Mercy
Family Medicine
ABCs of INFANCY
INTRODUCTION
This information will help make you a better informed parent and assist you
in managing some relatively minor, but often troublesome problems that arise
in caring for infants and children.
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GETTING TO KNOW YOUR BABY
Sometimes new parents are unsure of themselves. But as long as your baby is
loved, well fed and comfortable, you need not worry that you are an inexperienced
parent.
Your baby is an individual from the day he or she
is born. As parents, and the people most closely involved, you will come to
know your baby best. Don’t take all the advice of well-meaning friends
and relatives too seriously. Trust your own judgment.
All babies sneeze, yawn, belch, have hiccups, pass
gas, cough, cry, can look cross-eyed and get fussy. These are normal behaviors.
Sneezing is the only way that babies can clean their noses. Hiccups are merely
little muscle spasms, and they often can be stopped by giving the baby a few
swallows of lukewarm water. Crying is a baby’s way of saying, "I’m
wet." "I want to be held." "I’m too hot." "I’m
too cold." "I’m bored." "I’m hungry." You
will gradually learn to know what your baby means when he or she cries.
Because your baby has not had time to build up
resistance to infection, try to limit visitors during the first few months.
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THE FAMILY
Your new baby represents a change in the family structure. If this is your first
baby, the couple’s relationship might change. Many new demands are placed
on the mother’s time and energy. She may find herself fatigued and susceptible
to periods of de-pression. These are not abnormal, but may call for some adjust-ment
in daily routines. One such adjustment, in order to give the new mother her
chance for appropriate rest, is frequent catnapping.
The new father may at times feel neglected. What
little time and energy the mother has available she may want to devote to some
of her own needs. New demands are often placed on the new father. Household
tasks which were previously shared equally or unequally between the father and
mother may, for a time, fall more heavily on the new papa. Some mild changes
or resentment are common under these circumstances. Mothers, too, sometimes
feel put upon by the new bundle of joy which she dearly loves. Neither father
nor mother are bad or evil parents for having these occasional feelings.
Siblings may feel insecure and need to be reassured
of your love for them and be made aware that the new arrival does not change
their position in the family. Regressive behavior may be noted and should be
dealt with firmly and positively.
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ROUTINE VISITS
Baby’s first planned office visit will be
at two weeks of age. Immunizations will begin in the hospital nursery. Subsequent
visits occur at two months, four months, six months, nine months, 12 months,
15 months, 18 months, and two years. These visits will include assessment of
growth, development, and general health as well as providing immunizations and
advice on safety and a variety of other parenting issues.
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IMMUNIZATION CHART
View the Recommended Childhood Immunization Schedule,
United States, 2002 by clicking on the graphic below:
UMBILICAL CORD CARE
The umbilical cord should be cleansed with a Q-tip and 70% alcohol three or
more times daily. This aids in drying the cord and promotes healing. The cord
usually falls off within one to three weeks after birth. If a few drops of blood
appear when the cord falls off, continue to clean the area with alcohol until
it is healed. Diapers folded below the navel help in keeping the umbilical area
dry. The baby should not have a tub bath until the cord falls off.
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CIRCUMCISION CARE
If the baby is circumcised, A & D Ointment or petroleum jelly may be applied
to the circumcision for three or four days. Notify the doctor if the circumcision
does not appear to be healing properly or if there is unusual swelling or bleeding.
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BATHING
Infants and older children may be bathed as often as needed. One or two baths
a week are adequate, depending upon the degree of cleanliness.
Sponge wash your baby until the umbilical cord
falls off. Then, the infant may be bathed in a small tub or basin. The room
should be comfortably warm and supplies readily at hand. A regular time for
bathing should be established and the experience should be a happy, playful
one.
Use a mild soap and warm water to wash the baby’s
body. Be sure to wash in the folds and creases of skin. Rinse well. Pat the
baby dry. If you use powder after the bath, always shake the powder into your
hands first because the baby could inhale the powder and have trouble breathing.
If the skin is very dry, you may use baby lotion sparingly after the bath.
Wash the face with a soft cloth and clear, warm
water. Do not try to clean the inside of the nose and ears, but clean outer
areas with a moist washcloth. Never Use Q-tips in ears.
Wash your baby’s head with a mild shampoo.
Work from front to back, keeping the suds out of the baby’s eyes. Carefully
clean over the soft spot on a young baby’s head. If you notice a greasy
scaling on the scalp, follow the instructions for Cradle Cap.
Nails may need to be trimmed when they grow beyond
the ends of the fingers or toes. Cut nails or use an emery board straight across
without rounding the corners so that ingrown nails can be prevented. To avoid
injury, use a nail clipper.
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CLEANSING THE GENITALS
Care of the genitals is the same whether using
a sponge or in a tub bath. In caring for girls, cleanse gently with a washcloth
and spread the labia apart and cleanse downward toward the rectum with a cotton
ball for each downward stroke. Do not clean up from the rectum as this could
cause some contamination of the area. A mucus or bloody discharge may be present
for up to three weeks of age and is normal.
In caring for boys, moisten a cotton ball or soft washcloth and gently cleanse
the penis. Plain petroleum jelly or A & D Ointment may be applied to the
circumcision if it is raw and sore. When washing your baby boy, lift the scrotum
and cleanse underneath to prevent irritation. After every bowel movement, clean
between the groin and buttocks with water or a "baby wipe." Apply
A & D or Desiten ointment if mild irritation is present.
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DRY SKIN CARE
The following information is given to increase
moisture in the skin and make it less itchy and less susceptible to irritation.
1. Take baths and showers as infrequently as possible and rely on "sponge
baths" for cleanliness.
2. Use body temperature water in the shower and tub and make the shower or bath
as short as possible. Don’t soak.
3. Pat dry rather than rubbing dry.
4. Use a mild non-detergent soap such as Dove or Tone.
5. Avoid contact with irritation elements in the environment; i.e., wool clothing,
alcohol, detergents, etc.
6. Apply moisturizer or medicated creams after washing, such as Vaseline Intensive
Care Lotion, Eucerin Cream, A & D Ointment, etc.
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SLEEPING
The infant should always be placed on his/her back or side when put to bed or
nap. Recent studies have shown that this sleeping position reduces the incidence
of sudden infant death syndrome. During the first six months of life sleep patterns
can vary.
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FEEDING
Whether you breast feed or bottle feed your baby, you will find it is one of
the times when you will feel closest to your baby. The physical closeness and
face-to-face position promotes feelings of intimacy. The pleasure your baby
gets from feeding makes him/her feel secure and generates the earliest feelings
which will grow into love for the parents.
BREAST FEEDING
You may need to help a newborn baby start nursing.
Do not push the baby toward the breast. Instead, as you hold the baby, gently
stroke the cheek nearer the breast. The baby will respond by turning his or
her head to the breast and seeking the nipple.
The nipple and the dark area around it (the areola)
should be in the baby’s mouth. Pressure from the baby’s mouth on the
areola releases milk from your breast. You may need to place a finger or two
on your breast to keep it away from the baby’s nose. Use both breasts during
each feeding. Breast milk supply is not well established until three to six
days after delivery. So do not be discouraged if the baby seems to getlittle
milk at this time. Breast fed infants should be encouraged to feed every two
to three hours during the day. Hind milk is not available until after five to
eight minutes of nursing and is richer in calories and fat content. Most newborns
nurse 8 to 12 times in a 24 hour period. The amount of milk you produce is directly
related to how frequently the baby nurses. When you first begin to nurse, put
the baby to each breast for about five to ten minutes. Gradually build up to
10 to 15 minutes at the first breast. Continue at the second breast until your
baby is satisfied. Many babies will suck for a long time; however, the milk
is usually emptied from each breast in 10-15 minutes. Alternate which breast
you start with.
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BOTTLE FEEDING
Bottle feeding requires the preparation of formula, but it gives the father
the opportunity to share in the infant’s feedings. Formulas come in concentrated,
powder or ready-to-use forms. We generally recommend Enfamil or Similac with
iron. If you want to use some other formula, please discuss this matter with
your doctor.
Hold the bottle so that the neck of the bottle
and nipple are always filled with formula. This helps your baby receive formula
instead of air. Air in the baby’s stomach may agravate the normal tendency
of infants to spit up and may cause discomfort. Most bottle fed babies feed
every three to four hours. Let your baby’s appetite guide how much to feed.
Most babies require only one to two ounces at first. When your baby regularly
takes four ounces at a feed, try putting five to six ounces in the bottle. When
your baby takes 28 to 32 ounces of formula a day, please ask you doctor about
starting solid food.
Never prop a bottle and leave your baby alone to
feed (in the bed or otherwise). The bottle could slip and make the baby gag.
Drinking from a propped bottle will cause tooth decay (cavities) in older infants
(one year or greater). Remember, too, your baby needs the security and pleasure
of being held at feeding time. Face-to-face contact is very important for your
baby. Most babies feed for 15 to 20 minutes. Sometimes your baby will take all
the formula in the bottle and sometimes not. Don’t worry; this is normal.
You should never force your baby to eat or to finish every bottle. Throw out
any formula left in the bottle
After feeding time, rinse the bottle with cool
water and squeeze water through the nipple hole. Although you will wash the
equipment thoroughly later, nipple holes may clog if they are not rinsed after
use. Test nipples regularly to be sure the holes are the right size. If the
nipple holes are too small, the baby may tire of sucking before getting all
the formula he or she needs. If the holes are too large, the baby will get too
much formula too fast. The baby may also get so much air that he or she spits
up all or part of the feeding. When the nipple holes are the right size, infant
formula should drip smoothly, without forming a stream. Check the nipples periodically
for excessive wear. Tears or stickiness indicate nipples that should be discarded
to prevent a choking hazard.
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SOLID FOODS/OTHER LIQUIDS
All the infant needs for nutrition during the first four months of life is breast
milk or formula. The addition of cereals and other foods to your baby’s
diet will be discussed at the four month checkup.
SPITTING UP
feeding, try using nipples with a smaller hole.
Thickening the formula with rice cereal is also sometimes helpful. If your baby
screams or arches its back or has blood in the spit-up you should see your doctor.
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BURPING
Burping your baby helps remove swallowed air. To
burp your baby, hold him or her upright over your shoulder, and gently pat or
rub the back. Another way is to place the baby face down across your lap and
gently rub the back. Or you can sit the baby on your lap, leaning slightly forward,
with you hand supporting the chest and/or chin.
Burp your baby once or twice during, as well as
after, each feeding. Sometimes, a baby will not be able to burp. Do not try
to force the baby to burp if the first few attempts are no successful. Don’t
be alarmed if your baby spits up a few drops when being burped.
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BOWEL MOVEMENTS
It can be normal for some babies to have a stool after each feeding. Other infants
have less frequent stools. Breast fed infants average from two to four stools
a day with a range of one to seven during the first three or four months of
life whereas formula fed infants average one or two stools per day. Breast fed
babies usually have yellow to golden loose stools whereas formula fed infants’
stools are pale yellow to light brown or brownish green and are firm in consistency.
Occasionally, infants have very infrequent stools, sometimes only one in two
to three days, and this can be normal. By the end of the first year of life,
many infants have only one stool a day, although more or less than that is not
abnormal.
As the infant grows older, the stools become more
characteristic of those of adults in both odor and color. By two years of age,
the stools usually become formed although young infants may have formed stools
especially if their diet is high in protein.
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PARENTING FOR THE OLDER INFANT
AND CHILD
This section discusses symptomatic treatment of certain illnesses; gives medicine
dosages, immunization side effects and their management; and answers other frequently
asked questions.
THE COMMON COLD
The common cold is caused by viruses and is characterized by clear, white or
cloudy nasal drainage and often a decrease in appetite. Young children may have
a low-grade fever (less than 101.4 degrees) during the initial stages. The duration
of the average cold is three to seven days. Antibiotics are of no value unless
there is evidence of a bacterial infection in addition to the "cold"
virus. Young children average 6 colds a year.
TREATMENT IS AS FOLLOWS:
Encourage liquids, especially clear fluids. Use a cool-mist vaporizer containing
only water at the bedside during naps and at bedtime. This will help keep the
secretions more liquid and enable the child to clear them more easily. The vaporizer
should be emptied and dried after each use. Periodically you should clean your
vaporizer. Fill it with cold water, and add 1/4 cup liquid bleach. Run for 1
1/2 hours. Pour this solution out, refill with cold water and run again for
1 1/2 hours. Pour this water out and the vaporizer is again ready for use. This
process should be done outside or in a room where the windows can be opened,
since this odor will go through the whole house.
Older infants and children may take a decongestant
by mouth. Smaller infants may use two or three drops of saltwater nose drops
(made by dissolving 1/4 teaspoonful table salt in four ounces of warm water
or purchased in the drug store) in each nostril followed by bulb suction as
often as needed.
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FEVER
Fever itself does not hurt the child. The reason
we try to control the temperature is that, just as with adults, children seem
to react and feel better when their temperatures are near normal. Fever, however,
in an infant under 12 weeks of age in and of itself is an indication for phoning
the doctor. It should not be treated unless the physician has been contacted.
Fever of 101 degrees Fahrenheit or less in a child
who acts well with cold symptoms or other obvious mild infection (such as chicken
pox) may be treated with Tylenol or Tempra to make the child more comfortable.
However, unexplained fever or fever that persists more than 48 hours is reason
for consultation with your doctor. Your child will probably need to be seen.
For fever greater than 102.5 degrees Fahrenheit,
consult your doctor immediately. In young infants and children a rectal or axillary
temperature may be taken. For children who are old enough to cooperate, an oral
temperature or ear temperature is fine. Please do not add or subtract any degrees
when reporting fevers. Report the reading on your thermometer and how the temperature
was taken. Be sure to dress your child lightly when he or she has a fever. Excessive
clothing or bundling in blankets may cause the fever to go higher. Cool liquids
to drink will help bring a fever down.
|
TEMPRA/TYLENOL DOSAGE*
|
| |
|
|
|
|
| Age |
Weight |
Drops |
Syrup |
Chewables |
| 2-3 mos |
*****
|
1/2 dropper (0.4 ml) |
1/4 tsp |
*****
|
| 4-11 mos |
13-20 lbs |
1 dropper (0.8ml) |
1/2 tsp |
*****
|
| 12-24 mos |
21-26 lbs |
1 1/2 droppers |
3/4 tsp |
*****
|
| 2-3 yrs |
27-35 lbs |
2 droppers |
1 tsp |
2 tablets |
| 4-5 yrs |
36-43 lbs |
3 droppers |
1 1/2 tsp |
3 tablets |
| 6-8 yrs |
44-62 lbs |
4 droppers |
2 tsp |
4 tablets |
| 9-10 yrs |
63-79 lbs |
*****
|
2 1/2 tsp |
5 tablets |
| 11 yrs |
80-89 lbs |
*****
|
3 - 4 tsp |
6 tablets |
| 12 yrs |
90 lbs |
*****
|
3 - 4 tsp |
6-8 tablets |
| to adult & over |
*****
|
|
|
|
| Dosage may be given every 4 hours
as needed. |
HOW SUPPLIED:
DROPS: Each 0.4 ml contains 40 mg of acetaminophen
Each 0.8 ml contains 80 mg of acetaminophen
SYRUP: Each 5 ml teaspoon contains 160 mg of acetaminophen
TABLETS: Each tablet contains 80 mg of acetaminophen
*If child is significantly under or overweight, dosage may need to be adjusted
accordingly. |
If Tempra or Tylenol does not control the fever,
and it is greater than 102.5 degrees Fahrenheit, lukewarm or body temperature
sponge baths should be given or you may use children's ibuprofen (Advil, Motrin).
The child should be placed in a bathtub with room temperature water up to the
navel and allowed to play with a familiar toy while water is poured over the
body so that evaporation can occur. The child should remain in the tub for at
least 15 minutes. It may take 45 to 60 minutes to reduce the fever. Note:
Alcohol baths are not recommended as the alcohol may be absorbed through the
skin and enter the child’s blood stream.
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VOMITING AND DIARRHEA
These may occur together or separately. The most
common cause is a virus and therefore only the vomiting and/or diarrhea can
be treated. If these occur in a newborn or small infant, call the office
Symptomatic treatment for older children is as
follows:
The child with vomiting should be
given nothing by mouth for one or two hours. After that, one or two teaspoonfuls
of the syrup from canned pears or peaches may be given every 10-15 minutes for
four doses. After this, clear liquids in small quantities may be started. These
include ginger ale, Seven-Up (with bubbles stirred out), Jello, Jello water,
Kool-Aid, Gatorade or soup broth. For a child with diarrhea alone, Gatorade,
Pedialyte or other oral rehydration solutions can be tried. If these are tolerated,
the child may be given a regular bland diet after 12-24 hours, without dairy
products or excessive sugar content. After that, milk is then reintroduced,
if tolerated. Do not maintain a child on a strictly clear fluid diet beyond
48 hours as this provides very little nutrition for a child and may prolong
the diarrhea.
Call your doctor if:
1. The child does not show improvement with these measures within 48 hours.
2. The urine output is greatly diminished.
3. There is blood in the bowel movements.
4. Oral intake is poor.
5. There is a high (103 degrees Fahrenheit or above) or prolonged fever.
6. The pain is localized in the abdomen.
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DIAPER RASH
Although there is sometimes no obvious reason for
irritation of skin in the diaper area, it can be caused by a number of things,
such as:
1. Diarrhea
2. Excessive wetness of the diapers.
3. Yeast (monilia) infection.
4. Reaction to the soap, detergent, bleach or fabric softener used in washing
the diapers.
To clear up the rash:
1. Leave the skin exposed to air as frequently and as long as possible.
2. Wash well after every bowel movement with water.
3. Use a protective ointment on the infant’s bottom (i.e. A & D Ointment,
Desitin, Zinc Oxide, or Diaparent Ointment/Cream).
4. Stop using bleach and fabric softeners when washing cloth diapers.
5. Change diapers as soon as they are wet or soiled. Using a high absorptive
disposable diaper at night might be helpful.
6. If the rash does not improve in 48 hours, call your doctor. He/she may recommend
an over-the-counter antifungal (lotrimin, monistat).
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TEETHING
The degree of discomfort associated with teething varies greatly from child
to child. The common symptoms include excessive chewing on objects or fingers,
fretfulness, awakening at night, a temporary decrease in appetite and loose
stools. Teething alone is never the cause of high fever, rashes, vomiting or
severe diarrhea.
Rubbing the gums with such remedies as Oragel or
Numzit (no prescription needed), or letting the child chew on an ice cube wrapped
in a tower or a cold teething ring may be temporarily soothing. Tempra or Tylenol
(acetaminophen) may relieve fretfulness. Encourage fluid intake, but do not
force food.
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CRADLE CAP
This is a crusting and scalines of the scalp that may extend down the forehead
to the eyebrows and behind the ears. It occurs frequently during the first six
months.
For mild cases, frequent shampooing using a washcloth
to thoroughly cleanse the scalp will suffice. For more severe cases, washing
with Head & Shoulders shampoo is helpful. Remember that the baby’s
soft spot is durable and will not be injured by thorough washing. Application
of oil should be avoided unless it is used as a means of removing crusts. The
oil should be thoroughly removed with soap and water.
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CONSTIPATION
In infancy, constipation may be indicated by intermittent straining and irritability
relieved by passage of a hard or firm stool.
Both infants and older children may withhold stool
because of fear of pain on defecation. Frequently, children who pass a large,
hard stool will experience pain or have a blood-tinged stool which is caused
by a small tear or fissure near the rectum. (If repeated pain or bleeding occurs,
call you doctor.)
Constipation can occur at any age. It can usually
be managed by altering the diet. Remember, bowel habits normally vary the first
six months of life. For the child under six months of age, Karo syrup (one teaspoonful
per eight ounces of formula) can be used for several days. For older children,
increasing fluids, fruits, juices, vegetables and bran can help to regulate
bowels. If the infant is in pain a glycerin suppository may be tried.
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COLIC
A baby with colic is irritable, fussy and cries frequently despite looking healthy
and growing well. This condition usually starts at about one to two weeks of
age and may last until the baby is about three or four months old. The baby
usually cries and draws the legs up as if having cramps. These symptoms can
occur anytime but often are in the afternoon and evening hours and are often
not relieved by rocking, holding or feeding. Keep in mind that holding the infant
will not spoil the child and may help.
In most cases, no causes can be determined, however,
other causes of crying should be ruled out. Your doctor will want to examine
our baby and discuss this with you.
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SAFETY ISSUES
CAR INJURIES
Car crashes are the biggest danger to your
child’s life and health. Most auto injuries and deaths can be prevented
by the use of car safety seats. Besides being much safer in a car seat, your
child will behave better, so you can pay attention to your driving. Ask your
doctor which seats are safe. Make the "First Ride" a safe ride home
from the hospital.
Make certain that your baby’s car seat is installed properly. Use it every
time your child is in the car. Remember that no child in a car seat should be
in the front seat of a car with an airbag. If there is no airbag installed in
your car the child should be rear facing in the carseat while in the front of
the car.
FALLS
As soon as he is born your baby will wiggle and move and push against things
with his feet. Even these very first movements can result in a fall. As he grows,
he will suddenly be able to roll over and fall off everything. Do not leave
him alone on high places such as changing tables, beds, sofas, or chairs. If
left unprotected, he will fall.
He may be able to crawl as early as six months. Use gates on stairways and keep
him out of rooms where he might hurt himself.
HEAD INJURIES
You should call the office/hospital if any of the following occurs after a fall:
1. If the child is under two years of age.
2. There is a convulsion or loss of consciousness.
3. The child complains of weakness, or is unable to move one or both arms or
legs.
4. Walks with a peculiar gait, stumbles or behaves in a definitely peculiar
way.
5. Becomes very sleepy, and you cannot wake the child easily.
6. The child’s eyes move peculiarly, has difficulty focusing, or one pupil
looks larger or different than the other.
7. The child vomits.
If none of these occur and the fall or accident was fairly minor, you may observe
your child carefully at home. Initially, give your child only clear liquids,
such as Kool Aid, tea or juice, for eight hours. Observe the child carefully
for 12-24 hours. You may allow the child to sleep, but check every two hours
while sleeping. See that there is a normal response to gentle shaking and that
the color and breathing are normal. If you are uncertain of the condition, call
your physician.
BURNS
At three to five months, your baby will wave his fists and grab at things.
NEVER eat, drink, or carry anything hot near your baby or while you are holding
him. He will get burned. You can’t handle both! If your child does get
burned, put the burned area in cold water immediately. Then cover the burn loosely
with a bandage or clean cloth. Call your doctor for all burns. To protect your
child from scalds, reduce the temperature of your hot water to 120-130 degrees
Fahrenheit.
To protect your child from house fires, be sure
you have a smoke alarm in your house.
CHOKING
Your baby will soon be exploring his environment by putting anything and
everything into his mouth. NEVER leave small objects in your baby’s reach,
even for a moment. NEVER feed him hard pieces of food. He may choke. Be prepared
for this very serious event.
Learn how to save the life of a choking child.
Your doctor will recommend the steps you need to know.
INGESTION OF TOXIC SUBSTANCES
If your child swallows something potentially harmful (poisons, cleaners,
adult medications), you should call the Poison Control Center at Cardinal Glennon
Hospital, 772-5200. Give the name of the product, the amount ingested and any
ingredients on the container. The people on duty will tell you what to do.
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FREQUENTLY ASKED QUESTIONS
1. What should I do after office hours if I have a problem?
Most of the routine problems can be handled by using good judgment
and following these instructions until morning. If there is an emergency, such
as seizure, possible fracture, difficult breathing, serious head injury, poisoning,
bleeding or cuts needing stitches, take your child to a hospital emergency room.
You may call your doctor through the hospital operator or exchange if there
are other urgent problems with your child’s health.
During the daytime office hours, there are a number of people available for
referral and notations; and questions can be answered at that time. After office
hours or weekends when the above situation is not present, the doctor can be
reached through his/her exchange.
2. What medicines should I have on hand?
You should keep Tempra and Tylenol to treat fever and/or pain. A cool mist vaporizer
is helpful, especially during the winter months. A decongestant that works well
for your child should be available to treat symptoms of a cold, congestion,
runny nose or cough.
If your child has a history of allergies, bronchitis or asthma, it would be
wise to keep on hand the medication that your doctor has prescribed.
Lastly, you must remember to keep these medications out of reach of small children.
A lot of families keep Ipecac on hand to induce vomiting should the child ingest
something. However, before this is given, Poison Control Center should be contacted
for specific advice.
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