NEWBORN INSTRUCTIONS - East Lake Pediatrics
Contents
1. IPV 2 Injectible Polio Prevnar 2 Pneumococcal Rotateq 2 Rotavirus oral 6 Month Visit DTaP 3 Diptheria Tetanus Pertussis Hib 3 Haemophilus B Prevnar 3 Pneumococcal Rotateq 3 Rotavirus oral 9 Month Visit HBV 3 Hepatitis B Vaccine 12 Month Visit Hib 4 Haemophilus B Prevnar 4 Pneumococcal 15 Month Visit Proquad 1 Measles Mumps Rubella Varicella HAV 1 Hepatitis A 18 Month Visit DTaP 4 Diptheria Tetanus Pertussis IPV 3 Injectible Polio Vaccine 24 Month Visit HAV 2 Hepatitis A Vaccine 5 Year Visit DTaP 5 Diptheria Tetanus Pertussis IPV 4 Injectible Polio Proquad 2 Measles Mumps Rubella Varicella 11 Year Visit Tdap 1 Tetanus Diptheria Pertussis Menactra 1 Menigococcal Gardasil 1 Human Papilloma Virus series of 3 over 6 months This schedule is subject to change based on recommendations of the CDC ACIP and the AAP as well as availability of each vaccine DESCRIPTIONS OF IMMUNIZATIONS Hepatitis B HBV The hepatitis B virus can cause short term illness that leads to loss of appetite tiredness diarrhea and vomiting jaundice and pain in the muscles joints and stomach It can cause long term illness that leads to liver damage cirrhosis liver cancer or death Vaccination against hepatitis B prevents this type of hepatitis and the severe liver damage that can occur 20 to 30 years after a person is first infected More th2. It should be strongly noted that measles still cause about 745 000 deaths in unvaccinated children who live in underdeveloped countries mostly Africa Most of the publicity has centered on a possible link between the MMR vaccine which was introduced in 1988 and a variant of autism that includes inflammatory bowel disease IBD and impaired behavioral development Such findings have been rigorously reviewed and refuted in a number of well conducted studies Of special note a 2002 analysis of vaccination records of children born between 1979 and 1998 found no higher incidence in autism with or without behavioral problems and gastrointestinal disorders In the study there was a link between impaired behavioral development and bowel problems but they were not related to the vaccine The popular media has incorrectly reported the possible link between autism and MMR as causing a split in the scientific community but virtually all experts refute any association In fact reports of symptoms related to autism increased only after widespread publicity of this supposed side effect Varicella Chickenpox Varivax Chicken pox is a common childhood disease It is usually mild however it can be serious especially in young infants and adults It is spread from person to person through the air or by contact with fluid from chickenpox blisters It causes a rash itching fever and tiredness It can lead to severe skin infections scars pneumonia brain d
3. Committee of Nutrition of the American Academy of Pediatrics that you use an iron fortified formula for your baby until he she is at least 12 months old Iron is a mineral that is used to make good red blood cells which carry oxygen in the blood and supply it to all parts of the body A rapidly growing baby has a great need for iron not only for day to day maintenance but also to constantly replenish iron stores that are being used to support his her growth By using an iron fortified formula such as Enfamil Lipil with Iron you are ensuring that your infant has plenty of iron to use when he she needs it The amount of iron in your baby s formula will not cause gastrointestinal distress such as vomiting constipation diarrhea cramps gas or colic so please do not change or discontinue the iron fortified formula unless we have advised you to do so Upon leaving the hospital your baby will take 1 2 ounces of formula per feeding Every week or so thereafter you will probably observe that your baby will desire more See the infant feeding summary below for the average formula intake at different ages There is a broad range of normal formula intake the best judge of the proper amount for your baby is to follow his her specific appetite Remember that your baby may be full before the bottle is empty Never force him her to drink more than he she wishes Overfeeding can cause your baby to forcibly vomit When your baby is finished feeding it is best to
4. breast or bottle feed The time spent feeding your child provides him her with needed love as well as nutrition This early contact that your infant receives establishes the maternal child bond that will continue to grow throughout the years Therefore regardless of the feeding method you choose it is important that you try to remain relaxed confident and enthused during the process BREASTFEEDING We strongly encourage mothers to breastfeed if they have the desire and an adequate milk supply Human milk has a perfectly balanced distribution of protein fat carbohydrates and minerals to provide for all the nutritional needs of your baby Its composition is unique and changes to meet the varied needs of your baby as he she develops It is designed to be easily digestible by your infant s sensitive and immature system resulting in fewer problems with constipation gas and colic Calcium and iron absorption is better from breast milk than formula and it presents a smaller sodium and protein load to the kidneys In addition certain protective immune substances called antibodies are secreted by the breast which help your infant combat potential infections by bacteria and viruses and protect against allergies Breastfeeding often has the additional positive effect of helping you lose some of the post pregnancy pounds faster While breast feeding mom s diet may be a normal regular diet with few exceptions Food tolerances are individual to each
5. most common hazards for babies Burns Bath water should be checked with your elbow to prevent scalding Hot liquids should be kept out of reach Do not drink hot liquids with your baby in your lap Set the water heater to 120 degrees or below Falls Never leave your baby unattended on a changing table The safety strap should be used and all diaper changing supplies should be ready prior to changing the baby Toys Toys should be too large to swallow and too tough to break Be sure that they do not have sharp points or edges Small and Sharp Objects Keep pins buttons beads and other small or sharp objects out of baby s reach If using cloth diapers be sure to use diaper safety pins with plastic shields Smothering Plastic bags long toy telephone cords harnesses and soft pillows can smother or strangle A firm crib mattress and a loose warm covering for a sleeping baby are the safest Keep the baby s crib and playpen away from Venetian blind cords Do not allow the baby to chew or suck on balloons Auto Travel A car seat is a MUST Do not hold your baby on your lap Use an approved infant carrier placed in the backseat facing backwards If possible avoid placing the car seat behind the side where an airbag is present Pools As soon as an infant is able to crawl there is a risk of tumbling into the pool All families with young children and a pool should have a quality pool safety fence at least 4 feet high immediately
6. on a spoon that has been mixed well with formula or breast milk to a thin consistency Next vegetables and fruits can be introduced followed by meats To observe for possible allergic reactions you should wait 3 5 days between each new food Be relaxed and flexible in your approach to feeding solid foods Do not get discouraged or frustrated if your baby does not want to take a particular food When your baby is ready for a particular food is usually discovered through trial and error Generally try introducing foods by their color starting light and working into the darker stronger foods yellow orange green See the feeding guideline below for examples of how to incorporate solids into your baby s diet The volumes listed should only be used as a guide AGE BREAKFEAST LUNCH DINNER 4 months 2 4 TBSP Infant Cereal 2 4 TBSP Infant Cereal 2 4 TBSP Infant Cereal 5 6 months 4 TBSP Infant Cereal 4 TBSP Strained Fruit 4 TBSP Strained Fruit 4 TBSP Strained Fruit 4 TBSP Strained Vegs 4 TBSP Strained Vegs 7 9 months 5 TBSP Infant Cereal 4 TBSP Strained Dinner 4 TBSP Strained Dinner 6 TBSP Strained Fruit 4 TBSP Strained Vegs 4 TBSP Strained Vegs 5 TBSP Strained Fruit 5 TBSP Strained Fruit 10 12 months 8 TBSP Cooked Cereal 6 TBSP Jr Dinner 6 TBSP Jr Dinner 6 TBSP Jr Fruit 5 TBSP Jr Vegs 5 TBSP Jr Vegs 6 TBSP Jr Fruit 6 TBSP Jr Fruit VITAMINS AND FLUORIDE The American Academy of Pediatrics recommends that breastfed infants be given either a sup
7. to have your child drink plenty of cold fluids and dressed in light clothing It is important to remember that regardless of the intervention your child s temperature should only be expected to come down 1 to 3 degrees Fever itself is not cured by antibiotic therapy The fever is a symptom not a disease Fevers can be caused by either viral or bacterial infections If the cause is a viral infection antibiotics will not cure the illness However if the cause is a bacterial infection such as strep throat pneumonia or an ear infection antibiotic therapy will be prescribed It is important to give any antibiotics prescribed for the full duration of the therapy Never save leftover antibiotics to start them yourself for future illnesses THERMOMETER USE The preferred method of temperature measure in an ill infant is a rectal temperature A rectal temperature can be taken with a mercury thermometer or a digital thermometer The thermometer should be inserted about 1 inch and left in place for 2 3 minutes with a mercury thermometer or until the beeping tone is sounded with a digital thermometer The normal body temperature varies throughout the day ranging between 98 100 degrees highest temperatures in the evening Tympanic ear temperatures are accurate in older children however due to improper fit in the ear they are not as accurate in infants and young children therefore should be avoided Pacifier thermometers and forehead str
8. to you with his her different cries However it is not uncommon for there to be times when you will be unable to comprehend the cause for the tears It does not mean that there is necessarily anything wrong with you or the baby Between the ages of 3 weeks and 3 months some babies will have a fussy period that can last several hours Your baby may draw up his her legs and pass gas His her face may become beet red and he she may be difficult to comfort Some infants respond simply to being picked up and held Others prefer being rocked or going for a ride in the car Usually there is no magic cure Just remember you cannot spoil a newborn by holding and loving them SIGNS OF ILLNESS Every parent has concerns at one time or another that their infant may be ill Infants are seen in the office on a regular basis to be examined by the physician to screen for any potential problems The following list gives examples of what signs of illness parents can watch for If your baby has any of the following please call the office to Schedule an appointment Sleeping more than usual Vomiting repeatedly or forcefully not just spitting up Diarrhea greater than 12 16 stools liquid stools stools with an offensive odor or flecks of blood or mucous Refuses to eat 2 times in a row Looks off color especially if blueness in the lips yellow eyes or a general paleness is noted Inconsolable Temperature greater than 100 4 rectally o
9. NEWBORN INSTRUCTIONS Mike Jordan M D Amy Harbage D O M P H Vicki Skidmore D O Jennifer Hammond A R N P P N P 4150 Woodlands Pkwy Ste B 2137 Little Road Palm Harbor FL 34685 Trinity FL 34655 727 772 1452 727 372 6760 Board Certified Pediatricians Newborn Instructions Guideline for Infant Care Congratulations upon entering one of life s greatest adventures Parenthood Although it will be filled with newly acquired responsibilities frustrations and concerns it will be full of countless joys and immeasurable rewards as well Being a good parent requires time effort and patience It will be challenging due to the various demands and situations you will encounter As a new parent you will have many questions arise concerning infant and child care This booklet will be a helpful guide This booklet should be used as just that a guide since there are several acceptable approaches to any given situation The information enclosed combined with your own common sense will be sufficient in assisting you with handling most problems that may arise and keeping your baby healthy and happy For more comprehensive reading on a variety of parenting and child health issues there are several excellent books available Two such books that are particularly good are the American Academy of Pediatrics Caring for Your Baby and Young Child and What to Expect the First Year For individual questions please feel free to contact o
10. Newborns often have pinpoint white heads surrounded by some reddened areas on their face These come and go and do not require any particular care except routine gentle bathing If the rash seems extensive or is blistery or has pus please call our office for an appointment Your baby may also get an irritation rash from drooling This should be cleansed gently with water only and dried by patting the area Avoid soap lotions creams or Vaseline unless advised to do so CRADLE CAP Cradle cap is a common skin condition in babies It appears as red patches with oily yellow scales or crusts on the scalp Hormones from mom cause the oil glands in the skin to become overactive and release more oil than normal It often begins in the first weeks of life With treatment it will clear up in a few weeks Without treatment it will go away on its own after several months Treatment is to apply an antidandruff shampoo to the scalp once a day While the hair is lathered massage your baby s scalp with a soft brush or rough washcloth Baby oil can be used to soften the scales prior to treatment however it will not clear the scales on its own HICCUPS Hiccups are common for new babies They often occur during or after eating There is no cause for concern or intervention such as sugar water they will stop on their own CRYING Crying is your baby s way of communicating As you get to know your infant you will learn what he she is trying to convey
11. Proquad is a combination vaccine that may be substituted for MMR and Varicella at 15 months and 5 years of age Note that the availability of combination vaccines varies and sometimes are not available Because of this and occasional updates to the routine vaccination recommendations the immunizations your child receives at East Lake Pediatrics may differ from the schedule listed in this guide cost Lake Pediatrics Date Weight Length Head Circumference
12. amage or death About 12 000 people are hospitalized for chickenpox each year About 100 people die each year as a result of chickenpox The chickenpox vaccine is routinely given to toddlers between the ages of 12 and 18 months however it can be given to older children if they have not had the vaccine or the disease Children age 13 or older receive 2 doses given 4 weeks apart The vaccine is 70 to 90 effective in preventing chickenpox after the first dose and up to 99 effective after the second dose If vaccinated children get chickenpox they have a much milder form of the disease By being vaccinated you can reduce the chance of missed work and school skin infections medical costs and getting Shingles later in life Influenza The American Academy of Pediatrics recommends that all children age 6 to 59 months of age receive a flu shot It is especially important for all children of any age greater than 6 months with chronic illnesses such as asthma to get a flu shot This population of children are at a greater risk of getting severely ill or needing to be admitted to the hospital as a result of the flu Please plan to have your child immunized at the beginning of the flu season in late September early October Gardasil Gardisil helps protect against 4 types of human papillomavirus HPV 2 types that cause 70 of cervical cancer cases and 2 more types that cause 90 of genital warts cases It is for girls and young women ages 9 t
13. an 5000 adults die each year in the U S from hepatitis related liver cancer or cirrhosis The younger the age when the infection occurs the greater the risk of serious problems Diphtheria Tetanus Pertussis DTaP Diphtheria Diptheria causes a thick covering in the back of the throat which can lead to breathing problems paralysis heart failure and even death Tetanus Tetanus also known as lockjaw causes a painful tightening of the muscles usually all over the body It can lead to locking of the jaw causing the inability of opening the mouth or swallowing It leads to death in 1 out of 10 cases Pertussis Pertussis also known as whooping cough is a very dangerous disease especially for infants The risk of suffering and death caused by whooping cough is far greater than the possible side effects of the vaccine A child who has not been immunized against pertussis has a chance of 1 in 3000 of getting whooping cough In contrast a child who got the vaccine has a chance of 1 in 2 million of having neurological damage with the vaccine The risk of children getting pertussis increases if fewer children are immunized Haemophilus Influenzae type B HIB Haemophilus influenzae is a type of bacteria that causes several life threatening diseases in young children such as meningitis epiglottitis and pneumonia Before the vaccine was available over 10 000 children in the U S developed haemophilus meningitis each year Abou
14. ases resolve without serious complications In severe cases however measles can cause pneumonia and in about one out of 1 000 cases it can lead to encephalitis inflammation in the brain or death The risk for these severe complications is highest in the very young and very old In pregnant women measles increases the rates for miscarriage and low birth weight and birth defects in their infants Mumps The mumps virus causes fever headache and swollen glands It can lead to deafness meningitis infection of the brain and spinal cord covering painful swelling of the testicles or ovaries and rarely death Rubella German Measles The rubella virus causes rash mild fever and arthritis If a woman gets rubella while she is pregnant she may have a miscarriage or her baby could be born with serious birth defects Note Much controversy has arisen over unsubstantiated reports of neurologic side effects attributable to MMR This is of great concern since such reports have resulted in a decline in immunizations in certain areas notably affluent areas in England where the vaccination rate has dropped from 92 in 1996 to 84 currently Here measles outbreaks are now climbing and experts fear that unless immunization rates increase rapidly case numbers will significantly increase In these and other regions some parents mistakenly believe that the dangers of immunization outweigh a dangerous childhood illness that only older people remember
15. ate consider hiring a baby sitter or asking a relative to help If you do not take care of yourself you will not be able to take care of your baby POSTPARTUM BLUES More than 50 of women experience postpartum blues on the third or fourth day after delivery Symptoms may include tearfulness tiredness sadness and difficulty in thinking clearly This temporary reaction is linked to the sudden decrease of maternal hormones Since the symptoms commonly begin on the day of discharge from the hospital the impact of being totally responsible for a dependent newborn may be a contributing factor as well Many mothers have the belief that they should be overjoyed about caring for their newborn and therefore feel let down and or guilty about experiencing these symptoms The symptoms usually diminish as hormone levels return to normal usually within 1 to 3 weeks and a routine is developed which provides new parents with a sense of control over life If the symptoms are not better by the time your baby is one month old you should contact your physician There are several ways to cope with postpartum blues See the following suggestions to help you through this difficult time Acknowledge your feelings and discuss them with your husband and or a close friend Do not try to suppress crying or try to be a super mom Get adequate rest Get help with housework childcare Socialize with others do not allow yourself to become isolated t
16. ays wash your hands thoroughly before you pump your breasts A daily shower or bath will keep your breasts clean After each use of a breast pump wash all the parts that come into contact with your milk using hot soapy water Tell your doctor and your baby s doctor if you become ill or need to take any medication Collection of Milk Pour the milk expressed during one pumping session into a clean plastic container Plastic is better than glass because some of the immune factors in breast milk stick to glass You may use a plastic bottle that has been washed in soapy water and rinsed or a disposable bottle bag If you use disposable bottle bags put one inside another to prevent tears or holes Tightly cap bottles Do not store bottles with nipples attached Bottle bags are best closed with a clean rubber band Label each container with your baby s name and the date and time the milk was expressed Put several bottle bags in a larger plastic bag to prevent them from sticking to the freezer shelf For healthy babies who are not in the hospital it is safe to layer milk collected at different times on the same day in the same bottle Chill freshly expressed milk in the refrigerator before adding it to previously frozen milk Storage of Breast Milk In the refrigerator for at least 72 hours after pumping and 24 hours after thawing assuming the temperature of the refrigerator is 34 F to 40 F or 1 C to 4 C Ina f
17. be offered between breast feedings for 6 to 24 hours You may have to stop breast feeding temporarily if your baby is too exhausted to nurse and needs intravenous IV fluids for severe diarrhea and dehydration Pump your breasts to maintain milk flow until you can breast feed again usually within 12 hours Remember that something in the mother s diet may cause a breast fed baby to have more frequent or looser bowel movements for example coffee cola or herbal teas If you suspect this take it out of your diet and see what happens DIAPER RASH Diaper rashes are usually due to irritation of the skin from a damp diaper Diaper wipes should be avoided during this period since they tend to sting the irritated skin instead wash the diaper area with a soft cloth or cotton and warm water Use care to clean the creases around the labia of little girls Pat the area dry with a clean soft cloth 1 hydrocortisone no prescription necessary applied to the area and exposure to the air will work well on mild irritations A protective ointment such as Vaseline can be applied to the skin until healing occurs If the rash is bright red or does not start getting better after 3 days of warm water cleaning and air exposure your child probably has a yeast infection Apply Lotrimin cream no prescription necessary four times a day If the rash does not improve or if it consists of large water blisters please call the office for an appointment FACE RASHES
18. cognize that all of the time effort and love you invest now will soon pay off with big rewards for you and your baby Stress and tension can inhibit milk production therefore it is important to relax and get comfortable Experiment with various feeding positions such as lying in bed or sitting up making sure that the baby and your arm are adequately supported to prevent fatigue Use your free hand to grasp your breast above the areola between your fingers and thumb and guide the nipple into your baby s open mouth Be sure that the baby latches onto the entire areola not just the nipple otherwise he she will not compress the milk glands properly This will leave your baby hungry and you sore It is also important that you make sure that he she is not sucking on his her own tongue and that his her nose is not covered by your breast During the first couple of days you can expect to be producing only small amounts of pre milk called colostrum The colostrum is very high in antibodies Fortunately most newborns do well despite their relatively small intake and will not need supplementation Most breast fed babies want to eat every 1 to 2 4 hours at least 8 10 times per 24 hours Offer both breasts at each feeding alternating the side you start with Since newborns are often very Sleepy try nursing about 5 minutes per side with each feeding the first day 10 minutes per side the second day and 15 minutes or more per side thereafter Once y
19. cratch himself herself or others Trim the nails once a week after a bath when the nails are softened by the bath Use special baby clippers or scissors An infant emory board or a dull adult emory board can be used to gently file your baby s nails as well This technique is often safer since newborns fingernails are often attached to the skin at the tip of their fingers CIRCUMCISION Plastibell circumcisions require no routine care The area should simply be kept clean and dry The plastibell should not be pulled off it usually falls off on its own in 7 10 days Surgical circumcisions require the placement of Vaseline gauze over the head of the penis with every diaper change for 3 5 days to prevent the penis from sticking to the diaper With either type of circumcision it is common for a yellow substance to form on the penis it is part of the healing process and should not be removed The foreskin may adhere to the rim of the head of the penis and it should be gently retracted daily The best time to do this is after a bath when the skin is soft It is also important to observe the nature of your son s urine stream The urine should be forceful and shoot out especially when the baby begins to urinate If you notice that your baby dribbles his urine please notify us LAUNDRY It is best to launder your infant s soiled clothing in a hypoallergenic detergent such as Dreft Ivory or Purex Baby and refrain from using fabric softeners and o
20. discard any remaining formula in the bottle AGE SUGGESTED AMT OF FEEDING FEEDINGS PER DAY Newborn 2 3 ounces 6 8 2 weeks 3months 3 5 ounces 5 6 3 6 months 5 7 ounces 4 5 6 8 months 6 8 ounces 3 5 8 12 months 6 8 ounces 3 4 Generally your infant will be ready to eat about every 3 4 4 hours If during the day your baby goes longer than 4 2 hours awaken him her and feed him her On the other hand if your infant cries in between feedings you may try other soothing techniques such as holding rocking or playing soft music To avoid excessive air or milk intake it is best to avoid feeding your baby at more frequent intervals Doing so can cause your baby to become a grazer eating an ounce or so nearly every hour as well This can create gas cramps stooling problems irritability and a need to re adjust the feedings After the first month or so if your baby demonstrates a willingness to sleep through the night consider yourself fortunate and allow him her to sleep until morning Most babies will be able to sleep through the night by four months of age Try burping your baby every ounce or two as well as at the end of the feeding Do not worry if he she does not burp successfully each time It is common for babies to spit up occasionally as they are burped however if your baby vomits forcibly or the amount seems excessive please call our office Cow s milk is not an acceptable alternative to breast milk or formula and should not be
21. drying out and falling off Getting the cord a little wet doesn t matter The bath should consist mostly of water with little soap Too much soap will dry your newborn s Skin Any basic non perfumed soap is acceptable such as Dove or Johnson s For the first few months a full bath 2 to 3 times a week is often enough Gently clean your baby s face and scalp to remove excessive oil and skin debris Use caution to keep the suds out of your infant s eyes At the end of the bath rinse your baby well soap residue can be irritating Be sure when washing the genital area on females to use warm water only and wipe from front to back to prevent irritation This practice along with avoidance of any bubble baths before puberty may help prevent many urinary tract infections and vaginal irritations Commercial oils lotions and powders are not necessary due to your infant s natural protective oils EYES Mucus often collects on the eyelids and eyelashes A moist cotton ball can be used to remove the mucus To clean your baby s eyes be sure to start at the inner corner of his her eye closest to his her nose and gently wipe outwards toward the outer corner of his her eye A clean cotton ball should be used for each eye If there is pus or the whites of your baby s eyes and or the tissues around the eyes are red or swollen please call the office to schedule an appointment NOSE Sneezing is normal in the newborn it is the baby s way of clearing the mucus which
22. e Block The New Way to Calm Crying and Help Your Baby Sleep Longer By Harvey Karp M D Bantam Books New York 2002 Caring for Your Baby and Young Child Birth to Age 5 American Academy of Pediatrics By Steven Shelov M D Bantam Books New York 1991 What to Expect the First Year By Arlene Eisenberg Heidi E Murkoff and Sandee E Hathaway B S N Workman Publishing New York 1996 The Complete Book of Breastfeeding By Marvin S Eiger M D and Sally Wendkos Olds Workman Publishing New York 1989 Vaccines What You Should Know By Paul Offit M D and Louis Bell M D Wiley Publishing 2003 INTERNET ADDRESSES eastlakepediatrics com cispimmunize org aap org cdc gov thehappiestbaby com drgreene com ACKNOWLEDGMENTS MDConsult com Elsevier Inc St Louis MO HBV DTaP HiB IPV Pentacel Prevnar Rotateq MMR Proquad HAV HPV Dose 1 Dose 1 Dose 1 Dose 1 Dose 1 Dose 1 Dose 1 Dose 1 Dose 1 Dose 1 Dose 1 IMMUNIZATION RECORD Dose 2 Dose 2 Dose 2 Dose 2 Dose 2 Dose 2 Dose 2 Dose 2 Dose 2 Dose 2 Dose 2 Dose 3 Dose 3 Dose 3 Dose 3 Dose 3 Dose 3 Dose 3 Varicella TDaP Menactra Dose 3 Dose 4 Dose 5 Dose 4 Dose 4 Dose 4 Dose 4 Dose 1 Dose 2 Dose 1 Dose 1 Pentacel is a combination vaccine that may be substituted for DTaP IPV and HIB at 2 4 6 and 18 months of age t
23. e helping out in the family restaurant but was also a competitive volleyball player Dr Vicki received her undergraduate degree in Biology from Eckerd College in St Petersburg and received her medical degree is from Nova Southeastern University College of Osteopathic Medicine in Ft Lauderdale She completed her pediatric training at the University Of South Florida at Tampa General Hospital and All Children s Hospital in St Petersburg FL During her residency Dr Vicki served as Co Chief Resident and was named Pediatric Resident of the 1st quarter in 2006 Pediatric Resident of the Year in 2007 and Pediatric Cardiology Resident of the Year in 2008 Jennifer Hammond A R N P P N P Jennifer Hammond A R N P is a provider at the Trinity office After growing up in Dade City and she graduated from University of South Florida College of Nursing School and then went on to earn her Advanced Registered Nurse Practioner degree from there as well Prior to joining us here at East Lake Pediatrics Jennifer spent seven years working as a Nurse Practioner for Pediatric Gastroenterology Hepatology and Nutrition of Florida at All Children s Hospital There she specialized in treating infants and children with feeding problems failure to thrive reflux colic constipation and abdominal pain along with other serious liver and nutrition issues In addition to her expertise in dealing with pediatric GI disorders she is also well versed in general ped
24. e the rich high fat hind milk When your baby starts to suck less vigorously on the first side or begins to doze off you can burp him her change his her diaper and arouse him her to take the second breast Since the first breast gets drained better begin each feeding on a different side This way both breasts will get about the same stimulation and emptying Your newborn nurses at least 8 times every 24 hours Nurse your baby as often as he she shows hunger cues such as waking from sleep becoming alert bringing a hand to his her mouth turning his her head or moving his her mouth or tongue Remember that crying is a late sign of hunger and a baby may not nurse well after crying too long You can expect your baby to eat about every 1 2 to 3 hours with a single longer stretch up to 5 hours between feedings at night At times you may need to awaken your baby to nurse Some babies just don t demand to be fed as often as they should especially in the first few weeks of life Your baby appears satisfied after nursing and may fall asleep at the second breast Breast fed infants who appear hungry after most feedings who cry chew their hands or often need a pacifier after nursing may not be getting enough milk Your breasts feel full before each feeding and softer after your baby has nursed After the longest time between feedings at night your breasts should feel particularly full Your baby s bowel movements look like cottage cheese and mus
25. er children by age 2 years If he or she is not in day care consider starting or joining a playgroup Young children can learn important lessons from each other especially how to get along with other people Avoid formal teaching until age 4 or 5 Some groups have recently overemphasized academic cognitive development of young children The effort to create superkids through special lessons drills computer programs and classes can put undue pressure on young children and may result in an early loss of interest in learning Old fashioned creative play and spontaneous learning provide a foundation for later academic efforts and are much more beneficial during the early years IMPORTANT TELEPHONE NUMBERS East Lake Pediatrics Trinity 727 372 6760 East Lake Pediatrics Palm Harbor 727 772 1452 All Children s Hospital St Petersburg 727 892 4104 Bayfront Medical Center St Petersburg 727 893 6390 Healthy Start Pinellas 727 824 6900 Mease Hospital Maternity Center Dunedin 727 734 6962 Mease Hospital Countryside 727 725 6100 Morton Plant Women s Center Clearwater 727 298 6350 Palm Harbor Pediatric Urgent Care Center Palm Harbor 727 787 5439 Pinellas County Health Department Clearwater 727 469 5800 Poison Control 1 800 222 1222 St Joseph s Hospital Tampa 813 870 4000 The Depression After Delivery hotline 1 800 944 4773 The Family Health Line 1 800 451 2229 SUGGESTED READINGS The Happiest Baby on th
26. exes not signs of illness The following is a list of common reflexes that are due to an immature nervous system and will disappear in 3 or 4 months Chin trembling Lower lip quivering Hiccups Irregular breathing This is normal if your baby is content the rate is less than 60 breaths per minute any pauses are less than 10 seconds long and your baby doesn t turn blue Occasionally infants take rapid progressively deeper breaths to completely expand their lungs Sleep noise from breathing and moving Sneezing Spitting up or belching Brief stiffening of the body after a noise or sudden movement called the startle or Moro reflex Straining with bowel movements Throat clearing or gurgling sounds of secretions in the throat Trembling or jitteriness of arms and legs are common during crying Jittery babies are common Convulsions are rare During convulsions babies also jerk blink their eyes rhythmically suck with their mouths and don t cry If your baby is trembling and not crying give her something to suck on If the trembling doesn t stop when your baby is sucking call our office immediately FEEDING Providing your baby the best possible nutrition in infancy and early childhood is not only important for maintaining good health it is necessary for proper growth and development While breastfeeding is our first choice the basic approach to feeding your infant is the same whether you have selected to
27. ge for gestational age and premature infants All infants are screened for inherited metabolic problems through a test called the PKU or newborn metabolic screen The test is performed by obtaining a blood sample via a simple heel stick after the baby has had a full 24 hours of feedings It detects several metabolic diseases including phenylketonuria congenital hypothyroidism galactosemia sickle cell disease and congenital adrenal hyperplasia RESPIRATORY PROBLEMS Occasionally newborns can develop breathing difficulties of varying degrees This is common in premature infants very large infants and infants born by C section If the problem becomes severe your baby will be managed in the Neonatal Care Unit WEIGHT LOSS All babies lose a few ounces during the first few days after birth However a baby should never lose more than 7 of their birth weight Most bottle fed babies are back to their birth weight by 10 days of age breast fed babies by 14 days of age BREAST ENLARGEMENT AND MENSES Male as well as female babies may occasionally have enlargement and or a thin discharge from one or both breasts The area should not be massaged Cool compresses may be applied If redness is noted please call the office for an appointment Some female infants experience a white or thin bloody vaginal discharge The vaginal area should be cleansed well with warm water only Care should be taken to cleanse the area from top to bottom Both cond
28. given during the first year The following are examples of what can occur if cow s milk is used in place of breast milk or formula Allergic reactions Low iron content which can cause iron deficiency and anemia Injury to the intestinal lining due to milk protein effects Butterfat of cow s milk is poorly absorbed depriving your infant of a necessary energy source The mineral content greatly exceeds the infant s requirements and physiologic limits which combined with the protein excess cause an excessive solute load to the kidney We suggest that you plan to wean your baby from the bottle by 12 15 months of age You can start introducing a sippy cup at 6 months It is important to never prop a bottle or let your baby have a bottle overnight in the crib Prolonged bottle use and or propping can lead to poor teeth dental cavities increased ear infections and greater difficulty in weaning To avoid burns bottles should never be warmed in the microwave INTRODUCTION OF SOLIDS Adequate nutrition for growth is provided by breast milk or formula in the initial months Your infant will need breast milk or formula until about one year of age Solid foods can be introduced any time after 4 months of age Prior to that your baby s gastrointestinal system is not adapted to handle solid foods In addition if solid foods are given earlier there is a risk of potential allergic reactions The first solid food usually introduced is infant cereal
29. iatric care as well and loves working with children She is the proud mother of three and loves spending time outdoors with her family Insurance Plans We accept most major insurance plans The following is a list of insurance plans we are currently billing If you do not see your plan please contact our office Aetna Americhoice Amerigroup AvMed Baycare Blue Cross Blue Shield Cigna Citrus Healthcare Evolutions First Health Great West Healthease Humana Medicaid Medipass PHCS Staywell TriCare Standard amp Prime United Health Care FIRST WEEKS AT HOME WITH A NEWBORN PREVENTING FATIGUE AND EXHAUSTION For most mothers the first weeks at home with a new baby are often the hardest in their lives You will probably feel overworked even overwhelmed Inadequate sleep will leave you fatigued Caring for a baby can be a lonely and stressful responsibility You may wonder if you will ever catch up on your rest or work The solution to this is to ask for help No one should be expected to care for a young baby alone Every baby awakens one or more times per night The key to avoiding sleep deprivation is to know the total amount of Sleep that you need per day and obtain it in bits and pieces Try going to bed earlier in the evening When your baby naps it is vital that you nap also While you are napping turn off the telephone and place a sign on the door stating MOTHER AND BABY SLEEPING If your total sleep remains inadequ
30. initiation of the vaccine almost all children become infected at some time within the first 3 years of life however not all infections cause severe diarrhea Hepatitis A HAV The hepatitis A virus infects at least 180 000 Americans every year and causes symptoms in about 134 000 of them Almost 30 are children under age 15 Hepatitis A formerly called infectious hepatitis is always acute and never becomes chronic The virus is excreted in feces and transmitted by contaminated food and water Eating Shellfish taken from sewage contaminated water is a common means of contracting hepatitis A It can also be acquired by close contact with individuals infected with the virus It is estimated that 11 to 16 of reported cases occur among children or employees in daycare centers or among their contacts The hepatitis A virus does not directly kill liver cells and experts do not yet know how the virus actually injures the liver Proquad Measles Mumps Rubella Varicella Vaccination against Measles Mumps Rubella and Varicella may be given in one injection as Proquad or separately as the MMR and Varicella depending on the availability of Proquad Measles Mumps Rubella MMR Measles The measles virus causes rash cough runny nose eye irritation and fever It can lead to ear infection pneumonia seizures brain damage and death Tt is the most contagious of all human infections and used to be a very common childhood disease Most c
31. ips are convenient but are not very reliable Axillary temperatures are good for screening as long as the room temperature is neutral and your child is not over bundled or underdressed The thermometer should be placed in a dry armpit for 4 minutes for a mercury thermometer or until the beeping tone is sounded with a digital thermometer TEETHING Teething usually begins anytime after 3 months Signs of teething such as drooling finger or thumb sucking and chewing on hands may occur months prior to this Teething can cause your baby some discomfort which can cause the baby to be somewhat irritable However it does not cause fevers diarrhea vomiting constipation or runny nose In other words it will not make your baby sick Comfort measures such as teething rings and teething toys may be helpful and occasionally a dose of acetaminophen Tylenol may need to be given Ibuprofen Advil or Motrin can be given to infants over 6 months of age Topical medications are usually not effective Teething biscuits and cookies Should be avoided since they can be a choking hazard SAFETY Your baby needs full time supervision and protection Accidents tend to occur more often as babies begin to roll over crawl and grasp The only place a baby is safe alone is in his her crib or playpen Be certain that the spaces between the crib bars are 2 4 inches or less and the crib sides are secure and placed in the upright position Below is a summary of the
32. is often present in their nasal passages If you notice that your infant remains congested you can instill several drops of saltwater nose drops 1 4 tsp of salt in a measuring cup of water into one nostril Wait 15 30 seconds then aspirate with a bulb syringe Repeat this process in the other nostril Since babies depend on nose breathing while they suck the best time for this is prior to feedings EARS Itis important to only clean the outside of your infant s ear NEVER insert a Q tip into the ear canal More often this just pushes the wax further down the ear canal while posing a risk of damaging the eardrum UMBILICAL CORD The umbilical area may be cleansed with alcohol 3 4 times daily to keep it clean and dry Care should be taken to ensure that the area at the base and in the crease where the cord is attached is cleansed well Diapers should be kept folded down below the cord area since air exposure helps the cord stay dry and eventually fall off The cord usually falls off between 7 21 days after birth It is normal to see a few drops of blood from the area when the cord detaches Please call the office for an appointment if the skin surrounding the navel is red swollen and tender or if red streaks are present on your baby s abdomen around the cord FINGERNAILS AND TOENAILS Cut the toenails straight across to prevent ingrown toenails When cutting your baby s fingernails round off the corners of the nails so your baby doesn t s
33. itions are due to hormonal influences from mom and will clear on their own NORMAL BEHAVIOR DEVELOPMENT Below is a summary of what you might see your baby doing between the ages of O and 2 weeks old Each infant is unique however so it is difficult to describe exactly what should be expected Reflexes Reflexive actions crying grasping yawning swallowing sucking blinking coughing gagging sneezing Grasps whatever is placed in hand Sucks whatever is placed in his her mouth Is startled by sudden noises and movements Movement Jerky mostly uncontrolled motions Waves arms kicks legs wiggles and squirms Cannot turn body or support head without assistance Cannot sit without support May turn head from side to side while lying on back Sleep Wakefulness Usually sleeps from 17 to 20 hours per day Cries and fusses about 1 to 4 hours per day Is alert and quiet about 2 to 3 hours per day Vision Cannot focus clearly Sees best at 8 to 10 inches Interactive Behaviors and Senses Smiles spontaneously and unselectively Discriminates between some smells Begins to turn in direction of sound Begins to distinguish the human voice from other sounds Is more sensitive to high pitched voices especially mother s voice Is best calmed by a soft rhythmic voice Cries a lot Makes tiny gurgling sounds when content Shows preference for the human face Some normal newborn behaviors that concern parents are actually harmless refl
34. mom and her baby Food filters into breast milk within 4 6 hours after eating If you find that a certain food bothers you or your baby eliminate it from your diet Foods that commonly cause problems while breastfeeding include tomatoes onions cabbage broccoli beans chocolate and spicy foods Prenatal vitamins and iron supplements Should be continued Alcohol consumption and tobacco smoking should be avoided Plenty of fluids should be consumed with an average of twelve 8 16 ounce glasses per day water is the healthiest choice It is not necessary to drink milk to produce milk however calcium intake is important Frequent nutrient rich meals and snacks are recommended since your body needs extra calories to produce breast milk For thousands of years women around the world have been breast feeding and making it look easy Therefore many women who chose to breastfeed envision breastfeeding as natural and instinctive However many women are surprised and disappointed to discover that the early days of breast feeding can be awkward exhausting anxiety producing and in some cases simply frustrating Breastfeeding is a learned skill that can only be mastered by practice and experience Nearly all new parents are worried that their baby is not getting enough milk The fact is that normal milk supply can be very scant for the first 2 3 days The key is to be aware of this and not allow yourself to become discouraged Instead try to be confident and re
35. n varies SPEECH DEVELOPMENT Speech develops from cooing to babbling to imitating speech sounds to first words to using words together Again however the normal rate can vary considerably Since each child is unique it is difficult to describe exactly what should be expected at each stage of his her development For example although the average child walks at 12 months the normal age for walking is any time between 9 and 16 months of age The following guidelines are offered as a way of showing a general progression through the developmental stages They should be used as a guideline only not as a fixed requirement for normal development Your child s individual development will be addressed at each well child visit If at any point you have any concerns related to your child s own pattern of development please contact our office Babies O 3 months Babies 3 6 months Smiles Rolls over Lifts head while on stomach Turns to find your voice Looks at an adult s face Looks at and follows bright colors Makes cooing sounds Babies 6 9 months Begins to crawl Smiles at mirror image Babbles Begins to sit without assistance Starts learning games like peek a boo Explores objects closely with eyes and hands Plays with hands and feet Brings most objects to his her mouth Reaches out toward objects with both hands Recognizes the difference between happy and sad voices Babies 9 12 months Pulls to standing Takes a few ste
36. nts when considering the health and well being of their child For this reason our office is designed for individualized pediatric care and services Our staff is committed to the health care of all of our patients We enjoy working with children and are well trained in well care visits as well as childhood illnesses We provide patient care services to children of all ages with convenient office hours for families with busy schedules We are available to you and your family at all times for emergencies When the office is closed an answering service will relay all necessary telephone calls to one of our providers We welcome you to East Lake Pediatrics and look forward to watching your family grow Mike Jordan M D Dr Jordan grew up in Palm Harbor and received his undergraduate degree from the University of Florida and his medical degree from the George Washington University School of Medicine in Washington DC He completed his pediatric training at the University of Florida Health Science Center in Jacksonville and Wolfson s Children s Hospital Upon the completion of his residency Dr Jordan worked as a Pediatric Hospitalist at Mease Countryside Morton Plant and Tampa Children s Hospital It was during this time he recognized the need for individualized and personal attention for his young patients In August of 2004 he founded East Lake Pediatrics with a vision of creating a pediatric practice with an atmosphere that is conducive n
37. o 26 Anyone who is allergic to the ingredients of Gardasil should not receive the vaccine It is not for women who are pregnant and does not treat cervical cancer or genital warts Gardasil may not fully protect everyone and does not prevent all types of cervical cancer so it s important to continue routine cervical cancer screenings Gardasil will not protect against diseases caused by other HPV types or against diseases not caused by HPV The side effects include pain swelling itching and redness at the injection site fever nausea dizziness vomiting and fainting Gardasil is given as 3 injections over 6 months DEVELOPMENTAL MILESTONES The most rapid changes in development occur during the first year of life A baby grows from a helpless little bundle into a walking talking unique personality Almost all parents wonder if their baby is developing at the right pace While certain behaviors and physical milestones tend to occur at certain ages a wide spectrum of growth and behavior for each age is normal The most reassuring signs that a child is developing normally are an alert facial expression alert eyes and curiosity about his her surroundings MOTOR DEVELOPMENT Motor development occurs in an orderly sequence starting with lifting the head then rolling over sitting up crawling standing and walking Although the sequence is predictable and follows the maturation of the spinal cord downward the rate at which these stages happe
38. ooler FORMULA FEEDING Not every mother has the desire to breastfeed each family must choose which feeding option best suits them It is important for parents to know that a bottle can be fed to a baby with just as much warmth love and affection Formula feeding does have its advantages One big advantage is that dad can participate too Another is that formula fed infants tend to eat less frequently and therefore may be easier to conform to a schedule and or may sleep through the night sooner Milk based formula is designed to imitate as closely as possible the contents of breast milk and to provide for all the nutritional needs of an infant in the first year of life It is a sufficient form of feeding during the first 6 months of life it is usually served in conjunction with solids during the following 6 months Enfamil Lipil is available at food stores pharmacies and discount stores It is available in the following forms Ready to feed This form is the most convenient however more costly It is available in 4 or 8 ounce bottles and in 8 or 32 ounce cans Water is not to be added Concentrate This form is mixed with equal parts of water Powder This form is even more economical than concentrate It is mixed with one scoop provided in the can to 2 ounces of water It is important to prepare formula according to the directions to ensure proper nutrition We at East Lake Pediatrics support the recommendation of the
39. ot only to providing excellent care to children of all ages but also establishes a warm friendly environment where families feel at ease when visiting their doctor and interacting with the office personnel Dr Jordan enjoys spending time with his family fishing scuba diving and cheering for the Gators He is certified by the American Board of Pediatrics Amy Harbage D O M P H Dr Harbage is originally from Clarksville TN and received her undergraduate degree and a Master of Public Health degree from the University of Tennessee in Knoxville Her medical degree is from the University Of Health Sciences College Of Osteopathic Medicine in Kansas City MO She completed her pediatric training at the University Of South Florida at Tampa General Hospital and All Children s Hospital in St Petersburg FL Since completing residency in June of 2005 Dr Harbage worked in primary pediatrics and in the Morton Plant emergency department serving acutely ill children She joined East Lake Pediatrics in January of 2006 and since then has become a vital member of our team She enjoys traveling the outdoors spending time with her family and friends and most importantly is a proud Tennessee Volunteer Dr Harbage is certified by the American Board of Pediatrics Vicki Skidmore D O Vicki Skidmore D O is originally from Massachusetts and moved to Clearwater when She was 9 years old Growing up in Clearwater she spent most of her free tim
40. our milk is in you may want to nurse 10 minutes on the first side then as long as he she wants on the second side The more your baby suckles at the breast the more milk your breasts are stimulated to produce Therefore try to minimize other forms of sucking such as bottles and pacifiers while breastfeeding is getting established In certain circumstances you may feel it is necessary or we may recommend giving oral supplements Examples of such circumstances include babies who are getting dehydrated babies with significant jaundice or where there is a longer than expected delay in establishing good milk supply Many parents are concerned that their breast fed infant is not receiving enough since they are unable to see exactly how much milk their baby is taking while nursing The following patterns are typical of a well nourished breast fed baby during the first month of life You start producing milk abundantly 2 to 4 days after your baby is born If your baby seems hungry after most nursings or you do not think your milk has come in by 5 days after delivery please call our office Your baby latches on correctly and sucks rhythmically for at least 10 15 minutes per feeding Your baby may pause sometimes while breast feeding However he she should nurse vigorously during most of the feeding You should hear your baby swallow regularly while breast feeding Allow your baby to remain at the first breast until it is well drained so he will receiv
41. plemental multivitamin or a minimum of 16 oz of formula per day to avoid vitamin D deficiency Commercial infant formula is fortified with all the vitamins and iron your baby needs in the first year therefore bottle fed babies do not require additional supplements If fluoride is not added to the natural water supply where you live fluoride supplementation daily prescription drops will need to begin at 6 months Your individual water company should be contacted to be certain that fluoride has not been added prior to beginning any supplements Alternatively formula fed infants may be fed formula that has been mixed with Nursery Water STERILIZATION We do not feel sterilization is a mandatory procedure when you live where your drinking water is from a properly treated source If you have well water you need to boil your water for 10 minutes plus 1 minute for each 1000 feet of elevation above sea level or use distilled water until your child is 6 months old All utensils used in preparing the formula must be kept scrupulously clean Measuring pitchers and other utensils should be cleaned well preferably scalded Scrub bottles nipples and caps with hot soapy water and a clean brush Rinse thoroughly with hot water making sure to always rinse water through the holes of the nipples to be sure that they are not plugged Protect bottles by placing them upside down ona rack or clean towel Nipples and caps should be stored in a clean covered ja
42. ps while holding on Copies your sounds Uses 1 to 3 words Understands more than they say Drops and throws objects Holds a bottle Toddlers 12 18 months Toddlers 18 36 months Likes to imitate Affectionate offers hugs and kisses Has rapid mood shifts Plays well with others or alone Has difficulty in sharing Enjoys talking about pictures Physical growth slows down Likes repetition Self help skills begin to develop Likes to help feed and dress him her self Enjoys looking at picture books Possessive over playthings Enjoys object hiding activities Still developing bowel and bladder control Helps pick up and put away toys Appetite decreases Speech is 25 percent intelligible Not very flexible Responds to simple questions with yes or no Says no a great deal If your child does not meet the following developmental milestones please contact our office Speech and hearing Makes gurgling cooing or babbling sounds by age 3 months Turns head to quiet sounds or whispers by age 9 months Makes ma ma and da da sounds by age 12 months Uses at least 10 specific words by age 2 years Fine motor skills Plays with hands by touching them together by age 6 months Uses fingers to put pieces of food in mouth by age 12 months Uses a cup without spilling by age 18 months Gross motor skills Rolls over by age 6 months Sits without support by age 9 months Supports own weight on legs when held under the arm
43. r GROWTH CONSIDERATION If your baby is gaining weight and growing appropriately then your particular approach to feeding is working It is important to remember that your baby s size is directly linked to heredity as well as nutritional intake There isa wide range of normal weight gain so do not worry if your infant seems significantly larger or smaller than another baby the same age At each well baby check we will review your baby s individual growth and development If your baby feeds poorly or doesn t appear to be growing well especially in the first 1 4 weeks please call our office for an evaluation Most obesity in infancy is due to overfeeding Nursing mothers naturally terminate a feeding when suckling stops and thus obese breastfed infants are few When giving formula remember that your baby does not always have to finish the bottle If your baby demands more volume or suckling it is preferable to offer a pacifier or if your baby is greater than 6 months of age give a little water An overweight baby is not necessarily the healthiest one If you feed your baby too much or too often you may notice an increase in the number of spit ups stools or cramps and gas Usually this can be corrected by simple changes in feeding routines CARE TIPS BATHING Until the umbilical cord falls off and the umbilical area is healed your infant should be given a sponge bath Submerging the cord could cause infection or interfere with its
44. r baby The sensations of milk let down are tingling pins and needles or a tightening feeling in your breasts as milk begins to flow When your milk let down occurs your baby may start to gulp milk Milk may drip or spray from the other breast You may find that just hearing your baby cry causes your milk to let down even before your baby starts nursing If you don t notice any signs of milk let down your milk supply may be low Once your milk comes in your breast fed baby should gain weight rapidly at least 1 ounce each day for the first couple months of life The only way to be absolutely certain that your baby is getting enough milk is to have your baby weighed regularly If your baby is not gaining enough weight your milk supply may be low or your baby may not be nursing effectively Such breast feeding difficulties are easier to overcome if you recognize and treat them early PUMPING STORING AND HANDLING BREAST MILK There may be times when you need to be away from your baby and unable to nurse You may need to return to work the baby s father or another person may want to feed the baby or your baby may not be able to breast feed for a while because of a medical problem Regardless of the circumstance it is best for your baby to be fed milk that has been pumped from your breasts when he she cannot be breast fed Thus you will want to know how to handle and store your breast milk safely for later use Preparation and Hygiene Alw
45. r fabric softener sheets If using cloth diapers be sure to launder them separately STOOLS There is a wide range of normal stooling patterns and colors Some infants stool with each feeding while others may go several days between a bowel movement As long as your infant s stool is soft in texture either pattern is acceptable Stool colors that should prompt a parent to call our office are red black and white Almost all babies will strain and appear uncomfortable when they stool As long as the texture remains soft no intervention is necessary After 2 months of age if the stool is hard and especially if there is evidence of blood streaking from straining we recommend giving an ounce of diluted apple pear white grape or prune juice 4 ounce juice ounce water 2 4 times per day Increasing mom s fiber intake can help infants who are strictly breastfed If the above interventions are unsuccessful please contact our office DIARRHEA Diarrhea in an infant can be defined as stools that are more fluid and more frequent than usual One or two loose stools rarely require specific therapy Diarrhea usually lasts several days to a week regardless of the type of treatment The main goal of treatment is to prevent dehydration Symptoms of dehydration include a dry mouth the absence of tears infrequent urination for example none in 8 hours and a darker concentrated urine Your child needs to drink enough fluids to replace the fluids los
46. r less than 98 rectally in the first 8 weeks of life Redness around the umbilical cord or discharge or odor from the umbilical cord Labored distressed or rapid breathing Bleeding from the circumcision FACTS ABOUT FEVER A fever indicates that your baby has an illness The degree of fever however does not always indicate the seriousness of the illness Most fevers are not harmful and last 2 to 3 days It is most important to evaluate how your child is acting with the fever If he she is still playing smiling and eating drinking well most likely he she is not seriously ill A fever is a rectal temperature over 100 4 F 38 C Fever is the body s way of fighting infections Medication should only be used if your child needs it Generally medication should be avoided until the temperature reaches 101 degrees or higher unless your child is uncomfortable Medication should never be given to an infant under 3 months of age for a fever without consulting our office first Otherwise acetaminophen Tylenol can be given every 4 to 6 hours Aspirin should not be used A lukewarm bath can be used as well to help lower your child s temperature It is important to make sure that the water is lukewarm not hot or cold and that you do not submerge your child completely in the water The water level should be at waist level A washcloth can be used to place water on the chest back and head Alcohol rubs should not be used It is also helpful
47. reezer inside a refrigerator for up to 3 weeks after pumping assuming the temperature of the freezer is 20 F to 28 F or 7 C to 2 C Ina separate door freezer for up to 3 months after pumping assuming the temperature of the freezer is 5 F to 15 F or 15 C to 9 C Ina deep freezer for up to 6 months after pumping assuming the temperature of the freezer is O degrees F or below or 18 degrees C or below Thawing of Milk Slowly in the refrigerator Volumes of 3 or more ounces 100 or more milliliters of milk may take several hours to thaw Relatively quickly under running warm water or by placing it in a bowl of warm water Be sure the top of the container remains above the water at all times Do not thaw milk at room temperature Warming Milk Under warm running water Ina pan of warm water not over direct heat In a purchased bottle warmer Do not warm milk in the microwave Additional Recommendations DO NOT overheat milk Overheating will cause it to curdle and will destroy some immune components DO NOT leave milk at room temperature for more than 1 hour Milk may be reheated and used for the next feeding if it has not been left at room temperature for more than 1 hour Throw out any milk left after a second feeding DO NOT refreeze thawed milk DO NOT store milk in the door of your freezer where the temperature may change frequently Always transport milk on ice in an insulated c
48. ry to go out at least once a week go to the hairdresser visit a friend go shopping or see a movie THE FATHER S ROLE It is important for fathers to take time off of work to be with mom during labor and delivery as well as when mom and baby first come home from the hospital Many fathers often feel left out since most of the attention is usually focused on mom and baby In addition many fathers are concerned that they may hurt their baby and or be unable to comfort him her if he she cries However it is important for fathers to get involved Not only will this help mom it will help to develop a close relationship with the baby as well Below are some suggestions of activities that a father can use to develop a closer stronger relationship with his baby Bathe the baby Change the baby s diaper Assist mom with positioning the baby when breastfeeding Feed the baby pumped breast milk or formula once breastfeeding has been established Burp the baby Walk the baby Rock the baby Comfort the baby when fussy Take the baby for a ride in a stroller Play with and talk to the baby Read to the baby VISITORS OUTINGS After the much anticipated arrival of your newborn many well meaning friends family and neighbors will want to Share in your excitement and come by for a visit As proud new parents the desire to show off your newborn is normal and expected However it is best to minimize your newborn s contact with
49. s by a parent by age 9 months Walks across a large room without help by age 18 months WAYS TO STIMULATE YOUR CHILD S NORMAL DEVELOPMENT Hold your baby as much as possible Touching and cuddling is good for your baby Give him or her lots of eye contact smiles and affection Use feedings as a special opportunity for these warm personal interactions Talk to your baby Babies of all ages enjoy being talked and sung to Babies must first hear language before they can use it themselves You don t need a script just put into words whatever you are thinking and feeling Play with your baby If this doesn t come easy for you try to loosen up and rediscover your free spirit Respond to your baby s attempts to initiate play Provide your baby with various objects of interest Toys need not be expensive for example homemade mobiles rattles spools pots and pans and boxes Encourage your baby s efforts at discovering how to use his or her hands and mind Read to your baby Even 4 month olds enjoy looking at pictures in a book Cut out interesting pictures from magazines and put them in a scrapbook for your baby Look at the family photo album By 8 months of age begin reading stories to your child Show your baby the world Enrich his or her experience Point out leaves clouds stars and rainbows Help your toddler describe what she sees or experiences Everything we see or do has a name Provide your child with social experiences with oth
50. surrounding the pool It is important to remember that even children who go to swimming classes should never be considered water safe ALL children must be very closely supervised at all times when in or around any water Pacifiers If you choose to give your baby a pacifier it is important to use it safely Be certain that you purchase the type that is a single molded unit the ones that are jointed have been known to come apart and choke children The pacifier should NEVER be hung around the baby s neck with cord or string IMMUNIZATIONS Routine scheduled immunizations are a necessary part of your child s preventative health program State law mandates that immunizations be completed and current prior to entering school We follow the current recommendations by the Committee on Infectious Diseases of the American Academy of Pediatrics Below is the Schedule we follow Prior to administering any vaccinations the physician will perform a comprehensive physical exam on your child review each vaccine and address any questions concern you may have An informational sheet on each vaccine will be provided as well Newborn Visit HBV 1 Hepatitis B Vaccine 1 Month Visit HBV 2 Hepatitis B Vaccine 2 Month Visit DTaP 1 Diptheria Tetanus Pertussis Hib 1 Haemophilus B IPV 1 Injectible Polio Prevnar 1 Pneumococcal Rotateq 1 Rotavirus oral 4 Month Visit DTaP 2 Diptheria Tetanus Pertussis Hib 2 Haemophilus B
51. t 500 of them died and 3800 became mentally retarded blind deaf or got cerebral palsy as a result of the disease Because of the vaccine haemophilus influenzae type B is now uncommon in the U S The Hib vaccine does not protect against flu and meningitis caused by viruses Polio Vaccine IPV Polio is a disease caused by a virus It enters a child s body through the mouth Sometimes it does not cause serious illness however sometimes it causes paralysis In some cases it can result in death due to paralysis of the muscles that help breathing The polio vaccine protects children from this now rare but crippling disease Prevnar Pneumococcal PCV 7 Pneumococcal infections are serious bacterial infections that may cause pneumonia bloodstream infections and meningitis The PCV7 vaccine protects against the 7 types of pneumococcal bacteria that cause most of these serious diseases The vaccine also prevents a small percentage of ear infections caused by pneumococci Before the vaccine was available each year pneumococcal infection caused over 700 cases of meningitis 13 000 blood infections and about 5 million ear infections Rotateq Rotavirus Rotavirus is the most common cause of severe infection in the intestines usually causing diarrhea Although most cases occur between 6 months and 2 years of age a rotavirus infection may affect people of any age It is very difficult for a child to avoid being exposed to rotavirus Prior to the
52. t in the diarrhea Do not expect a quick return to solid bowel movements If your infant child appears sick experiences pain runs a fever or passes blood with his her diarrhea please notify us Bottle fed infants If your infant has several loose stools we recommend taking him her off milk for 24 hours and replacing with clear liquids Pedialyte is recommended especially for young infants because it has the right balance of salt minerals and sugar to keep your baby s blood chemistry normal Flattened Sprite diluted Gatorade and Jello water are OK for toddlers and older children Fruit juices should be avoided Do not use plain water and avoid using red jello since it can be mistaken for blood when it appears in stool After 24 hours on clear fluids formula can be resumed You should start by giving it half strength 2 formula water or pedialyte then three quarters strength 2 formula water or pedialyte and finally returning to full strength formula For older babies previously on solid foods once the diarrhea stools return toward normal you may try introducing rice cereal bananas and applesauce Once he she is doing well milk and a regular diet can be resumed Breast fed infants If your breast fed baby has diarrhea treatment is straightforward Continue breast feeding but at more frequent intervals Don t stop breast feeding your baby because he she has diarrhea For severe watery and frequent diarrhea Pedialyte can
53. tard by the 4th or 5th day of life Bowel movements that look like cottage cheese and mustard are called milk stools If your baby is still having dark meconium green or brown stools by 5 days of age please call our office Your baby urinates 6 or more times a day once your milk has come in The urine should be colorless not yellow If it looks like the diaper has reddish brick dust on it after your baby is older than 3 days your baby s urine probably is too concentrated and your baby may not be getting enough milk Your baby has 4 or more good sized bowel movements each day Many breast fed babies have a bowel movement every time they nurse during their first 3 to 4 weeks of life Your nipples may be a little tender for the first several days of nursing especially at the beginning of feedings The discomfort should be nearly gone by the end of the first week of breast feeding Nipple pain that is severe lasts throughout a feeding or continues more than 1 week after birth could mean your baby is nursing incorrectly If your baby does not latch on properly to nurse your infant may not be getting enough milk Two or three weeks after delivery you may notice the sensations associated with milk let down Breast feeding causes the release of the hormone oxytocin which causes the uterus to cramp These after pains with breast feeding are more noticeable than any early breast sensations They usually go away 7 to 10 days after the birth of you
54. unnecessary visitors for at least the first month It is also recommended to avoid unnecessary outings and exposure to children with the exception of siblings Your newborn s immune system is not equipped to handle all the potential exposure to infectious diseases Your baby can be taken outdoors however sun exposure should be limited to 10 to 15 minutes at a time It is important to dress your baby with as many layers of clothing as an adult would wear for the outdoor temperature The most common mistake is overdressing in the warm Florida weather Overdressing can cause sweating and an irritating heat rash In the winter the baby will need a hat to prevent heat loss PHYSICIAN APPOINTMENTS Your baby will have a series of scheduled well child visits The first visit will be approximately 2 days after discharge from the hospital 1 2 weeks 1 month 2 months 4 months 6 months 9 months 12 months 15 months 18 months 24 months of age and yearly thereafter The physician will perform a complete physical evaluation on the baby and appropriate immunizations will be administered Please see the immunizations section for a summary of the scheduled immunizations It is necessary to schedule a routine newborn exam in the office within 48 hours of discharge from the hospital The baby will have a full evaluation by the physician Screening for jaundice appropriate weight maintenance gain voiding and stool patterns and overall health will be revie
55. ur office and we will be happy to discuss any questions or concerns you may have Baby s Name DOB Birth Weight Length Head Circumference Hospital Discharge Weight Table of Contents I Introduction IL First Weeks at Home With a Newborn Preventing Fatigue and Exhaustion Postpartum Blues The Father s Role Visitors Outings Physician Appointments Sleep Position Jaundice Infection Metabolic Problems Respiratory Problems Weight Loss Breast Enlargement and Menses Normal Behavior and Development Feeding Breastfeeding Pumping Storing and Handling Breast Milk Formula Feeding Introduction of Solids Vitamins and Fluoride Sterilization Growth Consideration III Care Tips Bathing Eyes Nose Ears Umbilical Cord Fingernails and Toenails Circumcision Laundry Stools Diarrhea Diaper Rash Face Rashes Hiccups Crying Signs of Illness Facts about Fever Thermometer Use Teething Safety Immunizations IV Descriptions of Immunizations V Developmental Milestones VI Immunization Measurement Record VIL Growth Charts VIII Important Telephone Numbers Suggested Readings Internet Sites Acknowledgments INTRODUCTION Our mission at East Lake Pediatrics is to provide outstanding pediatric care that is personalized to the needs of our patients We know that choosing the right pediatrician is an important decision for pare
56. wed The two week exam is probably one of the most important visits for your baby during the first year of life Symptoms of any possible physical conditions that were not present during the hospital stay will usually develop by this time SLEEP POSITION The American Academy of Pediatrics recommends placing your baby in a crib with a firm mattress on his her back This reduces the risk of Sudden Infant Death Syndrome SIDS To avoid potential smothering unnecessary toys blankets and stuffed animals should not be placed in the crib JAUNDICE Some degree of yellow jaundice is common and normal for your newborn especially if breastfeeding If it becomes significant your baby may need to be treated with special light therapy At times we have to supplement a jaundiced baby for better hydration Jaundice bilirubin levels may need to be performed on your infant which requires a simple heel stick to collect a small amount of blood to determine what intervention if any needs to take place INFECTION Your infant may need to be observed closely for signs of infection if you have been ill near the time of delivery or if your water broke or leaked for an extended period of time If necessary your baby may need to be kept in the hospital for evaluation and treatment METABOLIC PROBLEMS Occasionally infants may have problems with the level of blood sugar calcium etc This is especially true of infants of diabetic mothers infants lar
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