Your Baby’s First Year
This essential guide offers expert insights to help you navigate the first months with your baby.
Learn health schedules, hospital care, feeding, sleep, common concerns and safety measures for a healthy first year.
INTRODUCTION
Welcome to the exciting and sometimes overwhelming journey of parenthood! Dr. Marylee Mundell D.O. and Dr. Marie Carrier Kinsley M.D., the founders of Pediatric Care Group, have compiled this essential guide on helping you care for your newborn. Dive in to discover comprehensive insights on everything from crucial health maintenance schedules to navigating common infant concerns like feeding, sleep, rashes and other common concerns.
Learn vital safety tips and how to recognize health emergencies, ensuring you're prepared for every precious moment. This resource is designed to help make the early years of your child's life as healthy and joyful as possible.
HEALTH MAINTENANCE SCHEDULE
Listed below is the recommended schedule of well visits and immunizations that your child should adhere to in order to maintain health. Your child’s growth and development will be assessed at these visits, and any questions you may have will be answered at that time. The doctor will also discuss the necessary immunizations with you at each visit.
Flu shots are given seasonally to children between 6-23 months, and to children with chronic health problems such as asthma, diabetes, etc. Teenagers may receive the meningococcal vaccine prior to entry to college. Please bring your child’s immunization record to each visit. If your child has any abnormal reaction to a vaccine, please call the office.
ROUTINE CARE FOR YOUR INFANT IN THE HOSPITAL
Your Pediatrician
It is important that you choose your pediatrician well before your baby is born. This way you can ask questions and discuss any concerns prior to birth. Additionally, the hospital staff can call your pediatrician immediately if there are any serious concerns about your baby after birth.
Vitamin K
A vitamin K injection is given to every baby shortly after birth to prevent hemolytic disease of the newborn. This rare but potentially very serious condition can be prevented with this vitamin.
Antibiotic Eye Ointment
Antibiotic eye ointment will be applied to your infant’s eyes soon after birth to protect against infections of the eyes. The ointment dissolves at body temperature and is well tolerated by the baby.
Metabolic Screen
By state law, every infant’s blood is tested for many metabolic disorders before the baby leaves the hospital. The blood is usually drawn via a heel prick. Some of the disorders tested for in Pennsylvania include hypothyroidism, Phenylketonuria (PKU), Maple Syrup Urine Disease and Sickle cell disease. The tests are analyzed by the state, and the results will be sent to your pediatrician within a few weeks.
Hearing Screen
Many hospitals are now routinely screening all newborns for possible hearing problems. The tests used are quick, simple and provide a good screening test. If the baby passes the test, the likelihood of a hearing problem is very low. If the baby doesn’t pass the test, it doesn’t necessary mean that the baby has a hearing problem. It means the test needs to be repeated when the baby is 4-6 weeks of age. Noisy conditions, a fussy baby or debris in the ear can lead to an invalid result. In most cases, a repeat test in several weeks is normal.
Immunizations
Your infant will receive his or her first hepatitis B vaccination in the hospital. This is the first of many vaccines that your baby should receive in the first two years of life. Immunizing your baby with Hepatitis B vaccine early protects the infant whose mom has been exposed to hepatitis B but is not yet aware of it. The hepatitis B vaccine is very well tolerated and has minimal side effects. Ask your pediatrician if you have concerns regarding this or any other vaccine.
CARING FOR YOUR INFANT
Feeding
It is a very personal decision about whether to breast or bottle feed your infant. Breastfeeding is the perfect nutrition for an infant and supplies immune benefits, is inexpensive and provides a wonderful bonding time with mom and baby. For some families bottle feeding is the feeding of choice because of ease, convenience or personal preference. This is a decision to explore, preferably before the baby is born. Discuss these issues with your partner, your obstetrician, your pediatrician, family members and friends. Ultimately, whatever you decide is best for your and your baby is the right decision.
Breastfeeding
In most cases, breastfeeding will begin immediately following birth while you are still in the delivery room. Your baby will receive colostrum for the first three to four days following delivery until your mature milk appears. The colostrum is yellowish in color and filled with lots of protein and important antibodies for your baby. Colostrum also acts a laxative and helps with your infant’s stooling. The baby’s stool will change from the initial thick, black meconium stools to a brownish-green stool to a loose, seedy yellow stool. Most breast-fed infants will begin stooling with each feeding after five to six days. Breast-fed infants feed very frequently the first few weeks. Breast milk is easily digested and gentle on your infant’s digestive system. Most newborns will feed every one to three hours for the first four to six weeks. Good positioning, a good latch and a comfortable space is important to breastfeeding your infant. For good positioning, the baby’s head, shoulders and hips should be in a straight line. A good latch requires the infant to open his/her mouth wide, and the infant’s head should be brought to the breast. The baby should have a good mouthful of the areola and not the nipple alone. Sucking on the nipple alone will lead to improper latch, pain and cracking of the nipple.
Feeding time varies with each infant. The baby should be offered the first breast and allowed to feed until he/she falls asleep or pops off the breast. The baby should then be burped and offered the other breast. If your baby does not awaken on his/her own to feed, you should wake your baby every three hours during the day. Your baby can go a little longer at night, but during the first week do not allow your baby to go longer than five hours without feeding.
Supplements of breast milk or formula should be avoided for the first three to four weeks. This allows adequate time to establish a good milk supply and a good nursing relationship. Nipples from baby bottles allow quicker milk flow and less work on the infant’s part which can lead to a preference for the baby bottle nipple rather than the breast. This is also true for pacifiers. Pacifiers should be avoided for the first three to four weeks unless you’ve been instructed by your pediatrician or lactation consultant.
Breast feeding is a wonderful way to start your child’s nutrition off to a good start. Don’t hesitate to call with any questions or concerns you may have.
Bottle Feeding
There are many good infant formulas available and usually the best one to start with is a milk-based formula supplemented with iron. This type of formula has the nutrition makeup most similar to breast milk. Your baby may take anywhere from ½ to 2 ounces per feeding initially. He or she may be interested in feeding every 1 ½ to 4 hours apart. Offer your baby a bottle if it has been more than 3 hours during the day or more than 5 hours at night for the first few weeks. It is fine to allow the baby to feed on demand after the first few weeks if your infant’s weight gain has been adequate. Make sure to attempt to burp your baby after every ½ to 1 ounce to prevent swallowed air, gas pain, and increased spit up.
Whether you breast feed or bottle feed, your infant gets plenty of fluid from the breast milk or formula. He or she does not need any additional water or food at this time. You will know the baby is staying well hydrated when there are 6 or more wet diapers in a 24 hour period (after the first week). Also you will know the baby is getting good nutrition by the weight gain over time. Your pediatrician will let you know if the baby is gaining a normal amount of weight.
Reflux
Many infants have gastroesophageal reflux, commonly referred to as reflux, spitting up or wet burps. Reflux is caused by a loose muscle where the esophagus (swallowing pipe) meets the stomach. The milk the baby drinks comes back up because of the loose muscle causing the baby to spit up. As the baby grows, this muscle tightens and reflux is no longer a problem. Occasionally, the baby will need to be treated for reflux if the spitting up is causing the baby not to gain weight, or if the baby is in a lot of discomfort from the stomach acid that comes up with the milk. If your child has these symptoms, you should discuss them with your pediatrician.
Colic
Some infants will suffer from inconsolable crying for a prolonged period during the day or evening. The cause of colic is unknown. This can be a very frustrating time for both parents and babies. Colic usually begins around 4-6 weeks of age and can last for 3-4 months. Aggressive burping and feeding small amounts has been shown to help. Also, “white noise” such as vacuum cleaner will occasionally improve the crying. Time and patience are the keys when your baby has colic.
Thrush
Thrush is a yeast infection that occurs in the baby’s mouth or on the tongue and cheeks. It looks like white plaques that you cannot wipe away. If untreated, it can become worse causing pain for the baby while feeding. You should notify your pediatrician if you suspect thrush. It requires a prescription medication for cure.
Sleep
Infants require a large amount of sleep initially. Newborns can sleep as much as 12-16 hours per day. It is important to wake your baby every 2-3 hours for feedings during the day and every 4-5 hours during the night if he/she doesn’t awaken on his/her own. As your baby grows, a more routing feeding pattern will develop.
Your infant should always be put to sleep on his back. Never place your infant to sleep on his belly. Infants who sleep on the belly have a higher incidence of SIDS (Sudden Infant Death Syndrome). Your baby should be placed in a clean, open space for sleeping. Do not place stuffed animals, toys or pillows in the crib or bassinet.
Diaper Changes
Your infant should wet 6 or more wet diapers in a 24 hour period after the first week. The number of stools will be variable. Some newborns have bowel movements with every feed and some stool daily or every couple of days. Any of these patterns is normal and the pattern may change with time. You’re baby’s stools will change in color from the initial thick, black meconium stools to brownish-green to yellow by day of life 5 or 6. The stools should be soft and pasty if formula-fed and more liquid and seedy if breast-fed. If your baby seems constipated, check with your pediatrician. Sometimes infants will require pear or prune juice. You should never give your baby honey or Karo Syrup™.
Rashes
Diaper rash is the most common rash in the newborn period. To prevent rash in the diaper area, change the diaper frequently and use soap and water to wash the area. Baby wipes can be irritating to a newborn’s skin and should not be used for the first 3-4 weeks. Allowing the diaper area to air dry can also help prevent diaper rash. A diaper cream may be used as a barrier between the infant’s skin and urine to also help prevent or alleviate diaper rash. If your child has a rash that does not resolve with 5-7 days or is worsening, notify your baby’s doctor.
Circumcision Care
After circumcision, a gauze wrap is placed around the head of the penis to protect the skin while healing. This gauze will usually fall off on its own. If it doesn’t, you may remove it after 24 hours. As the penis heals, it will change from a beefy red color, to yellowish to normal skin color with a slightly bluish hue. Vaseline™ or A & D ointment™ should be place on the penis with each diaper change for the first week to facilitate healing.
Umbilical Cord Care
The umbilical stump requires little care in the first few days. Use a swab or cotton ball to apply alcohol to the stump with each diaper change. Keep the area clean and dry. Try to fold the diaper under the umbilical area. The stump should fall off within 2-3 weeks of age. It is normal for the stump to bleed for a day or two before and after it falls off. If you notice any foul-smelling drainage or redness in the umbilical area, call your pediatrician.
Bathing
Infants do not require frequent bathing. Sponge baths may be given until the umbilical cord falls off (2-3 weeks of age). Always use warm water and a gentle, mild soap for bathing. The scalp and hair can be washed with soap and a washcloth. Gentle pressure over the fontanel or “soft spot” will not injury your baby. Never leave your baby alone while bathing.
Clothing
As a general rule, your infant should be dressed as you would dress yourself. An infant does not require any more clothing than an adult. If you are wearing a coat or jacket, your infant should be bundled. Sleep wear that is fire proof is best. Avoid highly perfumed detergents and fabric softeners when washing your infant’s clothing. They can be irritating to baby’s skin.
INFANT HEALTH EMERGENCIES
The first 8 weeks in an infant’s life can be very stressful for many reasons. These first 8 weeks is also a time when your infant is more susceptible to colds or viral illnesses. It is important for anyone handling your infant to wash their hands before picking up the baby. Anyone who is ill should not be around the baby until they are well. Large groups or gatherings should also be avoided for the first 8 weeks. These precautions will help minimize your infant’s risk of becoming ill.
Fever
If your infant is excessively cranky, irritable, feels warm or is not feeding well, these are signs to take your infant’s temperature. A rectal temperature is most accurate in the newborn/infant period. If your infant is less than 2 months of age and has a temperature of 100.5° or more, notify your pediatrician immediately. The immune system in infants is immature and they can become ill quickly without showing many signs or symptoms. Acetaminophen (Tylenol™) should never be given to an infant less than two months of age without consulting a physician first. For older babies, the dose depends on the weight of the baby. NEVER GIVE ASPIRIN TO CHILDREN. Consult with your pediatrician before administering acetaminophen to your infant.
Vomiting
Vomiting in infants is always a concern since it may lead to dehydration or be a sign of serious illness. Don’t confuse spitting up with vomiting. It is normal for infants to have wet burps after feeding. Vomiting occurs when a child brings up at least 1-2 ounces of fluid. Also, if the vomit is green or yellow, notify your baby’s doctor. If repeated vomiting occurs, contact the doctor. Do not give tap water or bottled water to infants. Regular water does not contain salt and other necessary electrolytes can promote further dehydration. Oral rehydration solutions, such as Pedialyte™, contain salt and other electrolytes are sold in stores. It may be substituted for formula when your child is vomiting. Consult with your pediatrician before switching to Pedialyte™.
Diarrhea
Loose stools in infants are very common. The consistency of the stool depends on the type of nutrition. Breast fed infants have loose, seedy stools, and can have 6-10 stools per day. Formula fed infants tend to have more formed, firm stools that are less frequent. A child with more than 10 water stools per day has diarrhea. If your child is not vomiting, you can continue to breast feed or formula feed your baby even if they have diarrhea. Blood in the stool is never normal. If your child shows signs of dehydration, such as decreased urine output, or blood in the stool, notify your doctor.
Jaundice
It is common for newborns to have yellowing of the skin, or jaundice, in the first 72 hours of life. Jaundice is caused by an accumulation of bilirubin, which is a normal breakdown product of the red blood cell. This condition usually resolves without any intervention. However, some children may require special therapy to help the jaundice resolve. If your child develops jaundice after going home from the hospital, notify your pediatrician.
INFANT SAFETY
Providing a safe environment for your newborn is sure to be a prime concern for parents. Here are a few safety tips that every parent should be aware of before bringing their infant home.
Car Seats
One of the first pieces of infant equipment you will purchase is an infant car seat. Pennsylvania law requires infants to be placed in infant car seats when riding in a vehicle. Never hold an infant on your lap while in a car. Your child can be severely injured or killed in an accident if not placed in a proper car seat. The safest place for the infant seat is in the back seat, rear facing. Make sure you review how to properly install the car seat before taking your child home. Never place a car seat in the front seat.
Smoke Alarms
All homes should have working smoke alarms on each floor of the home. The batteries should be checked twice a year. Carbon monoxide detectors should also be strongly considered.
Passive Smoke
If there are smokers in the house, they should smoke outside. It is very important to create a smoke free environment for your baby. Smoking in another room or in bathroom is not satisfactory since smoke travels and drifts especially through venting systems. Studies have shown that children who live in homes with passive smoking have a higher incidence of ear infections and asthma. Passive smoke has also been linked to Sudden Infant Death Syndrome (SIDS) or “crib death”.
Walkers
Do not use walkers. Many children are severely injured while placed in a walker because it allows them to gain access to places that they normally would not be able to reach, ex: stairs.
Falls
Never leave your baby unattended on a sofa, bed or changing table. Infants can roll off furniture and sustain head injuries or other traumas after falling from small heights.
Crying
Most infants will let their parents know when they are hungry or need their diaper changed by crying. Some infants suffer from colic and cry for long periods of time. However, crying can also be a sign of illness in an infant. If your child is consistently irritable, obtain a rectal temperature and call your pediatrician.
Cyanosis
Cyanosis is the term used to describe a blue coloring of the skin or body part. Infants may develop this if they are not receiving enough oxygen. If your child has blue discoloration of the lips or any body part, this is an emergency and the physician should be contacted immediately. Cyanosis may also be accompanied by rapid or difficult breathing. If your child shows signs of respiratory distress, call 911.
PCG Owners
Marylee Mundell, D.O.
Dr. Mundell graduated from The University of Medicine and Dentistry of New Jersey and completed her pediatric residency at St. Christopher’s Hospital for Children in Philadelphia. She is a board certified pediatrician and a fellow of the American Academy of Pediatrics. Dr. Mundell is a general pediatrician and has a special interest in special needs, developmental pediatrics and adolescent medicine.
Marie Carrier Kinsley, M.D.
Dr. Carrier Kinsley graduated from The Medical College of Pennsylvania and completed her pediatric residency at The Children’s Hospital of Philadelphia. Board certified in pediatrics and a fellow of the American Academy of Pediatrics, Dr. Carrier Kinsley is a general pediatrician involved in many community outreach programs. She also has a special interest in caring for preterm infants after discharge from the hospital.
Schedule your free consultation or appointment today by calling 215-885-8700.