RASHES – The newborn skin is quite sensitive and rashes are common.
*Many newborns experience a red blotchy rash with a white pimple in the middle. It usually appears during the first few days. Often it migrates to different parts of the body and spontaneously disappears during the 2nd or 3rd week. It is called “Erythema Toxicum Neonatorum” - which literally means “red rash of the newborn.” No treatment is required.

*Many newborns may experience a bright red rash in the perianal area, which is likely due to the acidity of their stool. Most over the counter diaper rash creams are helpful as well as “dry air.” If it persists, call the office during regular office hours.

VAGINAL DISCHARGE AND BLEEDING – Most newborn girls experience a white, mucus-like discharge during the first few weeks and some may also have a day or two of bloody discharge. Both are related to hormones and will resolve. No treatment is necessary.

PINK DIAPERS – Newborns have very concentrated urine with uric acid crystals. These uric acid crystals often react with disposable diapers and leave a pink or peach colored stain in the front of the diaper. Parents often mistake this for blood. As the newborn consumes more fluid, (breast milk or formula), the urine becomes more dilute and the diaper discoloration disappears.

NEWBORN STOOLS – Your baby’s stool will likely go through many changes in the first few weeks. Initially, the newborn stool is a dark brown-black, tarry and infrequent. As the baby consumes more formula, the stool becomes more brown or green and with breast milk may become more yellow and seedy. Some newborn infants will have 1-2 bowel movements a day while others may have a bowel movement with each breast feeding (8-10 times a day). If bowel movements are tarry/black beyond the first few weeks or bright red or pale, call the office.

PERIODIC BREATHING – Periodic breathing is common in newborns – both full-term and premature. It is manifested as rapid shallow breathing (panting) followed by a short pause. It occurs most often during deep sleep and resolves within a month. If your baby has pauses in his/her breathing that is greater than 20 seconds or associated with pale or blue colored skin, call the office immediately.

NEWBORN ACNE – Many babies experience red bumps on their face, shoulders, neck and chest. This represents newborn acne which results from a transient surge in hormones. It usually shows up between 2-4 weeks and resolves by 3 months. It usually requires no treatment but if it persists, your physician may recommend an ointment or cream.

NASAL CONGESTION – Newborns often experience nasal congestion at approximately one month of age. Parents often mistake this for a cold. This is Newborn Rhinitis, a transient condition. Suctioning the baby’s nose with a bulb syringe is helpful. Your physician may recommend saline nose drops (Ocean, Nasal, Ayr, Little Noses) as a way to loosen the mucus prior to suctioning. A cool mist humidifier may be helpful. Again this condition is transient and resolves within 1-2 months.

Post-circumcision care
" Plastibell ring type Gently cleanse the area with water 3 times a day or whenever it becomes soiled by wringing a wet towel over the site. Soap is usually unnecessary.

" Incision type (no plastic ring used) Remove the dressing (which is usually gauze with petroleum jelly) using warm water 24 hours after the circumcision was done. Then care for the area as described for the Plastibell. May apply petroleum jelly or antibiotic ointment to keep from sticking to diaper.

Signs of possible complications
Call IMMEDIATELY if your child has been circumcised recently and:
- He hasn't urinated within 12 hours of the procedure.
- The Plastibell ring falls off within the first 24 hours.
- The urine comes out in dribbles.
- The head of the penis turns blue or black.
- There is bleeding on the diaper more than the size of a quarter.
- The circumcision looks infected. (Red and swollen with red streaks up the penile shaft).
- There is thick yellow discharge after the second day.
- He develops a fever.
- He is acting sick.
Call during office hours if:
- The circumcision looks abnormal to you.
- The Plastibell ring does not fall off within 14 days.
- You have other concerns or questions.

What is colic?
Colic is unexplained crying (not due to pain or hunger) that usually lasts more than 3 hours per day. The child acts fine between bouts. Colic usually begins by 3 weeks of age and ends by 3 months.

What is the cause?
All babies cry during the first months of life. When babies cry excessively and without apparent cause (not due to being hungry, overheated, or in pain), it is colic. About 10% of babies have colic. While no one is certain about what causes colic, these babies seem to want to be soothed so they can go to sleep.
Colic is not the result of anything you're doing wrong, so don't blame yourself.
Colic is not caused by abdominal pain. Babies use their abdominal muscles to cry, so the muscles feel hard. Drawing up the legs and flexing the arms are also normal postures for a crying baby.
Colic is not due to excessive gas, and won't be relieved with extra burping or special nipples.

How long does it last?
The severe crying starts to improve at the age of 2 months and is gone by 3 months.
This fussy crying is harmless for your baby. Although the crying can't be eliminated, the minutes of crying per day can be reduced by following the suggestions below.

How can I take care of my child?
Hold and soothe your baby whenever he cries without a reason. A soothing, gentle activity is the best approach to helping a baby relax, settle down, and go to sleep. You can't spoil a baby during the first 4 months. Consider using the following to calm your baby:
*Cuddling your child
*Rocking your child in a cradle, rocking chair, swing, or vibrating chair
*Swaddling your baby in a light blanket. Swaddling is extremely helpful for calming crying babies. It also reduces awakenings caused by the startle reflex and increases the length of sleep. To swaddle your baby use the 3-step "burrito-wrap" technique. Start with your baby lying on the blanket and the arms at the sides. Then pull the left side of the blanket over the body and tuck. Next, pull the bottom up and then pull the right side over and tuck. It is a useful technique from birth to 4 months of age
*Carrying your child in a frontpack or pouch
*Going for a stroller ride, outdoors or indoors
*Other soothing activities, like a pacifier, massage, or warm bath.
For other ideas, read Dr. Harvey Karp's book, The Happiest Baby on the Block.

Get rest and help for yourself. Avoid fatigue and exhaustion. Get at least one nap a day, in case the night goes badly. Ask your spouse, a friend, or a relative for help with other children and chores. Caring for a colicky baby is a two-person job. Hire a baby sitter so you can get out of the house and clear your mind. Talk to someone every day about your mixed feelings. The screaming can drive anyone to desperation.

The available medicines for colic are ineffective and some are dangerous for children of this age. The medicines that slow intestinal motion (the anticholinergics) can cause fever or constipation and should not be used. Simethicone (Mylicon) is an over-the-counter medication to relieve gas bubbles-it is rarely helpful, but is harmless. Rotating the legs or inserting a thermometer or suppository into the rectum to "release gas" usually doesn't help.

When to call the Doctors' office
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
You are afraid you might hurt your baby.
Your baby is acting very sick.

Call during office hours if:
Your baby cries constantly for more than 2 hours.
You can't find a way to soothe your baby's crying.
The crying continues after your baby reaches 4 months of age.
Your baby is not gaining weight and may be hungry.
You have other concerns or questions.

(See also Sleeping, Crying, Reflux sections)

Why is my baby crying?
Crying is the only form of communication newborns have. Crying does not always mean your baby is hungry. He may be tired, bored, lonely, too hot, too cold, or just generally learning to adapt to his new environment. Hold your baby at these times or put him to bed. Don't let him get into the bad habit of eating every time you hold him, or let feeding become a pacifier.
As you get to know your baby, however, you will get better at understanding what causes your baby to cry and what will get him to stop. Soon you will be able to distinguish hungry cries from boredom cries, hurt cries from angry cries. (Sometimes your baby will cry seemingly for no reason at all).
When your baby cries, first check the obvious causes such as hunger, discomfort, fatigue.

HUNGER: If it is possible that your baby is hungry, try feeding first.
Newborns need short (20 minutes), frequent (every 1-4 hours) feedings.

FEEDING PROBLEMS:
If you are breast-feeding, avoid excessive coffee, tea, colas, and other stimulants (2 servings a day is usually fine).
If your child also has diarrhea, vomiting, eczema, wheezing, or a family history of milk allergy, he may be allergic to cow's milk (this is different than lactose intolerance, which is extremely rare in infants) in your diet. If you are breast-feeding, avoid drinking or eating any forms of cow's milk for 2-3 weeks to see if your baby's condition improves.
If you are feeding your baby formula, and he also has symptoms of allergy, try a soy formula or a more easily digested formula like Nestle Good Start or Enfamil Gentlease for 1 week. These formulas are nutritionally complete. If your baby's condition dramatically improves when he is on this new formula, call our office for additional advice. Also, if you think your child is allergic, but soy formula doesn't seem to help him feel better, call our office about even more specialized formulas.
Reflux - See the Reflux section

DISCOMFORT: Your baby may be bothered by something.
Diapers: A dirty or wet diaper can be an easy fix for a crying baby.
Illness: If your child is sick, there are usually other signs, such as fever, vomiting, diarrhea, decreased appetite. Rarely, illnesses cause discomfort without other obvious symptoms. Sometimes a baby can get scratched in the eye or get something stuck in the throat. Make sure your baby's eyes look okay and that he can swallow. Check for fever if he feels warm.
Clothes: Check clothing to see if it is too tight. Sometimes threads from the baby's clothes get wound around his fingers or toes and cut off circulation.

BOREDOM: Crying can also mean that your baby wants a change in scenery or activity.
Babies can often be distracted by lively music, by your dancing with them in your arms, or by a noisy rattle or toy. Car or stroller rides often work wonders for a crying baby and for parents as well. A baby swing may also work. Since babies love to see the sights and to be held close in someone's arms, walking your baby from room to room is generally a good cure for crying.

Other soothing methods
Sucking on a pacifier or a finger (his or yours) can be just the thing to relax your baby and put him to sleep. Pacifiers won't cause difficulty with feeding and are not harmful for infants.
Swaddling tightly in a blanket--like in the hospital when he was born
Quiet music, gentle rocking, soft singing or talking, a warm bath or a gentle massage
If you think your baby is not ill, he may simply need to cry himself to sleep.

What is colic?
Colic is a term used to describe a baby who cries daily for several hours at a time, usually at the same time each day. There is no known cause and no sure cure for colic other than time. Almost all babies outgrow colic by 3 months of age.
The methods listed above or a steady sound (white noise) such as a fan, a dishwasher, clothes washer or dryer, or a vacuum cleaner may calm your baby.

What if I get angry and frustrated?
If at all possible, try to be relieved often by a spouse, friend, neighbor, or relative. If your baby has been crying and you are getting so angry that you are afraid you might hurt your baby, call your health care provider or an emergency room and talk about the problem.

When to call the Doctors' office
Call IMMEDIATELY or seek IMMEDIATE medical attention if:
Your child looks or acts very sick.
You are feeling angry, resentful, or exhausted and you are afraid you might hurt your baby.
Call during office hours if:
Your baby seems to be in pain.
Your baby has cried constantly for 2 hours or more.

(See also Sleeping, Colic, Reflux sections)

What is SIDS?
Sudden infant death syndrome, or SIDS, is the sudden unexplained death of a baby under age 1. SIDS is the most common cause of death in babies in the United States between 1 month and 1 year of age. Most deaths from SIDS are in babies over 21 days and under 6 months of age.

How does it occur?
The causes of SIDS are not known. SIDS happens during sleep. Sleeping face down increases the risk for SIDS. Babies exposed to cigarette smoke also have an increased risk for SIDS.

How can I avoid SIDS?
- Be sure you put your baby to sleep on his back at all times (day and night sleep).
- Have your baby sleep in a crib specifically designed for infants.
- Do not use soft bedding material for your baby.
- Do not place soft items (such as pillows and stuffed animals) in your baby's crib.
- Do not use loose blankets or other covers in your baby's crib. If you do use a blanket, tuck it in so that your baby's face will not be covered. Never allow your sleeping baby's head to be covered with a blanket (or comforter or quilt).
- Do not sleep with your young infant. Babies can be brought into bed for comforting or nursing, but should be returned to their crib when you are ready to go back to sleep.
- Do not overheat your baby's room. The room temperature should be comfortable for an adult wearing light clothing. Your baby should not feel hot to the touch and should never be sweating while asleep.
- Do not smoke when pregnant or near a newborn infant.
- If anyone else takes care of your child, be sure they are aware of the recommendations noted above.
- Pacifiers have been associated with a lower risk for SIDS. Infants between 1 month and 1 year old should be allowed to use pacifiers during naps and at bedtime. It is not necessary to replace a pacifier once your baby has fallen asleep and you should not force your baby to use a pacifier if he or she refuses.

When to call the Doctors' office?
Call 911 immediately if your baby is not breathing or looks blue.

(See also Sleeping section)

The safest sleep position for the risk of Sudden Infant Death Syndrome (SIDS) is supine (on the baby's back) on a firm mattress.

Crying is the only form of communication newborns have. Crying does not always mean your baby is hungry. He may be tired, bored, lonely, too hot, too cold, or just generally learning to adapt to his new environment. Hold your baby at these times or put him to bed. Don't let him get into the bad habit of eating every time you hold him, or let feeding become a pacifier.

Place your baby in the crib when he is drowsy but awake. He must learn to put himself to sleep without you. It often takes 20 minutes of restlessness for a baby to go to sleep. If he is crying, rock him and cuddle him. But when he settles down, try to place him in the crib before he falls asleep. Handle naps in the same way. This is how your child will learn to put himself back to sleep after normal awakenings.

Hold or comfort your baby for all fussy crying during the first 3 months. All new babies cry some during the day and night. Always respond to a crying baby. Gentle rocking and cuddling seem to help the most. Babies can't be spoiled during the first 3 or 4 months of life. If your baby cries excessively, the cause may be colic. But even colicky babies have a few times each day when they are drowsy and not crying. On these occasions, place your child in the crib and let him learn to comfort himself and put himself to sleep.

Make middle-of-the-night feedings brief and boring. Feed him quickly and quietly, don't turn on the lights, talk to him, or rock him. Provide extra rocking and playtime during the day. This approach will lead to longer periods of sleep at night.
Give the last feeding at your bedtime (10 or 11 PM). Try to keep your baby awake for the 2 hours before this last feeding. Going to bed at the same time every night helps your baby develop good sleeping habits.

(See also SIDS, Crying, Colic sections)