PEDIATRICS
Roger Knapp, M.D., F.A.A.P.
Telephone: 817-329-9234
Welcome:
Your baby is resting comfortably and warm in his or her own bassinet. I
have given your baby a thorough physical examination. Any abnormalities
will be explained to you as soon as they are apparent. If you notice any
difficulties or have any questions, please notify the nurse or me.
During the next
few days, most of your time will be spent in resting and regaining your
strength. You can put this time to good use by getting to know some of
the simple things that will help to make your life with baby easy and
fuss-free.
You must
remember the baby is experiencing a new phase in his life. A short time
ago, he was totally dependent on you as his mother. Now, even though he
is actually quite helpless, he is to some extent independent in that he
can breathe the open air, sleep peacefully, or object strenuously by
crying loudly. He is truly an individual and with your help, care and
love will grow physically and make rapid strides in his development.
Adapt these instructions to your baby because every baby is different.
Do not depend solely on friends and relatives. We will be happy to give
you guidance and answer your questions, while you are in the hospital,
later by phone and during your visits to the office. Bring in the list
of questions. Do not let it frustrate you when every shift of nurses,
every relative, and every book tells you something different. When
someone tells you something different, just put that information into
your mind's database for future reference that there is one more way you
could feed, bathe, or diaper the baby.
Friends and
Relatives:
These people are interested in your baby and want to hold and hug him.
So long as family and friends are not ill and they wash their hands,
there is not a problem in their handling the baby. Stay out of crowds
where you cannot be sure of the health of people present. You may take
him out after 2 - 4 weeks but be careful not to expose him to anyone who
is sick. Taking the baby out will not make them ill. Five things you
can do to decrease illnesses, keep them away from people who are ill
(duh... this is just common sense!),
wash your hands, don't smoke in the house, try not to put them into
daycare, and buckle them up in the car. Getting out does not
make them ill. Put a TV stand by the front door with a hand
sterilizer bottle and pleasant sign asking everyone that enters to do
their hands. The family needs to do their hands after returning
from the store, work, or school. Also visitors need to do their
hands when entering. Then they do not have to their hands before
picking up the baby. Also the family needs to do their hands after
using the bathroom.
You can also drape the infant carrier when
you go to the store. Get some thin sheer cloth that can be put
over the carrier when you put the baby in the grocery cart. Most
studies show that germs usually only infect another person if the cough
inside 3 feet. But worse is that people in the store reach in and
touch the baby and they have not washed their hands. The most
germs in town are on the grocery cart handle. So get the hand
sterilizer and wash down the handle of the cart. The covers will
get nasty and you will take the germs home with you. Just
sterilize the plastic/metal handle.
In General:
Babies Are
Babies: All babies sneeze, yawn, belch, have hiccoughs, pass gas, cough
and cry. They may occasionally look cross-eyed. Sneezing is the only way
in which a baby can clean his nose of mucus, lint or milk. Hiccoughs are
little spasms of the diaphragm muscle. They may often be stopped by
giving a few swallows of warm water. Coughing is baby's way of clearing
his throat. Crying is his way of saying I'm hungry, I'm wet, I'm
thirsty, I want to turn over, I'm too hot, I'm too cold, I have a
stomach-ache, or I'm bored, or constipated. You will gradually learn to
know what the baby means. Even a well baby will probably cry for 3 hours
a day.
FEEDING
The baby's
first love for his parents arises primarily from the feeding situation.
Both of you should be comfortable as possible and both try to
participate if possible.
Breast Feeding:
If you choose to breast feed your baby, we want to help you in every
way. Although the first several days may seem awkward and frustrating to
you or the baby, most mothers are successful if they relax and have
patience. Introduce as much of the nipple and areola (dark portion
around your nipple) as possible into the baby's mouth to promote
adequate sucking and milk flow. The most vigorous sucking occurs at the
first breast, so alternate the breast on which you begin feedings.
Nurse the baby
5-10 minutes on each breast every 3-4 hours for the first 24 hours. Your
breast milk usually "comes in" on the third day. Your breasts will then
feel firm, hard, and tender. At that time you may nurse 10 minutes on
each breast. Breast feeding a long time on an empty breast will cause cracked
and sore nipples. Nursing a long time on an empty breast does not make
more milk... it gets you sore. So I recommend less minutes than
others recommend. Some will suggest nursing 20 minutes on each
breast and wow will you get sore. Even when your breast milk comes
in ... 10 minutes on each breast will empty most of the milk out.
If the "hind" milk does not come out and left in the ducts, then the
first thing to come out at the next feeding will be the hind milk from
the last feeding. So I don't think it is important to worry about
that. It is important not to get sore. After a feeding, always remove the baby from your
nipple by inserting your finger between his/her gums to break suction on
your nipple. If the baby wants to go longer, then give them a
pacifier. To use your breast as a pacifier will make them sore and
the pain will decrease the let down of the milk. Studies proved
that use of a pacifier will not decrease the success of breast feeding
and not give them "nipple confusion."
There are two rules that need to be
followed so that other nipples do not interfere with breast feeding.
-
First breast nipple and then other
nipples. If the baby does not latch on to your breast,
then no other nipple goes in their mouth. Once they have
nursed 5-10 minutes, then you can use a pacifier (rather than
using your breast)
-
If you have to supplement, then
just one a day.. usually in the evenings. If you follow
your breast up with formula after every nursing, then that
satisfies them 4 hours and you will not be nursing every 2-3
hours to stimulate more milk.
Most babies are
not hungry the first few days or so. Don't be alarmed if baby isn't
interested at first. He or she will get hungry. If they are getting
enough milk, he will be content after nursing and will go 3 to 4 hours
between feedings. They are born with excessive fluids so they are not
hungry for the first two or three days. They loose weight that week
urinating off the fluid they don't need. Then they get hungry around
the third day and that is when the mother's milk comes in. So this is
the way it is designed to work. Don't be bothered by very poor nursing
the first day or so. Call if the baby is not eating well by the fourth
day.
Most infants go
through a growth spurt at 1 to 3 weeks of age. He or she will be hungry
every hour or two and appear to be unsatisfied. Stay calm and simply put
baby to breast as often as needed. If your breasts get sore, cut back
to 5 or 7 minutes. Frequent nursing will increase your milk supply in
about a week or so, after which time feedings should be 3 to 4 hours
apart and baby will seem more satisfied by the third to fourth week of
life. If during this time you supplement with formula after most breast
feedings thinking: "baby isn't getting enough to eat" or "you are drying
up," then the baby will be satisfied with the formula for 4 hours and
you will not be nursing frequently enough to stimulate the breast to increase your supply. So
feed the baby "on demand" and ride with the fluctuations in his or her
eating habits. Approximately 10-20% of mothers have less milk
production by the evening time and have to supplement one bottle a day.
That is not bad and will not turn off the baby to the breast if you only
give one a day.
Your diet does
not have to change, but we emphasize your eating well-balanced meals.
Consuming too much of any one thing will determine whether baby gets a
reaction. Any food item can affect the baby. For example, one cup of
coffee may not bother the baby, but 5 cups could cause trouble. Some
foods known to increase gas/colic in newborns are caffeine (chocolate,
caffeine soft drinks, coffee, tea), milk products, dry beans, peas,
cabbage, broccoli, and spicy foods. If you feel your diet is causing
colic try eliminating some foods from your diet for two days and see if
your baby calms down. The chemicals are out of your breast milk in 24
hours and they inter your breast milk and cause symptoms in the baby in
approximately 4-6 hours.
Many
medications for Mom are permissible while nursing, like acetaminophen
(Tylenol), allergy pills and antacids. Ibuprofen (Advil, Motrin) is OK
after 1 month. We do not want the nursing mother to take it when the
baby is jaundiced. Mineral oil, Metamucil, and stool softeners are good
for constipation. Most over-the-counter medications are OK except
Aspirin, Aleve, and laxatives. Stool softeners are fine. Always watch the infant for any changes
in behavior when you take any medication. Call us if you need to take
any other medicines, or if you are in doubt. Ask your doctor or us on
all prescription medications. What ever your OB doctor gives you and
says it is safe, it probably is safe. There are very few drugs that you
should stop breast-feeding. The PDR tells you that every medication
should not be taken if breast-feeding your infant. Call us for more current
advice.
Bottle Feeding:
Sit comfortably with your baby in your arms. Relax and let baby feed at
his own pace. Do not prop the bottle in his/her mouth. Hold your baby in
your arms with his head raised and resting in the bend of your elbow.
Formula
Preparation:
Sterilization is not necessary if you prepare each bottle as you give it
to the baby. If, however, you choose to make up 20 bottles ahead of
time, then you will have to sterilize the bottle and water. You must use
these bottles within 48 hours.
The easier way
is to use the concentrated or powdered formula. Wash the bottles and
nipples in hot water or dishwasher. They should be clean, but do not
have to be sterile if you pour the formula into each bottle as you feed
your baby. Wash the top of the concentrated formula can and open it.
Either leave it in the can, covered, or pour formula into a covered
container and refrigerate. When you are ready to feed a bottle, for
example 4 oz., first pour 2 oz. of cold concentrate into the bottle and
then add 2 oz. of warm tap water that was boiled or distilled water.
Then you are ready to feed the warm bottle. Discard any unused portion
if there is very little remaining. If the baby takes a sip out of a
full bottle, then you may put it immediately back into the
refrigerator. Then you can warm it up, feed it to the baby one more
time, and throw out the remainder.
If you use
powdered formula, mix it according to directions with warm tap water
that was boiled or distilled water. Filters for water only filter out
chemicals and do not filter out germs. Bottled water and powdered
formula is easier to use on trips and going camping.
If you use the
Ready-To-Use formula, pour it into the bottle and warm it if desired.
Warming the formula is usually helpful for several months but not
necessary for all infants. Room temperature (70) is adequate.
You do not have to warm it to body temp 98.
Dr. Knapp
recommends using distilled bottle water or boiling tap water for at
least 6 months. There are germs in the tap water that the chlorine does
not kill and can cause trouble in the baby.
Burping:
Burping the baby helps remove swallowed air. Hold him or her upright
over your shoulder, pat or rub her back very gently until she lets go of
the air.
The baby can
also be burped by holding him or her in a sitting position (baby leaning
slightly forward) on your lap, with your hand supporting his or her
chest and your thumb and finger supporting their cheek bones. Babies don't
have to burp every time. The main reason to burp them is to slow down
the feeding. If they "inhale" the bottle in one minute, then they will
get a stomachache and spit up. The breast naturally does this. So burp
the baby after each breast and every 1-2 oz of formula. The interval
can be increased to 3-4 oz as they get older. But whether they
burp or not is not important as to slow down the feeding.
A Schedule With
Flexibility:
Feeding
schedules are usually more satisfactory if the hours are set roughly,
and the baby is allowed to eat when he or she becomes hungry. It's
better not to wake a baby for feeding. You will find out that if they
are not hungry, then you cannot make them eat, and if they are crying
hungry, you will end up feeding them. Let the baby set their pace.....
baby rules the house. Feeding on demand allows the baby to tell your
breast how much milk to produce. Babies do not generally over eat so
when bottle feeding, let them have as much as they want when ever they
want. Baby runs the house!
How Much
Formula:
Most
babies are not hungry the first day and the amount of formula taken will
vary with each baby. Some babies will only take 1/2 oz. at first and
usually by the second to third day will take 1-2 oz. Others will take
an entire 4 oz. When you put the nipple back into the baby's mouth and
they spit it back out again, this usually indicates he or she is full.
If your baby does not enough to grow then we need to run tests to see
what is wrong with your baby and you should not force them to eat more
than they want.
If your baby is
taking up to 4 or more oz. of formula every 1 to 2 hours, and is not
satisfied by liquid milk, (usually at 9-10 lbs of body weight) call the
office for the next step in feeding.
Water is not
necessary for the baby to drink extra water since there is enough fluids
in the formula and breast.
Testing bottle
nipples regularly will save time when you are ready to feed your baby.
Nipple
holes should be the right size to help baby suck easily. When the nipple
holes are the right size, warm milk should drip as rapidly as possible
without forming a stream, about one drop per second.
If
nipple holes are too small, baby may tire of sucking before he gets all
the formula he or she needs. If holes are too large, baby gets too much
formula too fast, and may gag or spit up.
To
enlarge holes that are too small, push a hot needle gently through from
the outside. If nipple holes are too large, the nipple is worn out and
should be thrown away.
Sometimes nipple holes become gummy. Place the nipples in a pan of
water, add a pinch of salt, and boil for a few minutes.
BABY CARE
Bathing:
Although
you will bathe the infant most days, it is not necessary to bathe baby
every day. Keep the room warm during the bath. Sponge bathe baby on a
dry mat until the cord is healed. Or you can put them in the foam tub
for babies and put them partly into warm water as long as the cord or
circumcision is out of the water. It does not hurt them to get wet for
a minute.
Face:
Keep the face clean and dry. Wash with mild soapy water. "No Tears baby
shampoo" is a good one to use on the face because it will not cause the
eyes to sting. There are usually white bumps on the nose which is
normal and will go away with time. The cheeks will occasionally get red
bumps on them from the spitting up of milk and from baby rubbing
his/her cheeks when sleeping. (Newborn acne) Wash and leave the face
clean and dry. Do not apply lotion or anything else on the face or the
pores will become more irritated and increase the rash. Watch out for
your perfume or after-shave lotion when you place the baby against your
cheek or neck.
Eyes:
Clean with soft cloth and clean water. A little matter or mucus once or
twice a day is normal. If the eyes tear a lot and are matted closed each
morning let us know. There may be a clogged tear duct. If there is pus
coming out of the eye every hour, call the office.
Nose:
The nose may be congested from time to time. If there is mucus, aspirate
by carefully squeezing the bulb syringe, placing the tip at the entrance
of the nostril to make an air seal, and releasing the bulb rapidly. This
will extract mucus from the nose into the bulb, which can then be
squirted out into a Kleenex. You also can help loosen mucous in nostrils
by placing salt water nose drops or spray (Ocean or AYR nasal spray) in
each nostril, then suction with bulb.
Head:
Wash the scalp when needed. There may be dry white flakes at first.
Wash with any standard brand of baby shampoo. Cradle cap is thick burnt
orange scales after two months of age which requires different
treatment, and we will recommend these to you as needed.
Body:
Wash with baby soap for the time being. Later you may switch to a bar
soap after 2 months of age. You can use Ivory or Dove unscented soap.
Lotion on the body is permissible but not baby oil. Heat rash is
nothing more than small red pinhead size bumps on the chest, neck, arms,
etc. This is caused by the pores being clogged by sweat, lotion, milk,
or chemicals in the clothes i.e., Downy in the rinse or deodorant Bounce
drier sheets. Rashes are almost never caused by the detergent so you do
not have to use Dreft or Ivory or any special brand. Do the baby's
clothes like yours. To help clear up the heat rash, wash area clean
with soap and leave it clean and dry. Talcum baby powder can cause lung
damage if inhaled. When using powder, do so sparingly and try to keep
baby from inhaling any, or simply do not use it. Corn starch powder
without talc is safer. They will have “dry skin” for a month but this
really is the baby shedding a layer of cells. So it looks worse after
the bath but that is helping get them off the skin so it will look good
in a few weeks.
Diaper Area:
Wash
with water or mild soapy water. The commercial diaper wipes are very
irritating and some infants may develop a rash due to their chemicals. Many of these
chemicals have not been tested. Water and paper does a fine job of
cleaning the area. Even dry paper like you and I use will clean up
the diaper area very will. If you try to sterilize the diaper area
and remove all the normal healthy germs, then the yeast or staph will
get in there and cause more trouble. Most rashes are caused
by the baby pooping and sitting in it for 15 minutes. You can protect the diaper area with
Vaseline, A&D Ointment or other protective ointment. If rashes appear, discontinue wipe use and stay with
washcloth/paper and water. Then try Desitin, Dr. Smith's, Budro's
But Paste, or Diaperene
diaper rash creams. If the rash continues to worsen, call the office for
advice. If rashes occur frequently, then put Vaseline on the diaper
area after every changing.
Navel:
Keep
clean and dry. The plastic clamp will be taken off before you go home.
You do not have to clean the cord. If you ignore it then the cord
will fall off just fine and not get infected. If you want to clean
the cord, you can use a cotton ball with alcohol. Use the alcohol very sparingly.
Rubbing alcohol is not good for you if you absorb it. Wipe the base of
the cord when it is wet or draining mucus. You do not have to clean it
after every diaper change. If it is dry and crisp and clean, then
leave it alone. Getting the cord wet with water will not hurt the cord
or cause it to get infected. The cord usually will fall off in 2 to 3
weeks. The area may smell bad and may also ooze mucous or blood for
several days. This is normal. Continue wiping any drainage off until it
stops draining. When the cord falls off you may wash with soap and
water and give baby a tub bath. A sign of infection is when the skin of
the abdomen surrounding the naval becomes a bright red. Binders or
strapping the naval is not necessary to prevent/treat hernias and can
cause irritation.
Circumcision:
If you
so desire, the pediatrician or obstetrician will perform the
circumcision prior to discharge. There are two methods. One is the
Plastic Bell and the other a metal clamp called a Gomco. If the
"plastic bell" is used, the penis will have a plastic ring around the
end. It will slowly come off in a week. Wash with clean water, leave it
clean and dry, and wait until it is loose in the diaper. Some times a
few spots of blood may appear on the diaper which is normal. If it
bleeds excessively, apply pressure and let us know. If it gets
infected, the whole shaft of the penis will get red and swell twice its
normal size. A little redness at the edge of the ring is normal. After
the bell comes off, rinse it with water and put Vaseline on it. It will
be red and have a white or yellow-white mucous on it. Gently wash and
put Vaseline on it. The other method of circumcision performed is with a
Gomco clamp. The penis will have all the skin taken off with a raw red
area present. A generous amount of Vaseline should be applied to the
penis in order to prevent it from sticking to the diaper. Clean off any
urine or stool with warm water or soap and water. Apply Vaseline with
each diaper change. Continue applying the Vaseline until the area is
completely healed (usually about 5-7 days). Do not pull back on the
skin until months later as shown by your pediatrician.
Vaginal area:
The
girls will have a mucous discharge for weeks and some times bloody. Do
not be alarmed. Clean with water and paper/washcloth and wipe front to
back gently to clean out most of the stool and urine. You do not have
to clean out all the mucous since that is nature's diaper-rash ointment
and protection from irritation. Apply Vaseline between the labia so
they do not get stuck together.
Stools:
The
initial stools are black tarry meconium. After a few days the stools may
be yellow or green and are usually seedy. They normally have a stool
after every feeding. Breast stools are usually yellow water with some
seeds in it. Bottle fed babies have stools between apple sauce and
loose mashed potatoes consistency. Constipation is hard pellet-like
stools. Treat this by starting some apple juice. Give us a
call if there is a question. Not having a bowel movement for days is common and if they
feel fine, eating well and actin normal, then ignore it. It has to come out some day and when it does,
stand back. You do not have to make them have a BM every day. But if it has been
several days since a BM and they are getting fussy, then stimulate a BM
by taking their temperature with a lot of Vaseline, or insert 1/2 a
glycerin suppository. Watch for blood in the stools, crying
continuously, vomiting green stuff, and not eating.
Diapers:
Cloth
or disposable diapers are fine and some mothers use both. If you wash
the cloth diapers at home, you may use any average detergent but rinse
them thoroughly. Any brand of diapers is fine but watch for rashes and
change brands if you need to.
Comfort:
Try to
keep an even, comfortable temperature in the baby's room. On hot days
provide ventilation. On cold days check on your baby occasionally to see
that he's covered enough to be warm and comfortable. The room
temperature should be around 70-72 degrees. If you are comfortable in a
short sleeve shirt, it is about right for your baby. Then the baby will
be fine if a t-shirt, diaper, one outfit on, and one receiving blanket
around them. If it is colder, put more layers on them and if hot, take
some off.
Sleeping:
You may expect your new baby to do a lot of sleeping. The Academy of
Pediatrics has recommended that infants sleep on their side or back.
This new recommendation is based on research which found a 50% lower
incidence of SIDS (Sudden Infant Death Syndrome) in these babies.
Initially, most babies sleep 16 to 20 hours per day. Be sure to vary
their sleep position. One night on their right side, next on their
left, and the next square on their back. Keep rotating them. If they
keep their head turned to one side only, then let us know when you come
in for a check up. If their skull gets deformed, then they have to
wear a helmet to round it back to normal.
Bassinet or
Bed:
The baby's mattress should be firm and flat. No pillow should be used.
Protect the mattress with a waterproof cover. Next comes a soft baby
sheet and one or two cotton blankets. Babies like being swaddled the
first one to two weeks. After that they usually kick the cover off.
Clothing: Your
baby does not require any more clothing as an adult, so try not to over
clothe him. Dress him according to the temperature. Some babies are
allergic to certain materials, so watch for rashes in clothing contact
areas. It is common to be allergic to the metal snaps on the garments
and have small areas of rash where the snaps make contact. Most babies
are comfortable in a diaper, shirt, one outfit, and one light receiving
blanket.
Outdoors: A
fairly good rule to follow is to take your baby out whenever the weather
is pleasant. Babies may be taken out on a nice day after they are two
weeks old. Babies need some indirect sunlight but they sunburn easily.
Early morning or late afternoon reduces the risk of sun burning. Some
type of cover overhead is also a good idea. Getting out does not cause
babies to get sick. Wind in the ears does not cause ear infections. Keep
baby away from people who are sick. Be sure to wrap baby up warmly when
it is cold. Babies may fly in airplanes in 2 or 3 weeks.
It generally does not hurt
their ears to fly until nearly school age.
Fever.
If your child has a fever during the first 2 months of life, your child
will need to be seen promptly. If this occurs when the office is
closed, bring him into Children's Medical Center Emergency room in
Dallas or Cooks Children Emergency Room in Fort Worth. Fever is 100
degrees or more under the arm and 101 degrees in the rectum. I do not
recommend the ear or forehead type because they are not accurate.
Things That are
Normal but Worry You:
1. Hiccups are
normal and frequent. You can try to stop them by burping or giving a
drink of water. Usually they do not upset the infant and you should
ignore them.
2. Sneezing a
lot is common. This is not a cold or allergy. This is the way they clear
the nose.
3. Nasal
congestion is frequent during the first week and frequently continues
for up to 2 months. If there is a runny nose or a lot of coughing, it
could be a cold and we should see the baby. The congestion does not need
treatment as long as baby isn't fussy, and is eating and sleeping well.
Expect a "snorty" baby for several months. They also do not know how to
handle the post nasal secretions. So many babies have a gurgling in the
back of their throat when they breath. This noise can echo down their
airways into the chest where you feel and hear the "rattle in the
chest". This in not in the lungs but is in the back of the throat and
not an illness. Ignore it. Watch for labored breathing that looks like
your brother who ran around the block and is out of breath.
4. The normal
colic occurs in the evenings for 2 hours around 6 to 11 p.m. Usually it
is not severe crying and the infant can be rocked, given a pacifier or a
drink of water or nursed more often. You can also put them in a
vibrating chair or in a swing. It also does not hurt to put
baby down and let him or her have a good cry as long as you have met all
their possible needs. If the baby is crying all day or all night, we
need to check the baby in the office. Mylicon and other preparations
for gas usually do not help but is safe and if you want to waste your
money, go ahead and give it to them. If needed, call the office for a prescription of Levsin that
helps colic more. Burping more frequently does not help. Changing formulas
can rarely help but you can try Lactofree or soy formula. If breast
feeding, try stopping certain things in your diet. Milk is the most
common thing to cause colic in the breast fed baby.
5. Most babies
spit up often. Once a week, a baby may vomit a large amount. Do not be
alarmed. Clean up and watch for recurrence. If this happens 2-3
feedings in a row, bring the baby in for evaluation. If the baby
is spitting a lot but gaining weight and is not colicy, then it is a
messy problem and not a health problem.
6. Babies may
have irregular breathing; have a startle reflex where their arms
suddenly flip out; have chin, hands, and feet quiver (almost like a
shiver but they are not cold), or they have crossing eyes. All of
these are normal for newborns for weeks.
7. All babies
turn yellow (jaundice). First their face and chest, then their arms and
legs, and then their palms and soles of feet. If you go home and they
are turning yellow, watch for the bottoms of the feet. Press on
the bottom of the feet for a few seconds and if it is flesh pink, then
they are OK. If it is yellow as the face, then call the doctor. Put them in
some indirect sunlight, not directly into sunlight. Call the office if
they start looking more yellow and especially is the feet are yellow. It usually hits the highest at 3-5 days
of age. Breast babies may have higher jaundice and some small
amounts of jaundice for a month or two.
Office Visits:
Your baby should have his/her first routine office check-up when he/she
is two-three weeks old. For your convenience, please call the office
for an appointment right away. The receptionist keeps the appointment
book, so please call her several weeks in advance. You also need to get
your baby's newborn screening PKU blood test at the hospital lab. The
nurses should instruct you about it at discharge.
If the baby is having nursing problems, has
more yellowness to the skin, or limp and lethargic, then call the office
for an appointment immediately. We will be glad to see the baby at
3-5 days old if not nursing well and having problems.
Both well and
sick child care visits to the office are an important part of
comprehensive medical care. During a well-child visit we are mainly
concerned with observing the growth and development, counseling and
teaching of parents. There is also early detection of illness through screening
examinations and laboratory tests, physical examination, immunizations, and getting to know
one another. We limit our counseling to the disease at hand during a
sick-child visit. Write down the questions you want answered before
coming in for the well exam appointment. Make certain before leaving that your
questions are answered fully and that you understand what the doctor has
told you. Well-care and sick visits are scheduled separately. When
making an appointment, tell the receptionist the reason for the visit
plus any other pertinent information which will help her give the
necessary amount of time. If cancellation of an appointment is
necessary, please call us as soon as possible. Other patients are
waiting for that time slot.
Immunizations
are very important and will be started at the 2 week and/or 2 month
check-up. Your baby should have immunizations to prevent whooping cough,
diphtheria, tetanus, polio, measles, rubella, mumps, meningitis and
hepatitis. These are safe vaccines and we follow the recommended
schedule from the C.D.C. and American Academy of Pediatrics. The
immunizations do not cause Autism!!!
Let us know if
there is any way we can help you. This is exciting and scary. We want
to be there for you.
Dr. Knapp
