Caring for your Baby
Common Concerns
- Fever
- Blocked Tear Duct
- Diaper Rash
- Jaundice (Newborn)
- Flattened Head Syndrome (Positional Plagiocephaly)
- Spitting Up by Infants (GE Reflux)
- Umbilical Cord, Bleeding
- Umbilical Cord, Oozing
Fever
In a newborn, fever is defined as a rectal temperature over 100.4° F (a rectal temperature is the most accurate). A normal rectal temperature is from 97.7°F to 99.7°F. Fever is simply an indication that something is wrong. It may be as simple as a cold, or something much more serious. Any fever in infants under three months should be reported immediately.
How to Take a Rectal Temperature
- We do not recommend the use of glass thermometers. Digital thermometers are recommended.
- Have your child lie stomach down on your lap.
- Before you insert the thermometer, put some petroleum jelly on the end of the thermometer and on the opening of the bottom (anus).
- Insert the thermometer gently into the bottom about 1 inch. If your child is younger than 6 months old, gently insert the thermometer only 1/4 to 1/2 inch. If you put the thermometer in just until the silver tip disappears, that is about 1/2 inch. Never try to force it past any resistance. Forcing could damage the bowel.
- Hold your child still while the thermometer is in.
- Take it out when you hear the correct signal (usually a series of beeps).
- Read the temperature on the thermometer.
- If the rectal temperature is over 100.4°F (38°C), your child has a fever.
Blocked Tear Duct
What is a blocked tear duct?
When the pathway that normally carries tears from the eye to the nose is blocked, it is called a blocked tear duct. This happens often in very young babies. Most of the time, only one tear duct is blocked at a time.
Your child may have a blocked tear duct when:
- One eye is always watery.
- Tears run down the face even when your baby does not cry.
- When crying, the nostril on the blocked side is still dry.
- The eye on the blocked side is not red, and the eyelid is not swollen.
- The problem starts before your child is 1 month old.
Although the blockage was present at birth, your baby may not have symptoms right away. This is because in some babies, tear production is sometimes delayed until 3 or 4 weeks of age.
How long does it last?
This is a common condition, affecting 6% of newborns. Both sides are blocked 30% of the time. Over 90% of blocked tear ducts open up spontaneously by the time a child is 1 year old. If the blockage continues after age 1 year, an ophthalmologist (eye specialist) can open it with a probe.
How can I take care of my child?
Massage the lacrimal sac (where tears collect) twice a day to empty it of old fluids. Always wash your hands carefully before doing this. The lacrimal sac is in the inner, lower corner of the eye. Start at the inner corner of the eye and gently press upward, using a cotton swab. A small amount of clear fluid should come out.
The massage technique is somewhat controversial. Some physicians recommend massaging downward instead of upward in hopes of washing out the plug that blocks the lower duct. Some physicians recommend not massaging the sac at all. Massage in either direction must be done gently, since it may irritate the eyelid tissue and contribute to infection. Because of poor drainage, eyes with blocked tear ducts can become easily infected. The infected eye may produce a yellow discharge. If the eye becomes infected, it is very important to begin antibiotic eye drops and to stop the massage.
When should I call my child’s health care provider?
Call IMMEDIATELY if:
- The eyelid becomes very red or swollen.
- A red lump appears at the inner lower corner of the eyelid.
Call during office hours if:
Diaper Rash
What is a diaper rash?
A diaper rash is any rash on the skin area covered by a diaper. Almost every child gets diaper rashes. Most of them are due to prolonged contact with moisture, bacteria, and ammonia. The ammonia and other skin irritants are made by the reaction of bacteria from bowel movements to certain chemicals in the urine. Bouts of diarrhea cause rashes in most children. Diaper rashes occur less frequently with disposable diapers.
How long will it last?
With proper treatment, these rashes are usually better in 3 days. If the rash does not improve with treatment, then your child probably has a yeast infection (Candida). If your child has a yeast infection, then the rash becomes bright red and raw, covers a large area, and is surrounded by red dots. You will need a special cream for yeast infections.
How can I take care of my child?
The key to successful treatment is keeping the area dry and clean so it can heal itself. Check the diaper about every hour, and if it is wet or soiled, change it immediately. Exposure to stools causes most of the skin damage. Make sure that your baby’s bottom is completely dry before closing up the fresh diaper.
Leave your baby’s bottom exposed to the air as much as possible each day. Practical times are during naps or after bowel movements. Put a towel or diaper under your baby. When the diaper is on, fasten it loosely so that air can circulate between it and the skin. Avoid airtight plastic pants for a few days. If you use disposable diapers, punch holes in them to let air in.
Washing the skin with soap after every diaper change will damage the skin. Use a mild soap (like Dove) only after bowel movements. The soap will remove the film of bacteria left on the skin. After using soap, rinse well. If the diaper rash is quite raw, use warm water soaks for 15 minutes three times a day.
At night, use the new disposable diapers that are made with materials that lock wetness inside the diaper and away from the skin. Avoid plastic pants at night. Until the rash is better, awaken your baby once during the night to change the diaper.
Most babies don’t need any diaper cream. However, if your baby’s skin is dry and cracked, apply an ointment such as Vitamin A and D to protect the skin after you wash off each bowel movement. A barrier ointment is also needed whenever your child has diarrhea.
Cornstarch reduces friction and can be used to prevent future diaper rashes after this one is healed. Recent studies showed that cornstarch does not encourage yeast infections. Avoid talcum powder because of the risk of pneumonia if your baby inhales it.
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 or after each bottom rinse for BMs.
How can I prevent diaper rash?
Changing the diaper immediately after your child has a bowel movement and rinsing the skin with warm water are the most effective things you can do to prevent diaper rash.
When should I call my child’s health care provider?
Call IMMEDIATELY if:
- The rash looks infected (pimples, blisters, boils, sores).
- Your child starts acting very sick.
Call within 24 hours if:
- The rash isn’t much better in 3 days.
- The diaper rash becomes bright red or raw.
Jaundice (Newborn)
What is jaundice?
In jaundice the skin and the whites of the eyes (the sclera) are yellow because of increased amounts of a yellow pigment called bilirubin in the body. Bilirubin is produced by the normal breakdown of red blood cells. Bilirubin builds up in the body if the liver doesn’t send it into the intestines at a normal rate.
What is the cause?
Jaundice can be caused by several different problems.
- Physiological jaundice: This is the most common cause of newborn jaundice and occurs in more than 50% of babies. Because the baby has an immature liver, bilirubin is processed slower. The jaundice first appears at 2 to 3 days of age. It usually disappears by 1 to 2 weeks of age, and the levels of bilirubin are harmless.
- Breast-feeding jaundice: Breast-feeding jaundice may occur when your baby does not drink enough breast milk. It occurs in 5% to 10% of newborns. The jaundice symptoms are similar to those of physiological jaundice, just more pronounced. The jaundice indicates a need for help with breast-feeding.
- Breast-milk jaundice: Breast-milk jaundice occurs in 1% to 2% of breast-fed babies. It is caused by a special substance that some mothers produce in their milk. This substance causes your baby’s intestine to absorb more bilirubin back into his body than normal. This type of jaundice starts at 4 to 7 days of age. It may last 3 to 10 weeks. It is not harmful.
- Blood group incompatibility (Rh or ABO problems): If a baby and mother have different blood types, sometimes the mother produces antibodies that destroy the newborn’s red blood cells. This causes a sudden buildup of bilirubin in the baby’s blood. This serious type of jaundice usually begins during the first 24 hours of life. Rh problems used to cause the most severe form of jaundice. However, they are now preventable if the mother is given an injection of RhoGAM within 72 hours after delivery. This prevents her from forming antibodies that might endanger other babies she has in the future.
What is the treatment?
- Physiological jaundice: If you feed your baby with a bottle, feed your baby more often. Try to feed your baby every 2 to 3 hours during the day.
- Breast-feeding: The main treatment is to increase the supply of breast milk. Read about breast-feeding or talk with a lactation specialist. Nurse your baby more often. Nurse your baby every 1-and-1/2 to 2-and-1/2 hours. Since the bilirubin is carried out of the body in the stools, passing frequent bowel movements (BMs) is helpful. If your baby sleeps more than 4 hours at night, awaken him for a feeding. Frequent weight checks are also important. If you must supplement, use formula, not glucose water.
- Breast-milk: Occasionally, the bilirubin will not come down with frequent feedings. In this situation, the bilirubin level can be reduced by alternating each breast-feeding with formula feeding for 2 or 3 days. Supplementing with glucose water is not as helpful as formula for moving the bilirubin out of the body. Whenever you miss a nursing, be sure to use a breast pump to keep your milk production flowing. Breast-feeding should not be permanently discontinued because of breast milk jaundice. Once the jaundice clears, you can return to full breast-feeding and you needn’t worry about the jaundice coming back.
- Severe jaundice (blood group incompatibility): High levels of bilirubin (usually above 20 mg/dl) can cause deafness, cerebral palsy, or brain damage in some babies. High levels usually occur with blood type differences. These complications can be prevented by lowering the bilirubin using phototherapy (blue light that breaks down bilirubin in the skin). In many communities, phototherapy can be used in the home.
In rare cases where the bilirubin reaches dangerous levels, an exchange transfusion may be used. This technique replaces the baby’s blood with fresh blood. Physiological jaundice does not rise to levels requiring this type of treatment.
How do I check for jaundice?Newborns often leave the hospital within 24 to 48 hours of their birth. Parents, therefore, have the responsibility to closely observe the degree of jaundice in their newborn. The amount of yellowness is best judged by viewing your baby unclothed in natural light by a window.
When should I call my child’s health care provider?
Call IMMEDIATELY if:
- You observe any signs of dehydration.
- Jaundice is noticed during the first 24 hours of life.
- Your baby looks deep yellow or orange.
- Your baby hasn’t passed urine in more than 8 hours.
- Your baby develops a fever over 100.4°F (38°C).
- Your baby also starts to look or act sick.
Call during office hours if:
- Your baby is not getting enough milk or gaining weight well.
- Your baby has less than three good-sized BMs per day.
- Your baby has less than six wet diapers per day.
- The jaundice is not gone by day 14.
Flattened Head Syndrome (Positional Plagiocephaly)
What is flattened head syndrome?
If a baby lies on his back with his head turned in one position for a long time, day after day, the head can become flat on the back or on one side. This can cause the baby to have a crooked looking forehead and face. These changes can remain for the rest of the child’s life. You can help prevent this flattening by constantly changing your baby’s head position. This is especially important when the baby is very young and can’t move around a lot.
How does it happen?
Babies have very little room inside the uterus towards the end of pregnancy and may get “stuck” in one position. Infants who are in a breech position (bottom down) or twins have less room to move around, but even single babies in a normal position may have so little room that they can’t change position. Babies who stayed in one position in the uterus continue to lie in that position after they are born. They may not have the strength to change their position without some help from their parents.
A newborn’s head is soft and easily molded into a flat shape. If your baby continues to lie with her head turned to one side all the time, the head will become flattened and eventually facial changes will develop. You can start to see flattening as early as 4 to 6 weeks of age. You may notice facial changes by 3 to 4 months.
How can I help my child?
If you pay close attention to your baby’s head position and make sure that her head is in many different positions throughout the day and night you can prevent head flattening.
Here is what you can do:
- Sleeping: Always lay your baby down to sleep on her back. This is important to prevent sudden infant death syndrome (SIDS). However, change your baby’s head position each time you lay her down. Lay your baby with the head towards the top of the crib one time and the next time lay her down with her head at the other end. Babies like to look out towards the room and this encourages a baby to move her head to a different side each time she is laid down. Put toys or mirrors in the crib to cause the baby to look towards the outside of the crib.
- Infant seats, strollers, bouncy seats, and swings: Watch to see if your baby likes to put his head to the same side all the time while sitting in a seat. Roll up a blanket or use a neck roll to put around the baby’s head to keep the head in the center.
- Playtime: It is very important to start placing your baby on her stomach for playtime once the umbilical cord has dried up and fallen off. Time spent lying on the tummy helps develop neck, stomach, arm, and back strength. It also helps to get the baby ready for rolling, sitting, and crawling. Babies don’t like lying on their tummies at first because they are weak and it is hard for them to push up. Don’t worry if your baby fusses some of the time. Begin for short periods of time (2 to 3 minutes), 3 or 4 times a day. Try it after a feeding or a diaper change. Talk to your baby, place toys in front of him, and encourage him to lift his head and begin to push up. Gradually increase the time spent on the tummy and your baby will get stronger and eventually like to play on her tummy. “Tummy time” is a time for playing with your baby. Do not allow your baby to fall asleep while lying on the stomach.
When should I call my health care provider?
Call during office hours if:
- Your baby always wants to lie in one position and resists changing that position. Sometimes special stretching exercises or positioning are needed for babies who have tight neck muscles or have been very cramped in the uterus.
- Your baby’s head looks misshapened.
Spitting Up by Infants (GE Reflux)
What is spitting up?
Spitting up (also called regurgitation or reflux) is the effortless spitting up of one or two mouthfuls of stomach contents. Formula or breast milk just rolls out of the mouth, often with a burp. It usually happens during or shortly after feedings. It begins in the first weeks of life.
Spitting up is harmless as long as your infant doesn’t spit up large amounts that interfere with normal weight gain.
This condition is also called gastroesophageal reflux (GE reflux).
What is the cause?
Spitting up results from poor closure of the valve (ring of muscle) at the upper end of the stomach. Spitting up is normal and harmless for over half of all babies. It becomes a problem if it causes poor weight gain (from spitting up large amounts), choking and breathing it back in, or acid damage to the lower esophagus (esophagitis).
How long does it last?
Spitting up improves with age. By 7 months of age, most reflux has decreased or is gone. The reasons for this are probably because the baby is old enough to sit up or is eating solid foods. By the time your baby has been walking for 3 months, even severe reflux should be totally cleared up.
How can I take care of my child?
- Feed smaller amounts.
Overfeeding always makes spitting up worse. If the stomach is filled to capacity, spitting up is more likely. Give your baby smaller amounts (at least 1 ounce less than you have been giving). Your baby doesn’t have to finish a bottle. Wait at least 2 and ½ hours between feedings because it takes that long for the stomach to empty itself. - Avoid pressure on your child’s abdomen.
Avoid tight diapers. They put added pressure on the stomach. Don’t put pressure on the stomach or play vigorously with him right after meals. - Burp your child to reduce spitting up.
Burp your baby two or three times during each feeding. Do it when he pauses and looks around. Don’t interrupt his feeding rhythm in order to burp him. Keep in mind that burping is less important than giving smaller feedings and avoiding tight diapers. Also cut back on pacifier time. Constant sucking can pump the stomach up with air. - Keep your child in a vertical position after meals.
After meals, try to keep your baby in an upright position using a frontpack, backpack, or swing for 30 minutes. When your infant is in an infant seat, keep him from getting scrunched up by putting a pad under his buttocks so he’s more stretched out. After your child is over 6 months old, a jumpy seat or infant activity station can be helpful for maintaining an upright posture after meals. - Use a proper sleep position.
Most infants with spitting up problems can sleep on their backs, the position recommended by the American Academy of Pediatrics to reduce the risk of SIDS. Sleeping in a car seat will also reduce reflux. Again, put a pad in the low spot so your baby isn’t too scrunched up. Try to elevate the head of the bed a bit. If your child is having breathing problems (choking or sleep apnea), talk to your provider.
When should I call my child’s health care provider?
Call IMMEDIATELY if:
- You see blood in the spit-up material.
- The spitting up causes your child to choke or stop breathing for more than 10 seconds.
Call during office hours if:
- Your baby doesn’t seem to improve with this approach.
- Your baby does not gain weight normally.
Umbilical Cord, Bleeding
Why is my child’s umbilical cord bleeding?
A few drops of blood at the point of separation of the cord is common. The area may bleed a few times from the diaper rubbing on the area or your baby’s normal movements.
The bleeding usually stops by itself or can be stopped easily by direct pressure with sterile gauze.
When should I call my child’s health care provider?
Call IMMEDIATELY if:
- Bleeding doesn’t stop after 10 minutes of direct pressure.
- Any bleeding amounts to more than the size of a quarter.
Call during office hours if:
- Bleeding continues for more than 3 days.
Umbilical Cord, Oozing
Why is the umbilical cord oozing?
If the umbilicus (navel) is oozing or moist or has some dried pus on the surface, your baby probably has a mild infection from surface bacteria. It usually can be cleared up fairly quickly. Infection of the umbilicus must be treated with care because of the risk of spread to the liver or the abdomen.
Oozing can happen after the cord has already fallen off, but more often the cord is still attached.
How can I take care of my child?
Six times a day, clean the area with rubbing alcohol for several minutes. Use a cotton swab and remove all dried pus or debris. The umbilical area does not have any sensation, so the alcohol won’t sting. If the cord is still present, clean underneath it by lifting it up. If the cord has fallen off, pour some alcohol into the depression and remove it after 2 or 3 minutes. It takes that long to kill bacteria. Air exposure and dryness help healing, so be sure to keep the diaper folded down below the cord area. Although using alcohol can delay the separation of the cord by 1 or 2 days, it does prevent cord infections, and that’s what is most important.
Do not put talcum powder on the umbilicus; it can cause irritation and tissue reaction. Ointments should be avoided, because they delay drying and healing.
When should I call my child’s health care provider?
Call IMMEDIATELY if:
- Red streaks develop on the normal skin surrounding the navel.
- Pimples or blisters appear around the navel.
- Your baby’s rectal temperature is over 100.4°F (38.0°C) or under 97.5°F (36.8°C).
- Your baby acts sick.
Call during office hours if:
- The umbilical area is not completely dry and clean after 2 days of this treatment.
Meet our team
We look forward to your first office visit. Please bring in a written list of questions that you may have as well as your baby’s immunization card from the hospital verifying the receipt of the hepatitis B vaccine. This visit will be on their third or fourth day of life (or 1-3 days after being discharged from the hospital).
From there, please plan on seeing us for well visits at 2 weeks of life, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months and 24 months.
We wish you happy parenting in a time of blessings and challenges.