Congratulations on your new baby!
At Agave Pediatrics, we believe in personalized care for all of our patients. Your baby is an individual, and no book or set of rules can cover everything you need to know about your baby. However, we have put together this guide to serve as a starting point to answer many of the questions you may have. Remember as you go through this new and exciting iourney that a parent's loving care is so much more important than following any specific technique of child rearing. To your child, you are the absolute best parent.
Birth,The Golden Hour 80, Visitors
The first hour after birth is referred to as the Golden Hour. This hour (at the least) is best spent with mom and baby having uninterrupted skin to skin time. This is incredible for bonding,breastfeeding and helping build a healthy immune system and microbiome. Your birth process may dictate how the first hours and days go, but making a plan ahead of time, and expressing your wants will help you achieve your goals.
Making a plan for visitors in the hospital/ birthing area, and for when you return home, is also beneficial. Many visitors can interrupt the new family. The first days and weeks should focus on recovering from birth, resting, establishing breastfeeding, and bonding with your baby. If you do want visitors, don't hesitate to set limits on the length or timing of visits, or requesting help with meals or older siblings.
Less than 5% Of babies are born on the day they are due, with 50% born at least a week within their due dates and 90% born within two weeks of their due date.
Perinatal (Postpartum)
Mood Anxiety Disorders
As many as 1 in 5 new mothers will experience postpartum depression or anxiety, potentially serious but treatable condition. Almost all mothers will feel the up and downs of hormone changes, sleep deprivation and the feeling of being overwhelmed in the first 1-3 weeks. However, these feelings can tip into more severe or long-lasting symptoms.
These symptoms can include:
-
Anxiety, excessive worry
-
Sadness, depression
-
Anger and irritability
-
Difficulty sleeping even though you are exhausted
-
Changes in appetite
-
Losing touch with reality
-
Intrusive thoughts (which may include thoughts of harming the baby or yourself)
If you are feeling any of these symptoms, please contact your OBGYN or primary care provider. There are many ways to treat PMADs (Perinatal Mood and Anxiety Disorders), including breastfeeding-safe medications and counseling or therapy. It is important to care for yourself and seek out support,
so that you can feed confident in your role as a new parent. Arizona has a Postpartum Warmline that you can use to talk to someone or get resources, 1-888-434-6667
Safe Sleep
Where your baby sleeps in incredibly important. A safe sleep surface is defined as one firm and flat, and is clear of all toys, stuffed animals, blankets, pillows, and bumpers. Placing baby on their back is recommended by the American Academy of Pediatrics. The back (or
supine) position reduces the risk of Sudden Infant Death Syndrome (SIDS). Never put your baby on his/her tummy when you are not watching him/her They can safely sleep on their stomach if they are old enough to roll to their stomach on their own.
It is also recommended that your child sleep in the same room as their parents, until at least 6-12 months, This can reduce SIDS risk by 50% and makes it easier for you to care for your young baby.
Leaving the Home
You can take your baby outdoors at any age. Dress the baby with as many layers of clothing as an adult would wear for the outdoor temperature. A common mistake is overdressing a baby in the summer. In cold weather, a baby needs a hat. Cold air or winds do not cause ear infections or pneumonia. The skin of babies is more sensitive to the sun than the skin of older children. Keep sun exposure to small amounts - 10 to 15 minutes at a time. Sunscreen cannot be used until 6 months of age. Protect your baby's skin from sunburn with longer clothing and a hat. Crowds should be avoided during your baby's first two months of life. Also, during your baby's first year of life, try to avoid close contact with people who have infections.
Pacifiers
A pacifier is sometimes helpful in infancy for fussiness. Rounded pacifiers with a gradual change from wide to narrow (imagine a triangle) are better than flatter/ "orthodontic" shapes, or ones with a sudden protruding nipple. Ideally, do not introduce a pacifier until
breastfeeding and supply are established. Try to limit usage, as pacifier can affect oral development, and hide hunger cues. If possible, stop pacifier use around 6 months of age.
Breastfeeding
Infant Feeding
Experts from the American Association of Pediatrics (AAP) and the World Health Organization (WHO) recommend exclusively breastfeeding for 6 months, and continuing to breastfeed until your child is at least 1-2 years old. Breastfeeding and breastmilk have multiple benefits for both the child and breastfeeding parent.
Breastmilk contains the best possible nutrition for your baby. It changes composition over time (and even during a feed!) to best meet your child's nutritional needs.Breastfeeding is not only beneficial nutritionally. Breastmilk provides immune defense, and babies benefit from antibodies produced by the nursing parent's system, and have less risk of colds, diarrhea, and other infections and illnesses. Parents who breastfeed have less risk of some cancers, diabetes, and cardiovascular disease. Feeding at the breast provides warmth, reassurance, comfort and bonding, for both the parent and baby. The benefits of skin to skin (baby in a diaper, parent shirtless) contact are numerous.
Breastfeeding Continued
Educating yourself on breastfeeding and finding support will help you meet your feeding goals! Agave Pediatrics offers in-office lactation consults with International Board Certified Lactation Consultants (IBCLCs). You may also find it helpful to find non-profits like La Leche League, and
local and virtual support groups.
During pregnancy, your body is already preparing to breastfeed by producing colostrum, milk made especially for baby's first days of life. After birth, your milk will transition to a more mature, whiter milk. This usually happens between days 2-5. The key to this transition and milk production starts the first hour after baby's birth. Immediately after birth, place your baby skin to skin on your chest. Baby may be able to nurse shortly after birth, but you also have the option to hand express and give your colostrum to baby. It may be beneficial to see both the hospital/ birth center's IBCLC, or one when you arrive home.
During pregnancy, your body is already preparing to breastfeed by producing colostrum, milk made especially for baby's first days of life, After birth, your milk will transition to a more mature, whiter milk. This usually happens between days 2-5. The key to this transition and milk production starts the first hour after baby's birth. Immediately after birth, place your baby skin to skin on your chest. Baby may be able to nurse shortly after birth, but you also have the option to hand express and give your colostrum to baby. It may be beneficial to see both the hospital/ birth center's IBCLC, or one when you arrive home. Breastfeeding parents often experience breast swelling/engorgement, warmth or tightness in the days following birth. Breastfeeding often can help relieve this swelling. Ensure baby is latched comfortably and is nursing effectively, and let them finish one side, before offering the second side.
Milk is made in response to the demand made by the baby, For newborns, the goal should be to breastfeed 10-12+ times per 24 hours (or pump/ hand express if baby isn't latching), Offer both breasts at every feeding, and let baby breastfeed until they unlatch themselves, or stop sucking and swallowing. YOU may have to wake a sleeping baby to ensure they are breastfeeding frequently enough, especially the first few weeks.
To achieve the best latch, sit or recline in a comfortable position, skin to skin, and bring the baby to your breast. Their body should be held gently against yours, tummy to tummy, so they are not turning their head to breastfeed. Line UP their nose to your nipple — this allows baby to tip their head back slightly, open wide, and latch deeply- They should be latched deeply, not suckling on the nipple tip, and the nipple should be pointing slightly towards the roof of their mouth. If your baby is falling asleep during feeding, you can undress them if they are not already skin to skin, begin gentle breast compressions/ massage to keep milk flowing, and rubbing their jaw, back, or the bottom of their feet, Do not hesitate to seek professional support if you have any questions or concerns.
Another way of determining if baby is getting enough breastmilk, is by looking at their weight gain. It is common for breastfed babies to lose some of their body weight during the first week of life. If weight loss is more than 7-10%, or baby does not return to birthweight by 2 weeks, contact your pediatrician and an IBCLC (lactation consultant). With guidance, you can supplement with your pumped milk, or formula, and get breastfeeding back on track.
When to Seek Help Breastfeeding is a learning process for mom as well as for the baby.
International Board Certified Lactation Consultants (IBCLCs) can assist with:
-
Nipple damage or pain
-
Low weight gain
-
Latching difficulty or refusal
-
Clogged ducts or mastitis
-
Low milk supply
-
Low weight gain
-
Pumping/ hand expression
-
Bottle-feeding
Various things can impact breastfeeding, such as prematurity, torticollis (neck tightness), tongue and lip tie (ankyloglossia), cleft lip/ palate, and more. However, a lactation consultant can team up with your pediatrician to provide the best care for your baby. Whatever the cause of breastfeeding difficulties, your healthcare provider will work with you to create a plan to overcome them.
Breastmilk Storage
You may find that milk storage guidelines vary, and that is due to the fact that there are so many variables to factor in. Many things can influence the storage durations, such as what temperature your fridge, freezer, or home is set to, what location in the fridge or freezer it is stored in etc. Below is a table with general recommendations. Always smell/ taste milk before offering to baby.
Supplementing 8,Combo feeding
There may be a time when a provider recommends supplementing, to ensure that baby gets what they need. Or you may wish to include formula or bottle feeding in your feeding journey. This should be a plan made with your physician or lactation consultant, specific to your baby's needs. Know that your milk is perfect! If your baby is not gaining well, it is not due to the content of your milk, but that they need more of it. Supplementing with formula does not help babies gain more than supplementing with your own milk,
First, the most important thing is to feed the baby- make sure they are getting the nutrition they need, from breastmilk or formula. Second, maintain your supply. Anytime a bottle is given, you should pump to let your body know milk was needed by baby at that time. This will not only let you supplement with your own milk, but will make it easier to get baby back to the breast. Third, find support to meet your breastfeeding goals. A lactation consultant can help ensure baby is getting what they need, while also getting breastfeeding and supply back on track.
Bottlefeeding
Bottle nipples will vary in size and shape. You may find yourself trying different kinds of nipples until you find the nipple that works best for your baby. Often slow flow nipples mimic the flow at the breast, and is ideal. A nipple that gradually narrows to a tip (imagine a triangle) may be better than a wide base that quickly moves into a nipple tip.
We recommend paced bottle feeding. Paced feeding refers to offering a bottle in a slow, paced manner, to prevent overfeeding. Overfeeding can cause spitting up, gas, discomfort and more. It will usually be difficult for a parent to pump these inflated amounts as well. To pace feed, have baby sitting up slightly, not fully reclined, or lay baby on their side in your lap, Offer the bottle, keeping it mostly horizontal and level with the floor. Tipping the bottle up too much will increase the flow. Take breaks, burp your baby about halfway through a feeding, and switch which side of your body they are resting against. Assume the bottle will take 15-20 minutes to finish.
Formula Feeding
Commercial formulas come in a few types: cow's milk, goat's milk, soy, and protein hydrolysates (e.g., Nutramigen, Alimentum). The most commonly used formula is cow's milk based. In some cases, there may be a strong family history of milk intolerance, so we will recommend a protein hydrolysate or soy formula. Signs of formula intolerance may include vomiting, diarrhea, bloody stools, or colic, but consult with your pediatrician before making any changes.
Formulas come in 3 different preparation formulations: ready-to-feed mixture (no prep needed), concentrated formula, and powdered formula. Always read the preparation instructions thoroughly.
Preparation (https://www.cdc.gov/nutrition/infantandtoddlernutrition/formula-
feeding/ infant-formula-preparation-and-storage.html)
-
Wash your hands well before preparing bottles or feeding your baby. Clean and sanitize the workspace where you will be preparing the infant formula.
-
Bottles need to be clean and sanitized, To learn more about how to properly clean your baby's bottles and other feeding supplies, visit the CDC webpage How to Clean, Sanitize, and store infact feeding Items.
-
Baby's milk or infant formula does not need to be warmed before feeding, but some people like to warm their baby's bottle. If you do decide to warm the bottle, never use a microwave. Microwaves heat milk and food unevenly, resulting in "hot spots" that can burn your baby's mouth and throat, To warm a bottle: Place the bottle under running warm water, taking care to keep the water from getting into the bottle or on the nipple. Put a couple drops of infant formula on the back of your hand to see if it is too hot.
-
If you use powdered infant formula. Use water from a safe source to mix your infant formula. If you are not sure if your tap water is safe to use for preparing infant formula, contact your local health department. Use the amount of water listed on the instructions of the infant formula container. Always measure the water first and then add the powder. Too much water may not meet the nutritional needs of your baby. Too little water may cause your baby's kidneys and digestive system to work too hard and may cause your baby to become dehydrated.
-
If your baby is very young (younger than 2 months old), was born prematurely, or has a weakened immune system, you may want to take extra precautions in preparing your infant's formula to protect against Cronobacter (boiling the water).
Pacifiers
A pacifier is sometimes helpful in infancy for fussiness. Rounded pacifiers with a gradual change from wide to narrow (imagine a triangle) are better than flatter/"orthodontic" shapes. Ideally, do not introduce a pacifier until breastfeeding and supply are established. Try to limit usage, as pacifier can affect oral development, and hide hunger cues. If possible, stop pacifier use around 6 months of age.
Solid Foods
All current worldwide health organizations and experts recommend starting solids at 6 months of age. Baby should be able to sit mostly unassisted. Offer solid foods with baby sitting in a high chair, ideally with a foot rest. You can offer purees or appropriately sized finger foods (known as baby-led weaning).Ideal first foods are fruits. vegetables, and protein. Babyledweaning.org and Kellymom.com/nutrition are good places to get more information,
Breastmilk or formula should be baby's main source of nutrition until 12+ months of age. At 6 months old. baby only needs one serving of a few tablespoons. The amount given will increase with time. After a month or two, you can offer a second meal. At 12 months, some babies will be ready for 3 meals a day, consisting of a few ounces each.
Water: For babies under 6 months old, water is not needed since there is sufficient water in the milk]formula. After 6 months of age, you can offer an ounce or two with meals.
Juice: Juice has no nutritional value and does not benefit children. It should not be given to babies under 6 months old for constipation. However. small amounts can be given to toddlers as a treat.
Infant Care
Well Child Checks
Agave Pediatrics recommends following the American Academy of Pediatrics' recommended schedule for Well Child Checks- The purpose of these appointments is to ensure that your child is healthy and meeting anticipated developmental milestones appropriately. It's also incredibly helpful to have routine exams of children in their healthy state, so our providers can recognize when something may require further attention.
Babies usually go home within 24 to 48 hours after birth. Your baby needs to be rechecked about 2 days after discharge to check how well they are feeding, urinating, producing stools, gaining weight, and breathing. Your baby will also be checked for iaundice and overall health, We will then see your infant again a few days to a week later for a follow up visit and a second newborn screen.
Immunizations
Immunizations protect your child against several serious life-threatening diseases. Agave Pediatrics follows the recommendations of the American Academy of Pediatrics (www.aap.org) and Center for Disease Control (www.cdc.gov) and encourage all children to be vaccinated, We do offer alternative schedules, which you can discuss with your pediatrician.
Why are vaccinations recommended? Children who are vaccinated are at a much lower risk of catching the disease that is prevented by that particular vaccine. These diseases can cause multiple complications, including serious disability and death. While your child may not be exposed to these diseases in the immediate future, most vaccine immunity lasts many years. With some parents choosing not to vaccinate their children, some of these preventable diseases are becoming more prevalent. The two most recent outbreaks of measles in the United States were caused by unimmunized children from Europe who transmitted the disease to children who were not immunized or
had not completed the recommended vaccine schedule for their age.
How do vaccinations work? Some vaccines are made from a weakened portion or inactivated form of a virus or bacteria. Commonly, the vaccine contains the 'antigen' of the virus or bacteria. This is the portion of the germ that the body reacts to. The vaccine causes the body to react and make antibodies to the weakened form, so that if the body were to encounter the actual virus or bacteria, it would already be prepared to fight it off, causing little to no symptoms.
What side effects do vaccinations have? Most vaccines have very mild side- effects. The most common ones include fever, fussiness, sleepiness, mild pain or redness at the injection site. Very rarely a child may have a more serious reaction or an allergic reaction to a vaccine,
Do vaccinations cause autism? No, all of the research and studies regarding thimerosal and mercury in vaccines have not shown any relationship between vaccines and autism. In particular, the MMR vaccine has also not been shown to cause autism or autism-related disorders.
Why does my child need more than one dose of a vaccine? One dose of a vaccine only gives partial immunity or protection from a disease. Multiple doses provide the full effect of immunity, as each dose allows the body to make more antibodies, thus better protection against the disease. Some vaccines, such as D Tap, have 'booster' doses later in life to ensure that
protection does not wear off.
When can my child not be vaccinated? Children that have high fever because of unknown cause or have been sick enough to miss daycare or school most likely will not be vaccinated that day. If the illness were to worsen, we WOUId not know if it was a reaction to the vaccination or the normal course of the illness that the child already had. In addition, the immune system also may not react completely to the vaccine as needed because it is already working to fight off another virus or bacteria.
When can my child not be vaccinated? Children that have high fever because of unknown cause or have been sick enough to miss daycare or school most likely will not be vaccinated that day. If the illness were to worsen, we WOUId not know if it was a reaction to the vaccination or the normal course of the illness that the child already had. In addition, the immune system also may not react completely to the vaccine as needed because it is already working to fight off another virus or bacteria.
A child can be still given his/her vaccines if any of the following conditions are true:
• The child had soreness, redness, or swelling at the iniection site after a previous shot.
• The child had a fever of less than 1050 F (40.50 C) after a previous shot.
• The child has a mild illness such as a cold, cough, or diarrhea without a fever.
• The child has recently been exposed to an infectious disease.
• The child is taking antibiotics.
• The child was premature.
• The child's mother is pregnant.
• The child is breastfeeding.
• The child has allergies (unless it is an egg allergy).
• The child's family has a history of convulsion or sudden infant death syndrome
Newborn Screening Tests
Newborn screening tests check for treatable diseases that can appear early in life. These tests can detect certain diseases before they cause serious damage. They are performed by the Arizona Department of Health. The tests are run on small amounts Of blood taken from the babyis heel, Infants are tested in the hospital and then again at 1-2 weeks
of age. If a test does suggest your child has a disease, the health department will contact you and your baby's doctor. If the tests do not show any diseases, you will generally not be contacted. We receive copies of the newborn screening test results. While newborn screening tests are very accurate, they are not perfect. Sometimes they incorrectly detect a disease (a false positive), so all children who test positively for a disease
should be tested again. False negatives are extremely uncommon. If these rare diseases are diagnosed and treated early, they can be often improved or cured, so screening at the proper times is incredibly important.
The Arizona screening panel includes:
• 6 amino acid disorders
• fatty acid oxidation disorders
• 9 organic acid disorders
• Biotinidase deficiency
• Classic galactosemia
• Congenital hypothyroidism
• Congenital adrenal hyperplasia
• 3 hemoglobin diseases
• Cystic Fibrosis
Infant Concerns
Jaundice
Jaundice is when your new baby has yellow-looking skin. The white of your baby's eyes may also be yellow. This can happen for various reasons. Normal Jaundice OCCUrs because the baby's liver isn't able to
get rid of all of the yellow pigment (called bilirubin). This type of jaundice starts when the baby is 2 or 3 days old. It goes away by the time your baby is 2 weeks old. This happens to about half of all babies. Breastfeeding Jaundice happens when your baby does not drink enough breast milk. It starts when the baby is 4 to 7 days old, and may last 3 to 10 weeks, but it is not very common.
Rh or ABO problems can cause a serious type of jaundice that most often starts the first day of life, because of different blood types between mother and baby. Infants are typically screened for jaundice (hyperbilirubinemia) at 36 hours of age before leaving the hospital. A blood test may be needed once the baby is home to help decide if the
iaundice needs to be treated, Jaundice is treated by placing the baby under ultraviolet lights, Usually, it takes only a few days for iaundice to be treated. To help your baby with iaundice associated with breastfeeding or breastmilk, breastfeed often. Nursing your baby every 1 to 2 hours can
help lower the bilirubin. You may also place the baby near a window as this indirect sunlight may help to decrease the bilirubin level slightly; if severe, however, your baby will likely need to be treated as described above.
Umbilical Cord Care
It is important to care for your newborn's umbilical cord in the first few weeks of life to prevent infection, It will naturally dry up and fall off on its own in the first 3 weeks of life. Do not attempt to pull the cord off on your own as this may lead to
unnecessary bleeding. Your iob is to make sure the cord stays clean and dry.
Tips and tricks:
-
DO not apply any topical substances or alcohol to the area.
-
When changing your newborn's diaper, fold the front of the diaper down so that it sits below the cord to allow it to dry.
-
If your baby pees or poops on the cord, you may wipe the cord with plain water and allow it to air dry to prevent infection.
-
Only give sponge baths to your baby until the umbilical cord falls off. Once the cord has fallen off and is healthy, you may give your baby a full bath.
-
It is important to watch for any signs of infection. These include redness, swelling, yellow discharge, foul smell, or bleeding.
-
Call your baby's provider right away if you have any concerns about infection.
Diaper Output
The first stools passed by your infant, called meconium, will be black and sticky. Gradually, they change to a yellowish pasty or seedy looking stool. A good rule to follow is to look for 1 bowel movement on Day 1, two on Day 2, three on Day 3, and four on more on Day 5 and beyond. If baby is not meeting these goals, it can be a sign that feeding is not going well,
and you should contact your pediatrician. Breastfed infants typically have more frequent bowel movements and they are less formed. They will look very loose/ wet, and be yellow or green and seedy. Formula fed infants tend to have a smaller number of stools that may be more formed. Your child's stools may vary on a day to day basis in form and color. Changing formulas or adding formula to a breastfed infant many change your child's stool color and consistency; adding solids may change your child's stool patterns.
Wet diapers (urine) are also important to watch. Newborns should have a wet diaper for each day of life, until day 5 or so (or when milk transitions from colostrum to mature milk). At that time, expect 5-6+ wet diapers every 24 hours.
Tips and tricks:
-
DO not apply any topical substances or alcohol to the area.
-
When changing your newborn's diaper, fold the front of the diaper down so that it sits below the cord to allow it to dry.
-
If your baby pees or poops on the cord, you may wipe the cord with plain water and allow it to air dry to prevent infection.
-
Only give sponge baths to your baby until the umbilical cord falls off. Once the cord has fallen off and is healthy, you may give your baby a full bath.
-
It is important to watch for any signs of infection. These include redness, swelling, yellow discharge, foul smell, or bleeding.
-
Call your baby's provider right away if you have any concerns about infection.
Constipation
Constipation is defined as hard, dry bowel movements. Skipping a day or more without a bowel movement does not mean your child is constipated. If your child has had a hard, dry stool, try increasing the amount of breastmilk or formula your child receives, under your IBCLC's or pediatrician's guidance. Remember, some babies will grunt, strain, turn red, and they may pull up their legs while passing stools. This can be normal. If stools are soft, even though infrequent after the first month, with no other feeding or digestive issues, there is no need to intervene.
Diarrhea
Most infants can continue to breastfeed or formula feed through mild bouts of diarrhea as long as they are making wet diapers and there is no sign of dehydration. Dehydration is defined as less than one wet diaper in 12 hours. For severe bouts of diarrhea or signs of deh dration contact our ediatrician.
Diaper Rash
Almost every child will ger a diaper rash at some point. The mixture of bacteria from bowel movements (BMs) and urine can irritate the skin. Diarrhea, thrush or a sensitivity to wipes or diapers can also cause a rash. To help prevent diaper rash:
• Change diapers frequently - Keep the area dry and clean.
• If you are cloth diapering, be sure to clean and sanitize them correctly.
• Let your baby's bottom get more air. Leave your baby's bottom exposed to the air as much as possible each day. When the diaper is on, fasten it loosely so that air can get between the diaper and the skin.
• Rinse the skin with warm water - Don't use soap or wipes.
• Most babies don't need a diaper cream with every diaper change. However, using a barrier cream like Vaseline cab protect the skin from damage (especially with frequent bowel movements or diarrhea).
Contact your pediatrician if the rash looks infected (pimples, blisters, boils, sores), or becomes bright red and raw or bleeding, your child starts acting very sick, or the rash isn't much better in three days,
Thrush
Thrush is an infection caused by a yeast or fungus called Candida. Most people already have yeast in their mouths and other parts of their bodies. Sometimes certain conditions, such as use of an antibiotic or too much moisture can cause the yeast to grow rapidly and cause thrush, In babies, thrush often occurs in area where the lining of the mouth is cracked and moist, and can cause mouth discomfort. If your child has thrush, they will have white, patchy areas on the inside of the mouth and lips that cannot be wiped off easily. If the only symptom is a uniformly white tongue, it's likely due to a layer of milk/ formula, not thrush. Diaper rash occurring at the same time will also need to be treated.. Sanitize anything that
comes into contact with baby's mouth or the breast.
If you are breastfeeding and your baby has thrush, the yeast could cause thrush on your breasts/ nipples If a breastfed baby is diagnosed and treated with thrush, the breastfeeding parent should also be treated at the same time. Your pediatrician and 0B can go over treatment options.
Contact your pediatrician if your child refuses to feed, the thrush gets worse during treatment, or the thrush lasts beyond ten (10) days.
Crying & Fussiness
Babies cry for many reasons - they may be hungry or thirsty, too warm or too cold, need to have a diaper changed, be in an uncomfortable position, or are iust having the usual periodic fussiness that is normal for infants. In fact, infants cry for an average of two (2) hours a day for the first two (2) months. Although crying is not harmful, it can certainly be upsetting for all, and make even the calmest of parents feel helpless at times. When infants are fussy, try things like skin to skin contact by either parent, babywearing, bouncing, and fresh air. If your baby is crying a significantly higher amount, contact your pediatrician.
Blocked Tear Duct
Babies cry for many reasons - they may be hungry or thirsty, too warm or too cold, need to have a diaper changed, be in an uncomfortable position, or are iust having the usual periodic fussiness that is normal for infants. In fact, infants cry for an average of two (2) hours a day for the first two (2) months. Although crying is not harmful, it can certainly be upsetting for all, and make even the calmest of parents feel helpless at times. When infants are fussy, try things like skin to skin contact by either parent, babywearing, bouncing, and fresh air. If your baby is crying a significantly higher amount, contact your pediatrician.
A blocked tear duct (dacryostenosis) is when the pathway that carries tears gets blocked. This happens often in very young babies. Most of the time, only one tear duct is blocked at time. Your baby may have a blocked tear duct when one eye is always watery, tears run down the face even when your baby does not cry, when your baby does cry, the nostril on the blocked side is still dry, or these symptoms start before your child is one (1) month old Gently rub the inner, lower corner of your baby's eye with a clean cotton swab. Doing this helps get rid of old tears that can build up.
To do this:
• Wash your hands, start at the inner corner of the eye and gently press upward.
• A small amount of clear fluid should come out.
Contact your pediatrician if:
• Your baby's eyelid is very red or swollen.
• There is a red lump at the inner lower corner of the eyelid.
• There is a lot of yellow discharge from your baby's eye.
• Your child is more than one (1) year old.
Fevers & Sickness
Congestion
Some congestion is normal in babies Since they only breathe through their noses. Sneezing is also common for most infants, It is their normal way of clearing the nasal passages. This does not mean they are coming down with a cold. Chronic congestions should be looked into by your pediatrician.
Fevers
Not all fevers need medication. Fevers help fight infections. If your child is fairly comfortable, acting normal, and staying hydrated, a mild fever may not need medication, Contact your ediatrician for guidance.
Seek medical care if your child has a fever if they:
• Have a rectal, ear or forehead (temporal artery) temperature of 100.4 F (38 C) or higher
• Have an oral temperature of 100 F (37.8 C) or higher
• Your child is younger than 3 months and has a fever
• If a child of any age shows any of the following:
• Fussiness, or acting abnormally, which doesn't improve even after taking medications to bring down the fever
• Signs of dehydration, such as no wet diapers over eight to 10 hours, crying without tears, a dry mouth or refusing to drink any fluids.
• Stiff neck or a headache
• Abdominal pain, ioint pain or swelling
• Trouble breathing Rash
• The fever lasts more than five days in a row.
Care for the Uncircumcised Penis
At birth, the foreskin is normally attached to the head of the penis (glans) by a layer of cells.Over the next 5 or 10 years, the foreskin will naturally separate from the head Of the penis without any help from us. It gradually loosens up a little at a time. Normal erections during childhood probably cause most of the change by stretching the foreskin. The foreskin generally causes no problems. However, pulling the foreskin back too vigorously before it has fully loosened can cause it to get stuck behind the head of the penis, resulting in severe pain and swelling, If retraction causes bleeding. scar tissue may form and interfere with natural retraction. Occasionally, the space under the foreskin becomes infected. Most of these problems can be prevented. During the first year of life, clean only the outside of the foreskin. Don't try to pull back the foreskin. Don't put cotton swabs in the opening. Gentle, partial retraction can begin when your son is 1 or 2 years old. It can be done once a week during bathing. Perform retraction by gently pulling the skin on the shaft of the penis downward towards the stomach. This Will make the foreskin open up. revealing the end Of the penise During retraction. the exposed part of the penis should be cleaned with water. Wipe away any whitish material that you find there. This whitish material is simply the accumulation 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 because this can cause irritation and swelling. After cleansing,
always pull the foreskin forward to its normal position. Avoid vigorous retraction because this can cause the foreskin to become stuck behind the head of the penis. Retraction is excessive 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 the early years. Keep in mind that any degree of foreskin movement is normal as long as your boy has a normal urine stream. There should be no rush to achieve full retraction. Full retraction always occurs naturally by puberty. As the foreskin becomes retractable on its own, your son should clean beneath it to prevent infections.
Call Our Office immediately if:
• The foreskin is pulled back and stuck behind the head of the penis.
• Your child can't pass any urine.
• Your child starts acting very sick.
• The foreskin looks infected (yellow pus, spreading redness or streaks).
Torticollis & Plagiocephaly
Torticollis is a condition where your baby's head is tilted to one side or they have a preference to turn their head to one side, and experience difficulty or discomfort when moving certain ways. This can affect their comfort in a car seat, in tummy time, and breastfeeding (prefers to breastfeed on one side). It can be caused by their position in the womb, the birth process, or body tension, A newborn's head is soft and easily molded into a flat shape. If your baby continues to lie with his/her head turned to one side all the time, the head can become flattened and eventually the baby may have asymmetry. You can start to see flattening as early as a few weeks old.
Your pediatrician can recommend more tummy time, stretches, or more therapies if needed, but here are some helpful tips:
• Always lay your baby down to sleep on their back - This is important to prevent sudden infant death syndrome (SIDS). However, change your baby's head position each time you put them down. Lay your baby with the head towards the top of the crib one time and the next time lay them down with their head at the other end.
• Playtime - It is very important to start placing your baby on their stomach for playtime once the umbilical cord has dried up and fallen off, Time spent lying on the tummy helps develop neck, stomach, arm and back strength. It also helps to get the baby ready for rolling, sitting, and crawling and promotes digestion and whole body health. Begin for short periods of time (2-3 minutes), 3 or 4 times a day. Talk to your baby, place toys in front of him/her, encourage him/her to lift his/her head and begin to push up. Gradually increase the time spent on the tummy and your baby will get stronger and eventually like to play on his/her tummy. "Tummy time" is a time for playing with your baby, DO NOT allow your baby to fall asleep while lying on the stomach.
• Limit baby's time in containers - car seats when not in the car, bouncers, swings etc stomach.
• Carry your baby - Your baby's favorite place is in your arms. Holding your baby or babywearing is a great way to get him/her off his/her head and move the head in different positions. This also allows your baby to experience a variety of positions and is great for bonding and play.
• Contact your pediatrician if baby seems unable to participate in tummy time, excessively fussy in certain positions or places, or seems uncomfortable in their body.
Tongue & Lip Ties
For over 10 years, Agave Pediatrics has been a leader in tongue and lip tie diagnosis, treatment and education. We offer consults, procedures, and continued support. The lingual frenulum (tongue tie) is the small band of tissue that connects the underside of the tongue to the floor of the mouth, and the labial frenulum (lip tie) is the tissue that connects the upper lip to the gum-line. When this tissue is too tight, short, or thick, it can restrict movement, affecting breastfeeding mothers, infants, and children in a variety of ways.
Some signs and symptoms of oral ties include:
Breastfeeding mothers - nipple pain, cracked nipples, flattening of nipples, clogged ducts, mastitis, low supply etc.
Infants — difficulty bottle feeding, difficulty latching and/or staying latched, clicking, leaking, choking/gagging, reflux, gas, long feed times, fussiness during feeds, poor weight gain
Older children - difficult transition to solids, speech or articulation issues, restless or poor sleep, sleep apnea, dental issues.If you or your baby is experiencing any of these symptoms, please contact our office. We offer evaluations, tongue tie procedures, osteopathic manual medicine, and lactation support.
When To Contact Your Pediatrician
Coming to your baby's well checks is always important. Not only will your pediatrician explain what to expect, but consistent care helps parents and providers realize when something needs more care.
Please contact your pediatrician if:
• Your baby is less than I month old and sick in any way (for example, with a cough or diarrhea or looks pale).
• Your newborn's appetite or suck becomes difficult.
• Your newborn sleeps excessively - for instance, past feeding times.
• Your newborn cries excessively.
• Your newborn develops a fever over 100.4 OF (380C) measured rectally.
• Your newborn's temperature drops below 96.80F (360 C).
• You have urgent questions.
Safety
If your child is unconscious or needs emergency care, call 911
Poison Control (800) 222-1222
If your child is unconscious or needs emergency care, call 911 Poison Control (800) 222-1222 Call the Poison Center IMMEDIATELY any time you think your child has swallowed something harmful, such as medications, cleaners, cosmetics, homeopathics, or anything else not meant to be ingested. Keep the container with you so that you can answer any questions quickly, They can also help with bites and stings.
• Keep all poisonous household products and medications out of sight, reach. and locked away.
• Put all poisonous household products and medications away immediately after use.
• Keep poisonous materials in original containers.
• Poison-proof ahead of your child's growth. Remember, rapid growth and development bring new poison-proofing challenges.
• Do not leave your baby alone on a changing table, countertop, bed, etc. Babies can scoot or roll off, even while in an infant seat.
• Do not put your baby in a walker. Walkers can often lead to accidents. Babies who spend a lot of time in a walker actually walk later than those not placed in a walker.
• Get down on the ground (your babyis view) and remove all items that may be dangerous.
• Don't underestimate your child's ability to climb.
• Install safety gates to guard stairways.
• Remove things that can fall on a toddler and secure things to the wall (dressers, book shelves, etc.).
• Make sure windows are closed or have screens that cannot be pushed out.
• Lock second story windows.
• Turn your water heater down to 1200 F (500C).
• Install smoke detectors, Check them periodically to make they work.
• Install carbon monoxide monitors when indicated.
• Keep a fire extinguisher in or near the kitchen.
• Develop and practice a fire escape plan.
• Don't smoke inside the house or near your child.
Safety Continued
• Check formula and breastmilk temperatures carefully. They should not be microwaved.
• Keep hot foods and liquids out of reach.
• Put plastic covers in unused electrical outlets.
• Throw away cracked or frayed old electrical cords. Watch for electrical cords your baby can reach.
• Keep all electrical appliances out of reach.
• Use the back burners on the stove with the pan handles out of reach,
• Keep lighters and matches out Of reach, Teach your Child to never play With matches or lig hters
• Keep plastic bags, balloons, and baby powder out of reach.
• Remove hanging mobiles or toys before the baby can reach them.
• Keep window blinds cords, ropes, or strings away from your baby, especially near the crib. Ropes and strings around the baby's neck can choke him/ her. Keep the crib away from blinds.
• Use only unbreakable toys without sharp edges or small parts that can come loose.
• Keep all small, hard objects out of reach. If the Obiect can fit inside a roll of toilet paper, it's too small for your baby and can get stuck in his/her throat.
• Store toys in a chest without a dropping lid. All toy chests should have holes in them, so if a child gets stuck, he/she can still get air.
• Remove or pad furniture with sharp corners, especially coffee tables and fireplaces.
• Keep sharp obiects out of reach.
• Never leave a Child alone in water.
• Make sure pool gates are used properly and locked. Never prop open a pool gate,
• All caretakers should know CPR and choking rescue. The American Heart Association has many resources.
• Always watch your child around any water, including toilets and buckets. Infants can drown in a bucket that has water in it. Empty all water and store buckets turned over.
The Agave Approach
Agave Pediatrics is founded on the idea that medical care for children should focus on their mind, body, and spirit. This holistic approach ensures that your child receives top- quality individualized care, without losing the human touch that has drawn our large multidisciplinary team to practice medicine. Our goal is to provide well-rounded support, and to increase access to healthcare within our community.
We invite you to ioin the Agave
Pediatrics family and thank you for
entrusting us with your child's care.
Please visit our website and socials to
learn more about us!
