Dr

SHOULD I WORRY IF MY BABY IS JAUNDICED?
Jaundice is the yellowish discoloration of the skin that occurs in as many as 50% of normal babies. Jaundice is due to the buildup in the blood of bilirubin, which is released from the normal breakdown of red blood cells. Bilirubin is mostly processed by the liver and eliminated from the body in the stool. Most newborn jaundice clears up without treatment when the baby is about a week to 10 days old. There are several potentially problematic conditions that may cause the jaundice to be more of a problem to the newborn, including infections, thyroid abnormalities, liver disease, and any condition that causes abnormal breakdown (hemolysis) of red blood cells. An abnormally high level of bilirubin requires phototherapy (light therapy) treatment. Phototherapy delivers ultraviolet light that helps the infant excrete bilirubin in his urine by making it more water-soluble. It also helps induce bowel movements, so the child can excrete bilirubin in the stool. Depending on the cause of the jaundice, treatment may or may not be necessary. Untreated bilirubin levels that stay very high for a long period of time can cause brain damage. If you are worried about the child’s skin coloration seek medical evaluation.

IS MY BABY STOOLING NORMALLY?
By the fourth or fifth day of life, a breastfed baby's bowel movements will be yellowish and loose (even watery for the first 3 to 4 weeks), have a seedy consistency, and have an odor of yogurt. Normal baby bowel movements change from meconium (black to dark green tarry consistency) to transitional, to normal yellow, seedy baby stool within a one week period and should be expected. Between about 4 days and 4 weeks of age, your baby will have at least four bowel movements a day, usually one during or after each nursing session. Breast-fed babies may have as many as 7-8 stools per day or may go as long as 7 - 8 days between bowel movements, and bottle-fed babies may go as long as 3 to 4 days between bowel movements. Therefore, one cannot count on the frequency of stooling in infants to define constipation or stool problems. Rather the texture and/or consistency of the stool will determine whether any intervention is necessary. If any baby regularly has hard-formed bowel movements regardless of feeding method, intervention may be necessary. Treatment may be as simple as increasing the amount of fluid or may require more aggressive measures.

HOW SHOULD I CARE FOR MY BABY'S UMBILICAL CORD?
Apply rubbing alcohol to the umbilical cord with each diaper change until the cord separates to decrease the possibility of infection and to facilitate separation of the cord. No tub baths (or submerging the infant under water) are recommended until the umbilical cord has separated from the abdominal wall and is no longer oozing. Do not be afraid of pulling off the cord - be aggressive and lift the cord away from the abdominal wall to allow the alcohol to get to the base of the cord where it needs to be applied.

SHOULD I HAVE MY BABY BOY CIRCUMCISED?
The decision as to whether to have a male infant circumcised traditionally has been made based on cultural , ethnic, or religious beliefs or customs. However over the past few years studies involving large numbers of male children in military families enabling long-term follow-up has shown a significant decrease in urinary tract infections and, later on in life, decreased incidence of cancers of the male penis in circumcised males versus those uncircumcised. Although the decision whether or not circumcision is performed is still largely emotional, there is now at least some medical evidence to support the decision. Recently the American Academy of Pediatrics has stated that the benefits of circumcision do not justify it being done as a routine procedure.

HOW SHOULD I CARE FOR MY BABY BOY'S CIRCUMCISED PENIS?
Post-circumcision care consists primarily of keeping the circumcised penis clean. We recommend using no soaps (which can cause pain and irritation to the raw foreskin) and using just a warm water washcloth to clean the penis. After cleansing, use of petroleum jelly directly on the penis or preferably on a gauze pad which is then loosely applied around the end of the penis will facilitate healing of the circumcision and will prevent the raw foreskin from sticking to the diaper thereby preventing breaking loose the skin when the diaper is removed during changing.
HOW SHOULD I CARE FOR MY BABY BOY'S UNCIRCUMCISED PENIS?
No pulling on the uncircumcised foreskin is necessary as the skin will loosen on its own during the first several years of life. Other than routine cleansing as with any other body part, no special care is required.
WHAT ABOUT DAY CARE CENTERS FOR MY BABY?
Day care centers provide a necessary service for working parents but no doubt subject the baby to many infectious diseases most of which are not serious or life-threatening. Private day care or baby-sitters offer an alternative but are expensive and sometimes not readily available.

IN WHAT POSITION SHOULD I PUT MY BABY TO SLEEP?
Placing the baby on his back to sleep is the recommended position due to some large population studies in Europe and Australia which showed a significant decrease in the incidence of Sudden Infant Death Syndrome (SIDS) in babies sleeping in the supine position (on his back) or alternatively on their sides. Babies usually will not roll over on their own until 5 to 6 months of age at which time they are out of the high-risk time of their life for SIDS.

WHAT CAN I DO FOR MY COLICY BABY?
Colic is a common condition in infants under 3 months of age. It is characterized by intense crying and fussiness which is episodic in nature usually occurring the same time of day or night lasting anywhere from 1 to 5 hours. During this time the baby may be inconsolable and may act as if he is having stomach problems and draw up his legs and pass gas. The cause of colic is unknown and it occurs in both breast- and bottle-fed babies. Colic usually goes away by the age of three months and no one "treatment" is universally effective in controlling symptoms or preventing recurrence. Symptomatic treatment with Simethicone drops is sometimes helpful for the gassiness which accompanies colic. Pediatricians sometimes will use medications to calm the stomach and sedatives to allow the child to sleep but the risks of side effects of these medications must be weighed against any possible benefits they may give.

MY BABY GIRL IS HAVING BLOODY VAGINAL DISCHARGE, SHOULD I WORRY ABOUT THIS?
Vaginal discharge and/or bleeding in the newborn female infant is a common phenomenon and is usually considered normal. It occurs due to the changing levels of maternal hormones in the last few weeks of the pregnancy and is somewhat worsened by breastfeeding. Unless an abnormal amount of bleeding occurs (more than 30 ml) or bleeding occurs over a prolonged period of time, no intervention is usually required or indicated.
WHAT SHOULD I DO WHEN MY BABY DEVELOPS A DIAPER RASH?
Diaper rashes are very common in all newborns and in all babies still in diapers and occur in various forms. The most common diaper rash is irritant type and is essentially a reaction or sensitivity of the skin to urine and/ or stool when it comes in contact with the skin. Simple hygiene and frequent changing of diapers usually is all that is necessary to treat and prevent irritant type diaper dermatitis. Yeast diaper dermatitis is very common as yeast (which normally resides along the digestive tract of all infants) thrive in a warm, dark, moist environment such as an infant's diaper. Over the counter antifungal creams usually will successfully treat yeast diaper dermatitis and should be used with each diaper change until clear. Frequent loose stools or alkaline stools which often accompany diarrhea can cause some breakdown of the perirectal skin. The use of a cream which neutralizes the alkalinity of the stools or the skin with which it comes in contact can be helpful in treating this type of diaper rash. Petroleum jelly and similar skin barrier topical preparations can be helpful in protecting the baby's skin from further rashes.

HOW SHOULD I DRESS MY BABY?
Babies should be dressed in one layer of clothing more than what an average adult would be comfortable in to maintain normal body temperature. Be careful not to overdress an infant. Be sure to put shoes or proper footwear on the baby's feet when outdoors as this will help prevent any injury to the feet as well as helping to prevent some parasitic diseases in areas endemic to schistosomiasis.

WHEN WILL MY BABY SLEEP ALL NIGHT?
Babies usually do not sleep through the entire night until approximately 6 months of age - some may sleep all night sooner than this, however. It is usually not necessary to awaken a sleeping child for feedings during the night once mom's breast milk has come in and regular breast-feedings are established. Making the nighttime awakenings non-stimulating by leaving lights off or low, not turning on radios, stereos, and/or televisions and not playing with the baby during these times will help somewhat Newborn with getting the baby to sleep better at night. Conversely, during the day when the baby is awake is the time for stimulation with playing, baths, etc. Over a period of time, these measures will help get the baby on a more regular, livable schedule.
MY BABY OFTEN HAS THE HICCUPS, IS THIS ANYTHING TO WORRY ABOUT?
Hiccups are very common in normal newborn infants and are in and of themselves nothing to worry about. Many babies have hiccups in utero before they are born and these can continue intermittently for months. Unless the hiccups are continuous (lasting for hours at a time), they are benign and require no specific treatment.

WHEN DOES MY CHILD RETURN FOR HIS NEXT HEALTH SUPERVISION VISIT?
At 1 month of age your child should have his next health supervision visit.