding all create further worry and tension in parents if these things don't work. Infants can sense the worry and anxiety that you are experiencing, which just serves to worsen the crying episodes. Initially, babies need to bond with you, don't feel that you are 'spoiling' a child by holding and cuddling. This may be true for older children, but newborns need to be held. Generally, colic is outgrown by three or four months of age. If you find yourself getting frustrated, give her to someone else and go somewhere where you can't hear the crying. NEVER, NEVER SHAKE A BABY!

GAS gets blamed for many baby problems. Usually babies don't make gas like adults do (i.e. indigestible food). Typically they swallow air into their stomachs, which then passes through the GI tract. Frequent burping and smaller, slower feedings help this. Also, make sure there is no air in the nipple of the bottle. If he seems irritated by the rumbling and distention of stomach gas, Mylecon drops are fine to give for this. The newborn dose is on the bottle. If she cries and pulls up her knees, that doesn't necessarily mean she has too much gas. Sometimes these are normal behaviors, or may be associated with having a normal bowel movement.

Speaking of BOWEL MOVEMENTS, expect to see some changes early on. New babies pass a very black, thick material called meconium. This changes to the regular stool after a few days. Breast fed stools are typically yellow and seedy looking. Formula stools can be darker, larger, and firmer, and come less often. It is normal to 'grunt and strain' to have a bowel movement. In fact, BMs are probably the hardest work a little baby has to do! It takes time for the muscular coordination to develop (that is, to squeeze from above, and relax from below), such that babies may be pushing against a tightly closed anal sphincter. Eventually, he'll get the hang of it everything will all come out all right. Expect to see as few as two bowel movements per week for a formula fed baby, or as many as three or four per day. As long as it is soft, it is not constipation. If she has hard stools (constipation), has been three or four days since the last bowel movement, and seems to be fussy, consider placing a small glycerin suppository in her rectum. This will help stimulate a bowel movement. Be sure to cut the suppository down to her size before using it.

It is a good idea to have some Pedialyte or other electrolyte solution on hand in case she has diarrhea. This is when she has many watery bowel movements in a day. If this occurs, just feed Pedialyte for about one day, then go back to the regular feedings. If you see any blood in the bowel movements, or if she has any fever, please give us a call.

PACIFIERS can play a role in your baby's life. All infants are born with an innate need to suckle. They suck even when they aren't hungry. The pacifier can provide something to suck on when she isn't hungry. Remember to keep it clean, and if she gets a case of thrush, wash it thoroughly after every use. NEVER PLACE A PACIFIER ON A STRING AROUND A BABY'S NECK. It poses a strangulation hazard. When he is older, he won't have as strong of a need to suckle. Around four months of age, try to distract or amuse your baby with something other than the pacifier, and reserve its use only for unusual, stressful times, or bedtime. Children only get 'dependent' on the pacifier if the parents allow it. Excessive or prolonged use of the pacifier can cause dental and speech problems.

Clean your baby's TEETH with a wet rag when they start appearing. Teething can start at any age, but usually not as early as people think. Drooling a lot doesn't always indicate teething. When she has four teeth, start using a soft bristled toothbrush. We will discuss toothpaste use and fluoride supplementation at your regular checkups.

The American Academy of Pediatrics recommends that all newborns SLEEP ON THEIR BACK OR SIDE. Research has proven that this cuts down on the chances of Sudden Infant Death Syndrome (SIDS) or crib death. SIDS is a very frightening thing, and there are some things you can do to help prevent it. Back or side sleeping is one. Also, making sure that he sleeps in his own crib or bassinet. Infants who sleep with an adult, in an adult bed, are actually at INCREASED risk for SIDS. A firm mattress with only a fitted sheet, without any soft bedding or stuffed animals is the safest sleep environment. Also your baby should have a SMOKE FREE environment. Smoking only increases the risk of SIDS, as well as risk of colds, ear infection, and 'constant runny nose.' If you smoke, now is a good time to quit (mothers AND fathers!).

Sleep is more successful if you allow him to learn to put himself to sleep. This is a skill that must be learned, and the earlier the better. If he has to be rocked to sleep, he may be disoriented when he stirs later on, and you're gone. This may cause him to cry and fuss. Try to lay him in his bed awake, but drowsy. That way he will be in a consistent environment later on when he awakens. Most babies stop the nighttime feedings around two months of age, and can sleep through the night then. Its generally not a good idea to load the nighttime bottle with cereal hoping it will make him sleep thought the night. Night sleeping is a habit that is learned, and not generally a function of how hungry you are.

Signs of ILLNESS can be difficult to spot in a new baby. Lethargy (floppy, limp), poor feeding, few wet diapers, persistent irritability are all signs of illness that should alert you to call our office. Take a temperature if you think he has fever. A rectal temperature is the most accurate. You don't have to add or subtract any degrees to know the true temperature. It is safe if performed correctly. Use a short, stubby, glass thermometer. Hold it one half inch down from the tip. Lubricate with KY or Vaseline. Spread the buttock cheeks while the baby is on the stomach. Slip the thermometer in with the other hand. Remove after one minute and read the temperature. Any temperature of 100.4 is considered a fever. As long as the child is three months of age or younger, a temperature of 100.4 should prompt you to call our office immediately.

For children over three months of age, fever can just be another symptom of illness. Fever actually helps the body fight off infections. If your child has a mild fever, and feels all right, don't treat it with Tylenol (acetaminophen) or Ibuprofen. There is no 'magic' number of temperature over which the child will get brain damage. If the child feels bad due to the fever, go ahead and give a dose of Tylenol or Ibuprophen. Children can get some mighty high fevers and still feel fine! If you want to reduce fever with medicine, consider the WHOLE child's appearance, not just the number on the thermometer.

The best way to prevent illness is to keep her away from germs. We can't keep all the germs away, but we can give it our best shot! Frequent handwashing helps prevent the spread of illness. Insist on it when friends and relatives want to hold the baby. If someone is obviously sick, don't let him or her pick up the baby for now. Try to keep her away from crowds of people where you can't control who get around her. The best advice is to wait until she's about 6 to 8 weeks old before getting around any crowds (i.e. the grocery store, church nursery). Walks in the stroller, rides in the car, etc. are fine early on, but try to cut down on exposure to excessive sun and weather.

SIBLINGS will have greatly altered lives as well. Expect a little 'regression' in behaviors until things get settled. Try to set aside some special time for the big brother and sisters so they won't feel ambivalent about the new baby. Try to put a positive spin on the change in family dynamics: "now you can be the big sister!" Involve the siblings in the baby care in a limited way; i.e. "get a new diaper for your little brother for me." Never leave infants and small children together unattended.

All infants should go home in a rear facing, semi-reclined CAR SEAT. It must be anchored properly to the vehicle with a seatbelt in the middle seat position. Children should never be held in your lap in a moving vehicle. It's the law.

NEVER LEAVE YOUR CHILD UNATTENDED IN A CAR FOR ANY REASON.

Prevent burns by setting the hot water heater to 120 degrees. Have smoke detectors in your home and keep the batteries fresh. Never drink a hot beverage or smoke a cigarette while holding your baby. Crib slats should be no more than 2 3/8" apart.

I don't think I have covered all of your questions or concerns. I'm certain you have more. Hopefully this booklet has addressed the main ones. Feel free to write down your questions and bring them with you to you office visit. The well being of your child is of the utmost concern to me, and I look forward to seeing him or her grow and thrive for many years.