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Comprehensive information on child care for infants and toddlers, including nutrition, developmental milestones, safety tips, and common childhood illnesses. It covers topics such as weaning from breast milk or formula, toilet training, safety precautions, and the importance of vaccinations. The document also includes a list of common foods and their calcium content, as well as safety measures for preventing injuries and drowning.
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WELCOME TO CENTRAL OHIO PRIMARY CARE
Each COPC pediatric practice is a part of Central Ohio Primary Care, Inc. (COPC), an organization of pediatricians, internists, endocrinologists, and family doctors who have joined together to centralize billing and negotiate with insurance companies. COPC helps us with administrative responsibilities, allowing us to dedicate our attention to caring for our patients. With strength in numbers, we have a greater leverage with insurance companies, increasing the likelihood that they will cover appropriate services. We are confident that COPC allows us to provide excellent care for our patients while spending less time with administrative issues.
At COPC, we are committed to providing you and your children with top quality pediatric care. We believe that the care of your child is a partnership built upon our knowledge of pediatrics and your commitment to your child’s well being. We strive to remain current with advances in pediatric medicine and consider educating our families a top priority. We look forward to the opportunity to develop long-lasting relationships with our patients and their families.
The pediatricians at COPC have crested “A Guide to your Child’s Health” as a resource for families. Included in the book is information regarding general infant and child care, child development, and common childhood illnesses. The intention of this book is not to be a complete reference manual, but rather to answer questions commonly asked by parents. We encourage you to use this information to initiate care of common illnesses at home, but if you have additional questions, always feel free to call the office.
WELCOME
TO
PARENTHOOD
The following information has been prepared to assist you in caring for your newborn and young child. The doctors have summarized the most common nutritional, developmental and safety information questions asked by parents at well child visits. The newborn section is the most detailed because, understandably, that is the age for which parents tend to have the most questions. Newborns can be overwhelming, but remember, they really just need your love and careful attention. Well-intended advice is often offered to new parents by family, friends and the media. While it may be helpful, it can often be inaccurate or not the best advice for your baby. We hope that you will use this booklet to guide your efforts to provide the best care for your child, and direct additional questions to the pediatricians when the need arises. We have additional, more detailed information at our office that you may also find helpful. We wish our families the best experience possible with their new adventure in parenting.
GENERAL CARE OF YOUR NEWBORN
You will gain your first experience with your newborn in the birth hospital. We encourage you to stay as long as you are allowed to maximize rest and recuperation. Keeping your newborn close by (in the room) is helpful in gaining knowledge about your baby’s care and needs from the experienced hospital staff.
Once home, continue to rest and recuperate. Use the pain medication offered to you by your obstetrician and continue your prenatal vitamins if you are breastfeeding. Visitors are okay from the beginning, as long as they do not have any ill symptoms. Your newborn will not need bathing, temperature measurements or any medical care prior to your first office visits, unless his/her condition changes. We would like to see your newborn in the office shortly after discharge, within 5 to 7 days. If you have any concerns or questions prior to the first appointment, do not hesitate to call. The following information is intended to address many common questions asked by new parents.
Hunger is the primary infant drive in the first weeks of life. We recommend “on demand” feedings in the beginning (NOT on a schedule). Most newborns will quickly fall into their 2 to 4 hour schedule, depending on whether they are breast or bottle-fed. Newborn infants may require nighttime feedings until closer to 4- months of age. Remember that babies cry for many reasons, not just hunger. If your baby has been fed within the past 2 hours try other means of comforting them, other than feeding. Be aware that newborns suckle for enjoyment, and may continue this behavior after being fully fed. Therefore, limit a single feeding to a reasonable amount of time. Feeding your newborn can be frustrating initially, but it will soon become a pleasurable time for you and your baby.
We strongly encourage mothers to breastfeed their infants when possible. Advantages to the infant include protection from common viral illnesses including colds and stomach flu, excellent digestion and optimal nutrition. Although breastfeeding is the natural way to feed a baby, this skill requires patience, practice and often hands-on help.
Babies do not require additional feedings of water during the first few months. All nutrition and fluid requirements are met in breast milk or formula feedings. Water is not harmful in small (1-2 ounce) amounts and may be offered if desired after the first few months. Never add sugar or Karo syrup to the water. Never feed an infant honey, prior to 12 months of age. Do not give newborns any other form of solid or liquid feedings until 4-6 months of age.
A vitamin supplement containing Vitamin D is recommended for all breastfed babies shortly after birth. Your doctor will discuss this at one of your first visits. If your baby takes formula, your doctor will discuss if vitamins are necessary.
Fluoride prevents the formation of cavities. If your home water supply does not contain fluoride (well water), your child will need a supplement beginning at 6 months of age. Consider this when using bottled water to prepare formula, as many do not contain fluoride.
Your own comfort should serve as a guide to room temperature, clothing and activities for your newborn. Newborns can overheat and should be dressed appropriately and kept out of direct sun in warm weather. Avoid crowded indoor spaces in public areas for the first 4-8 weeks of age.
Newborn infants sleep an average of 16-22 hours per day. Your baby should ALWAYS be placed on their back to sleep. This has been shown to lessen the risk of Sudden Infant Death Syndrome (SIDS). Use a firm, flat mattress and do not place a pillow or any other objects, including bumpers, in the crib. Never place a comforter or blanket over your baby. Co-sleeping (placing your infant in your own bed) increases the risk of SIDS and IS NOT recommended.
It is only necessary to bathe your infant once or twice a week. The first bath must wait until the umbilical cord has fallen off; sponge bathe your infant until this occurs. Once the cord is gone, bathe your baby head to toe in a warm room with minimal drafts. Make sure that all of the necessary equipment (soft cloth, hair brush, gentle soap) is nearby. A special basin is not required but always hold your baby at all times while in the water. Never turn away or leave your infant during bath time. A mild, unscented soap is all that is necessary. Gently wash your infant from head to toe. No additional scrubbing is needed in the diaper area. Wash only the outside of the ears with a washcloth. Never use Q-Tips, as they can injure the ear and push wax in deeper. Infants do not usually require any lotions. If you feel that your baby’s skin is dry, use unscented lotion. Oils are discouraged because
they can actually clog the pores and powder should not be used because it is very easy for your baby to inhale.
Keep your infant’s umbilical cord clean and dry. Keep the front of the diaper folded down so that the cord is exposed. Your doctor may suggest that rubbing alcohol be applied once or twice a day, but this is not always necessary. The umbilical cord will fall off in the first several weeks of life, and there may be a small amount of blood when this occurs. This is normal. Call your doctor if you notice any redness of the skin around the cord, any unusual drainage or foul odor.
If your baby boy was circumcised, apply Vaseline to the penis until it is healed, usually 5-7 days. This will prevent the healing skin from sticking to the diaper. As the circumcision heals you may notice a soft yellow covering develop; this is a normal part of the healing process. If you notice redness of the surrounding skin, bleeding or pus, please call your doctor. If your infant was not circumcised, you simply need to wash his penis at bath time as you do any other part of his body. Do not attempt to pull the foreskin back over the tip of the penis; this will occur naturally, usually before 5 years of age.
Your baby boy's breasts may be swollen at birth. This is a normal result of hormones passed to the baby by the mother before birth. It will disappear within the first several months of life.
When bathing your baby girl it is important to gently separate the labial folds to prevent the formation of adhesions that may later be difficult to separate. Gentle wiping with soap and water is all that is necessary in this area as additional scrubbing may cause irritation. When cleaning your baby girl after a bowel movement, always wipe from front to back.
The hormones that are passed from mother to infant before birth can cause a small amount of white, mucousy discharge from the vagina; in some girls a small amount of blood may also be seen. This is normal and will resolve as the hormones leave the body. These same hormones may cause your baby's breasts to be swollen at birth. The swelling will disappear within the first several months of life.
Jaundice is a yellow coloring to the skin that is common in all newborns. Parents may notice this color change in the first several days after hospital discharge. Jaundice usually peaks on the fourth to fifth day of life and disappears over the next week. If your baby appears quite yellow to you, if the yellow color reaches the legs, if your infant is increasingly sleepy, or not eating well, please call your doctor.
THE 2-4 MONTH INFANT
At this age, most babies have developed a feeding schedule, and a few may begin to sleep throughout the night. Infants who are beginning to sleep longer at night will adjust their daytime feeding schedule to make up the difference. They may eat more often, take more during individual feedings, or “cluster feed” before bedtime. Formula or breast milk should still be the only component of your infant’s diet. Babies who are breast-fed will require a vitamin D supplement.
Your baby should be able to smile, coo, turn their head to sound, and become more alert to their surroundings. They should be able to hold their head up and lift it when on their stomach. Start to give your infant time on their “tummy” when they are awake. It is also a good idea to put them to bed while drowsy, but still awake. This will aid in the development of good sleep habits later in their development.
Never leave your infant unattended on services like a bed, sofa or changing table as they may roll off. Continue to put your baby to sleep on their back; if they begin to rollover in their sleep, you may leave them there.
THE 4-6 MONTH INFANT
Babies should start solid food after 4-6 months of age. Your doctor may discuss the introduction of food after your baby’s 4 to 6 month visit. There are no rules for what type of food to give first, but it is important to introduce only one new food every 2 - 3 days. Solids at this age are primarily to teach your baby how to eat. The solids should not replace formula or breast milk, these are still your babies main form of vitamins and nutrients.
Your baby should be able to roll over and sit with support. They should be starting to grasp objects and will begin to put things in their mouth. They are probably becoming more vocal. You should have a well established bedtime routine.
Now is the time to begin baby proofing your home. Electrical outlets should be protected and stairs gated off. All medicines, poisons and other potentially harmful substances should be moved up high, well out of reach.
THE 6-9 MONTH INFANT
By nine months, your infant should be eating solid food two to three times a day. Most babies 8-9 months old can tolerate ground meats, cheese and yogurt. Small pieces of soft foods can be given when your child develops the “pincher grasp”. Formula and breast milk are still the main nutritional source and your infant should take at least 16 ounces/day. If you want to give additional fluids, we recommend water rather than juice.
Your baby should be able to sit without support and can transfer objects from one hand to the other. Your baby may be able to feed themselves a bottle. Never give your child a bottle in the bed; this is harmful to the teeth and disrupts good sleep habits.
Make sure that any small objects that your infant could choke on are out of their reach. Do not use a mobile baby walker; they are dangerous and can cause serious injury. If your baby is over 20 pounds you may need a larger car seat. It should be a both rear and front facing as your child needs to remain rear facing until at least two years of age.
THE 9-12 MONTH INFANT
At one year of age, breast milk and formula may be weaned/stopped and replaced by whole (vitamin D) milk. We also recommend that bottles be stopped with this change. You can begin this transition by introducing your nine month infant to a “sippy” cup. Encourage them to eat three meals a day, offering age-appropriate table food each time and try to offer bottles or breast milk after or in between meals. Your infant should still be receiving at least 16 ounces/day of formula or breast milk.
Your baby should be crawling or scooting and is beginning to pull to a stand. He can say ”mama” and “dada” and understand simple commands. He may begin to be anxious around strangers.
Choking is a concern at this age; make sure small toys and objects are out of reach and keep bite-size foods in very small pieces. Your child should remain rear facing the car seat.
Most children are walking well at this age and are beginning to climb. Their vocabulary is quickly expanding and they can follow simple commands. They are becoming more independent and want to do more on their own. Because of this, it is important to establish boundaries and be consistent in enforcing rules as your toddler begins to test limits.
Recheck your home for dangers at your child’s level. Lock up dangerous things that may smell good or look similar to food and drinks like lamp oil, antifreeze, colored vitamins and medicines.
THE 18 MONTH TO 2 YEAR CHILD
Continue to be diligent about healthy eating habits and follow the tips mentioned in the previous section. If your child is not getting a well balanced diet, an over the counter multivitamin maybe added. Continue to offer healthy foods, especially fruits and vegetables, even if your child has refused them in the past. It is okay to get creative and let your child dip their vegetables in dressings, cheese or even ketchup. Continue to limit whole milk intake to 16 ounces/day and be aware of overall fluid intake. Your doctor may recommend a multivitamin for your child.
Your child’s vocabulary is approaching 20 words and they are beginning to use two word phrases. Limit testing continues and children this age often throw tantrums when mad. Your child needs to learn that tantrums will not help them to get their way. Ignore the tantrums completely; ANY attention, even in negative scolding, will only reinforce this behavior.
If your toddler is attempting to climb out of their crib, transfer to a toddler bed or mattress on the floor. Make sure to childproof their room and put a gate up at the door. Make sure that all windows and doors out of the house are secured.
THE 2-3 YEAR CHILD
Children at this age can be very picky. We encourage you to keep to the advice mentioned in the previous two sections. Toddlers may have days during which they seem to eat quite a bit and then several days during which they will eat foods they may not normally consume. At two years of age whole milk should be replaced with low fat or skim milk.
Most children are toilet trained by three years of age, but remember that is a milestone just like walking, and cannot be forced. Always give positive feedback when your child uses the potty and never punish your child for having an accident. Don’t make a battle out of using the potty as this will only frustrate you and your child. Discipline can become an issue at this age. Establish rules and boundaries and be consistent. Discipline needs to be appropriate and immediate if it is to be effective. You are in charge, not your child! Don’t attempt to reason with your toddler, they do not have adequate reasoning skills and your attention only provides positive reinforcement to behaviors that you are trying to discourage. Do not give her choices if none exist.
Watch your child closely both inside and out; children this age often wander away from their parents in public places. Teach your child their first and last name and to find another “mommy and daddy” if they get lost. Teach them his private parts and that no one can see them except his parents, including the doctor, unless a parent is present. Your child may now face forward in the appropriate car seat.
THE 3-4 YEAR CHILD
Most 3 year olds begin to be better eaters. A healthy diet with plenty of fruits and vegetables and limited sweets will help to create healthy eating habits well into your child’s future.
Most children will be speaking in sentences and the majority of what they say should be discernible by an adult. Three year olds know their colors and are learning to count to five. They can eat with a fork and can pedal a tricycle. It is important for the development of social skills that your child interact with other children in a group setting of some type. Playgroups, day care or preschool provide the appropriate setting for such interactions.
FOOD INTRODUCTIONS
We have put together this description of appropriate food introduction to try to help parents provide optimal nutrition for their children. This is merely a guide, and recommendations may vary for each individual child. Do not hesitate to discuss these recommendations with your child’s doctor at your Well Child visits.
The best and only nutrition for your baby is breast milk or formula for the first 4 to 6 months. Solids (baby foods) and cows milk are not appropriate for young infants. Breast milk and formula contain all the nutrients a baby needs, and your child’s digestive system is not mature enough to digest other foods until after 4 to 6 months. Cows milk lacks many of the vitamins and minerals needed by infants; it also contains a high-level of protein and sodium which can be too much for your infants system to tolerate. Researchers and experts in nutrition, along with the American Academy of Pediatrics, recommend that infants remain on breast milk or formula until they are 12 months of age.
We prefer that you do not introduce solids until your child is at least four months of age, but six months may be preferable to reduce the risk of allergies. Please discuss with your doctor what he/she recommends. There is a common myth that early introduction of cereal will help a child sleeps through the night. Although many mothers (and grandmothers) believe this to be true, many good scientific studies have proven this not to be the case. Early introduction of solid can increase the risk of allergies, not only to foods, but also to grass, pollen and other environmental agents. In addition, solids are not an optimal source of nutrition in the first 4 to 6 months of life.
When is it time to introduce solids, the rule of thumb is one food at a time. If you introduce too many foods at once and your child has a reaction (diarrhea, rash, vomiting, or general unhappiness) you will not know which food is the offending agent. Give one new food every two to three days. Once a food has been proven “safe” you can give it with other test foods. Please discuss with your doctor what food is appropriate to give first. If your infant refuses the spoon, coughs or gags, they may not be ready; it is best to retry in several weeks. Honey should be avoided until after your child’s first birthday because it can cause infant botulism.
In the first 6 to 9 months of life, breast milk or formula is the most important source of nutrients for your infant. It continues to be important until the child is one year old, but solids begin to take on an increasingly important role.
After one year of age, cows milk can be introduced. It is important to provide a child with adequate fat until two years of age, as this is needed for brain development. Accordingly, whole milk and full fat dairy products are important until the second birthday. A child over one year of age should not drink more then 16 ounces of milk per day. Too much cows milk can lead to anemia.
