II. Red flags requiring immediate evaluation
- Signs of infection
- Fever over 100.4
- Decreased alertness
- Signs of Dehydration
- See Pediatric Dehydration
- Weight loss >9% of birth weight (urgent)
- Increased Tiredness or sunken Fontanelle
- Less than 3 wet diapers per day
- Signs of breathing problems
- Signs of significant Jaundice
- See Neonatal Hyperbilirubinemia
- Yellow Skin below nipple line suggests Bilirubin test
III. Feeding
- See Infant Feeding
- Avoid harmful measures
- Do not give water (risk of Hyponatremia)
- Do not give honey for the first year (Botulism risk)
- No solid food (baby food) for first 4 months
-
Breast Feeding (preferred)
- Work with new mothers on Breast Feeding Technique
- Review common Breast Feeding Problems for the Infant
- Review Medications in Lactation
- Supplement with Vitamin D 200 IU daily
-
Formula Feeding
- Only use formulas containing full strength iron
- Choose one formula and continue the same one
- Heat formula only to room Temperature
- Dispose of unused formula immediately
- Wash bottles in warm soapy water
- Call physician if:
- Formula problems
- Consult with physician before switching
- Signs of Dehydration
- See above
- Formula problems
IV. Urine
- Infants usually urinate 6 or more times daily
- Call physician if:
- Less than 3 wet diapers per day
V. Stool
- Consistency: Often loose and may be watery at times
- Frequency
- Breast Feeding: >3 stools per day
- Formula Feeding: Stool every other day may be normal
- Problems: Constipation
- See Neonatal Constipation
- Try Apple, pear or prune juice 1 ounce 1-2x/day
- Maximize fluid intake (Breast Milk or formula)
- Consider Glycerin Suppository if continues
- Call physician if:
- Constipation: Less than 5 stools/week for 2 weeks
- Diarrhea: Stool runs out of diaper
VI. Umbilical Cord
- Clean cord area with water only
- May use a mild, pH neutral skin cleanser if needed
- Do not use Alcohol
- Call physician if:
- Infection signs (discharge or redness at Umbilicus)
- Umbilical Cord not detached by 2 weeks
VII. Genitalia
- Gently clean area with warm water at diaper changes
- Boys
- Uncircumsized boys
- Do not retract foreskin forcefully (Phimosis risk)
- Circumcision care
- Vaseline to area with each diaper change for 5 days
- Uncircumsized boys
- Girls
- Small bloody Vaginal Discharge in newborns is normal
VIII. Safety Issues
-
Child Safety Seat
- See Infant Car Seat
- Rear-facing, approved Car Seat (not in front seat)
-
Sleep
- See Crib Safety
- Should sleep on back on firm mattress (reduces SIDS)
- Avoid unnecessary exposures to illness
- Keep persons with acute illness away from newborns
- Stay away from supermarkets or malls
- Avoid second hand smoke exposure
IX. Follow-up: Initial visits
- Week 1: Recheck weight, Jaundice and other concerns
- May be performed by home health, nurse or physician
- Discharge <24 hours of life: Follow-up within 2 days
- Discharge <48 hours of life: Follow-up within 4 days
- Discharge >48 hours of life: Follow-up within 5 days
- Week 2: Well Child check with repeat full Newborn Exam
- Performed by physician in clinic
- Week 8: Well child check
- Initiates Immunization schedule
X. References
- Eliason in Rakel (2002) Family Practice, p. 578-82
- (2004) Pediatrics 113:1434-6 [PubMed]
- Friedman (2004) Pediatr Clin North Am 51(3):599-618 [PubMed]
- Langan (2006) Am Fam Physician 73(5):849-52 [PubMed]