II. Red flags requiring immediate evaluation

  1. Signs of infection
    1. Fever over 100.4
    2. Decreased alertness
  2. Signs of dehydration
    1. See Pediatric Dehydration
    2. Weight loss >9% of birth weight (urgent)
    3. Increased Tiredness or sunken Fontanelle
    4. Less than 3 wet diapers per day
  3. Signs of breathing problems
    1. Breathing more than 60 times per minute
    2. Using neck, chest or abdominal muscles to breath
    3. Wheezing
  4. Signs of significant Jaundice
    1. See Neonatal Hyperbilirubinemia
    2. Yellow Skin below nipple line suggests Bilirubin test

III. Feeding

  1. See Infant Feeding
  2. Avoid harmful measures
    1. Do not give water (risk of Hyponatremia)
    2. Do not give honey for the first year (Botulism risk)
    3. No solid food (baby food) for first 4 months
  3. Breast Feeding (preferred)
    1. Work with new mothers on Breast Feeding Technique
    2. Review common Breast Feeding Problems for the Infant
    3. Review Medications in Lactation
    4. Supplement with Vitamin D 200 IU daily
  4. Formula Feeding
    1. Only use formulas containing full strength iron
    2. Choose one formula and continue the same one
    3. Heat formula only to room Temperature
    4. Dispose of unused formula immediately
    5. Wash bottles in warm soapy water
  5. Call physician if:
    1. Formula problems
      1. Consult with physician before switching
    2. Signs of dehydration
      1. See above

IV. Urine

  1. Infants usually urinate 6 or more times daily
  2. Call physician if:
    1. Less than 3 wet diapers per day

V. Stool

  1. Consistency: Often loose and may be watery at times
  2. Frequency
    1. Breast Feeding: >3 stools per day
    2. Formula Feeding: Stool every other day may be normal
  3. Problems: Constipation
    1. See Neonatal Constipation
    2. Try Apple, pear or prune juice 1 ounce 1-2x/day
    3. Maximize fluid intake (Breast Milk or formula)
    4. Consider Glycerin suppository if continues
  4. Call physician if:
    1. Constipation: Less than 5 stools/week for 2 weeks
    2. Diarrhea: Stool runs out of diaper

VI. Umbilical Cord

  1. Clean cord area with water only
  2. May use a mild, pH neutral skin cleanser if needed
  3. Do not use Alcohol
  4. Call physician if:
    1. Infection signs (discharge or redness at Umbilicus)
    2. Umbilical Cord not detached by 2 weeks

VII. Genitalia

  1. Gently clean area with warm water at diaper changes
  2. Boys
    1. Uncircumsized boys
      1. Do not retract foreskin forcefully (Phimosis risk)
    2. Circumcision care
      1. Vaseline to area with each diaper change for 5 days
  3. Girls
    1. Small bloody Vaginal Discharge in newborns is normal

VIII. Safety Issues

  1. Child Safety Seat
    1. See Infant Car Seat
    2. Rear-facing, approved Car Seat (not in front seat)
  2. Sleep
    1. See Crib Safety
    2. Should sleep on back on firm mattress (reduces SIDS)
  3. Avoid unnecessary exposures to illness
    1. Keep persons with acute illness away from newborns
    2. Stay away from supermarkets or malls
  4. Avoid second hand smoke exposure

IX. Follow-up: Initial visits

  1. Week 1: Recheck weight, Jaundice and other concerns
    1. May be performed by home health, nurse or physician
    2. Discharge <24 hours of life: Follow-up within 2 days
    3. Discharge <48 hours of life: Follow-up within 4 days
    4. Discharge >48 hours of life: Follow-up within 5 days
  2. Week 2: Well Child check with repeat full Newborn Exam
    1. Performed by physician in clinic
  3. Week 8: Well child check
    1. Initiates Immunization schedule

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