Are You Expecting?
Congratulations! At this exciting time, you may have many questions regarding the care of your new baby. This guide will provide answers to some of your questions. We will be happy to discuss any additional concerns with you.
As of April 1, 2016, the doctors at Advocare Parsippany Pediatrics will no longer be visiting or directly caring for newborns or hospitalized children at St Clare's Hospital, due to policy changes directed by St Clare's new owners. We will continue to directly visit and care for newborns and hospitalized children at Goryeb Children's Hospital in Morristown Medical Center.
For an excellent resource providing up-to-the-minute pediatric health information, please visit healthychildren.org
, sponsored by the American Academy of Pediatrics.
Click here for questions about NJ State Newborn Screening (performed in newborn nurseries for all babies born in the state)
One out of eight new mothers experience postpartum depression. If you or a loved one has feelings of sadness that last more than a few weeks, seek help by calling 1-800-328-3838 or visiting http://www.njspeakup.gov
Successful Feeding in Newborns
How can you tell whether your baby is getting enough breast milk or formula? The best gauge of good nourishment is growth. All babies, both breast and formula-fed, tend to lose up to 10% of their birth weight in the first three to four days following birth. Daily weights are checked in newborn nurseries to ensure that the weight loss is within normal parameters and not excessive. Measurements of weight, length, and head circumference will be taken at each checkup, which is one reason why regular checkups are so important. Other signs of adequate breast milk or formula intake are regular bowel movements and frequent wet diapers. Bowel movements range from 10–12 times each day to one time every three days, and are typically yellow, green, or brown in appearance. Call the office if there is no bowel movement for more than three days, especially during the first two to three weeks after birth.
Breastfeeding is the best choice for your baby, unless maternal health or medication issues cause a conflict. Breast milk is the optimal choice for nutrition, raises I.Q., guards against infections, and provides long-term protection from diseases, including reducing the likelihood of diabetes, asthma, allergies, obesity, and SIDS (Sudden Infant Death Syndrome). However, breast-feeding is often challenging at first, and mothers typically struggle with helping newborns latch onto the breast or worry about an adequate milk supply. A small amount of initial fluid is expressed, called colostrum, which is extraordinarily nutritious. Colostrum is replaced by more plentiful breast milk four to six days after birth, following milk letdown.
We recommend nursing from both breasts at each feeding. Ideally, try to have 8–12 feedings per 24 hours one to two weeks after birth, or approximately every two to three hours. Do not be discouraged if this seems difficult at first
. We will support you and help with any problems that may arise. In addition, the nurses in maternity wards may offer guidance with breast-feeding technique. Lactation consultants (breast-feeding specialists) are also available if needed. During the first two weeks, breastfeed exclusively in order to establish a good feeding pattern, an ample milk supply, and make both you and the baby comfortable. After two weeks, we suggest giving your infant one bottle a day of expressed breast milk. This may be the appropriate time for dad to help with feeding while the baby gets accustomed to a bottle, as well as allow flexibility for breastfeeding moms who would like to use a babysitter or daycare.
Expressed milk can be stored for up to five days in a refrigerator and up to three months in a freezer. Frozen milk should be thawed in the refrigerator and used within 24 hours. Do not use microwaves for defrosting or warming milk
. Discard room temperature expressed milk after four to six hours.
Since breast milk typically lacks sufficient vitamin D, we recommend giving breast-fed infants supplemental vitamin D drops, such as D-Sol
or Tri-Vi-Sol (1 mL per day).
We also encourage breastfeeding mothers to continue taking daily prenatal vitamins prescribed by their obstetrician. Breastfeeding should continue as long as possible, ideally through the baby’s first year. We will discuss the introduction of solid foods at the four to six month checkups.
Do not give your infant water, juice, tea, or other drinks in the first six months unless otherwise directed by your doctor (as may be advised for constipation).
or 1-919-861-5577 to find a local lactation consultant certified by the International Lactation Consultant Association
- Find Breastfeeding support near you, by entering your zip code
- a database on drugs and lactation from the National Library of Medicine and Lactation
- breastfeeding and parenting information
US Breast Feeding Committee
Morristown Medical Center's Lactation Department Breastfeeding Support Line
Morristown Medical Center's Lactation Classes, Breast Pumps/Supplies
, Office Visits 973-971-5027
Morristown Medical Center's info online: www.atlantichealth.org/morristownparented
St. Clare’s Breast-feeding Support: 973-983-5262
Other numbers for breast pumps and supplies (commercial):
Medela, Inc. 1-800-835-5968
Breastfeeding Helplines for WIC participants:
Morris County 1-800-910-5050, ext. 5 or 23
Essex County 973-877-8904
Somerset County 908-387-0351
Warren/Sussex County 1-800-910-5050
Useful Books for Breastfeeding Moms:
American Academy of Pediatrics: New Mother's Guide to Breastfeeding
Breastfeeding Answers Made Simple: A Guide for Helping Mothers; Nancy Mohrbacher
Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, Mohrbacher, Kendall-Tackett, and Newman
The Compete Book of Breastfeeding, Marks, Wendkos Olds
The Nursing Mother's Companion, Huggins
For babies who will be receiving formula, we recommend a cow’s milk formula with iron. Formula is available in three forms: powder, ready-to-use, and liquid concentrate. To prepare liquid concentrate, rinse the top of the can with water, and mix equal portions of concentrate and water. You can make either one bottle at a time or the entire can. If you are supplied by city water, it is not necessary to boil the water. However, boil well-water for ten minutes and let it cool before preparing the formula. Once the can is opened, use the contents within 48 hours. Bottles should be capped, or the can covered with plastic wrap, and stored in the refrigerator. Sterilization of bottles and supplies is not necessary. Wash bottles and nipples with hot soapy water or in a dishwasher. Allow them to air dry.
Formula should be served at room temperature. Run hot tap water over the bottle for a few minutes or soak it in a pan of hot water. Do not heat the bottle in a microwave oven.
When feeding, hold your infant in a comfortable position with the head slightly raised. Do not prop the bottle and leave the baby to feed unattended. Begin with two ounces per feeding, but more may be added if the baby finishes the initial amount. If your baby does not finish the bottle at a feeding, that’s ok too. When your baby has had enough to eat they will reject the nipple or fall asleep. Note that rejecting the nipple may be an indication that your baby needs to be burped. Allow your baby to guide you with needs for increasing the amount of formula, to a maximum of six to eight ounces by two months. If the bottle is not finished within one hour, discard the remainder. Do not refeed from the same bottle.
Be flexible with the feeding schedule. We recommend demand feeding, which varies from two to four hours. During the day, wake your baby at four hour intervals for feeding. If the baby sleeps more than this amount at night, enjoy the sleep!
We suggest starting solids between four and six months. Continue breast milk or formula until your baby turns one year old. Since cow’s milk doesn’t supply the balanced nutrition your child needs and is often hard on infants’ sensitive digestive systems, it should not be used to replace breastmilk or formula until one year of age (although dairy products such as yogurt may be used starting at 6 months of age, just not in quantities that are replacing routine breastmilk or formula). We recommend whole milk after the first birthday and 2% milk at age two. Infant cereals: Begin with a tablespoon of cereal and mix with formula or breast milk to make it thick enough to stay on the spoon. Give your baby a tablespoon per day for three to four days. If there is no adverse reaction, serve cereal twice daily. Gradually increase the amount every one to two weeks to a maximum of four to six tablespoons per serving.
Fruits and vegetables: Serve single ingredient fruits and vegetables at first.
We advise following a routine eating schedule such as:
breast-feed or bottle, cereal, fruit
breast-feed or bottle, fruit or vegetable
breast-feed or bottle, fruit, vegetable, and cereal
When your baby is five to six months old, add other foods to this schedule, including meats. Continue breast milk or formula with iron until one year of age.
By six to nine months, introduce your child to drinking from a cup. Most babies can be weaned from the bottle at nine to twelve months of age. Do not put your child to sleep with a bottle of milk or juice as this can cause serious tooth decay.
As your baby gets older and acquires more teeth, offer different textures of food. Avoid choking hazards, such as nuts, uncut hot dogs, popcorn, raw carrots, and whole grapes. Do not give honey prior to 12 months of age, which can cause infant botulism.
Initially, burp your baby after consuming approximately one ounce of formula. When breast-feeding, burp the baby about halfway through each breast and again when finished nursing at the breast. The frequency of burping can be reduced as your child grows.
Occasional spitting up is normal for babies and is usually due to swallowed air or excessive intake. Feeding in a more upright position or additional burping may reduce spitting up.
Supplemental fluoride is beneficial for tooth development. Most water in New Jersey, except for a few areas, is not adequately fluoridated (less than 0.3 ppm). We will give you a prescription for fluoride drops at age six months. Once your child has teeth emerging, please discuss routine teeth cleaning with your doctor.
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Eat a healthy, well-balanced diet. As a nursing mother, you will require 500–600 more calories per day than before pregnancy. You will gradually learn which foods adversely affect the baby and cause excessive gas or crying. Drink plenty of fluids, at least two quarts a day. Do not smoke in your home and make every effort to wean yourself from tobacco! Caffeinated beverages may be consumed in moderation.
To care for your nipples, wash only with water. Avoid excessive washing or use of soap directly on the nipples. If redness or soreness develops, expose your breasts to air. You also may use commercial creams or lanolin after nursing.
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Newborn babies sleep a lot, usually waking every two to four hours for feeding. By four months of age, most babies sleep through the night, although some infants begin much sooner. Although you may have heard that starting solid foods will cause a baby to sleep all night long, there is no evidence to support this. Even after sleeping continuously, your baby may begin to wake once again during the night. This is a normal developmental phase, and a typical pattern of nighttime sleeping will soon return. Remember that babies must be placed on their backs for sleep to reduce the risk of SIDS (Sudden Infant Death Syndrome).
Hiccups, Sneezing, and Congestion
Hiccups and sneezing are normal reflexes for all babies. Sneezing helps keep airways clear and does not necessarily indicate a cold or allergies. While nasal congestion is common, call the office if your child has labored breathing, fever, or decreased feeding. To relieve discomfort of nasal congestion, use saline nasal drops and a bulb syringe or nasal aspirator to suction out the mucus. Put a few saline drops in one nostril with a medicine dropper. Wait a few seconds and then suction with the syringe. Repeat this procedure with the other nostril. Do not treat both nostrils at the same time as your child will have difficulty breathing. Please use commercial preparations of non-medicated nasal saline drops, such as Little Noses Non-Medicated Saline Drops.
Breast Swelling and Vaginal Discharge
Baby girls often have slight vaginal discharge and bleeding after birth. Both girls and boys frequently have breast swelling. Although these conditions may persist for several weeks, they are not a cause for concern.
The frequency and character of bowel movements vary widely. Bowel movements may occur as often as after each feeding or less frequently, such as once every three days. The stools of breast-fed babies tend to be loose and seedy, while formula-fed babies generally have more solid stools. Stool color ranges from yellow to dark green. Although babies strain and become red in the face even with normal bowel movements, hard or pellet-like stools may indicate constipation. As long as your baby seems happy, is eating as usual, and has no signs of illness, don’t worry about minor changes in the stools.
During the first four to six weeks, a baby’s skin often has rashes, which are usually on the face in the form of small discrete lesions or pimples that may appear and disappear. Newborn acne is a common rash on the face, neck, and upper chest that typically clears up in six to eight weeks. Wash the area with mild, unscented soap once or twice daily. Do not apply oils, lotions, or creams, which only worsen the condition. Please call the office if the rash is severe or widespread on your baby’s body.
All babies cry as their way of saying, “I’m hungry, I’m thirsty, I’m wet, I want to be hugged, I’m bored.” In time, you will learn to distinguish the different cries. If you check the baby and all is well, don’t worry. Infants cannot be spoiled, so feel free to pick up your crying baby. Pacifiers often calm infants and have been shown to decrease the risk of SIDS. The pacifier can easily be discontinued at four to six months of age.
Excessive irritability in a young infant is sometimes a condition known as colic. The baby usually cries, turns red, and pulls the knees up toward the chest. The crying typically increases in the evening hours, between 4 and 8 PM. Colicky babies may pass gas or need to be burped more often than other infants. Most of the time there is no cure for colic other than patience and passage of time. The symptoms subside by three to four months of age. If your infant experiences colic, try to make the baby as comfortable as possible. Suggestions include turning the baby on the stomach, stroking the back, swaddling in a blanket, rocking, cuddling, taking a ride in a carriage/stroller or car, and giving a warm bath. For additional information about swaddling and colic, visit http://www.happiestbaby.com
The Umbilical Cord
The umbilical cord stump usually falls off by itself in one to four weeks. Keep the area clean and dry. Oozing and slight bleeding commonly occur before and after the cord stump falls off. It should dry out in one to two days.
Many babies have dry skin following birth. Since frequent baths increase dryness, bathe your infant every other day using a baby bath product or mild, unscented soap, such as Dove. Do not immerse the baby in a tub until the cord stump has fallen off and healed. Sponge baths are advised until that time, avoiding the cord area. Wash your baby’s hair with soap or baby shampoo two to three times per week. Lotions or creams are not routinely necessary. Peeling of the skin on the hands and feet is normal and usually subsides after three to four weeks.
The penis requires no special care, unless it is circumcised. After circumcision, generously apply petroleum jelly to the penis for one to two weeks. For baby girls, separate the labia and gently cleanse with a wet piece of cotton, wiping only from front to back. Clean the vaginal area after bowel movements in the same manner.
The key to preventing diaper rash is keeping the skin dry. We recommend frequent diaper changes as soon as possible after urination or bowel movement. Clean the area with warm water using a washcloth, paper towel, or cotton ball and pat dry. Avoid commercial wipes during the first month. A small amount of petroleum jelly in the skin creases will help protect that area. If a rash develops, use petroleum jelly. While exposure to air is the best treatment for most rashes, call our office if you see no improvement.
Eyes, Ears, and Nose
Do not use cotton swabs to clean the nose or ear canals. If a yellow discharge is noted from the eye, wipe away with a washcloth and warm water. If the discharge persists or you observe redness or swelling, call our office.
Call the office immediately if your infant is younger than two months and has a rectal temperature higher than 100.5 degrees Fahrenheit. While fever generally indicates infection, it is actually therapeutic. The degree of fever is less significant than the associated symptoms. Fever alone will usually not harm your child. We advise treating fever only to make your child more comfortable. However, please call the office if you are concerned about your child’s condition.
The effective methods of controlling fever in children over two months include:
- Acetaminophen for infants given orally or as rectal suppositories every six hours as needed.
- Ibuprofen drops, given every six to eight hours as required to a child over six months old.
- Sponge baths using lukewarm water. Repeat as often as necessary. Do not use alcohol to bring down fevers, which may cause chills and discomfort.
- Dress your child in lightweight clothing. Overdressing may cause heat retention and even raise the fever.
You will notice that your baby develops a pattern of bowel movements. If this pattern changes, such as increased frequency or watery stools, take precautions because your child could become dehydrated. Signs of dehydration include failure to urinate, dry mouth, and/or listlessness. If you observe any of these symptoms or your child is less than six months old, call the office immediately. Continue feeding breast milk or formula as well as regular food because proteins, carbohydrates, and fats help the intestines heal. It is important to replace the fluids that your child loses in the stools. If diarrhea continues repeatedly despite these measures, call the office.
Vomiting associated with a fever may indicate viral gastroenteritis (commonly called stomach flu) or more serious infection. If your child is vomiting, has a fever, and appears ill, or is younger than six months, call the office immediately. If there is little change from normal behavior and no fever, take steps to prevent dehydration. During the first day, stop giving your child milk. Clear liquids, such as an electrolyte solution (Pedialyte or other brands), should be given in small amounts of one to two ounces every half hour. After 12–24 hours, add soft foods to the diet if liquids are tolerated. Call the office if vomiting persists for more than 24 hours.
Your child’s first teeth usually appear between three months and one year. The bottom teeth generally erupt first, although order varies. Some children have no problems with teething while others become irritable and fussy. They may not eat as well as usual while the teeth are breaking through the gums. A runny nose and loose bowel movements are sometimes reported. Fever over 101 degrees Fahrenheit is not a typical symptom of teething. To relieve your child’s discomfort, you may rub the gums with an ice cube wrapped in a washcloth. You can also give your infant a hard teething ring to chew. If teething pain wakes your baby at night, you may give the appropriate dose of acetaminophen, or ibuprofen in babies over six months of age.
A car safety seat is required by law for all infants and children under the age of eight. A baby who is held in your lap has no protection from sudden stops. Install all new car seats in the vehicle’s back seat, preferably in the center when possible, and rear-facing until two years old. It is NJ law to keep chilren backward facing until age 2 due to statistics that demonstrate that it is five times safer to have a child under 2 facing backward rather than forward. Front seats are to be used only for children over 12 years old or if the vehicle has no rear seat. Never place a car seat in the front seat if you have front airbags. Children should be in 5-point harness restraints in a car seat until they are at least 4 years old AND 40 pounds, before considering changing to a booster seat. Booster seats should then be used until the child is BOTH at least 57 inches tall AND at least 8 years old.
Car Seat Resources
Click here for up to date recommendations and product listings from the American Academy of Pediatrics and enter search term "car safety seats families".
For New Jersey Child Passenger Safety Laws visit, http://www.nj.gov/oag/hts/childs.
The Morris County Division of Transportation has carseat inspection stations in our area -- a free service sponsored by Northern NJ Safe Kids/Safe Communities. For FREE local car seat inspection stations, visit http://www.preventionworks-nj.org/car-seat-inspection.php
Out of Doors
You may take your baby outside for short periods of time in pleasant weather when you feel well enough to venture outdoors. Avoid prolonged exposure to direct sun and wind. During the first two months, keep away from crowds, such as in shopping malls and supermarkets, as well as young children.
Dress your baby as you would dress yourself, according to the temperature. Do not overdress your baby on warm days. A hat is advisable when it’s sunny to protect the skin.
Room temperature should be comfortable, but not too warm. A temperature of 68–72 degrees Fahrenheit is ideal. If the temperature is lower, dress your baby appropriately.
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Once your child starts crawling and walking, many potentially dangerous situations can arise. We advise that you begin to baby-proof your home by the time your infant is six months of age. Cover outlets so fingers or metal objects cannot be inserted. Lock floor level cabinets as well as remove poisonous liquids and medications. If your home has stairs, we recommend installing gates to prevent accidental falls. Infants should be closely supervised while near screen or storm doors.
Walkers are one of the leading causes of injuries to infants. Never leave your toddler unattended while in a walker. Take precautions so that children cannot tumble down steps, go through glass doors, collide with furniture holding lamps or other objects that could fall on them, or hit their heads on sharp corners. Infants have difficulty controlling the walker once it gets started. Finally, there is no truth to the belief that children walk earlier if placed in a walker. Be careful!
Stationary walkers are a much safer alternative.
If your child swallows a dangerous substance, such as medications, plants, cleansers, etc., first call the Poison Control Center (1-800-222-1222)
or go to the Emergency Room immediately. We recommend that you keep the poison control center’s phone number right next to your home phone and/or program it into your cell phone.
Falls and Burns
Never leave a baby alone on a changing table, bed, or bath, even for a moment. To prevent accidental burns from hot water, the water heater thermostat in your home should be turned down to less than 120 degrees Fahrenheit.
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This is a very special time for you and your baby. We encourage you to enjoy, delight in, be proud of, and love your newest family member. If you have the urge to pick up and hug your baby, go ahead and do so! All infants need love and can never receive too much from their parents. Relax and enjoy!
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Call the office to make the appointment for your first visit. Your doctor may suggest scheduling a weight and jaundice check 48 hours after being discharged from the hospital. The American Academy of Pediatrics has a recommended schedule of well child visits that we follow during the first two years
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- 2 weeks check-up
- 2 months check-up, vaccines
- 4 months check-up, vaccines
- 6 months check-up, vaccines
- 9 months check-up, vaccines, hemoglobin
- 1 year check-up, vaccines, lead screen
- 15 months check-up, vaccines
- 18 months check-up, autism screen, vaccines
- 2 years check-up, autism screen, lead screen
- 30 months check-up, formal developmental screen
- At age three and thereafter, annual checkups are recommended.
Once you arrive home with your newborn, many questions will arise along with new experiences for you and your baby. Although the following sections will help prepare you, please do not hesitate to call our office if you have additional questions about your child’s health.
Standard items that are useful to have at home include:
When to Call
- infant nasal bulb syringe/aspirator
- cool mist vaporizer/humidifier
- acetaminophen (do not give to a child less than two months old without first calling the office and speaking with a doctor or a nurse)
- ibuprofen (for fever or pain in infants older than six months)
- digital rectal thermometer
- antibiotic ointment or cream
- petroleum jelly
During the first two months it is often difficult to determine the cause of a baby’s distress. Call us immediately if the following situations occur:
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- fever over 100.5 degrees Fahrenheit rectally in the first two months
- refusal to nurse or take a bottle for two consecutive feedings
- persistent projectile vomiting
- less than three to four wet diapers in a 24-hour period
- frequent watery diarrhea
- unusual restlessness or irritability
- any concerns for which you would like immediate feedback
During the first two years, all children are immunized against hepatitis A and B, diphtheria, pertussis (whooping cough), tetanus, polio, measles, mumps, rubella (German measles), varicella (chicken pox), rotavirus, Haemophilus influenza type B (HIB), pneumococcal infections, and influenza (flu). Most of these immunizations begin at two months of age.
We recommend that parents, as well as anyone who will come in close contact with your newborn, receive the Tdap vaccine. This is a tetanus booster which also provides protection against pertussis (whooping cough). In addition, the flu vaccine is advised in the fall.
We believe in the safety of vaccines and their effectiveness to prevent serious illness. There continues to be outbreaks of serious childhood diseases, such as pertussis and measles because children are not being immunized. These, and most other diseases listed below, are potentially life threatening to infants and toddlers. It is extremely important to follow the American Academy of Pediatrics immunization guidelines. Our doctors take this matter very seriously and do not condone withholding immunizations. You will be provided with details about all of the immunizations at your first visit.
See our immunizations
info for more details.
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We are open Monday through Friday. If you need to be seen on the weekend, please call by mid-morning on Saturday (Saturday morning hours are only for emergency sick/injury visits).
After hours, please call our phone number, 973-263-0066 (yes, the same number as during office hours). A doctor is always "on-call," 24 hours a day, 365 days per year. We may be reached after hours through our answering service by calling 973-263-0066 and following the prompts. We are covered by another practice on alternate weekends after 11 AM.
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and click on "bookstore" for the American Academy of Pediatrics (AAP) on-line store:
AAP’s Your Baby’s First Year
AAP’s Caring for Your Baby and Young Child: Birth to Age 5
AAP’s Guide to Your Child’s Symptoms
AAP’s Guide to Your Child’s Sleep
AAP’s Guide to Your Child’s Nutrition
What to Expect the First Year
(Heidi Eisenberg Murkoff, Arlene Eisenbert, Sandee E. Hathaway)
Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer
(Harvey Karp). There is a very helpful DVD that can be ordered as well.
1-2-3 Magic: Effective Discipline for Children 2-12
(Thomas Phelan) 4th edition
Discipline Without Shouting or Spanking: Practical Solutions to the Most Common Preschool Behavior Problems
(Jerry Wyckoff, Barbara C. Unell)
What to Expect the Toddler Years
(Heidi Eisenberg Murkoff, Arlene Eisenb
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Feeding Your Baby
Collecting and Storing Breast Milk
Formula, Supplementing with
Herbal Remedies and Supplements
Herbs to Avoid While Nursing
How do I know my baby is getting enough milk?
Jaundice, Breast Milk
Weight Gain and Newborns
Weight Gain, Slow
Weight, Appropriate for Babies
When a Nursing Mother is Ill and Needs to Take Medications