1068 Union StreetBangor, ME 04401

207.947.0147

CONGRATULATIONS!You have a new member in your family. For most mothers and fathers, the first weeks at home with a new baby can be a challenge.

Caring for your baby is a big responsibility, but the rewards are endless.

This booklet provides information about the care of your newborn and answers some common questions and concerns.

If you feel overwhelmed or just have a simple question, please call Penobscot Pediatrics and one of our skilled providers will provide you with the assistance you need.

The Penobscot Pediatrics staff would like to help you during this exciting time. We want to provide information to help you care for your precious newborn and hopefully answer your questions and concerns.

When your baby arrives home from the hospital, you will need the following basics—which you are wise to have beforehand!

Bassinet or Crib — A bassinet which you can keep beside your bed is ideal for the first 2-4 weeks of home adjustment. Having your baby nearby will be convenient for the night feedings and your ease of mind and body. For the crib, it is wise to get baby into his/her own room after 2-4 weeks for the sake of everyone’s sleep. Make sure the mattress fits snugly around all edges, that the slats are 2-2 1/2 inches apart, there are no holes, curves or other markings to trap baby’s arms, head, etc., and no old lead paint is present. If this is a new or recently built crib, it is made to meet current federal safety standards.

Safety-tested Car Seat — A good car seat is mandatory. You will need this going home from the hospital — a baby is safer in a seat than in your arms (and it is the law!). Car accidents are a major cause of death/disability, and often happen in short trips near your home. Car seats should be placed in the back seat and facing rearward up until age 2 for maximum safety. Follow all instructions on insert. NEVER place an infant in a car seat or a child in the front seat if you have a passenger side air bag. Several deaths have been reported from airbag injuries. If you need your car seat inspected, contact your Police Department.

“Snuggli” or “Baby Bjorn” or Sling — A happy parent is one who is able to get out with the new baby — avoiding the “shut in”, “cabin fever blues”. A well clothed baby can usually be taken outside by the second week. Check out the many options online, in the stores or ask friends what they prefer for safely and comfortably transporting their baby.

Other items which will be necessary at home includes cloth or disposable Diapers, Rectal Thermometer (have the nurses demonstrate if you have questions), Alcohol with Cotton Balls, Nasal Aspirator and Baby Bottles.

Routine Equipment

While the newborn appears to spend most of the time asleep except for feedings, your baby will have many specific behavior patterns — some just recently discovered. He/she visually recognizes colors, patterns, and can distinguish mother’s face. Infants hear and prefer quiet, high pitched noises such as music boxes and mother’s singing voice.

Newborn Behavior

They can pick up tension/nervousness through a mother’s arms. Hence, you need to be calm — take some deep breaths and sit in a relaxing chair when holding the baby for feedings. A baby forms secure attachments to Mom and Dad only after hours of close physical holding, feeding, talking, etc. — this process is called “bonding” and magically brings forth the physical feelings of mothering and fathering for new parents. Make sure that Dad spends time holding the baby!

The newborn has a variety of natural responses that cannot be controlled. One is the startle response of out flung arms and legs in response to a noise or jolt. This is a normal reflex and not a seizure! Secondly, the sucking reflex is never ending — whenever anything is in the mouth, whether the baby is hungry or not. Breathing patterns may be irregular with occasional rapid breathing and then slowing, and sneezing. Newborns can only breathe through their nose, so you should know how to use a bulb syringe to clean mucus out of the nose as needed (depress bulb first, then insert gently into nostril until sealed, release bulb while holding shut the other nostril). This will make feeding easier for your baby.

Let’s discuss those natural feelings of insecurity every parent has taking home a new baby. First, there are the natural “blues” you may feel with the sudden change from pregnancy to motherhood and a bigger family. These are natural — you don’t need to feel guilty, they almost always will pass. Then there is the overwhelming feeling of being totally responsible for a completely dependent baby. These feelings will pass with good support from your family, your pediatrician and with your own increased sense of confidence you will gain as your child grows. Through educating yourself on child behavior and care, you will have less fear of the unknown by knowing what to expect at different ages and what to do as “first aid” for various common problems. Preventive education is one of the prime objectives at Penobscot Pediatrics. In regards to education, we’ll warn you ahead of time against the “backyard fence syndrome;” comparing notes on child development with your friends and neighbors. Every child is different and goes through the stages of development at his or her own pace with their own temperament. We recommend reading Brazelton’s Infants and Mothers and Infants and Fathers. These excellent books emphasize the normal differences in child development and will save tears at the “back fence” (Try to ignore his rather old-fashioned view of women!). After checking these books, always bring your questions and concerns straight to us as your child’s pediatrician. For more reading sources, see the back page of this booklet.

Attitudes and Feelings

Fatigue can be a major source of insecurity and frustration with the irregular schedules of the newborn. It is essential to be able to take “naps” whenever your baby decides to sleep. You will need extra help around the house for the first several weeks — hopefully from dad and the most easygoing of the grandparents. By the way, watch out for Grandmom’s well-meaning advice of feedings. “We’ve come a long way” with the infant nutrition from her child-rearing days. We recommend avoiding early solid feedings, and we encourage breast feedings.

Finally, we’d like to stress from the beginning that every parent needs a “life line.” Being alone with a colicky baby or contradictory toddler can frazzle any parent’s nerves. Try to get together with other parents of young children. Check at the YMCA, your gym or your church for Mommy &Me classes. Walk at the nearby park or playground. If the weather is bad, walking in the mall can get you out and about.

The following pages provide several useful tips for caring for your newborn. Remember — if your questions aren’t addressed in this booklet, call your pediatrician.

Every newborn experiences many, if not all, of these characteristics. Sneezing All babies sneeze repeatedly, and this does not mean they are catching a cold. Newborns are nose breathers and very sensitive.

Hiccups Babies also repeatedly hiccup, sometimes for extended periods of time. This is normal. Feeding and burping will usually interrupt (stop) the episode.

Noisy Breathing Some babies make a rattling sound when they breathe and they may sound like they are stuffy. This is usually related to mucus in the back of the nose and mouth, and it gradually disappears as the baby gets older.

Spitting Up After Meals Some babies bring up small amounts of milk (one tablespoon) after each feeding. This tends to disappear when the baby begins to sit up. It is not harmful in any way. Do call if there is repeated larger vomiting or coughing after spitting.

Red Face/Straining with Bowel Movements Most babies look like they are having a hard time passing a stool. As long as the stool is soft, and the baby is not actually crying when having a bowel movement, nothing needs to be done. Avoid using stool softeners and rectal suppositories.

Common Characteristics of Newborns

Swollen Breasts and Vaginal Discharge Both male and female babies frequently have swelling of the tissues in the breast areas, and female babies often have some bloody discharge from the vaginal area during the first week after birth. These are due to stimulation of the tissue by the mother’s hormones during pregnancy and gradually go away after birth. If the breasts become inflamed or red, let us know. Don’t squeeze them! A cotton ball in water may be used to gently remove any discharge, always wiping toward the rectum. Boys may well have some swelling of the scrotum from the pressure effect of delivery — this will go down within the first week. A bulging that develops in the scrotum or in the groin should be reported to us as it may be fluid in the scrotum or a hernia (we usually watch these for several months to see if they go away on their own unless they become discolored or painful).

Crying Most babies have irritable periods when they cry more than you think they should. If the baby is taking feedings well, has been burped and otherwise seems well, the crying does not mean anything serious is wrong. It should stop within 20 minutes.

Skin rashes Most babies develop temporary skin rashes on their cheeks and in their diaper areas. These are generally irritations from wetness and rubbing and, in the diaper area, respond to protective ointments such as Vaseline, A & D Ointment or Desitin ointment. Leaving off rubber or plastic pants at night will often help clear up diaper rashes.Bowel Movements Normal stools in infants vary greatly depending on if they are bottle or breast-fed. Breast-fed infants initially have yellow-green, seedy, watery stools many times a day (up to 6-10 times). This changes as the infant gets older (4 to 8 weeks of age) and the stools become less frequent. At this point, infants may not stool for several days. Some breastfed infants at 2-4 months of age only stool every 4-7 days. As long as the stool is not hard, this is not a problem. Bottle-fed infants initially stool more often as well and gradually decrease the amount that they stool to 1-2 formed stools per day. Please do not use suppositories, change the formula or give an enema without talking to us first.

Care of the umbilical cord The umbilical cord should be cleaned by swabbing alcohol with each diaper change until the cord falls off. This should be done with alcohol swabs or alcohol used with a Q-tip with every diaper change. It may take as long as three weeks for the umbilical cord to fall off. It is normal for the cord to smell badly just before the cord falls off. After it falls off, there may be a day or two of bloody discharge in the area. This is normal and will dry up on its own. If any redness or rash develops around the site or there are any concerns that there is an infection, please notify the office.

Foreskin care At birth, the foreskin is normally attached to the head of the penis by a layer of skin. Over the next 5 to 10 years, the foreskin will naturally separate from the head of the penis without any help from us. It gradually loosens up (and pulls back) a little at a time. The foreskin generally causes no problems. However, pulling back before the foreskin has fully loosened can cause it to get stuck behind the head of the penis, resulting in severe pain and swelling. If pulling back causes bleeding, scar tissue may form and interfere with natural retraction. Most of the time, leaving the foreskin alone can prevent these problems.

In general, the foreskin requires minimal care. During the first year of life, clean only the outside of the foreskin. Do not engage in any attempts at pulling back. Do not put any cotton swabs in the opening. Begin partial pulling back at 1 or 2 years of age. It can be done once weekly during bathing by gently pulling the skin on the shaft of the penis down toward the abdomen. This will make the foreskin open up, revealing the end of the glans. At this time, the exposed part of the glans should be cleansed with water. Wipe away any whitish material that you find there. This whitish material is simply the buildup of dead skin cells that are normally shed from the glans and lining of the foreskin throughout life. Do not use soap or leave soapy water under the foreskin as this can lead to irritation and swelling. After cleansing, always pull the foreskin forward to its normal position. Avoid pulling back too hard because this can cause the foreskin to become stuck. You can tell if you’re pulling back too hard if it causes any discomfort or crying. By the time your son is 5 or 6 years old, teach him to retract his own foreskin and clean beneath it once a week during baths to prevent poor hygiene and infection. Gentle reminders are necessary in early years. Call our office immediately if the foreskin is pulled back and stuck behind the head of the penis, your child cannot pass any urine, or if anything looks infected (yellow pus, spreading redness, red streaks). Call during office hours if the urine stream is weak and dribbly or if you have any other concerns.

Caring for your Newborn

Care of the circumcision Most boys, who get circumcised at EMMC, go home with Vaseline gauze wrapped around the head of the penis. This should be changed when dirty, or at least 1-2 times a day. Gently wash the penis with warm water and reapply the Vaseline gauze for 2-4 days, or until the head of the penis is pink instead of bright red. At this point, Vaseline gauze is no longer needed. If at any time the head of the penis looks infected (discharge, increased or spreading redness), please call Penobscot Pediatrics.

Sleeping The American Academy of Pediatrics now recommends placing infants and newborns on their backs for a sleeping position. This has been shown to decrease the incidence of SIDS. We also recommend that infants sleep on a firm mattress. There should be no use of sheepskins, fluffy comforters or pillows, mattress liners, down mattresses or water pads.

Feeding

Babies who are breast-fed have fewer infections and allergies during the first year of life than babies who are formula fed. Breast milk is also inexpensive and served at the perfect temperature. Overall, breast milk is nature’s best food for young babies. Babies who are breast fed initially feed every 2-4 hours during the first several weeks of life. Before your milk supply is established, the baby may want to feed more frequently than this. After your milk supply is established, the infant should be feeding every 2-4 hours. If your baby is sleeping for more than 3 hours during the day, wake your baby up to eat. During the night, allow your baby to sleep for as long as your baby will go prior to waking. Your baby should wake up on their own to breast feed anywhere from every 4-6 hours during the first 2 months of life. These recommendations do not apply to premature infants. Your baby will gain weight adequately if he/she is nursing 8 or more times per day initially. Allow your baby to feed from 5-10 minutes on the first breast and as long as he/she wants on the second.

Your goal is to have your baby nurse for about 20-30 minutes at each feeding. It is common to need to stimulate/awake your baby before taking the second breast. Remember to alternate which breast you start feeding with each time. Once your milk supply is well established (approximately 2-3 weeks after birth), 10 minutes of nursing per each breast is fine when you are in a hurry. During the first couple of weeks of life, if your baby has three or more good-sized bowel movements per day and six or more wet diapers per day, the baby is receiving a good supply of breast milk. In addition, most babies will act satisfied after completing a feeding. Your baby should be back to his birth weight by approximately 2 weeks of age.

Breast Feeding

The presence of a let-down reflex is another indicator of good milk supply. If you are breast-feeding your infant, you may attempt to supplement the baby with bottle feedings (formula or pumped breast milk) at about 2-4 weeks of age. This will allow the father, as well as other family members, to get involved in the infant’s feeding. Usually at this stage, it is uncommon for infants to get “nipple confusion.” Babies do not routinely need any extra water.

If you are bottle-feeding your infant, infant formulas are a safe alternative to breast milk. They have been designed to be similar to breast milk and fill the dietary needs of your infant by providing all essential nutrients in the proper amounts. Use a brand of formula that is iron fortified to prevent iron-deficiency anemia, as recommended by the American Academy of Pediatrics. The amount of iron in iron-fortified formula is too small to cause any diarrhea or constipation. Do not use the low-iron formulas unless directed by your physician. Most brands of infant formulas are available in three forms: Powder, concentrated liquid, and ready-to-serve liquid. Mix each type of formula as directed. When preparing formula, you can use tap water or distilled water. If using well water, boil it for 10 minutes prior to mixing the formula.

In the first several weeks of life, newborns initially start taking anywhere from 1 to approximately 3 ounces of formula every 3-4 hours. Infants usually have approximately eight feedings a day. Overfeeding can cause vomiting, diarrhea or excessive weight gain. A feeding should not take more than about 20 minutes. If it does, you are overfeeding your baby or the nipple is too small. Prepared formulas should be stored in the refrigerator and must be used within 48 hours. Prepared formula left at room temperature for more than one hour should be discarded. Babies do not routinely need any extra water.

Solid Foods We usually recommend nothing other than breast milk or formula until about 4 months of age. Solid foods may be prepared in an infant food grinder or blender; commercial baby food may also be used. The mixed baby foods are generally less satisfactory as they contain tapioca and starches. Again, watch out for the well-meaning grandmother encouraging early solid feedings — this used to be the routine, but we have learned from research that we can avoid obesity in babies and allergies in babies by waiting on solid foods until after 4 months, and cow’s milk after 10-12 months

FeedingBottle Feeding

The baby should be dressed comfortably. Infants like their environment to be the same as we do — they dislike extremes of hot and cold. Keep the temperature at 65-75° in the winter with the baby in diapers and shirt, and body pajamas and a blanket for sleeping. If overheated, the baby will fuss, cry and develop a red sweating rash on the face, meaning that he’s been kept too warm. Make sure that clothing does not have a tight neckline, or strings or belts that might catch the baby. Fire retardant “tris” has been removed from all new baby clothes as a general precaution. It is still advisable to wash new clothes several times to soften them before being worn. For cleaning, Dreft or Gentile lack the irritating effects of most laundry detergents, and are good for washing your baby’s clothes and diapers. Softeners may cause rashes. Remember, when the baby is taken outside, he or she should always wear a hat and the eyes should be protected from direct exposure to the sun.

Clothing

All newborns cry. Yours will too. It is a normal and natural expression. It does not mean that you are doing anything wrong. Your new baby is just saying that he or she needs you. Here are hints to ease and stop the tears. Remember, nothing is foolproof. What works today may not work tomorrow

What does your baby want? You will soon learn the different meanings of cries of your baby. Babies cry when they are trying to call for you, let off steam or just exercise. Check to see if your baby is hungry or needs something, perhaps a diaper change. He may be uncomfortable, wants to be held or placed in a different position. He or she may be bored or tired.Check on your baby when he or she cries. You cannot spoil him or her by picking them up too often when they are crying. Always respond quickly to your baby’s cries. If everything is okay and your baby has been fed, burped etc.— it is okay to let them cry 10-20 minutes to let off steam.

How long will your baby cry? Infants may fuss anywhere from 1-4 hours throughout the day. Babies cry less as they learn other ways to communicate with you and comfort themselves. If your baby is a heavy fusser and you have trouble comforting them, you may wish to call us. Certain foods can also make a baby fussy. Sometimes it is helpful for breast-feeding mothers to cut back on foods such as chocolate, onions, garlic, caffeinated drinks or milk products. For both breast-fed and formula-fed babies, it may help to have a nurse watch and make some suggestions about the way the baby is fed. Something else may be upsetting the baby, so always ask your doctor before changing formula.

Newborn Problems When your baby cries

How to comfort tiny tears: Here are some ways to soothe your baby. Soften the lights, keep it quiet and handle them gently. Rock your baby. A baby finds gentle movement calming. It may even put them to sleep. Rock and dance with your baby. Go for a ride in the stroller or car in an approved infant seat. Sing a lull-a-bye. Talk or sing in a quiet, sing-song way or play soft music. Make him or her comfortable. Check to see if he or she is too hot or cold, if the diaper is wet or soiled.

Lastly, take care of yourself. Take a break at times and let someone else take care of your baby for a while. If nothing works and the crying continues, put the baby down in the crib, turn on a radio, close the door and take a break. Everyone needs help at times. Call your family and friends for help with your baby before you reach a breaking point.

Many babies are born with rashes. Newborns rarely have the beautiful skin that every mother expects. Most babies have some skin problems. There is usually no reason for concern. Most go away on their own without treatment. Wash your baby gently with warm water and it is likely they will have baby-fine skin very soon (use mild soap, such as Dove, sparingly).

Why baby has a rash: A newborn’s skin may just be reacting to something in mom’s system or new home. While most newborn’s rashes are not serious, a rash may be a clue that your baby is sick. It may indicate a skin infection, a virus or an allergic reaction. If you are concerned about the rash, call us for an appointment. Infant acne usually disappears by itself. A newborn may show skin problems that look like pimples. He may have tiny whiteheads or red blotches across his face. Do not squeeze, scrub or apply lotion to the affected skin. Just wash it with water two to three times a day. Your baby’s skin will clear up in a few months with no lasting effects.

A rash in the baby’s mouth: Little white bumps on the gums are common in newborns. Some babies may have yellowish-white spots on the roof of their mouth. These will soon disappear without treatment. Sometimes a newborn has white patches in his or her mouth that look like cottage cheese, but do not rub off. This could be a fungus called thrush. It can keep your baby from eating well. If you see this, please call Penobscot Pediatrics.

Your Baby Skin Rashes

Diaper rashes Almost every child gets diaper rashes. Most are due to prolonged contact with moisture, bacteria, and ammonia. The skin irritants are made by the action of bacteria from bowel movements or certain chemicals in the urine. Bouts of diarrhea cause rash in most children. Diaper rashes occur pretty equally with cloth and disposable diapers. Persistent spotty diaper rash is usually fungal and needs a prescription

Changing diapers frequently: The key to successful treatment is keeping the area dry and clean so that it can heal itself. Check the diapers about every hour — if they are wet or soiled, change them right away. Exposure to stool causes most of the skin damage. Make sure your baby’s bottom is completely dry before closing up a fresh diaper. Leave your baby’s bottom exposed to air as much as possible each day. Practical times are during naps or after bowel movements.

Put a towel or diaper under your baby. When the diaper is on, fasten it loosely so that air can flow between it and the skin. Rinse the skin with warm water. Washing the skin with soap every diaper change will damage the skin. Use water-only or a mild soap (such as Dove/Caress) only after bowel movements. The soap can cause extra irritation. Chemical wipes can irritate the skin also.

Nighttime care: At night, use the disposable diapers made to keep wetness away from the skin. Avoid plastic pants at night. Until the rash is better, awaken once during the night to change your baby’s diaper.

Creams and ointments: Most babies do not need any creams or powders for their diaper area. If your baby’s skin is dry and cracked, however, apply an ointment to protect the skin after diaper changes. A barrier ointment (such as A and D ointment, Desitin ointment, Vaseline or bag balm) is useful whenever your child has diarrhea. Cornstarch reduces friction and can be used to prevent further diaper rashes. Studies show that cornstarch does not encourage yeast infection. Avoid talcum powder because of risk of irritation if your baby inhales it.

Yeast infection: If the rash is bright red and does not respond to 3 days of the above treatments, suspect a yeast infection. Call for an appointment so we can prescribe anti fungal medication.

Prevention of diaper rashes: Changing a diaper immediately after your child has a bowel movement and rinsing the skin are the most effective ways that you can use to prevent diaper rashes. If you use cloth diapers and wash them yourself, you will need to use bleach to clean them and kill any harmful germs. During the regular cycle, use Dreft. Then refill the washer with warm water, add one cup of bleach and run a second cycle. Unlike bleach, vinegar is not effective in killing germs.

Call us immediately if the diaper rash looks infected or if your child starts acting very sick. Call during office hours if the rash has not improved in 3 days or if you have any other questions or concerns.

Recognizing baby’s birthmarks Birthmarks come in different sizes, shapes, colors and textures. We will watch to see how the birthmark changes.

Strawberry mark: One out of every ten babies will have a strawberry hemangioma. This is a soft, raised red mark. It will usually be left untreated. It may get bigger for the first several months, but often completely disappears between the ages of 5 and 10 years. Stork bites or angel kisses: These pinkish patches are usually seen at the base of the neck and can appear around the forehead, eyelids, nose and mouth. Nearly all of these fade completely on their own.Port wine stains: These purple or red birthmarks may appear anywhere on the body. Although they sometimes change color slightly, they do not fade. Café-au-lait spots: These common, permanent spots range from tan to light brown and can appear anywhere on the body. Mongolian spots: These blue to gray spots look like bruises. They usually appear on the back, buttocks, legs or shoulders of dark-skinned babies. Most fade in the first year of life. Congenital moles: Small moles are very common. They vary from light brown to black and may be hairy.

Jaundice Jaundice is when a baby’s skin and eyes become yellow from an increased level of bilirubin. Jaundice usually peaks at day 3-4 of life. Jaundice is made worse by dehydration. If your baby appears to be getting yellow, try to feed your baby more often if breast feeding, then supplement with formula. Call us if your baby is yellow down to his or her diaper area, or when his/her eyes begin to look yellow.

Colic Colic means excessive crying in infants 2-12 weeks of age who are otherwise healthy. The cause of colic is unknown. However, because many physical problems can cause excessive crying in an infant, only a provider should make the diagnosis of colic. Colic usually begins by 2-3 weeks of age and may last until 3-4 months of age. Colicky infants usually cry at least 3 hours a day. This is 2 1/2 times more than non-colicky infants. The crying infant may or may not cry at the same time each day, but it usually happens more often in the evening. The colicky baby usually does stop crying when ways of comforting such as holding and feeding are tried only to restart when left alone again. The colicky infant usually shows the following signs: flailing arms and legs, clenched fists, arched back, drawn legs up toward the belly, bulging and tense belly, struggling and angry when held.

Possible causes of colic: No one really knows the real cause of colic, but some of these things may be related: Exposure to tobacco smoke; stomach spasms; immature nervous system; gas pain; hormones out of balance; immature digestive system; allergy to milk; or, tension or emotional stress in the baby’s environment.

Ways to help your baby: There is no sure treatment for colic. However, the following suggestions have been tried by other parents: Swaddling your baby; taking baby for a ride in a stroller or car; placing baby in a wind-up swing; rocking and cuddling your baby in a rocking chair; giving your baby a pacifier; burping baby often when feeding to remove as much air as possible from the stomach and to reduce excessive gas; massaging baby’s stomach; playing soothing music or tapes; carrying baby in a front pack; walking while holding your baby; or, running the vacuum cleaner or washer. (“White Noise”)

When to call the doctor: Call us if your baby has any of the following symptoms: Fever; hard stools; excessive spitting up; blood in stools; poor feeding; diarrhea; and, vomiting or poor weight gain.

Things to remember: A baby who cries too much despite everything you do to comfort him or her can make parents exhausted, nervous and angry. It is important for you to remember the following things: Colic is not your fault. Your anger and frustration are normal. Your baby is not angry with you. Your baby is healthy despite the excessive crying.

Suggestions for parents: Colic is a big problem. It affects 1 in 4 infants and can cause the entire family a great deal of stress. Please be assured that colic will end between the infant’s 3rd and 6th month of life. Until then, do not feed your baby every time he or she cries. Arrange for a relative or friend to stay with the baby while you get out of the house one evening a week. Try to rest when your baby takes naps. Enough rest will help relieve your tension. Caution: Never shake your baby. Shaking will not stop the crying and can cause serious brain damage. If you have concerns that your baby has colic, please call us.

Cradle cap Cradle cap is yellow scales and crust usually attached to the scalp causing the scalp to be greasy or dry. Cradle cap is not usually itchy or painful. It begins in about the first 2-6 weeks of life and is usually gone by 6 months of age. The cause of cradle cap is unknown. It may be caused by maternal hormones that cross the placenta before birth and stimulate the oil glands. It is not caused by poor hygiene. Cradle cap is not contagious and does not recur. Cradle cap is part of a condition called seborrheic dermatitis.

Expected course: Without treatment it can last for months, but will usually clear up on its own. With treatment, it can clear up within a few weeks.

Home care: Anti-dandruff shampoos such as Head and Shoulders or Selson Blue slow down the scaling and flaking of skin. They usually do not require a prescription. Be careful to keep it out of the eyes. Wash your baby’s hair 1-2 times per week . While the hair is lathered, massage your baby’s scalp with a soft brush or rough washcloth. Once the cradle cap has cleared, use a regular shampoo twice a week.

Softening thick crusts or scales: If your child’s scalp is very crusty, put some baby oil or olive oil on the scalp one hour before washing to soften the crust. Wash all the oil off, however, or it may worsen the cradle cap.

Resistant cradle cap: If the rash is red and irritated, lasts more than two weeks with treatment, starts to look infected, spreads beyond the scalp or if you have any other concerns, contact Penobscot Pediatrics for assistance.

A sick baby can be very distressing. Fortunately, the early years of life is the period when most illnesses can be cared for at home. If at any time you feel the illness is getting out of hand, check the temperature first and then call us. Since young infants can not tell us what is wrong, it is often more difficult to tell when they are ill. As a general rule, changes in their daily routine of feeding, sleeping, playing and stooling may suggest a problem. Examples of problems would be: • Persistent vomiting • Refusing to drink • Sleeping past 2 feedings • Lying listlessly or limply • Refusing to play • More than 10 watery stools per day • Persisting irritability not calming down with feedings or rockingFever A significant fever is a temperature over 100.5° Fahrenheit. In the afternoon and early evenings, temperatures are usually slightly higher. Newborn temperatures should be taken with rectal thermometers or underneath-the-arm thermometers. Any fever above 100.5° in an infant under 3 months of age is an emergency — notify us immediately. We will begin sharing more health care education about illnesses with you starting with the two month checkup.In the first few months of life, illnesses may be reduced by limiting the amount of visitors exposed to your baby — especially other children or those with colds or other signs of infection. It is also wise not to take too many trips outside into public places during the first few weeks. Respiratory illnesses can also be reduced by keeping the house temperature constant at a moderate 65-70°, providing enough quiet time for naps and preventing any contact to all forms of smoking. Babies exposed to smoking are at risk

Illness

for an increased number and severity of colds, ear infections and bronchitis during the first several years of life. Recent studies have revealed health threats from smoking through third-hand smoke contact. While first-hand smoke is that inhaled directly by the smoker and second-hand smoke is the smoke exhaled (and inhaled by others), third-hand smoke is the residue of nicotine vapor that sticks to surfaces. This residue adsorbs not only to indoor surfaces but also clothing and skin. These nicotine residues then follow a smoker back inside and are spread everywhere. The only way to prevent both second and third-hand smoke exposure is through implementation of a 100 percent smoke free environment. YOU WILL NEVER HAVE A BETTER CHANCE TO QUIT SMOKING!!!

Always call us if you have questions or an emergency. If your emergency is after office hours, call the Penobscot Pediatrics answering service at 947-0147 (this is the same phone number for Penobscot Pediatrics during daytime hours) — If it is a life-threatening emergency please call 911.

Most importantly, remember to —

•Relax•Enjoy the newest member of your family•Don’t be afraid to ask us questions

Penobscot Pediatrics1068 Union Street, Bangor

Located next to the Bangor International Airport, across from TD Banknorth

The Baby Whisperer by Tracy Hoff

The Happiest Baby on the Block by Harvey Karp

AAP guide, Birth to 5 (Caring for Your Baby and Young Child)

Infants and Mothers by T. Berry Brazelton, M.D.

Infants and Fathers by T. Berry Brazelton, M.D.

Nursing Your Baby by Karen Pryor

Your Baby from Birth to Age 5 by Penelope Leach

What to Expect the First Year by Heidi Markoff

On the Web:Parenting Corner: www.aap.orgDevelopmental Stages: www.bornlearning.orgDevelopmental Stages: www. zerotothree.orgOrthopedics: www.pedortho.comTravel Information: www.cdc.gov

Sites to Get Baby Supplies:www.onestepahead.comwww.rightstart.com

Vaccine Information:www.immunize.orgwww.cdc.govwww.chop.eduwww.aap.org

Recommended Readings

Penobscot Pediatrics is a service of Penobscot Community Health Care (PCHC). PCHC provides a wide range of services for the entire family including family medicine, dental, pharmacy, specialty services, physical/occupational therapy and mental health care. Ask your provider for more information.

For you. For your family. For our community.