NEWBORN GUIDELINES We have prepared these discharge guidelines to help new parents in particular to manage the first few weeks at home with a newborn infant. If you find that your own ideas work better for you and your baby than do our suggestions, follow your instincts.

Feeding
In the hospital, you were probably feeding your baby about every four hours. Once settled at home, most babies eat every 2-3 hours if breast feeding, and every 3-4 hours if bottle feeding. There is rarely a strict feeding schedule in the early weeks, although one will often develop by 8 weeks or so. Until then, feed on demand, whenever the baby seems hungry.

Breast Feeding
The key to successful nursing is short but frequent feedings!

Ideally, in the beginning,  an infant will nurse for 10-15 minutes on each breast, about 7-10 times in 24 hours. Your breast milk is usually "in" by the third to fourth day after delivery. If you find that the baby is sleeping a great deal and having fewer than 7 feedings per day, we do suggest that you wake the baby more frequently, particularly during daytime hours.  Remember to start each feeding with alternate breasts.

Early on, it is usual for a baby to nurse as often as every 2 hours. (Avoid allowing the baby to "snack" every hour.) Gradually, as the interval between feedings increases to every 3-4 hours, you may increase to 15-20 minutes per breast and find that the baby will nurse less often.

It may take two weeks (occasionally longer) for breastfeeding to become well-established. Please call us to help if you feel that nursing is not going as well as you had expected. The baby's weight is usually checked in the office within 48-72 hours of discharge.

Whether you plan to breastfeed for a few weeks or several months, we recommend that you nurse exclusively for the first two weeks. After that, it is fine to begin one bottle daily of expressed breast milk or formula.

Weaning
At your two week office visit, we will discuss your feeding plans, how long you would like to breastfeed, whether or not you are returning to work, whether formula supplements are needed, and when and how to wean from breast feeding when you are ready to do so.

Formula Feeding
If you have chosen to bottle feed your baby, unless there is a family history of milk protein allergy, we recommend that you start with a milk-based formula (e.g. Similac, Enfamil, or Good Start). If the baby has trouble tolerating this, we will recommend an alternative. Remember that feedings are approximately every 3-4 hours, but without a strict schedule. Generally, a more predictable schedule develops by 8 weeks of age.

At first, most babies take 1-2 ounces per feeding but will increase fairly quickly to 3-4 ounces. By your 7 week visit, the baby may take 4- 6 ounces per feeding. Remember to burp after each ounce. Once the baby is taking larger amounts, burp every 2-3 ounces and after each feeding.

NEWBORN GUIDELINES Elimination
We expect newborns to have 5-6 wet diapers in a 24 hour period. This is one way you can tell if your baby is getting enough to eat. There is great variability in the pattern of bowel movements for newborns. As many as 10 stools in a day or as few as one stool every 10 days can be a normal pattern, particularly if an infant is exclusively breast-fed. Do not be concerned about the frequency of stools, as long as they appear soft and easy for the baby to pass. The color of a baby's stool is rarely a problem. Any variation of green (even fluorescent), yellow or brown is acceptable. Call only if you see blood in the stool, chalky white or jet black stools.

Jaundice
Some babies will develop a yellow skin color during the first few days of life. This condition is called jaundice and results from an accumulation of bilirubin in the baby's bloodstream. A certain amount of jaundice is "physiologic" or normal in newborns. If a baby becomes jaundiced in the hospital, we will check a 'bilirubin' level. Depending on the baby's age, if the level reaches a certain value, we begin treatment with phototherapy. If the baby's color does not become more yellow until after discharge, call us to check the bilirubin in the office. Usually, the yellow color disappears on its own by the end of the first week.

Umbilical Cord Care
During diaper changes, use a cotton swab to apply alcohol to the skin around the belly button. Don't be afraid to pick up the cord and clean right where it meets the skin. You can expect the cord to shrivel and fall off within two weeks (occasionally a week or two longer). You can help speed the process by keeping the area dry and exposed to air (fold diaper down below the cord). It is normal to see a small amount of bleeding as the cord separates. You should call us for any of the following: foul odor, red streaky rash or green discharge. Before the cord separates completely, give the baby sponge baths. Once the cord has come off, you may immerse the baby in the bath water.

Circumcision
If your infant son has been circumcised, the tip of the penis may appear swollen and red for a few days after the procedure. You should wash the area with warm water using a cotton ball or soft wash cloth, and apply a thin layer of Vaseline or A & D ointment to the tip for the first 3-4 days. A layer of yellowish tissue may form on the surface of the tip of the penis as it heals. This is the normal healing process.

If your son is uncircumcised, no special care of the area other than normal cleansing is necessary. It is normal for the foreskin to adhere firmly to the tip of the penis. This will change as the child grows.

Female infants may appear to have a "period" during the first few days after birth. A small amount of blood may appear in the vagina or on the diaper. This normal occurrence happens because the baby has been separated from her mother's estrogen stores.

NEWBORN GUIDELINES Sleeping
The proper sleeping position for an infant is on the back. Babies must never be placed on the stomach or side to sleep.

At first, newborns often sleep during the day and are awake much of the night, i.e. their days and nights are completely reversed! There isn't much to do about this, but realize that the situation is temporary! The baby's body clock will gradually develop a normal wake-sleep cycle, but until then, we advise mothers to sleep during the day whenever the baby sleeps. By 8 weeks of age, most infants will begin to sleep 5-6 hours at night and entirely through the night by 4-6 months of age.

Parents often have a newborn sleeping in a cradle or bassinet in their room, particularly if the baby is nursing. Babies should be kept in parents' room for the first six months to one year.  Babies should never sleep in parents' bed.  By 4-6 weeks of age, most babies are ready to move from the bassinet into a crib. A bassinet quickly becomes too confining for a baby who has begun to move around at night. This causes more frequent night waking occurs than when sleeping in a larger crib. A baby soon learns to recognize their crib surroundings and to feel quite comfortable there.

At age 3 months, we suggest that you begin to develop a sleep routine, which includes putting the baby into the crib, sleepy but still awake, at both nap time and night time. By 4 months, the baby has learned how to "settle down" on his own to sleep and should begin to sleep 8-10 hours without a night feeding.