Newborn Info

Baby’s First Test is the first site to visit for more information about newborn metabolic screening tests. If your baby has had a concerning result on a newborn screen, you’ll find great answers there– and, of course, make sure to visit us with your baby for more information and followup testing.

 

 

Below is the entire text of Your New Baby: A Guide to Newborn Care, written by the pediatricians of this practice. We’ll give you a copy when your baby is born; or you can buy it via Amazon

CONGRATULATIONS!!

We welcome you and your baby to Pediatric Physicians, PC. This information is designed to help answer the most frequently asked questions regarding the care of your new baby as well as give you some information about our office and our office procedures. We hope it will be helpful to you and that you will read it carefully and refer to it in the future. At Pediatric Physicians, PC our goal is to keep your children Happy, Healthy, and Safe!

Table of Contents

Philosophy

In the hospital

Weight loss

Spitting up

Gas

Hiccups

Bowel movements

Loud breathing

Head shape

Eyes

Jaundice

Skin

Genitalia and breasts

Feedings

Nursing

Bottle feeding

Solid Foods

Vitamins

Going home

Visitors

Clothing & outdoors

Bathing

Umbilicus (navel)

Circumcision

Diaper care

Pacifiers

Crying

When to call us

Fever

Vomiting and diarrhea

Nasal congestion

Lacerations

Bone and joint injuries

Burns

Head injuries

Nose bleeds

Poisonings

Automobile safety

Home medicine cabinet

Emergency and after hours calls

Routine examinations

Office and financial information

Recommended reading

Philosophy

We encourage parents to discuss any aspect of infant care with us. All the doctors, practitioners, nurses, and office staff are part of our team, and we look forward to getting to know you and your children. We encourage you to develop a relationship with one of our physicians as your primary doctor. In other words, it is best to schedule all of your routine well child visits with the same doctor or practitioner when possible. This helps to develop a close relationship and improved follow up. Though our practice has two locations, your child’s records are available to any provider at either location at all times.

Relatives, friends and neighbors will offer you advice on child care, but you are the one who is ultimately making the decisions about the loving care that your child should receive. You are the one who will know your child’s needs and what has worked best, and will have to do the things that make you feel comfortable and feel right to you. Each child is unique and no general rule always applies. Use your own judgment, but we encourage you to feel free to call us for advice and guidance.

Since all newborns are different, they can be quite perplexing and sometimes cause you unnecessary worry. In this booklet, we’ll discuss some information that will describe what is characteristic of normal newborns. Hopefully, this will relieve some of your concerns and help you enjoy your baby more.

In the hospital

While you and your baby are in the hospital, one of our doctors will thoroughly examine your baby and meet with you within the first 24 hours (this has likely already happened since you are reading this book). We usually make our rounds between 7:00-8:30 AM. If you will be staying overnight, we will make another visit before your discharge. We will let you know when to make your next appointment in our office.

Prior to your discharge, the nurses at the hospital will perform a blood test called the Newborn Metabolic Screen, sometimes referred to as “the PKU test”. Your child’s heel will be stuck to obtain a few drops of blood that will be sent to the Georgia state lab to be tested for several medical conditions (PKU, thyroid disorders, metabolic problems, etc.). This test is required by Georgia state law and is also a good idea, since it is the best way to pick up these very rare diseases that require early treatment.

Weight loss

Your baby is born with extra stored energy and water which serves to nourish him for the first day or so. For this reason, the baby may not want or need much to eat during the first few feedings. A weight loss of up to 10% is expected within the first week, but we do expect them to regain their birth weight by the 2 week visit. By the fourth to fifth day, the baby should be eating well and starting to regain weight. This is when your breast milk will usually come in.

Spitting up

Spitting up is non-projectile regurgitation of food or liquid not associated with any signs of illness. Many parents become unduly worried because their baby spits up during feedings. Especially within the first few days, extra fluid may remain in their stomach from birth causing spitting. Also, it is not unusual for him to bring up food during the first few months, whenever he burps or has been active. Although spitting up is an inconvenience, it seldom is a serious problem in a child who is otherwise healthy and developing normally. Usually time and patience on your part will best handle this problem. However, if your baby seems to be in pain with spitting up, we may suggest additional steps to help.

Gas

Babies pass gas freely without control due to a combination of swallowed air and fermentation of food in the digestive process. This is normal and is not necessarily associated with colic. Though the gas may upset or worry your baby, keep in mind that it doesn’t hurt—it just feels “funny” to a newborn. Gentle reassurance from Mom and Dad is the best “medicine” for newborn gas.

Hiccups

Many infants have hiccups after each feeding; others only occasionally. This is not disturbing to your baby and will stop spontaneously after 10-15 minutes. No remedy is needed.

Bowel movements

Just as your baby develops a feeding pattern, he will develop a schedule for bowel movements. Normal stool patterns can include a movement after each feeding or one every second or third day.

Initially, the stool is a tar-like, black, sticky material called meconium. With the introduction of milk feedings, the stool becomes yellow and can be pasty, semi-formed, or loose. Formula fed babies may appear to have curds or seeds in their stool while breast fed babies may have thin, smoother stools. The consistency and color is highly variable. Stools, however, should not be small, hard or bead-like stool. This could be a sign of constipation, which is hard pellet-like stools, NOT infrequent stools.

Diarrhea means frequent (8-10 times a day), loose, and very watery stools. You may have noticed that your baby’s muscles are generally weak; that is why he does not sit up or control his head well yet. The same applies to the abdominal muscles which, in older children and adults, provide the force to move the bowels with control. Your baby has to work harder and longer to have a normal bowel movement. It is not unusual for a baby to grunt, fuss, and turn red when he is preparing to have a bowel movement. Instead of becoming anxious or trying to help, be patient and keep him secure and comfortable. This is a process that will get easier with practice.

Loud breathing

It is quite common for your baby’s nose to become slightly congested or stuffy during the first few months of life. Sneezing is a way of clearing this congestion from the tiny nasal passages. While at rest, babies breathe only through their noses for the first few weeks. Sometimes the breathing sounds noisy because the air turbulence caused by mucus in the nasal passages is amplified by the chest cavity. Babies can become cranky and may feed poorly if their noses are too stuffy. Salt water nose drops can be dropped in the infant’s nose and a nasal aspirator (bulb suction) can be used to clear the secretions. Salt water drops can be purchased at the drug store (e.g. Ocean spray) or be made at home with 4 oz of sterile water and 1/4 tsp. of salt. A vaporizer may also be useful to help keep the mucus thinner. Remember, this is a normal condition and does not require any treatment unless the baby is feeding poorly or unable to sleep. If he starts to exhibit any other symptoms of illness (fever, coughing, fast breathing, etc.) please contact our office for advice.

Head shape

The baby’s head shape usually changes as a result of labor. Molding or elongation of the head is present to some degree in all babies. In some newborns, there is a goose egg type of swelling on one side, or sometimes both sides of the head. This is called a cephalohematoma. It is common and resolves by itself by 6-8 weeks of age without any permanent effect on the baby. It has no direct connection to the baby’s brain since it involves only the skin and coverings of the skull. Treatment or special attention is rarely required. Please call our office if a sudden swelling occurs during the first week or so after your newborn arrives home.

Eyes

After birth in the hospital, erythromycin ophthalmic ointment is used to prevent eye infections. If your baby develops a discharge from the eyes, he may require treatment if it persists more than one to two days or is excessive. Please call our office if this is the case.

Jaundice

On about the second or third day of life, many normal full term newborns will develop a degree of jaundice or yellowing of the skin. The color of the skin results from a combination of two normal processes which involve the immaturity of the infant’s liver and the breakdown of red blood cells. Bruising of the skin and the presence of a cephalohematoma make the occurrence of jaundice more likely and more pronounced. A blood test determines the level of the jaundice by measuring a substance called bilirubin. Please do not become apprehensive if a test is ordered on your child. We will discuss the results with you and explain their significance. At times, jaundice is more prolonged in breast fed babies. Usually, nothing has to be done. If any treatment is necessary we will discuss it with you. Some jaundiced babies require phototherapy or “bilirubin lights.” This therapy helps to reduce bilirubin levels in the blood stream. The treatment is painless and will be fully explained to you if the need arises.

Skin

A newborn’s skin is often a source of concern for parents because of the numerous variations and rashes that occur. Understanding these variations will save you from needless worry. At birth, the baby’s skin is purplish-red in color. With their first breath, it brightens to a deep red. Occasionally, a baby’s hands and feet will remain somewhat bluish during the first few days or whenever the baby is exposed to the cold. This is known as “acrocyanosis” and is completely normal. Within a day or two, the redness fades and peeling of the skin occurs. Although the peeling skin may be unsightly, in no way does it harm or disturb the baby and requires no treatment, lotion, or oil. Bruising which might have occurred on the face, scalp, or limbs, will also clear.

Some babies will have blue marks over their buttocks or lower back which are called Mongolian spots. These are not bruises. They may fade but do not always disappear.

Many babies, while still in the hospital, develop a rash characterized by areas of redness with small white centers called “erythema neonatorum.” It usually appears during the first 24 hours on the trunk, face, and diaper area. This rash can last 5-7 days, is harmless and requires no treatment.

There are also a number of other facial rashes that usually appear during the first few months. These rashes do not represent an illness and do not require treatment. These include:

  1. Milia – tiny, shiny, white, pimple-like bumps without any surrounding redness.
  2. Infant acne – collections of small red spots or pimples on the cheeks, chest, and back. This rash can come and go for up to 12 weeks of age.
  3. “Angel kisses” – red, flat splotches or lines often on the eyelids, back of the neck, and scalp. These birthmarks usually fade away by the first year of life.
  4. “Stork bites” – a flat, red area on the nape of neck or top of the head. These don’t fade away, but won’t be noticeable once your baby has more hair.

Genitalia and breasts

During pregnancy, mother’s hormones can stimulate the baby girl’s uterus and vaginal lining. After delivery, the “withdrawal” of mother’s hormones can lead to a white mucous discharge that lasts about a week or even some bloody discharge. Breast tissue in babies of both genders are also stimulated, and may be enlarged at birth. Some babies may even have some milk secretion. This breast enlargement should not cause concern, unless the skin is red or warm.

Feedings

Feeding is one of the most important functions of the new parent-infant team. During feeding periods, many of the infant’s basic needs are satisfied. These are both physical and emotional needs including:

  1. Oral stimulation and gratification.
  2. The pleasant, contented feeling of fatigue and a full stomach.
  3. The warmth and love from being held and cuddled.
  4. Proper nutrition and hydration to ensure normal growth and development.

A feeding is successful when the infant has some sucking needs satisfied, is pleasantly exhausted, has a tummy full of nutritious mixture, and feels comfortable, loved, secure and ready for a nice period of sleep. During this sleep, the baby regains strength, digests food, empties the stomach, and awakens ready to repeat the performance. These needs can be met well by breast or bottle feeding.

Nursing

For many mothers, breast feeding is a satisfying and fulfilling experience. It requires a minimum of equipment, and is no doubt the most inexpensive form of infant feeding. There are at least two other advantages of breast feeding. First of all, breast fed babies are less susceptible to infections in the early months of life. This is because the milk contains antibodies from the mother’s body which help prevent some infections. Bear in mind, we cannot guarantee your breast fed baby will not get sick, but his chances of avoiding diarrhea, vomiting, and colds will be enhanced. Second, while the vast majority of babies tolerate commercial formulas well, a small number will be sensitive to either cow’s milk or soybean formulas or both. If you have a strong family history of allergies, especially if you had allergies to formulas as a baby yourself, breast feeding can delay or prevent this problem in your infant. There is an initial period of learning, when the mother and child are both inexperienced. Until the milk is in the baby may be become impatient and lose weight. Soon the milk flow begins, the baby learns to nurse well and the two of you are on your way to success. Not everyone chooses to breast feed- either because of preference or medical reasons. In these cases there are formulas available that your baby should do well on. We will be happy to discuss any feeding questions with you.

If you are breastfeeding you should gradually increase the nursing period as your nipples become more conditioned. As you progress, the goal is to have at least one breast emptied per feeding, alternating sides each time. In this way, supply meets demand, since the more you are emptied, the more you produce. At the beginning nipple discomfort is normal early in each feeding. However, as the feedings progress, this should subside. Continued and intensified pain is not common, and we should be told about it. The nipple must go into the infant’s mouth and rest between the tongue and roof of the mouth. The gums and lips should cover almost all of the dark area of the breast. This way, minimal soreness occurs and emptying is more complete. Usually, 10 – 15 minutes of active sucking will empty a side. Do not spend more than 15-20 minutes per side. Very little air is swallowed at the breast, so breast fed babies require little burping. The flow of milk is controlled by many factors, including your emotions. Success, therefore, requires family support and tranquility. In addition, your diet must be adequate and well balanced. Your fluid requirements are higher than usual, and vitamins and calcium are essential. Some medications cross into the milk and can affect the infant. If you are taking any medications, let us know.

Bottle feeding

If you’re going to bottle feed, use expressed breast milk or a commercial formula. Most commonly used formulas are based on cow’s milk with modifications to make them more like human breast milk, more digestible, and more nutritious. An occasional infant will be intolerant of cow’s milk and require a milk-free substitute such as soy formula. The nutritional value of all of the major formulas is essentially equal. Occasionally an infant is intolerant of both cow’s milk formula and soy based formula. In this case, a hypo-allergenic formula may be prescribed. Hypoallergenic formulas may be a good first choice in highly allergic families if nursing isn’t possible. These formulas are much more costly when compared to the first two types. Most formula is available in powder, concentrated liquid, ready-to-feed liquid and ready-to-feed bottles. Each form that is increasingly more convenient is also more costly. What the infant actually gets with each is the same. If powder or concentrate is used and mixed with city water, no supplemental fluoride is needed (since Atlanta city water contains fluoride).

Types of Bottles: There are glass bottles, hard plastic bottles and plastic shells designed to hold plastic liners. All of these are able to fit the standard sized screw-on caps that hold the nipple. There are a variety of nipples available in many shapes and many degrees of firmness. You may need to experiment to find the bottle and nipple combination that suits your baby best. In general, there is no special benefit to the more expensive bottle systems.

Sterilization: If proper precautions are used, sterilization of the bottles, nipples, milk or water is no longer necessary (unless well water is used.) Your dishwasher is an excellent way to clean your baby bottles and nipples. If hand washing, be certain that all parts of the bottle and nipple are carefully washed and rinsed and that no dry milk remains. Milk that has not been sterilized is much more easily spoiled, so prompt refrigeration and proper handling of the formula is important. If the feeding has been warmed and partially fed, the remainder of the feeding must be discarded if it has been kept warm over 30 minutes. If it has been warm less than 30 minutes, it may be reheated one additional time.

Water: Newborns do not need water. Breast milk and/or formula supply all the water your baby needs.

Solid Foods

For the first four to six months of life, your baby’s nutritional needs are met by the milk you are feeding. Solid foods are not needed yet. Please discuss feeding recommendations with us prior to instituting major changes.

Vitamins

An infant multivitamin is recommended starting at birth for breastfed infants to ensure adequate levels of vitamin D. If using a mix of breast and formula, no additional vitamins are needed once a baby is taking 32 oz or more of commercial formula. Breastfeeding mothers should stay on their prenatal vitamins unless advised otherwise. If using breast milk, ready-to-feed formula or formula mixed with non-fluorinated water, a fluoride supplement will be prescribed after 6 months of age to help make the teeth more resistant to cavities.

Going home

Have your baby comfortably dressed according to the weather conditions when you leave the hospital. We recommend that you transport your baby safely in an approved protective car seat with seat belts buckled. It is not possible to adequately protect a baby in your arms, even if you should only have a minor accident.

Every baby must adapt to new surroundings, and parents should not expect the first 24 to 48 hours at home to always be smooth.

Your baby should have his or her own room if possible. Furnishings should be easily cleanable, so they will not collect dust. All painted items should be lead-free. The baby may sleep in a bassinet, or you may use a crib from the start. The mattress should be firm and flat and protected with a water proof cover. No pillow should be used. Bumpers may be used to keep heads, arms, and legs from getting caught between the bars of the crib. Try to keep the temperature about 72 degrees. Provide adequate ventilation, but avoid drafts. Usually a single baby blanket will be enough covering even in cold weather.

Visitors

Having a baby can be physically stressful, and most new mothers need time to rest and become accustomed to their new routine. Babies are quite susceptible to infections and should not have exposure to many people in the early weeks of life. In addition, the baby and family need time to adjust to one another with a minimum of stress. We suggest that visitors be limited in the first several weeks. People who do visit must wash their hands or use an alcohol-based hand sanitizer.

Clothing and outdoors

Your baby requires no more clothing than an adult. Make an effort to dress him according to the temperature without overheating him. If the baby perspires, the baby is too warm. Clothing should be loose fitting, lightweight, and soft. Infants lose much body heat from the head, therefore put on a hat if it is cold.

When the weather is pleasant, you may take your baby outdoors as soon as you feel able. Avoid crowds and people who will want to touch your newborn, and bring a bottle of hand sanitizer with you.

Bathing

Until the navel (and circumcision) is healed, the baby should be sponge bathed. The face, ears, and nose should be washed with a soft cloth and plain water. There is no need to clean the inside of ears, nose, or mouth. Wash the baby’s head with mild baby soap. On the skin, wash in the creases, rinse thoroughly, and pat dry. In general, it is wise to avoid deodorants, perfumes, creams or beauty soaps. Oil should not be used, especially on the head. If a scaly, oily, dandruff-like area (cradle cap) appears on the scalp, an anti-dandruff shampoo (Selsun Blue or Head and Shoulders) along with gentle scrubbing with a soft brush can be used until the condition is cleared, and then every 2-4 days to keep the flaking from returning.

Umbilicus (navel)

The navel usually heals when the cord separates in ten to twenty-one days. Occasionally, you may see a few drops of blood when the cord separates. This is normal and harmless. Do not worry if the belly button protrudes. Belly bands are not recommended. Many hospitals recommend “dry cord care,” meaning that nothing needs to be applied to the navel. At other hospitals, it is recommended that the cord area be cleaned with alcohol after diaper changes. Either method is acceptable, though dry care does lead to a quicker separation of the cord stump.

Circumcision

Circumcision is not a medical necessity, though many families choose to have their sons circumcised. In the Atlanta area, circumcisions in the hospital are performed by a doctor from your obstetric practice.

Diaper care

Change your baby’s diaper as soon as possible after each bowel movement. Wash the area thoroughly with soap and water or a non-alcohol baby wipe. When cleaning girls, always wipe from front to back to avoid contamination of the vaginal area.

Because babies have sensitive skin, they are prone to have rashes and irritations, especially in the diaper area. Usually irritation is due to prolonged periods of wetness or contact with fecal material. Both prevention and treatment of diaper rash require frequent diaper changes. Exposure of the rash to air for several hours a day, avoidance of plastic or rubber pants, and thorough cleansing of the area will heal most rashes. A cream containing zinc oxide can be used with each change. If the rash is severe or, if after a day or two of such treatment, the rash persists, we should be consulted.

Pacifiers

All babies have an instinctive need to suck. This need goes beyond the sucking that accompanies feedings, and is often confused with a need for more food. If your baby has been fed, but is busily chewing the thumb or fingers, you may wish to substitute a pacifier. Do not over-feed the baby in an attempt to satisfy the sucking. At first, a pacifier may not be acceptable to the baby, but usually with persistence or trying different types, it will be taken. Of course, there are some babies who outgrow this need to suck and will voluntarily give up the hand or pacifier.

Crying

All normal newborn babies cry a certain amount of the time. During the first few weeks, crying is one of the ways they have of expressing themselves and of telling you their needs. Babies may cry when they’re hungry, too cold, too warm, have an “un-burped” burp, have a wet or soiled diaper, want to be held, or just because they feel out of sorts. It is very common for a baby to cry or fuss at about the same time each day, often in the evening, and this may go on for quite a while for no apparent reason. This period of fussiness often causes concern for new parents because they usually think that their baby is still hungry. It is tempting to keep offering him more milk, but this seldom really helps for more than a short time. Taking a ride in the car or stroller, swinging, being given a warm bath, or lying near a running clothes dryer to feel the vibrations may calm the baby. An infant carrier which attaches over mother’s shoulders may also help. Babies who fuss for inordinately long periods of time (often many hours) may have colic. Usually, no cause for colic can be found. There are a few treatments that can help. Call us if your baby has this problem. Anxiety on the parts of parents may increase the baby’s crying, so try to stay calm. A reassuring fact about crying is that it causes no physical harm to the infant. Many new babies fuss for fifteen or twenty minutes after each feeding before going to sleep.

When to call us

The following are some guidelines about when to call the doctor regarding your newborn. Even if you’re not sure you need to call, it’s always OK to call if you are worried.

  1. Persistent lethargy and inactivity.
  2. In a young infant, refusal to take any milk or fluid for several hours.
  3. Fever—Call us if a measured rectal temperature is over 100.4 degrees in a baby less than two months old.
  4. Difficulty breathing.
  5. Unusual rash (especially large welts, hives, or small spots that look like blood under the skin).
  6. Repeated vomiting (not just minor spitting up).
  7. Stiff neck.
  8. Persistent screaming or crying that cannot be soothed.
  9. If you are very worried about your child for any reason.

Fever

Babies over two months of age commonly run fever with illness, with temperatures usually higher than in adults with similar illnesses. Temperatures as high as 103-104 degrees are not rare in children and do not necessarily mean a serious illness. If your child appears ill or has a fever of 104 degrees or higher, call us for instructions.

If your baby is less than 2 months of age and runs any fever of 100.4 rectally, please call us immediately. Though most fevers are caused by viruses and will not harm your baby, children who are very young have a much higher chance of a serious problem.

Acetaminophen (Tylenol) is recommended babies of any age with fever. It can be given every four hours while the fever lasts, up to five doses in a 24 hour period. Acetaminophen is also available in suppository form without a prescription. Ask the pharmacist to help locate this if needed.

Ibuprofen is available without a prescription to help control fever in children over six months.

Do not use aspirin unless you have discussed this with us.

Printable Ibuprofen (Motrin/Advil) and Acetaminophen (Tylenol) dosing Chart

Vomiting and diarrhea

Illnesses causing these problems are common in infancy and childhood. Usually they are relatively minor infections caused by viruses.

An infant will vomit over a time period of a few minutes, then feel better for a while, after which the sequence may repeat itself. This could happen several times until the infection improves. It is good to rest the infant’s stomach by giving nothing to drink for 1-2 hours. Then give a prepared infant electrolyte solution in one ounce frequent feedings. Examples of these solutions are Pedialyte, Ricelyte and Rehydralyte. Do not use apple juice as this may worsen the diarrhea. Never use a diet drink as a clear liquid. Advance diet to bland foods as tolerated. Call us if the vomiting persists for more than about two hours or if the child looks very ill.

Mild diarrhea that lasts for a few days does not require any changes in an infant’s or child’s diet. More severe diarrhea may be treated with the same fluids as detailed above. In infants, the electrolyte solution is continued for 24 hours, then 1/2 strength formula for 24 hours (made by mixing 4 oz of full strength formula and 4 oz of unflavored Pedialyte together), advancing to full strength formula after that.

If you are breast-feeding, most infants can feed through an illness with vomiting or diarrhea episode. At times, however, we may suggest a prepared infant electrolyte solution if the diarrhea is severe. In this case, a breast pump should be used every four hours to maintain your milk supply. Do not use diet drinks for diarrhea because the lack of sugar may cause low blood sugar.

When vomiting and diarrhea occur together, follow the same directions as for vomiting above. Bear in mind that the infant may be more likely to become dehydrated if he/she cannot hold down enough liquids to replace what is lost in the stools.

The following are suggestions for when to call the doctor:

  1. When signs of dehydration occur such as listlessness, lack of urination for several hours, eyes appearing to be “sunken” into the head or dry mouth and tearless eyes.
  2. When an infant has bloody diarrhea, especially associated with fever.
  3. When an infant less than six months has persistent vomiting for more than four hours or diarrhea for 12 to 24 hours, especially if associated with fever.
  4. When there is bile stained (dark green) vomit, especially if associated with abdominal pain and swelling of the abdomen.
  5. When a child has severe vomiting along with behavioral changes such as disorientation, hallucination or extreme listlessness.

Nasal congestion

This is another problem that all infants will have at some time. Young infants may have some trouble breathing or taking their feedings if they become severely congested. This is because they breathe best through their nose until they are about four months old. A few simple treatments can usually improve the situation.

Give plenty of fluids, and use a humidifier to help keep the mucus thin and runny. Put some salt water nose drops in the nose and suction with a bulb suction (see under “Loud Breathing”). This can be done several times a day, especially before feedings.

EMERGENCY AND FIRST AID INSTRUCTIONS

Lacerations

Stop bleeding by applying firm pressure directly on the wound using a dry, clean cloth or handkerchief for about 10-15 minutes at a time. If not severe, you may wash it with mild soap and copious amounts of tap water. Go to the emergency room if sutures are needed after office hours. If there has not been a tetanus booster within the past five years, one will have to be obtained within 48 hours.

Bone and joint injuries

Apply ice to reduce swelling and a cold compress intermittently after that for the first 24 hours. If a fracture or dislocation is possible or obvious, do not move the injured part. Immobilize it with a splint until the doctor checks it. Do not move the child if there is a question of serious neck or back injury.

Burns

Immerse in cold water immediately for about 15 minutes. If it is first degree (redness without blisters) usually no medical treatment is required. Cool, wet compresses may help. For second degree burns with blisters, call the doctor or emergency room. Try to keep the blisters from breaking. If your child has not had a tetanus shot within the last five years, he/she will need one within the next 48 hours.

Head injuries

If unconsciousness or loss of memory about the accident occurs, or if the injury appears to have been more than a very minor one, call us. If the injury is not severe, watch for the following signs and call us if these or other worrisome findings occur:

  1. Pupils should be round and equal in size and should become smaller when light is directed into them.
  2. One to two episodes of nausea and/or vomiting are normal. Give only clear liquids in small amounts. If vomiting persists more than two times, or is forceful, notify us.
  3. Seizures or convulsions.
  4. Discharge from the nose or ears.
  5. Paralysis of arm(s) or leg(s).
  6. Persistent crying or headaches.
  7. Crossed eyes (when awake) or staggering when walking.
  8. Inability to be aroused.
  9. Acting unusual.

Nose bleeds

Place nose between thumb and index finger, keeping steady and tight pressure for at least 10 minutes.

Poisonings

It is important to have on hand the number for Poison Control (404) 616-9000. If your child ingests a non-food substance, he may need medical care. Identify the substance and estimate the amount taken. Next, call Poison Control. Begin following their instructions, then call us.

Automobile safety

Each year more children are killed by automobile accidents than by any other disease or injury. Your first expression of love for your child can be given prior to the baby’s birth, by acquiring an approved car seat. To protect your child in the car, be sure the infant is buckled in the seat whenever the car is in motion.

Holding a baby on your lap is the most dangerous way to transport a child in a car. The best place for your child is in the back seat in an approved child seat. Infants should be rear facing until 12 months old. Children should remain in car seats/booster seats until they reach at least 80 pounds or 8 years old. Do not put a child that is under 12 years old in a seat that has an airbag device as it may cause serious injury.

Home medicine cabinet

These are medicines every family should have at home. They should be stored in a safe place out of your child’s reach.

  1. For fever or pain, either acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil or Motrin) can be used. There is also a suppository form of acetaminophen (e.g. Feverall) if needed. This is not a prescription, but is in the pharmacy refrigerator.
  2. Salt water nose drops are very helpful when treating stuffy noses. Pre-packaged saline drops are available at the pharmacy without a prescription. You can also make your own drops by placing 1/4 tsp. table salt in 4 oz. of water. The dosage is 3-4 drops in each nostril as needed followed by bulb suctioning.
  3. For cuts or scratches, Bacitracin or Polysporin ointment can be helpful after thorough cleaning.
  4. A cool-mist humidifier is recommended for colds, croup, and dry hacky night coughs. Do not use any medications in the humidifier.
  5. A thermometer is a necessary part in evaluating your child.
  6. A nose bulb syringe is used for nasal suctioning.
  7. An oral rehydration liquid such as Pedialyte or Rehydralyte should be available in case of vomiting or dehydration.

Emergency and after hours calls

Please note that at night, on weekends, and holidays, you may still call by using our regular office telephone number. If you have anonymous call rejection on your phone, deactivate it with *82 so that we can return your call. Routine questions, minor problems, and prescription refills should be deferred until regular office hours so that we may have your child’s medical record available. After hours calls should be reserved for urgent or emergency situations. If your child is extremely ill and you cannot wait for a return call, call 911 and go immediately to the hospital.

Your call will initially be taken by the answering service. The information is then given to the Children’s Healthcare of Atlanta nurse advice line. A trained pediatric nurse will return your call and evaluate the situation. She will advise you on the care of your child. If necessary, she may recommend that you take your child to an emergency room or may have our doctor on call discuss the problem with you. If you do go to an emergency room or after-hours clinic, you must call our office and your insurance company on the next business day to insure proper verification by your insurance company.

When you call, please be sure to leave your line open and have the following:

  • pen and paper for instructions
  • phone number of a pharmacy that is open
  • your child’s temperature and weight
  • a list of your child’s symptoms and any medications the child is taking
  • a list of medications on hand

Routine examinations

Please call as far in advance as possible to schedule check-ups. The following is the schedule for routine check-ups. We recommend vaccinations according to the guidelines of the American Academy of Pediatrics. Please consult with our web site, www.PediatricPhysiciansPC.com, for the latest schedule of immunizations and recommended tests.

  • Within 1 week
  • 2 week
  • 1 month
  • 2 month
  • 4 month
  • 6 month
  • 9 month
  • 12 month
  • 15 month
  • 18 month
  • 24 month
  • 30 month
  • 3 years old and yearly after that
  • After 10 years old, check-ups should be done every 1-2 years depending on the individual situation. Participation in some sports requires yearly physicals.

Office and financial information

Our normal office hours are from 8:30 AM to 5:00 PM Monday through Friday (both offices) and 8:30 AM to 11:00 AM on Saturdays (Roswell only.) Office visits are made by appointment only. If you are unable to keep a scheduled appointment, please let us know at least 24 hours prior to that time so that we may allow another child to be seen then.

Copies of our Financial Policy are available at our office. We encourage you to obtain one during your first visit.

  • The American Academy of Pediatrics. Birth to 5 y.o. The Complete and Authoritative Guide.
  • Karp, Harvey. Happiest baby on the block.
  • T. Berry Brazelton. Touchpoints.
  • Benaroch, Roy. Solving health and behavioral problems from birth through preschool.
  • Meyers, Martin. Do vaccines cause that!? A guide for evaluating vaccine safety concerns.

Please visit our web page, www.PediatricPhysiciansPC.com, for an extensive updated list of recommended reading and helpful web sites.

IMPORTANT TELEPHONE NUMBERS:

Pediatric Physicians, PC: (770) 518-9277

Poison Control: (404) 616-9000

Scottish Rite: (404) 785-5252

Northside Hospital: (404) 851-8000

AMBULANCE:911

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