Newborns
I notice when there is an unusual or loud noise my newborn will have a brief episode of stiffening of her body as she straightens out her arms and opens up her hands. Is this normal?
Yes, what you are seeing is called the startle or Moro reflex. This reflex may follow after your infant hears noise or in association with an abrupt movement or other stimulation. It is noticed frequently at birth then gradually resolves by four months of age.
When a newborn starts sucking on his fingers or fists, does this mean that he is hungry and I should feed him?
The sucking reflex is a normal reflex that you may see even if your baby has just been fed. This is a survival reflex and will start to diminish between six and twelve months of age. Babies will suck on anything that is put in their mouth. Many newborns can be soothed with extra sucking using a pacifier or their fingers.
If I plan to stay home with my child and not send him to daycare, does my child really need vaccines?
In these days of global communities, it is more important than ever to immunize our children against diseases that are circulating and being imported by international travel. Keeping your child home does not guarantee that he will not be exposed to or contract these preventable, sometimes serious illness.
Why does my newborn turn red in the face when he is trying to have a bowel movement? Does this mean he is constipated?
Infants do not have the benefit of gravity to assist them in passing a bowel movement and may bear down and pass gas prior to passing a stool. As long as their stools are soft and not formed it is not constipation.
My newborn’s arms and legs tremble when she cries. Should I be concerned about this?
Trembling of the arms and legs when a newborn cries is a normal occurrence and usually subsides by 1-2 months of age. If you notice trembling when your newborn is not crying you should call and make an appointment for this to be evaluated by your pediatrician.
I sometimes notice that my infant's nose makes noises when she is breathing. Does this mean she has a cold?
Nasal noises in newborns are usually caused by dried mucus in the nasal passages, not a cold. Newborns are nose-breathers, especially during feeding. If your newborn is having difficulty feeding due to a blocked or stuffy nose, you can try a drop or two of warm water or over-the-counter nasal saline drops. Instill one or two drops one side at a time. This will loosen up the mucus so it can be cleared by sneezing, swallowing, or you can use a bulb syringe if necessary.
You may also hear gurgling noises from her throat. Babies do not know how to clear their throats and this noise is usually from air passing through normal saliva or milk. This is especially true while they are sleeping. This will resolve on its own as your infant gets older and learns to swallow more frequently.
Avoiding tobacco smoke, dust and strong odors will help minimize nasal congestion. You should call the office if the nasal washes are not working or if breathing becomes difficult.
Do you have more information on the types of rashes and birthmarks I may see on my newborn?
Infantile acne – More than 30% of newborns develop acne on the face which appear as small red bumps. Infantile acne usually begins around three to six weeks of age and may last 6-8 weeks. The cause is believed to be the transfer of maternal hormones just prior to birth. Since it is temporary, no treatment is necessary and it will resolve on its own. Baby oil or ointments may make it worse.
Drooling rash – Frequently babies will have a rash on the chin or cheeks that comes and goes. This is especially true in the dry winter months. Often these rashes are the result of contact with food or acid that has been spit up. Treatment is simply wiping the face with a soft moist cloth after feedings or spitting up.
Heat rash - This may appear on the face. These appear more in areas that come in contact while being held against the mother’s skin while nursing; these are seen more in the summer months. Changing baby’s position more frequently and applying a cool moist washcloth on the area usually helps.
Milia – This common newborn rash affects 40% of newborn babies. It is seen on the face, most commonly on the nose and cheeks but the chin and forehead may also be affected. Milia look like pimples but are much smaller and are not infected. They are actually blocked skin pores and the rash usually resolves by age four to eight weeks. No ointments or creams should be applied as this will clog the pores even more.
Mongolian spots – These bluish-green or bluish-gray birthmarks are flat and appear in over 90% of Native American, Hispanic, Asian and black babies. They are also seen in 10% of white children, especially those with Mediterranean descent. They are usually seen over the back and buttocks but can occur anywhere on the body. They are not associated with any disease and may vary in shape and size. Most fade away by 2-3 years of age, although a small few may persist into adulthood.
Stork bites or pink birthmarks – Flat pink birthmarks, also called capillary hemangiomas, occur in over 50% of newborns and are usually seen on the eyelids, the bridge of the nose and the back of the neck. The vast majority of these birthmarks appearing on the eyelids clear completely by 1 year of age, while those on the bridge of the nose may take a few years longer. Those that occur on the forehead and run from the bridge of the nose up to the hairline commonly persist into adulthood.
Breastfeeding
My baby is two weeks old and I am breastfeeding. How often should I be nursing her?
For the first month, in order to help establish a good milk supply you should nurse your baby every 1 ½ - 2 ½ hours (8 or more times a day). If your newborn has regained his or her birth weight you should wake her up during the day if more than 3 hours have passed since the last feeding. This is to encourage more daytime feedings and longer stretches of sleep at night. For infants with sluggish weight gains, your pediatrician may suggest shorter stretches during the day and waking them up if they sleep longer than 3-4 hours at night. Around 1 month of age or when your baby is gaining weight well, you can feed on demand and stop waking them up for feedings.
I was told to nurse my newborn from both breasts at each feeding but frequently find that after 15-20 minutes on the first side she falls asleep and does not seem hungry anymore. What should I do?
Babies get most of the milk out of the breasts in the first 7-10 minutes of suckling. After 10 about minutes of nursing, your newborn may find it takes more effort and energy to completely drain the breast. Many newborns will still hold the nipple in their mouth and linger even though they are not actively nursing. Some even fall asleep at this time. In the first week or two you can limit nursing on the first breast to 10 minutes, then nurse up to 15 minutes on the second breast if the baby is actively suckling. Remember to alternate which breast you start on, and keep in mind you may need to stimulate your newborn to take the second breast. At around 2 weeks, or when your milk supply is in and the baby is gaining weight, you can allow your baby to nurse up to 20-30 minutes on each breast to get the high-fat, calorie-rich hind milk.
General Questions
When do I bring in my baby for well visits?
We typically see newborns within days after being released from the hospital. After this initial visit, we schedule well visits at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months and 2 years. After 2 years of age we see children for well visits on a yearly basis. You may want to check with your insurance carrier, as coverage and length between well visits vary from plan to plan.
What vaccines will my child receive at their well visit?
Click here to see a guideline on what vaccines your child will receive. It may change as different combination vaccines come out, and issues with supply may cause the schedule to be amended.
What is the difference between a well visit and a sick visit?
Well visits, or yearly check up examinations are broad in scope and cover age-appropriate milestones such as language development, sleeping and eating patterns, fine and gross motor skills, and age-appropriate social issues. In these visits, the physical exam may be more extensive and include a neurological exam and a head to toe assessment. At these visits your pediatrician will ask you about any concerns you may have about your child’s development.
Sick visits are typically shorter visits that address a particular symptom or group of symptoms that have been present for a short period of time usually in conjunction with an illness.
If you find that your child has an ongoing or chronic issue, our schedulers and/or triage nurses will be happy to find an appropriate appointment that will give your child’s pediatrician ample time to address these problems.
I think my child may have ADD/ADHD, what do I need to do to get that evaluated?
All of our physicians use a certain type or combination of questionnaires to start the assessment for ADD/ADHD. Typically a parent calls the office with the concern and we have the parent pick up two sets of questionnaires. One set contains questions for teachers, and the other is for parents. These are filled out and brought back to the office and scored. The doctor will review the results, and the parents are usually contacted to set up a conference.
Vaccines
If I plan to stay home with my child and not send him to daycare, does my child really need vaccines?
In these days of global communities, it is more important than ever to immunize our children against diseases that are circulating and being imported by international travel. Keeping your child home does not guarantee that he will not be exposed to or contract these preventable, sometimes serious illness.
Will my child receive any vaccines containing thimerosal?
No. All of the vaccines we use are preservative-free and contain no thimerosal. In 1999 the FDA reviewed use of thimerosal in childhood vaccines and found no evidence of harm but as a precautionary measure recommended removing thimerosal from vaccines routinely given to infants. Since 2001 all vaccines manufactured for the US market and routinely recommended for children 6 years and younger have contained no thimerosal or only trace amounts (less than 1 microgram per dose).
What are the most common side effects of vaccines?
The most common side effects seen with vaccines are redness and tenderness at the injection site, irritability and fever for up to 48-72 hours after receiving vaccines. You may also see some mild alteration in their sleeping and eating patterns for a few days.
Will I be given any information about the vaccines my child will receive prior to getting them?
Yes, by federal law all parents and/or guardians are given Vaccine Information Sheets which give you basic information about what illness the vaccines help to prevent and possible side effects. In addition, any of our doctors or nurses will be happy to answer any questions you may have about vaccines.
Do vaccines cause autism?
There have been many studies that have looked at whether there is a relationship between childhood vaccines and autism. The results of these studies concluded that the weight of the evidence indicates that there is no association of autism with childhood vaccines.
Where can I find more information about the alleged relationships between vaccines and autism?
There is an abundance of information about the casual relationship between autism and vaccines on the internet. Much of this information is not factual information and has no scientific basis. We recommend the Centers for Disease Control or the American Academy of Pediatrics.
