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Newborn Owner's Manual & Fever Care
Children's Health Specialists
Phillip C Gioia, MD
Chakrapani Irri, MD
Alina Krishnan, MD
Pediatrics and Preventive Medicine
Health Central, Suite 201 (behind Holiday Inn and north of 5&20)
37 West Garden Street (to east of State Street by Curley's)
Auburn, NY 13021
And
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- Newborn Owner's Manual
- Fever Care
Newborn Owner's Manual
Phillip C Gioia, MD
Phone 315- 253-6257 , The Answering Service: 255-6285
for after hours emergencies
(email drgioia@verizon.net)
( fax 253-8693)
As the new owner of your family your newborn will likely be quite demanding. The newborn often requires frequent feedings, constant changing of soiled clothes and diapers, and continuing education whenever boredom strikes.
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Feedings
Human babies often do best with human breast milk. They have drank
it for 200,000 years or so. It is easy to digest, helps fight infections, and
produces less allergies than formulas do. To breast
feed successfully a mother must be comfortable doing it. Oral vitamin D
supplement is needed for breast fed infants when there is cold weather.
Formulas now are the best they have ever been. Most babies thrive on them. Some
babies feed every 1 to 2 hours. Some babies only feed every 4 to 6 hours. In
the first 2 days of life the baby's appetite is usually poor. Newborns often
lose weight in the first week and are then back up to their birth weight by
their 2 week old office visit. Prematures tend to
lose more weight for a longer time.
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Bowel Movements, Stools or Poops
Newborns start with sticky frequent dark meconium
stools that are non-irritating. These change to loose yellow stools which are
irritating. When breast feeding the stools often stay loose
and frequent. To protect the skin in the diaper area
use only water to clean the area, dry thoroughly with corn starch powder, and
if reddness begins use petrolatum or ointment to
protect the skin after drying. When using formulas the stools become
mushy or pasty over the first 2 weeks. If the baby tends to have a hard time
passing stools then you may offer the baby sugar water twice a day. {Sugar
water: mix one teaspoon of table sugar in 1 ounce of boiled and cooled water.}
The normal baby will wet the diapers at least twice a day and usually much more
often.
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Love that Baby
Babies are learners from the start. Before birth the baby hears voices of the family and after birth the baby tends to be content when spoken to by the family members. Newborns like looking at faces also. Most newborns like be held and rocked. Many like listening to music. At 4 weeks of age be prepared to talk to, look at, hold and rock,and play music to your baby often since this is usually the age when infants cry the most. Babies learn speach patterns and develop a sense of security in the first 6 months. The more you hold your baby in the first 6 months the more independent the baby will be later on. Spoiling only becomes a problem later on when the family does things for the child that the child may do without help.
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Breathing
Babies have less Sudden Infant Death Syndrome (SIDS) when they sleep on their back or side. The risk of SIDS is much higher if the baby sleeps on the stomach on something soft like a sheepskin, a waterbed, or a bean bag pillow. About 1 in 10 babies will only sleep on their stomachs. These babies should only sleep on a firm mattress with only a thin pad and sheet under them. Sneezing is very normal in newborns. If the baby is congested try sucking loose mucus from the nose with a bulb syringe. To loosen mucus in the nose or help with congestion you may use salt water nose drops. {Nose drops: 1/8 teaspoon salt in 1 ounce of boiled and cooled water} Use 2 drops in each nostril up to every 2 hours. In the Winter when the air very dry a humidifier or vaporizer may help to loosen up dry mucus. Pediacare Infant Decongestant Drops may also be used with 0.4mls every 6 hours by mouth. If the baby is coughing often or breathing hard, and is unable to drink or sleep please call. Even without a fever an infant may have a viral pneumonia or a severe upper respiratory blockage which may need special treatment.
Smoke from cigarettes or wood stoves increases the risk of SIDS, ear infections, pneumonia, and food allergies. Smoking cigarettes is a difficult habit to break but it is well worth it for improved infant and adult health.
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Fever
If you feed, change, talk to, walk, rock, and play music to your baby and the baby is still fussing or feels very warm check the baby's temperature. A normal rectal temperature may go up to 100.5 F or 38.0 C. The average rectal temperature for well humans is 99.5 F or 37.5 C. Temperatures in the armpit tend to be lower by 2 F or 1 C and require you to keep the thermometer in the armpit for 5 minutes. A rectal temperature only takes 1 minute with the thermometer tip just inside the rectum. If the rectal temperature is over 103.0 F please call day or night. If the temperature is elevated but less than 103 F and the baby is otherwise well please call the office on weekdays or Saturday morning or the Answering Service Sunday at 8 AM. The baby will be seen that day.
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Vomiting and Diarrhea
If the baby has frequent vomiting and severe diarrhea dehydration may occur. If the baby is very sleepy and unresponsive to the family members or has a dry diaper for over 12 hours please call. If the baby vomits breast milk or formula try an oral electrolyte solution or oral rehydration treatment (OES or ORT). These may be bought at the store or a similar solution may be made at home. {OES: 20 ounces of boiled and cooled water with three teaspoons of sugar and 1/4 teaspoon of salt} Once the baby is keeping down the OES or ORT then breast milk or a lactose free formula may used until the diarrhea is gone. The most common of these formulas are the soy formulas: Isomil, Prosobee, or Nursoy; or Lactofree.
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Eyes
Thick frequent yellow/green mucus in the eyes indicates the presence of germs or bacterial conjunctivitis. This drainage is irritating and should be cleaned off with a clean cotton ball and boiled and cooled water. If there is frequent waterry drainage the tear duct between the inner corner of the eye and the inside of the nose may be blocked or poorly developed. If this continues over 12 months of age surgery may be needed. Infections in the eye may make the tear duct blockage worse. Call the office weekdays or Saturday morning or the Answering Service Sunday at 8 AM when there is thick drainage. If the eye is very swollen or red the baby will be seen but if it is a mild infection eye drops and an oral anti-bacterial medicine may be called in with a follow-up visit made. About one half the time infants get eye infections they also get an ear infection. The follow-up visit is mainly to check on the ears.
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Belly Button
The umbilical stump rots away over one to three weeks and then falls off. The triple dye or blue pigment often put on at the hospital nursery kills harmful germs that sometimes grow on the stump. To keep the stump from getting too smelly keep water off of it. If there is much mucus or blood at the base of the stump before it falls off use alcohol to clean it. Once the stump falls off hydrogen peroxide may be used to clean the belly button to remove old blood and mucus and to dry up the area.
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Newborn Boys
Circumscions are optional though 9 out of 10 boys in this area are circumscized. Circumscions or removing the end of the foreskin off the penis does prevent urinary tract infections in boys and prevents cancer of the end of the penis. Urinary tract infections decrease from 1 in 2,000 to 1 in 10,000 and the rate of cancer goes from 1 in 100,000 to 1 in 10,000,000 with circumscion. In Europe most boys are uncircumscized and in Canada about one half are circumscized. If there is much thick yellow pus and swelling of the penis around the circumscion please call. An oral antibiotic may be needed. If the site of the circumscion has some reddness and mucus use soap to clean and then put on triple antibiotic ointment (Neopsporin).
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Newborn Girls
In the first 2 weeks of life baby girls may have a cloudy white mucus discharge due to the effect of the mother's hormones prior to birth. These hormones also cause breast buds to develop in newborn boys and girls. There may also be a bloody vaginal discharge due to the withdrawal of the adult female's hormones.
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Jaundice
About one half of all newborns get a yellow orange color by three days of age. This color comes from the natural but toxic chemical: bilirubin. The average bilirubin level in a 3 day old is 7 but in children and adults the average level is less than 1. Levels of 40 are definitely toxic to the brain. About 1 in 10 newborns will get levels over 12. If the baby is full term and healthy bilirubin levels of 15 or less are considered safe by most experts. The levels are low at birth because the mother's liver gets rid of the bilirubin before birth. The levels rise in the newborn until the baby's liver starts to get rid of the bilirubin which is usually on the third day of life. Bilirubin comes from the hemoglobin of the red blood cells, so that a disease that breaks up more red blood cells may give more jaundice. Babies born early or with severe breathing problems are more sensitive to the toxic effects of bilirubin. Sunshine and fluorescent lights help to get rid of the bilirubin.
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Colic
About 1 in 20 babies will fuss all evening in the first few months of life. If they also are sleeping well at night, eat well in the day, and are without fever they might be having colic. If your baby does this please call during regular office hours so that the nurses may discuss what you may do. These babies are very frustrating but are usually healthy. If the feeding, changing, rocking, holding, and music fail to help sometimes a visit to the doctor will be needed to check for an infection or irrtation. Sometimes the diet may be changed to avoid food irritants or allergens. Even some breast fed infants may become sensitive to foods such as chocolate or milk that their mother's eat or drink. Cigarette smoking in the family tends to increase the risk of developing food and also inhalant allergies. Putting off the introduction of new foods tends to decrease the risk of food allergies. Solid foods usually are needed only after the baby is 13 pounds in weight or 4 months old.
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Bathing
Babies only need to be bathed every 3 to 4 days since their skin is dry. In very hot humid weather baths may be done more often. If the skin is especially dry soap should be avoided and only water used. Baby soaps are usually milder than regular soap. Skin lotions or creams may be used if the skin is cracked or red. Antibacterial soap should be avoided unless the skin is infected. These soaps have chemicals which may be harmful. Baby wipes may be used for travel care of soiled areas but plain water and a clean washcloth are usually easier on the diaper area.
Safety First
Infant car seats should always be facing backwards until the infant is old enough to be able to seat with assistance. Never place a backward facing car seat in front of an air bag.
Hot water should be at 120 degrees F or less. At higher temperatures burns with severe blisters form within a second. At lower temperatures there is time for feeling the heat and avoiding it.
To keep your brains healthy never scrape or sand lead paint.
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Education
This is probably the only time that your child will listen to you and learn with every expression that you say. So you better get a lot of information into the baby in this first year. Once your infant learns to breath, sleep, eat, smile, laugh, jabber, babble, roll , crawl and sit the baby is well on the way to human success. At this later stage the parent of the infant must start judging what the child may do safely without help.
PHILLIP C. GIOIA, M.D. MPH
Health Central, Suite 201
37 West Garden Street Auburn, New York 13021
(315) 253-6257
and
27 Fennel Street, Skaneateles, NY 13152
Fever Care
Fever is usually a response by the body to infection. Fever helps to fight infections by slowing the growth of the germs (bacteria or viruses).
Temperatures of 107 degrees F (42.7 C.) or higher, taken rectally, may cause permanent brain damamge. Rapidly rising fevers may cause convulsions or seizures or fits in 5 percent of children 6 months old to 7 years old. When an infection occurs, the body's thermostat is set upward. The average rectal temperature is 99.5 degrees Farenheit (F) or 37.5 C. and the oral temperature is 98.6 degrees F or 37 C. An infection may set the thermostat to 104 degrees F or 40 C. The body then cuts down on blood flow to the hands and feet to prevent cooling of the blood. This makes the hands and feet feel cool. The body may start shivering to produce more heat to increase the temperature toward the new thermostat value of 104 degrees (the set point). C stands for Celsius temperature scale of the metric system.
When the infection decreases, the body's thermostat goes back down to 99.5 degrees rectal from 104 degrees rectal. Then the body sweats and the hands and feet get warm in order to get rid of the excess heat in the body.
Rectal temperatures are about 1 degree F above oral temperatures and are about 2 degrees F above axillary, or armpit, temperatures.
Even adults must avoid exercising vigorously in extreme heat since it may cause temperatures over 107 F or 42.7 C. Automobiles left in the sun in the summer may get to 120 F easily.
WHEN TO CONTROL A FEVER
In the 5 percent of children 6 months old to 7 years old who have febrile seizures, or convulsions, fever control should be initiated at the first sign of fever. Febrile seizures generally have no long term effects but do cause shaking and unconsciousness for 5 to 10 minutes. When a first febrile seizure occurs call the doctor to be sure of what is happening. Children with febrile seizures should use acetaminophen every 4 hours or ibuprofen every 8 hours to prevent further febrile seizures. This should be done whenever there is a question of an illness starting until 7 years of age. Ibuprofen (Advil or Motrin) irritates the stomach so it should be avoided if there is vomiting.
In children without febrile seizures or convulsions, fever control may be delayed until the rectal temperature is at 104 degrees (103 degrees oral, 102 degrees armpit) or above in order to benefit from the infection fighting effect of the fever.
CAUSES OF FEVER
The best way to control a fever is by reducing the infection. If infection is caused by bacteria, an antibotic such as penicillin or amoxicillin may help. Ear infections, strep throats, pneumonia, and severe skin infections are usually treated by antibacterial medicines. Viruses which cause most colds and most cases of vomitting and diarrhea are not suppressed by antibiotics. If you are unsure of what is causing the fever, especially if the child is less than 12 months old or has a temperature above 104 degrees F or 40 C. rectal, you should call or see a physician in order to check for bacterial causes of fever. If the child is less than 6 months old or has a stiff neck or has bleeding under the skin, a physician should be contacted within the hour.
FEVER CONTROL
The easiest and most comfortable way to control a fever is by setting the body's thermostat back down toward the normal 99.5 degrees F rectal temperature. This is what acetaminophen and aspirin do. Aspirin use for fevers has been found to be associated with Reyes Syndrome, a rare but often fatal disease, which occurs after febrile illnesses. Aspirin has long been known to irritate the stomach. Aspirin should be avoided for fever in people less than 21 years old.
Acetaminophen or paracetamol is sold under many name brands: Tylenol, Tempra, Panadol,
By letting the heat leave the child's body and keeping the room moderately cool at 70 degrees Farenheit or below, the child's temperature will not rise as fast or as high. Children should only have on diapers or panties. They should not be wrapped up or bundled.
If the acetaminophen or the coolness of the room are not sufficient to keep the temperature less than 106 degrees Farenheit (41.8 C.) rectally, then sponging or bathing the child's body with room temperature water should be done. Very cold water or alcohol should NOT be used since they cool the skin too much and slow the flow of blood to the skin. Alcohol fumes may also be toxic if inhaled.