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Your Baby at 2-4 Weeks

By Dr. Michael Boettcher

Congratulations on the birth of your new baby.  Although this is a very exciting time, it can also be stressful and busy.  The following information includes general information and recommendations to assist your family in the care of your child.  Remember, every baby is different and requires lots of care, love and support.  The entire family should be involved in caring for the infant in order to provide the best environment in which to thrive.

 

GROWTH AND DEVELOPMENT:            

The young baby is most concerned with eating and sleeping.  He will generally sleep approximately 16 -18 hours per day, with the waking hours increasing as he grows.  Sleeping through the night (5 hours straight after midnight)  is variable, and usually does not happen until the baby is 8 to 12 weeks old (some babies wake during the night through the eighth month, a problem we can assist you with if needed).   It is not unusual for breast-fed babies to wake up for a feeding until 5-6 months of age.

Your baby will enjoy some stimulation now.  One way to stimulate her visually is to look at her at close range.  The human face is her favorite thing to watch.  You can also hang bright shiny objects within 8-10 inches of her face.  If you place a mobile above the crib, be sure to stand underneath it to see if the view is interesting – some mobiles are only interesting from the side and should be hung at the foot of the crib.  Your baby will also enjoy having you talk and sing to her.  Music boxes, radio, TV, and ticking clocks provide auditory stimulation.  You can stimulate your baby’s sense of touch by holding, caressing and cuddling her.  She likes to be kept warm and may enjoy being swaddled.  Rocking her, using a front carrier, and taking her for walks in a stroller will stimulate her sense of motion.  At this age, it is not possible to “spoil” your baby; therefore, cuddle her as much as possible.

The First Month:  Startling, fitful waking, sneezing, and hiccups are common at this age, but these will disappear as his brain develops. Other normal newborn behaviors include straining with bowel movements and gas.  When your baby lies on his belly, he can raise his head slightly.  If you pull him to a sitting position, his head will lag behind, and then fall forward.  He keeps his fists clenched most of the time, and if you press your finger into his hand, he will grasp it automatically.

The Second Month:  At 1 month of age, your baby’s language consists mainly of crying to express displeasure, but she will also make small throaty sounds and make comfort sounds during feeding.  She will fixate on moving objects and follow a light to midline.  When she hears a voice, she will quiet and will watch a parent’s face intently as he or she talks to the infant.

FEEDING/ELIMINATION:          

If you are breast-feeding, we encourage you to continue for at least 12 months as recommended by the American Academy of Pediatrics.  You should breast-feed your infant approximately every 2-3 hours or 8-12 times per day.  Continue with your prenatal vitamins for as long as you are breast-feeding.  It is recommended that breast-fed babies be supplemented with vitamin D.  This can be done either by giving a multivitamin drop (1 ml daily) or over the counter vitamin D drops (1 ml daily) to provide the recommended dose of 400 IU of vitamin D.  Breast-feeding alone will provide her with all the necessary nutrition for the first 4 to 6 months.  Do not feed her any extra water without consulting your doctor. There is no need for solids, such as cereal, fruits or vegetables at this age.  Your physician will advise you as to when to begin solids, generally at 4 – 6 months.

Formula-fed infants should be fed an iron-fortified formula.  At this age, babies average 2-4 ounces every 3-4 hours.  Do not change formulas without consulting your provider. Do not give any extra water without consulting your provider.  There is no need for solids, such as cereal, fruits or vegetables at this age. He gets enough nutrition from the formula alone for the first 4 to 6 months.  Your provider will advise you as to when to begin solids.

Babies vary in the amount and frequency of bowel movements.  Your baby may poop from 5-7 times/day to once every few days.  It is not too unusual for breast-fed babies to go a week without having a bowel movement, usually starting between 6-10 weeks of age.  Babies also will grunt, groan, and strain with bowel movements because they do not have the stomach muscles to push very effectively.  Stools should always be soft and without form.  If your baby is having formed or hard stools, difficulty feeding, stomach bloating, blood in the stools, or frequent vomiting, please call, and we may have you make an appointment to be seen.  Babies also vary as to the amount of urine they make.  Usually, babies will have about 4-6 moderately wet diapers/day.  Call us if you have any concerns.

POSTPARTUM DEPRESSION:

You should have received a screening questionnaire regarding postpartum depression.  This is to help us identify moms who are having a tough time with the hormonal, psychological, and physical stresses of having a new baby.  Please fill out the forms and if at any time you are concerned about your mental well- being, please contact us or your primary care provider, in order to assist you in the very common and potentially dangerous condition.  DMG is committed to taking care of not just your child but your family as a whole.

SAFETY:

Car Seat: 

Babies need to be secured in a car seat whenever in a car.   The safest position is the center of the backseat.  The recommendations are for rear-facing position until 2 years of age.   For information on all types of car seats, you can call the Auto Safety Hotline at 1-800-424-9393.

Suffocation and Sleep Position:

Place your infant on his back or side during sleep, never on his stomach.  Never place your baby on a waterbed or beanbag chair.  Do not use pillows or quilts in a crib.

Smoking:

Do not smoke.  While in the process of quitting, go outdoors and never smoke in the car.  Smoking is associated with increased ear infections, pneumonia, colds, and increased risk of crib death.  For assistance, contact the Smoking Cessation Hotline at 1-866-QUIT-YES.

Shaking Prevention:

Never shake or hit your baby.  If you are angry or feel out of control, place your baby down safely and take the time to regain control.  Contact the FUSSY BABY NETWORK at 1-888-431-BABY if you feel your baby’s crying or needs are overwhelming you.  This is a free service.

Choking Prevention:

Do not sprinkle powder directly on the baby – place it on your hand before rubbing it on her.  Keep the container closed and out of her reach.  Start baby-proofing your home.  Ensure miniblinds or curtain cords are away from the crib (cut or tie up all cords in house).

Burns and Fire Safety 

Do not warm formula in microwave oven. Do not smoke or pour hot liquids while holding your baby.  Turn your water heater down to 120 degrees F and always check bath water temperature.  Do not leave him in the sun for more than a few minutes.  Check the care seat temperature before placing him into it.  Ensure the smoke alarms and carbon monoxide monitor (if gas heat) are working.  We recommend a fire escape plan and fire extinguishers.

Supervision and Child Neglect:

It is considered child neglect to leave an infant home alone (even if sleeping).  Resist the temptation to leave your sleeping infant at home to run an errand!  Never leave the baby in a parked car, even with the windows open.  Always watch your baby during bath time.

 

ILLNESSES AND GENERAL CARE OF YOUR BABY:

Parents are bound to have a lot of questions about issues that arise during infancy and childhood. Some can be answered by one of the standard baby care books.  We used the collective knowledge and experience of pediatricians and developed “The Baby Book:  Infant and Pediatric Care,” a resource that has useful advice and anticipatory guidance that you will need over the next few years.  We also recommend What to Expect the First Year. A. Eisberg, H. Murkoff, S. Hathaway; Your Child’s Health. A Pediatric Guide for Parents. B. Schmidt; and The Happiest Baby on the Block, H. Karp.  Various handouts on illnesses, behavior, and developmental related topics are also available at our offices.  Call your pediatrician’s office if you have questions about your baby that are not answered by these valuable resources.  Our nurses are excellent resource for you, and if they are not able to answer your questions or solve your problem, they will either consult with a provider or make an appointment for your baby.

If your baby’s umbilical cord has not fallen off yet, continue sponge bathing.  If the umbilical cord has not fallen off by 1 month of age, make an appointment to see your child’s physician.  If your boy was circumcised, he should now be well healed.  During diaper changes and baths gently retract the foreskin to help prevent adhesions.

Use common sense and good judgment in caring for your baby.  During the first 2 months your baby needs to be evaluated immediately if any of the following exist:

  • RECTAL Temperatures > 100.4º F.
  • Lethargy or inconsolability with crying for over 3 hours.
  • Respiratory distress resulting in inability to feed.
  • Dehydration manifested by dry mouth, no tears, and no urine output for 12 hours.

IMMUNIZATIONS:         

At DuPage Medical Group, immunizations are generally given initially in the hospital or at the initial newborn visit, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 4-6 years, and 11 - 14 years.  If your child falls behind on immunizations, your provider will coordinate with you in order to ensure the immunizations are updated in an orderly manner.  Every now and then, new or improved vaccines are developed and your provider will identify those who are in need of these new recommendations.  If you elect not to follow our recommendations of immunizations, we will need to counsel you regarding the possible adverse effects this may have on him and the community.  We will then request that you sign a Vaccine Refusal form indicating that we counseled you about these dangers.  If your child has had a severe or unusual reaction to shots in the past, please let us know.

Notify us if any problems occur after immunizations, such as:

  • An unusual, high-pitched cry or crying without stopping for 3 hours or more.
  • Other symptoms you think are serious.

From September to June we recommend flu shots for infants 6 months and older, along with all family members.  Children less than 9 years will need 2 shots separated by at least one month the first time they receive the flu shot.  In most cases, your provider is able to offer the entire family (parents, grandparents, and nannies too) the flu vaccine.  This program has made it more convenient for families and has really helped us see less influenza the last couple of years.

If mom, dad, or grandparents have not gotten the whooping cough vaccine (TdaP), which is recommended for all adult caregivers of newborns, please let us know,  as in most cases we are able to provide this service for them.

MYCHART:

DuPage Medical Group has become a leader in the area regarding electronic medical records.  With the expansion of the electronic medical record, we can now provide our families with access to much of the same medical information that we have through MyChart.  Immunization records, medication lists, allergies, lab and X-ray results, growth charts, and appointment reminders are all available through this wonderful program.  Also, the ability to communicate with your provider for non-urgent medical questions can be done via email with MyChart.  We encourage all our families to sign up for this secure and useful online medical record portal.  The opportunity to sign up will be given to you at check in.  If you have any questions regarding this program, please call or discuss with your provider.

NEXT APPOINTMENT:

At check out, please schedule your baby’s next appointment which will be advised by your care provider.  Our regular Well-Baby Visits are scheduled at 2 to 4 weeks (if needed), 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months (if needed), 3 years, 4 years, 5 years, 6 years, and annually thereafter.  Please try to arrive 5 -10 minutes before your appointment so the necessary paperwork can be done.  Unfortunately, sometimes unexpected or complicated problems will cause us to be slightly delayed, and you may need to wait awhile.  Bring toys and be prepared to feed your infant if necessary.  We appreciate your understanding. 


Topics and Subtopics: Children's Health & Infant Care

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