Pediatrics: Newborn Discharge Instructions

Please contact one of the offices to set up an appointment.

Office telephone numbers are available here and at the bottom of each web page.

Agawam:    (413) 789-6800
Chicopee:   (413) 594-3111
Springfield: (413) 733-4101
Westfield:   (413) 533-2900
Wilbraham: (413) 598-7770

We encourage your child to see their primary care provider at their usual “home” office for well and sick visits.

It is possible to have your child seen for an urgent or sick visit at a different RiverBend location if needed - request the office which works best for you when you make an appointment. Our five offices are linked through an electronic medical record (EMR). With EMR any visit at any office is part of one chart. With the EMR you can be sure that your child's primary care physician always has up-to-date information about your child's health.

If your child is sick in the middle of the night or on the weekend we have nurse triage 24/7. If your child needs a routine appointment, a refill or you have a non-urgent medical question you can request these through our web based portal called MyChart. You can also give us a call during regular business hours Monday through Friday 8:30AM - 5:00PM. We are available for urgent care appointments Saturday and Sunday from 9AM - 5:00PM at our Chicopee location. You can make urgent care appointments by calling 413-594-3111 on the weekends. For more information about RiverBend Medical Group visit our website at www.riverbendmedical.com.  To learn more about MyChart ask one of our staff.

Sleeping

Back to Sleep

Babies should sleep on their back. To reduce the risk of SIDS (Sudden Infant Death Syndrome) it is important to put your baby on his or her back to sleep. Back to sleep is best for naps as well as going to bed for the night. Some babies at first may not like sleeping on their back, but most get used to it. Be sure to rotate your baby’s sleep direction to decrease the chance of a flattened back of the head – head facing the left end of the crib for a few nights and then to the right a few nights. Use a firm mattress with no pillow. Pillows and soft toys can lead to suffocation in babies. Some “tummy time” during hours when your baby is awake and with you is good for your baby. Newborns can sleep much of the day. It is important to awaken your baby every 2 to 3 hours during the daytime to feed. Otherwise the baby may need to awaken more often at night to feed. Parents can catch a nap when the baby is napping. Have the room at normal temperature, 70 to 72 degrees is about right, and avoid placing the crib in a drafty area. It is fine to run your air conditioning or fan during hot summer months, but avoid blowing cool air directly on the baby.

Eating

Schedule for Feeding

You should feed your baby whenever he or she is hungry. Most babies eat every 2 to 3 hours during the day and each 3 to 4 hours at night. Your baby’s stomach is small and will only hold one to two ounces at first. Large babies may need to eat more often and take more at each feeding. If the baby takes too much or does not burp well he or she may spit up more. Take your time feeding the baby. When your baby is full, he or she will stop sucking and swallowing. She or he may pull away from the bottle or fall asleep. Do not prop the bottle in the baby’s mouth as they may choke. If you cannot hold onto the bottle while baby is feeding take the bottle out of the baby’s mouth. Also, bottle propping can lead to cavities later when the baby develops teeth.

Burping

  • Burp your baby in the middle and at the end of the feeding. This will get rid of any air swallowed.
  • After feeding, position the baby on your shoulder, over your lap, or sitting on your lap.
  • Gently rub and pat the baby’s back.
  • Do not burp the baby too hard or the baby may throw up.
  • Most babies spit up a little after every feeding. The spit up should always be milk colored and never green. The spit up should not be projectile.

Is The Baby Eating Enough?

Many parents worry about how much the new baby needs to eat. There are ways to tell if your baby is getting enough nourishment. The baby should have at least three or more wet diapers a day. After feeding the baby should be relaxed and sleepy, not crying and fussy. When we see the baby in the office we will check the baby’s weight. Weight gain is another way to ensure your baby is feeding well. A newborn will usually gain about ½ to 1 ounce per day.

Bowel Movements

The baby’s bowel movements (stools) will change as the baby eats. The first two days, babies have dark green, sticky bowel movements. As the baby feeds more the stool is often yellow to green in color and may be loose and have little white “seeds” in the stool. Your baby may have a bowel movement several times a day or skip 2 or 3 days. This is normal so long as the stool is soft. It is also normal for the baby to get red in the face and grunt when she/he has a bowel movement.

*If your baby acts sick or has bloody, black tarry, pale white, hard or overly watery stools, call your doctor’s office. 

Care of the Circumcision

If your baby boy is circumcised, his penis may be red and swollen for about a week. Initially, the tip of the penis will be very red and there may be a little blood or clot. Over the course of a few days it will slowly change to a more pink, flesh colored appearance as it heals. Any bleeding should stop in 24 hours. If you notice more than a little blood, please call your pediatrician. There may also be a yellow-white coating on his penis on the second day after the circumcision. This is normal and will go away as your baby heals. A little Vaseline applied directly to the area will keep the diaper from sticking. With each diaper change, place a quarter size amount of Vaseline on a piece of clean gauze and place it on the tip of the penis. By the sixth day or so the skin is healed, the yellow coating disappears, and the penis appears pink and normal. Warm water applied to a soft cloth is all that is necessary for cleaning the genital area. Wash the penis and scrotum gently. This will not harm the circumcision and is necessary for good hygiene. His penis may be sore for a few days after the circumcision, so put his diaper and clothes on loosely.

Care of the Uncircumcised Penis

Daily external washing is all that is necessary. You can gently retract the foreskin and clean the tip with warm water and a soft cloth. Do NOT forcefully retract the foreskin in an infant because it is still attached to the head of the penis. You may cause pain and bleeding by forcing the foreskin back. It usually takes several years for the natural separation of the foreskin from the head of the penis to occur.

Umbilical Cord care

Does the Umbilical Stump Require Special Care?

At delivery the connection between mom and baby is clamped and then cut. The left over umbilical stump will dry up and fall off within 2 to 4 weeks. Usually nothing need be done for the care of this area. The stump can dry better if you fold the top edge of the baby’s diaper so the stump is exposed to air. When the stump falls off, you may detect a little blood, which is normal. If the umbilicus has mucous or is smelly you can clean it with a cotton swab or gauze pad dipped in rubbing alcohol with each diaper change. Do not give the baby a tub bath until the belly button heals completely, usually about 2 weeks after the stump falls off.

What Are The Signs Of Infection?

You should call your doctor if:

  • There is redness of the skin surrounding the belly button
  • The naval and the surrounding area become swollen.
  • Your child develops a fever or appears unwell.

Bathing

How Often Should I Bathe My Baby?

Initially a bath isn’t necessary more than once or twice a week. (Just wash the baby’s face frequently and thoroughly clean his genital area after each diaper change.) When you do bathe your baby, you may find it a little scary to handle your wiggly little one when he or she is all soapy and slippery, so keep a good grip. Most babies find the warm water very soothing. 

Where Should I Bathe My Baby?

You can place a bath towel on the countertop next to the sink and wash the baby with a washcloth and warm water. As the baby grows beyond the newborn period you can use a plastic baby bath tub or bathe the baby in the sink. Never leave your baby alone at bath time as the baby may roll off the counter or may slip under the water and drown. Keep the room and water warm so your baby will not become too cold. Dry the baby quickly after washing.

What’s The Best Way to Give My Baby A Bath After The Umbilical Cord Has Fallen Off?

Here’s how to do it and what you’ll need to make baby-bathing easy. With any luck, bath time will become one of the most enjoyable parts of your days together:

  • Assemble all necessary bath accessories (bath towel, washcloth, baby soap and shampoo, baby lotion, clean diaper and clothes).
  • Fill the baby tub with 2 to 3 inches of water that feels warm but not hot.
  • Bring your baby to the bath area and undress the baby completely.
  • Gradually slip your baby into the baby tub, using one hand to support the neck and head. Pour cupfuls of warm bath water over the baby regularly during the bath so he or she doesn’t get too cold.
  • Use soap sparingly as you wash the baby with your hand or a washcloth from top to bottom, front to back. Never use soap near the baby’s eyes.
  • Rinse your baby thoroughly with warm water or a wet washcloth.
  • Wrap your baby in a towel and pat dry. If the baby has dry skin, or if there is some diaper rash, you may want to apply a mild lotion after the bath.

Tips for Safe Bathing

Bathtime can be fun for you and your baby, but you can’t be too cautious. Here are a few tips for safe bathing now and in the future.

  • Never leave your baby unsupervised, even for a minute. If the doorbell or the phone rings, and you feel you must answer it, scoop him or her up in a towel and take the baby with you.
  • Never put your baby into a tub when the water is still running (the water temperature could change or the depth could become too high).
  • Make the family tub safe: Outfit it with a rubber bath mat to avoid slips. Also place a towel or bathmat on the floor to prevent slips and falls.
  • Make sure the bath water is comfortably warm but not hot. Feel the water with your hand to be sure it is just right.
  • Fill the tub with only 2 to 3 inches for newborns and infants up to six months old and never more than waist-high (in sitting position) for older children.
  • Use soaps and shampoos sparingly as they can dry out your baby’s skin and may cause rashes. Do not use bubble bath as this can lead to pain on urination.
  • Shampoo your child’s hair at the end of her bath to avoid having him/her sit in shampoo-filled water, which can also lead to pain on urination.
  • Set your water heater to 120 degrees F. A child can get third degree burns in less than a minute much over that temperature.
  • Do not allow your child to touch the faucet handles. Even if he can’t move them now, he’ll be strong enough to do so soon and that could lead to serious injury if he/she turns on hot water.

Dressing

As a general rule, infants should be dressed as you might want to be dressed, plus one additional thin layer.

Summer Dressing

In the warm summer days, babies are usually fine in just a diaper and T-shirt.

  • Check the baby for a red, raised rash when the weather is warm. This heat rash may mean the baby is too warm.
  • Give your baby plenty of shade when outdoors.
  • Put a hat with a rim on your baby’s head when you go outdoors. The sun will bother their eyes and may make him or her fussy.
  • Keep your baby’s skin and head covered if she is going to be in the sun. Since babies have delicate skin she or he may get severe sunburn.

Winter Dressing

In the winter, the temperature indoors should be kept between 68 and 75 degrees F.

  • Layer the baby’s clothes. Usually your baby will be warm enough in a T-shirt and diaper with a
  • one piece sleeper over them. If you need a sweater, the baby probably needs one too.
  • If you go outdoors in cool or cold weather, put a hat or cap on the baby. Babies can lose a lot of
  • heat through their head and get cold quickly. This may be a good idea indoors too if you tend to keep the house cool.
  • When your baby is sleeping, swaddle your baby loosely in a light blanket. Cover your baby with another light or medium weight blanket.

Health Issues

When to Call Your Baby’s Doctor

  • Has a sharp, high cry for no reason or is unusually fussy.
  • Feels hot or has a dry mouth.
  • Doesn’t eat in his/her usually way.
  • Breathes in a different way (slower, faster, or noisier).
  • Acts like he/she has a cold.
  • Fever, especially when accompanied by signs of illness. Call for any rectal temperature over 100.2 degrees F or 38 degrees C.
  • Vomiting (not just spitting up) especially if it is green or projectile.
  • Refusal of food several times in a row.
  • Excessively tired appearing when the baby would usually be active.
  • Loose stools if there is mucus or blood.
  • Unusual rash that looks like blood spots.

Temperature

Use a digital thermometer, which can be used to take rectal (in the bottom) or axillary (in the armpit) temperature readings. Taking a rectal temperature gives the most accurate reading of body temperature in infants and young children. To take a rectal reading place some Vaseline on the tip of the thermometer, place the baby face down, place the metal tip of the thermometer into the anus, pinch the cheeks around the thermometer to hold it in place and press the button to begin measurement, take the thermometer out and read it when it beeps. If the thought of taking a rectal temperature makes you uncomfortable, take an axillary temperature. Remember that an under the arm temperature is about a degree cooler than a rectal temperature.

Once your child is older than 3 months, a tympanic (ear) or temporal (swiped across forehead) thermometer can be used. These other methods of taking a temperature can sometimes lead to readings that are too low. Try taking the temperature a few times and use the highest temperature as the most reliable. Be aware that temperature strips (color changes when placed on the forehead ) are inaccurate and should be avoided.

Temperature should be taken only if the baby feels hot or is acting sick. A baby’s average temperature is 98.6 to 99 degrees rectally. The under the arm temperature may be a degree cooler. Temperatures greater than 100.2 degrees F or 38 degrees C rectally in your newborn should be reported to your pediatrician.

Breast Feeding

There are several advantages to breastfeeding: it is inexpensive, it is convenient, and it provides protection against illness. After the baby is born, mom makes a watery liquid called colostrum. As the baby sucks at the breast, mom’s body is stimulated to produce milk. The more the baby nurses the better mom’s supply of milk.

Determining Whether Your Breastfed Baby Is Getting Enough Milk

Even though you can’t see how much milk your baby takes while nursing, you can tell whether breastfeeding is off to a good start if you know what to look for. This is what should be happening when breastfeeding is going well.

 Your milk should “come in” at 3 to 4 days after delivery. If your baby seems hungry after nursing or you do not think your milk has come in by the fourth day, consult your health provider.

•    Your baby should latch on correctly to your breast and suck rhythmically for 5 to 10 minutes (or longer) on each breast. He or she may pause periodically but should nurse vigorously throughout most of the feeding. A baby usually gets more milk from nursing at both breasts than from nursing on one side only. Alternate the side you start feedings on, so both breasts receive comparable stimulation and emptying.

•    Your baby should appear satisfied after nursing and probably will fall asleep at the second breast. If your baby falls asleep and will not take the second breast, try to divide suckling time between the two sides. A sleepy baby will eat more milk by nursing for 5 minutes at each breast than 10 minutes at one.

•    Your newborn baby should nurse at least eight times in 24 hours. A pattern that works well for many infants is nursing at 2 to 3 hour intervals throughout the day, with a single 4 to 5 hour stretch during the night. Don’t be surprised if you need to wake your baby up to feed.

•    Your breasts should feel full before each feeding and softer after feeding. You should hear your baby swallow regularly while breastfeeding. One breast may drip milk while your baby nurses on the other side.

•    Your baby should urinate six or more times a day. Most breastfed babies wet their diapers after every feeding. You may have difficulty telling whether a super-absorbent diaper is wet; if in doubt put a piece of toilet tissue between where the baby pees and the diaper to help you be sure.

•    Your baby’s bowel movements should look yellow to brown with white “seeds” mixed in by the fourth or fifth day of life.  If your baby is still having dark sticky meconium stools by 4 to 5 days of age, he or she may not be getting enough milk.

•    Baby bowel movements can vary each day. Many breastfed infants may pass a stool with every feeding at first. After the first few weeks the baby might only have a stool every 2 to 3 days. This is OK so long as the stools are soft.

•    Your nipples may be slightly tender for the first several days of nursing. Usually, tenderness is present only at the beginning of the feedings, and discomfort is gone by the end of the first week. Try an ice pack or cool compress to the nipples before feeding. Severe nipple pain, pain that lasts throughout a feeding or pain persisting beyond 1 week probably means our baby is nursing incorrectly.  If your nipples are very sore it may be a problem with latching or, in some cases, mom may have a nipple infection, ask your Obstetric provider or lactation nurse if in doubt. 

•    After 2 or 3 weeks, you may be aware of the sensations associated with the milk ejection or milk letdown reflex. The feeling can be described as tingling, pins-and-needles, or tightening sensation in your breasts as the milk begins to flow. Just hearing your baby cry can cause your milk to let down, even before your baby latches on.

•    Once your milk has come in, your breasted baby should gain about 1 ounce each day for the first few months of life. In the first week of life all babies loose weight – up to 10 % from birth weight. The baby should be back up to birth weight, or beyond, by 2 weeks of age. The only way to be certain that your baby is getting enough milk is to weigh him or her. If your baby is not gaining weight appropriately, it is possible that your milk supply is low or that your baby is not nursing effectively. Such breastfeeding difficulties are easier to remedy if they are recognized and treated early. Your baby’s health care provider can work with a breast feeding specialist to develop a feeding plan tailored for you and your baby.

Helpful Hints:

- Your baby should be awake before feeding. A sleepy baby will not nurse well.

- When you are holding your baby ready to nurse, touch your baby’s cheek to your nipple. Your baby will turn toward your nipple and begin to suck. This is called the “rooting reflex”.

- Make sure the entire nipple and surrounding dark area (areola) is in your baby’s mouth.

- Be sure your baby’s nose is not covered by your breast when nursing. Baby has to breathe through the nose and will not nurse well if unable to breathe.

- To remove your nipple from baby’s mouth, push your finger into baby’s mouth. This will break the suction and baby will release your nipple without discomfort to you.

- The size of the breast has nothing to do with the amount of success to be expected of breastfeeding. A small-breasted mother can produce just as much milk as a mother whose breasts are larger.

- Just because your mother or other close friend had difficulty or was unsuccessful with breastfeeding does not mean you will have the same type of problem or experience. Success at breastfeeding is not hereditary.

-  Each mom’s breast feeding experience is different; each baby is different as well.

Questions? Please contact our office or speak with our providers. You might also consider contacting the lactation clinic at Mercy Hospital - the support line is available at 413-748-7262.  A lactation nurse is present at the clinic Tuesdays and Thursdays from 12-2 PM. There is no charge and new mothers who have not delivered at Mercy are welcome to seek help from this service.

 

Bottle Feeding

When you bottle feed your baby, you should be seated comfortably. Hold the bottle so that the neck of the bottle and the nipple are always filled with formula. This helps your baby get formula instead of sucking and swallowing air. Never prop up the bottle or leave baby alone to feed. The baby can choke if the flow is too much to handle. Remember too that baby needs the security and pleasure of being held at feeding time. It’s a time to relax and enjoy each other. Baby should never take a bottle to bed. Bed bottles may contribute to ear infections and tooth decay. There are many varieties of formula on the market today. Each formula comes in many forms of preparation including powder, concentrated liquid that must be diluted, and individually prepared bottles that need only to be opened and fed. Be sure to read the instructions on each formula container carefully to see how to prepare it for feeding.

Powdered Formula

Powdered formula must be mixed with water before use. Unmixed, the can of powder stores well on the shelf and can be used a scoop at a time. The cost of powdered formula is a little less than the equivalent amount of concentrated liquid. Please note the instructions for mixing powder and liquid are very different so be sure to read the can for the proper mixing instructions. Remember all babies spit up some the first few days. Do not interpret normal spitting as a formula problem.

Concentrate

This means that the formula in the can is in concentrated form and must be diluted with water according to the instructions on the can. Always follow the instructions carefully or the formula will be too strong or too weak for the baby. Water straight from the tap may be used for mixing.  If you are using town water from the faucet, there is no need to sterilize the water or bottles which you use to prepare formula. The bottles and nipples should be cleaned in hot water.

Generally, most parents will warm formula to room temperature before serving to the baby. Unused or pre-prepared formula should be refrigerated and then disposed of if over 24 hours old.

Ready-to-Feed

The formula in this can is already diluted and sterilized and needs no further preparation than merely cleaning off the top of the can before opening and pouring into a clean bottle. It is now ready to feed the baby. Never dilute this formula or the baby will be receiving a greatly reduced number of calories per ounce.

Ready-to-Feed Bottles

These 4, 6 or 8 ounce bottles are already mixed so that all you do is remove the lid and screw on the nipple. The bottle is ready to feed to the baby in a few seconds from the cupboard shelf. These can be used only once and any remaining formula must be refrigerated or discarded. Unused refrigerated formula over 24 hours old should also be discarded. Ready to feed formula is much more expensive than powdered formula.

Formula Preparation

The amount of formula your baby takes will vary from one bottle to another. Most babies may take as long as 15-20 minutes to complete a bottle – some much faster. You will find that your brand new newborn baby takes about ½ to 1 ounce or formula at a feeding. Their appetite will quickly grow to 2 to 3 ounces of formula each 2 to 3 hours (sometimes more or less). As your baby grows, you will naturally increase the mount of formula you feed your baby. If the baby overeats he/she may spit up more. Some parents will mix just enough formula for each feeding while others will prepare a days supply in advance to fill and refrigerate several bottles. Any prepared and unused formula of any type needs to be refrigerated right away and thrown out if over 24 hours old. Nipples and bottles may be washed by dishwasher or by hand, rinsed with hot tap water and allowed to air dry.

Enjoy your baby!

Your child will never be this young again. Play with your baby and take plenty of pictures. Babies like being talked to and sung songs. They like seeing you and being with you.

Take the time to enjoy all that your baby has to offer.

 

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