Dearborn Pediatrics
Birth to Two Months

Birth through 10 Weeks

Congratulations on your new arrival!  This can be both an exciting and difficult time in life.  It is important to establish a partnership with your Provider and feel that we are here to answer your questions.  The following is a brief guide to commonly asked questions and newborn issues.

Newborns

Newborns do all kinds of things that may initially appear concerning.

  • They like to sneeze, cough and sometimes snort. These are attempts to clear the mucus from the nose and upper airway. Normal saline drops can be used to help clear the nose. This often makes babies sneeze, which naturally clears the nose.
  • A stuffy nose often mimics a wheezing sound. Be assured that newborns do not wheeze in the first month of life. Let us know immediately if your newborn has nasal flaring, repeated grunting sounds lasting more than a minute or appears to have difficulty breathing and feeding at the same time.
  • Newborns get the hiccups a lot. This sounds painful to adults but does not really bother your baby. Sometimes getting your baby to suck will relieve the hiccups.

Newborns often born with plugged tear ducts and this may last several weeks. Your Provider will show you how to massage the area. Your baby may need antibiotic eye drops if there is green or yellow discharge in the eye, volume of drainage, duration of drainage.

Jaundice

Jaundice can occur in the newborn period. The appearance of jaundice begins in the eyes and progresses from head to toe. We may run blood tests to determine the level of bilirubin, which may be present on days of life three and four. Please let us know if this happens. A small amount of jaundice can be normal and requires frequent feedings to help the body recycle the bilirubin more efficiently by the liver.

Feeding

Up to age four months babies only need breast milk or an iron fortified formula to meet their nutritional needs. They do not need water. Nursing moms should continue to take their prenatal vitamins and eat a healthy diet. To avoid developing a Vitamin D deficiency, the American Academy of Pediatrics recommends that breastfed and partially breastfed infants be supplemented with 400 IU per day of Vitamin D beginning in the first few days of life. The amount and frequency of feeds varies between babies. If your baby is acting hungry, feed him/her.

Always check the temperature of the formula after heating. When bottle feeding your baby always keep the head slightly elevated. If you feel that your baby may be thirsty give breast milk or formula. Both are water based. Giving water to newborn infants can lower the level of certain electrolytes in the body and cause seizures.

Elimination

Newborns usually have wet diapers with nearly every feeding. After four days of life your baby should have at least six wet diapers in a twenty-four-hour period. Please call us if this is not the case. Frequency of stools is more variable. Many newborns will have a stool with each feeding that can be liquid, seedy, yellow, or green. This is more common with breast fed babies. Nearly all babies give signals that they are having a bowel movement such as grunting, pushing, and pulling legs up and turning red in the face. This is often confused with signs of constipation. As long as your baby has soft stools, he/she is not constipated. Let us know if the stools are hard, contain blood or appear white or gray. The use of laxatives, enemas, or suppositories of any kind is not recommended. Please note that after four to six weeks of life it is normal for stools to become less frequent.

Sleep

 All babies should be placed on their backs to sleep. Over the last few years this has reduced the incidence of sudden infant death syndrome by 50%.  Avoid commercial sleep positioners as they are often made of foam and may cause suffocation.  The mattress should be firm. Do not place any blankets, pillows, stuffed animals or any other objects in a bassinet or crib.  For warmth place the baby is a zip up fleece sleeper that has no risk of covering the face.  It is not recommended that you put your newborn to sleep in your bed.  A bassinet adjacent to your bed makes nighttime feedings convenient and keeps your baby close at hand in the first few weeks.  Make note to alternate the baby’s head position from one side to the other in order to avoid flattening of the skull.  During wakeful periods, try to keep your baby off of the back of his/her head to decrease the flattering of the head.  This will be easier at two months of life when you will begin short spurts of observed tummy time.  Sleep length and times are variable.  

Cord Care

Your baby’s umbilical cord normally does not need any treatment and will normally fall off between 1 and 3 weeks. It is not uncommon for the cord to develop a foul odor before falling off.

  • The cord needs to dry before it will fall off.
  • Only give sponge baths to your newborn until the cord falls off.
  • Cords can also hang by a strand of tissue for 2-3 days.
  • You will need to check the skin around the base of the cord at least once a day. If the area is dry and clean no treatment is necessary.
  • Getting some poop on the cord is not serious but you will need to clean it gently with soap and water. That should prevent any infections.
  • When the cord has fallen off, the belly button may ooze secretions for several days. Normal secretions are clear or slightly blood tinged.
  • If you notice any secretions or need to clean around the cord use a cotton swab wet with water and gently clean the area & dry the area carefully.
  • You may need to push down on the skin around the cord to get at this area and you may need to bend the cord a little to get underneath it. Do NOT use alcohol or any other germ killer on the cord.
  • As the cord dries up it will change color from shiny yellowish hue to brown or gray. After the cord has fallen off the navel will gradually heal.
  • It is normal for the center to look red at the point of separation and to ooze some secretions for several days.
  • Normal secretions are clear or slightly blood tinged. Sometimes the navel will form a scab. Let it heal up and fall off on its own. It is NOT normal if the redness spreads to the belly.
  • Home treatment should clear up any cloudy discharge in a day or so. Sometimes the navel will form a scab. Let it heal up and fall off on its own. It is NOT normal if the redness spreads to the belly.

Call the office if:
You notice a red area spreading beyond the navel, a bad smelling or draining cord, or you notice a spot of blood greater than 2 inches from the navel.

Bathing and Diaper Care

Sponge baths are recommended until the cord has fallen off and the area is dry and well healed. Washing the diaper area with soap & water or a diaper wipe with each diaper change with help decrease irritation.

For circumcised boys continue to apply A & D ointment or Vaseline until all the scabbing has healed in order to keep the area from sticking to the diaper. You may clean it gently with a cotton ball and water. In uncircumcised boys, retract the foreskin very gently, as far as it will go without forcing, and absorb any moisture that is trapped by the foreskin. Never force the foreskin down as this may lead to injury.

For girl babies, take care to always wipe from the front to back to avoid carrying stool into the urethra and vagina. After a stool, spread the lips of the vagina and gently wipe the stool away. Please note that newborn girls often have labial swelling due to the effects of estrogen. They can also have a mucous like vaginal discharge due to the effects of hormones on a newborn girl’s vagina and uterus.

Development

It may seem to you that the first four to six week involve mostly eating, sleeping and the production of dirty diapers. Your baby will smile at random times and this will keep you going. This is a stressful time riddled with sleep deprivation. Parents should try and sleep whenever the baby sleeps. Respond to his/her needs promptly and lovingly, which will create a sense of wellbeing and security in your infant. Your baby will reward you for all of your efforts at around two months of life by cooing and smiling in response. Take time to talk to our newborn during wakeful hours. This promotes intimacy, verbal skills, and emotional development. Please note that you cannot “spoil” a baby by holding them too much in the first weeks of life.

Between two to four weeks of life, you will note that your baby is doing the following:

  • Raising head slightly when on stomach.
  • Blinking in reaction to bright light.
  • Beginning to focus and follow objects for short distances.
  • Responding to sound by either becoming quiet or turning towards the source.

Fever

Fever in an infant under two months of age is defined differently than any other age. It is defined as a RECTAL temperature of greater than or equal to 100.4 degrees. If you suspect that your baby is ill take an axillary (under the arm) temperature for five minutes. If the axillary temperature is 99.4 or higher take a rectal temperature.

A rectal temperature can be obtained by placing a small amount of Vaseline on the thermometer and gently inserting the thermometer about a ½ inch into the rectum.

Call us immediately if the rectal temperature is greater than or equal to 100.4 and your child is under the age of two months. After two months of age fevers of 100.4 or higher are not by definition emergencies.

Ask all visitors to wash their hands prior to holding your baby. Do not let visitors who could be sick close to your baby.

Safety

One of the most important jobs you have as a parent is keeping your child safe when your child is riding in a vehicle. Each year, thousands of young children are killed or injured in car crashes. Proper use of car safety seats helps keep children safe. There are so many different car seats available on the market that many parents find this an overwhelming task. If you are expectant parents, give yourselves enough time to learn how to properly install the car safety seat in your car before your baby is born to ensure a safe ride home from the hospital.

​The type of seat your child needs depends on several things, including your child’s age, size, and developmental needs. Read on for more information from the American Academy of Pediatrics (AAP) about choosing the most appropriate car safety seat for your child.

The American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools at 9, 18, and 30 months and for autism at 18 months or whenever a parent or provider has a concern. Ask your Provider about your child’s developmental screening.