As a pediatrician, there are several key pieces of knowledge that I equip all new parents with before they head out into the world. However, the doctor’s office can be a hectic place and parents are often too overwhelmed to soak up all the guidance that can be useful—and even life-saving, in some cases. These are my top ten basic pediatric tenants that I, as well as my fellow colleagues, wish all new parents could carry in their arsenal to protect their newborn babies.
1. Newborn fever
Many parents are unaware of what is considered an actual fever in a newborn. Any temperature equal to or greater than 100.4 degrees Fahrenheit (or 38 degrees Celsius) is considered a fever in a baby less than 2 months old, and he or she should be taken to the closest ER. Newborn babies oftentimes do not display the typical symptoms that adults do when they are ill. Fever is one of the few predictors of infection in babies less than 2 months of age and may even indicate bacteria growing in the blood, urine or surrounding the layers of the brain.
2. Tylenol dosing
A nationwide initiative is in order for all pharmacies to replace the old 80mg/0.8mL concentration of infant Tylenol and replace them with the new 160mg/5mL. The old infant dose is three times stronger and more likely to lead to accidental overdose. While this transition in some stores is still being made, please be careful about which concentration you use for your baby.
3. Breastfeeding tactics
During the first few days of milk production, your body makes a substance called colustrum that contains important antibodies and growth factors not present in formula. This substance is very beneficial to your newborn and helps to protect him or her from infection.
When you breastfeed, be sure to use both breasts during each feed and alternate the side you start out with for each subsequent feed. When your baby stimulates your nipple by suckling, a chemical called oxytocin is produced in your body which allows milk to be let down through your nipple and enables continued milk production to kick in for future breastfeeding.
4. Vaccination myths dispelled
There is no supportive association between Thimerosal (the mercury substance in certain vaccines) and autism. Speak with your doctor about equipping your baby with the right armor to shield him or her against potentially deadly diseases.
5. Starting solids
Hold off on introducing solid foods until your baby is 6 months of age. According to a recent study published in Pediatrics in March 2011, this has been shown to significantly reduce obesity in children. Once your baby is 6 months of age, start off with spoonfuls of rice cereal (never place in the bottle as this can be a choking risk). Advance to one new food group each week. This way, in case your baby has an allergic reaction to a food, you will be able to pinpoint the exact culprit.
6. Sleep hygiene
No co-sleeping! Your baby should be put to sleep in a crib, always on his or her back and should never be sleeping in the bed with mom or dad (this includes bassinettes that strap on to the parent’s bed). Whether purchasing a new crib or using a hand-me-down it is important to follow the new guidelines specified by the Consumer Product Safety Commission to prevent body entrapment. Crib bars should be less than or equal to 2 & 3/8 inches apart with no drop down rails. Rails should be 26 inches above the mattress and you should not be able to fit more than 2 fingers-width in between the mattress and the side of the crib. Only use hardware that is present from the original crib, since substituting nuts and bolts from the local hardware store can lead to accidents.
7. The sniffles
Babies are primarily nose-breathers. Their airway muscles are not as strong or developed as ours are so they won’t be able to cough or sneeze as efficiently when their airways are clogged with mucous. If your baby is congested, try using a simple bulb syringe with nasal saline drops to clear both nostrils up to 4 times a day. The saline drops are available over-the-counter.
8. Baby poop
At birth, the first few stools of life are usually dark and tarry, called meconium. As the baby feeds (breast milk or formula), stools tend to appear mustardy or seedy and are soft in consistency. Blood in the stool is never normal, and you observe this, you should call your doctor right away. Your baby should be increasing one wet diaper with urine for each day of life up until day 6. After day 6, your newborn baby should have at least six wet diapers per day.
9. Reflux precautions
Baby’s esophageal muscles are not as well developed as ours, causing liquids to reflux more easily. Reflux can lead to discomfort after feeds, arching of the baby’s back and color change, as well as spitting up or even aspirating feedings. Holding the baby upright for at least 20 minutes after feeding helps prevent the baby from refluxing.
10. Tummy time
Doing “tummy time”, or placing your baby on her tummy while she is awake on top of your tummy for several minutes is an excellent activity for you do with your newborn. This activity not only helps to strengthen your baby’s upper body as she tries to lift her head and eventually her torso upright, but also helps to form a strong bond between parent and baby.
Dr. Ayala Miller is a Resident Pediatrician at New York Presbyterian Hospital- Weill Cornell Medical College located on the Upper East Side of Manhattan. She attended the Johns Hopkins University and graduated with Honors receiving a B.A.in Writing Seminars and then went on to attend the University of Maryland School of Medicine, where she was the recipient of the J. Edmund and Kathryn Bradley award for Excellence in Pediatrics.