Common questions occur often when there is a newborn at home regarding feeding.

Breast Feeding Facts:

1. Feeding should occur every 2-3 hrs around the clock for the first 2 weeks.  If weight gain is satisfactory at that point, you may space out feedings.  Feeding less frequent is OK at night but not longer than 5hrs should pass until they have doubled their birth weight.  Feeding sessions should last 20-30 minutes in length per feeding.
2. Your baby is getting enough milk when they are having at least 6 or more wet diapers per day.  Breast feeding stools are usually mustard-colored yellow, very loose, and have a seedy appearance. Many stools are often mistaken for diarrhea because of the loose consistency. 
3. You can store breast milk in the back of the refrigerator for 5-7 days. You may store labeled breast milk in the freezer section of the refrigerator for 3-4 months. You must use the breast milk once thawed in 24hrs. Never refreeze thawed breast milk.
4. A nursing mother should continue taking her prenatal vitamins while nursing to ensure having adequate vitamin storage for herself.  It is important for a breast feeding infant to have supplemental Vitamin D obtained with commercial supplements such as D-Visol, Tri-Visol, or Poly-Visol.
5. Almost any drug a breast-feeding mother consumes will be transferred in small amounts to her breast milk. Therefore, try to avoid any drug that is not essential, just as you did during pregnancy.  Should you need to start any medication, please feel free to contact us to ensure it is compatible with nursing.
6. Don't drink more than 2 cups of coffee, tea, cola, or other caffeine-containing beverages a day.  It's OK to have an occasional beer or glass of wine (one or two glasses a week).   If you have a hospitalized premature or ill newborn, DO NOT drink ANY alcohol.
7. Check with your doctor before you start a program to lose weight.

Bottle Feeding Facts:

1. Breast milk is the first choice for feeding during the first year of life. A commercially prepared infant formula is the second choice. Whole cow's milk should not be given to babies before 12 months of age because of increased risks of iron deficiency anemia and allergies.
2. Most commercial infant formulas are available in three forms: powder, concentrated liquid, and ready-to-serve liquid. The majority of infant formulas contain lactose (milk sugar) as the only carbohydrate, just as breast milk does. Lactose aids digestion and promotes normal bowel function and healthy tissue formation.
3. Mix concentrated liquid formula with water in a ratio of one to one. Mix each level scoop of powdered formula with 2 ounces of water. Never make the formula for your baby more concentrated by adding extra concentrated liquid or extra powder. Never dilute the formula by adding more water than specified.
4. Formula fed infants generally will be taking 2-3 oz every 2-3 hrs after leaving the hospital. Some larger babies may take up to 4oz per feeding.  No baby should drink more than 32 ounces of formula a day. If your baby needs more than 32 ounces and is not overweight, consider starting solid foods. Overfeeding can cause vomiting, diarrhea, or excessive weight gain. Prepared formula should be stored in the refrigerator and must be used within 48 hours. Prepared formula left at room temperature for more than 1 hour should be thrown away. At the end of each feeding, throw away any formula left in the bottle.
5. All infants should be fed with their head slightly elevated. Feeding your infant when they are flat on their back can increase chances of ear infections or respiratory problems. 
6. Stool patterns for a formula fed baby can be various ranging from once a day to once every other day. Call the office if your child has not had a stool in more than 4 days. Avoid allowing your child to sleep with a bottle as can cause severe tooth decay.

What is a cold?
Common symptoms include: runny or stuffy nose, may have a fever and sore throat, and at times a cough, hoarse voice, and red eyes

What causes a cold?
Colds are often caused by a viral infection of the nose and throat. Usually spread from person to person by hand contact, coughing, and sneezing. There are up to 200 viruses that can cause colds, so most healthy kids can get 6-9 colds a year.  Prevention is best with good hand washing, covering coughs and sneezes, and limiting unnecessary exposures.

What to expect?
Colds usually last anywhere from 7-14 days with the worst symptoms usually being much improved after the first 4 days.  It is important to watch for signs of secondary bacterial symptoms such as earaches, sinus pressure or pain, difficulty breathing, new fever appearing again, or persisting yellow drainage for >10 days.  If you have a young infant, make sure the baby does not get dehydrated. A blocked nose can interfere so much with the ability to suck that dehydration can occur.

HOME CARE:
Most of all, your child needs rest, plenty of fluids, and tender loving care. Make your child as comfortable as possible.  Relieving symptoms can help your child get through their cold

For Runny Noses:
*remember that a runny nose a way for the body to get rid of the virus*
Young Infants: Use a soft rubber suction bulb to gently remove secretions
Older Children: Gently blowing or allowing your child to sniff/swallow the secretions

For Dry or Stuffy Nose:
Use Saline nasal drops (Ayr, Little Noses) or warm tap water to loosen dry mucus.
Home made saline drops:  Mix ½ tsp table salt in 8oz of warm water. Keep in clean bottle.
You may use a nasal saline wash up to 4 times a day or whenever your child can’t breathe through the nose.
*Clearing the nose of a young infant by suctioning is MOST important prior to breast- or bottle-feeding and when putting down for sleep.
*Using a Cool Mist Humidifier at bedtime with clear new water each night will help loosen secretions in the nose and throat.

Sore Throat:
You may use pectin lollipops or hard candies for children over 4yrs and warm chicken broth for children over 1yr.
* See our other information on Sore Throats.

Cough:
Cough medicine can help if coughing makes it hard for your child to sleep or rest. Ask your doctor to recommend a cough medicine and the correct dose. We prefer that you do NOT give cough medicine to children younger than 2 years.
For loose or wet coughs- it is best to use a Cough Expectorant (Guafenesin) such as Mucinex during the day
For dry coughs that do not allow your child to sleep- it is okay to use a Cough Suppressant (Dextromethorphan) such as Delsym at night.

Fever:
Use Acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) for aches or mild fever over 102 F or 38.9 C. Do NOT give Ibuprofen to infants under 6months of age. Do NOT give Multi-symptom cold medicines that may contain Acetaminophen. 
Do NOT give Aspirin or Aspirin-containing products as they can cause liver failure in some viral illnesses.

Poor Appetite:
Encourage drinking plenty of fluids by letting your child choose what they want. Some examples are water, juice, popsicles, and soup.

Cold Medicines:
Most over-the-counter cold remedies are not very helpful. Nothing will shorten the course of a cold. If the nose is really running, you may consider using a pure anti-histamine (for example, Benadryl) if your child also has allergies. Avoid Multi-ingredient medications because they increase the chance of side effects.  Avoid decongestants if they make your child jittery or keep him from sleeping. Use Acetaminophen for a cold ONLY if your child also has fever, sore throat, or muscle aches.  NEVER give any leftover antibiotics because they have no effect on viruses and may be expired or harmful.

CALL YOUR CHILD’S PHYSICIAN IMMEDIATELY IF:
Breathing becomes difficult AND does not improve after you clear the nose
Your child is acting very sick.

CALL YOUR CHILD’S PHYSICIAN DURING OFFICE HOURS IF:
Fever lasts more that 3 days
Runny nose that lasts longer than 10 days
Child develops yellow eye discharge
You can’t unblock the nose enough for your infant to drink adequately
Your child is complaining of earache, sinus pain, or worsening sore throat

What is it?

• Hard Bowel Movements (BMs) that require child to strain or push for several minutes
• Painful BMs
• BMs that occur less than every 2 days
• Sometimes associated with stool withholding because child fears it will be painful
• Due to a diet without enough fiber or waiting too long to go to the bathroom

What to do?

• Dietary management- increase the amount of fluid your child is drinking, offer foods such as peaches, pears, prunes, cereals, raisins, apricots, broccoli, bran, popcorn (for children >4y). Avoid foods such as cheese, excess milk, bread, bananas. Offer apple or prune or pear juice to help soften the stool
• Encourage a regular routine – the best time to have a BM is 20 mins after a meal so encourage your child to spend some time on the potty at this time. If your child is resisting potty training, stop the training for a while and put your child back in diapers or pull ups
• Glycerin suppository- a pediatric glycerin suppository can be inserted into your child’s rectum to help him or her pass the bowel movement
• If severe constipation- your child may need a pediatric enema. Talk to your doctor about whether this is necessary
• If rectal irritation or pain after a BM- offer warm sitz bath, apply Vaseline to cleaned anal area

When to call?

• If your child has not had a BM in 3 days
• If your child is complaining of significant abdominal pain
• If your child remains constipated despite making changes as above

Normal Accepted Developmental Milestones by Age for the first 2 yrs:

2 weeks: Begins to recognize family voices and makes small "throaty" noises. Recognizes sounds by blinking, crying or showing the startle reflex (arms and legs move away from the body equally). Blinks at bright light and may begin to follow, but eyes often do not focus together. Watch for the first smile ... truly a milestone. It is the earliest sign of mental growth ... the first thing your baby can do on his or her own! (Usually not seen until 2-3 months). Lifts head briefly when lying on his or her stomach.

2 months: Your baby's smile is improving, especially when he or she sees you.  Infants at this age begin to show pleasure in their interactions with their parents. Before long, the neck muscles will begin to develop, allowing your baby to gain more head control.  Your baby will begin to grasp a rattle or tightly hold on to your finger.  Between now and the 4-month checkup, most babies will start to lift their head, neck and upper chest on their forearms, craning their necks like a turtle to see what is going on. They will also straighten out their legs when you let them sit on your lap and try to stand with support. And no, this will not cause them to become bow-legged.

4 months: A baby's development proceeds in a head to foot direction. At this age, the typical child can hold his or her head high and raise the body on his or her hands while lying on his or her stomach. Now the baby keeps his or her hands open while at rest. He or she will play with his or her hands, bat at mobiles and reach for rattles. Any object he or she holds goes directly into his or her mouth. Most babies this age will show a clear preference for parents and other caregivers. They will turn toward a sound and recognize their parent's voices. You will note babbling, smiling, laughing, and squealing. At this age, they will also begin to learn cause and effect. He or she shakes a rattle and it makes noise, you wind the mobile and it begins to move.

6 months: Begins to speak single (hard) consonants, like "dada". Rolls over both ways (front to back and back to front). The baby will begin to look for a toy dropped out of sight. Has no head lag when pulled to a sitting position. Begins to "tripod" (sits with one hand on the ground for support) and soon will begin to sit without support. Continues to grasp and mouth objects, but now can transfer small objects from one hand to another. Begins to rake at small objects but cannot pick them up yet because their finger coordination is not yet precise enough. Shows displeasure with loss of a toy. Is able to recognize each parent and may even begin to show some stranger anxiety. Makes attempts to feed him or herself. Smiles, laughs, squeals and begins to imitate sounds. Can be content in a playpen for a while playing with one or two toys. Can bear weight on his or her legs when held in a standing position.

9 months: During this period your baby will probably learn to creep, crawl and otherwise get around the room. He or she may even pull up in the bed or on furniture and begin "cruising" around the room. Responds to his or her own name. Understands a few words such as "no-no" and "bye-bye." Begins developing certain concepts - for example, your child will retrieve a toy after he or she watched you put it under a blanket. May say "dada" or "mama" but not specifically. Sits well independently. Bangs two toys together. Plays interactive games well such as peek-a-boo and pat-a-cake. Perhaps the most striking developmental achievement is the use of fingers and thumb to poke, pry, probe and pick up smaller and smaller objects. Sleeps through the night except for an occasional night wakening. The 9-month-old has now learned to be "cool" or even a little afraid of certain strangers - even family members he or she does not see very often. The baby of this age also begins to take a dim view of being examined by their doctor.

12 months: Pulls to stand, crawls rapidly, seats self on floor, cruises on furniture or walks alone with an unsteady gait. Plays social games such as pat-a-cake, peek-a-boo and so-big. Bangs two blocks together.  Drinks from a cup - not bottles. Waves "bye-bye." Feeds himself or herself. Points with a finger and displays a precise pincher grasp when picking up small objects. May say one to three meaningful sounds besides using "mama" and "dada" correctly. Shows definite understanding of a few simple words; Loves music, rhythms, and rhymes. Will begin to cooperate a little in getting dressed by holding still.

15 months: The vocabulary for a 15-month-old is usually three to six words that parents can understand and an entire language that they cannot! Will be able to point to one or more body parts. Understands simple commands ("bring me the ball"). Walking has improved and will begin to crawl up stairs. Can feed himself or herself with the use of his or her fingers. Drinks only from a cup, but still may need help in holding it. Recognizes himself or herself in a mirror. Indicates what they want by pulling, pointing, grunting and other methods of communicating Finds an object placed out of sight. Points to one or two body parts. Scribbles spontaneously.

18 months: Walks fast, walks up stairs with one hand held, and kicks a ball. Uses a vocabulary of four to 10 words and may combine two-word phrases. Understands simple directions. Points to some body parts correctly. Shows affection by kissing parents. Feeds himself or herself, drinks from a cup adequately and uses a spoon. Imitates a crayon stroke on paper. Holds and "loves" a doll or stuffed animal; may use a household-type toy (for example, a toy telephone) appropriately. Will sit for a short time and look at pictures in a book. Turns single pages in book or magazine. Likes to play with other children.

2 years: Climbs up steps alone, one step at a time holding the stair rail or the parent's hand. Jumps off the floor with both feet. Opens doors. Kicks a ball. Can wash and dry hands. Climbs on furniture. Uses a spoon and cup well. Asks frequent questions: "What is that?" Enjoys imitating adult activities. Two year olds often go through a short period of mild speech abnormalities (like stuttering). Selects and uses a toy appropriately (feeds a doll, hammers pegs in a cobbler's bench). Most 2-year-olds have a vocabulary of 50 or more words, although this number varies with the sex of the child (girls speak more than boys), if the child has older siblings (who will speak for him or her) or if two languages are spoken in the house.

What is a Developmental Delay?
Developmental delay is the failure to meet certain developmental milestones, such as sitting, walking, and talking, at the average age.  Developmental delay may indicate a problem in development of the central nervous system.  Developmental milestone screenings are an important part of your child’s routine well visits.  If you suspect any delays in your child’s development, please address these with your Pediatrician.

Diarrhea (watery stools) can be caused by several things, but is most often due to a viral illness. As long as you child is not vomiting, the best way to treat diarrhea is to “feed through” it. 

If your infant is breast fed, then you can continue to feed your child as you normally would. If your child is formula fed, then you can continue with this as well, although sometimes a lactose free formula may be used for the short term until the diarrhea improves.

When your older infant or child is hungry, you can introduce most of the usual foods he or she was eating before the diarrhea with an increase in starchy foods. However, your child may not want to eat the same volume of food he or she was eating before the illness.  Do not force your child to eat, but rather offer small amounts more frequently.

The best diet after or during a bout of diarrhea is low in sugar and fat. Sugar may aggravate diarrhea if consumed in concentrated amounts. Fat can delay gastric emptying and should be avoided, especially if your child is vomiting too.

If your child is less than 1 year old and is breastfeeding:

• Breastfeed more often to encourage good hydration
• If he or she is >5 mos old, offer strained bananas, rice or oatmeal cereal,  or sweet potatoes
• Offer additional amounts of Pedialyte in addition to breastfeeding to supplement extra fluids

If your child is less than 1 year old and formula fed:

• Offer additional amounts of Pedialyte between formula feedings to increase extra fluid intake
• Consider changing formula to a lactose free or soy based product if the diarrhea is not improving in 3 days or if it is very watery
• If he or she is >5 mos old, offer strained bananas, rice or oatmeal cereal, or sweet potatoes

If your child is older than 12 mos:

• Encourage extra fluids in the form of water, Pedialyte, or Gatorade
• Offer foods such as applesauce, bananas, rice, oatmeal, toast, noodles, mashed or baked potatoes, low fat soups or broth, saltine crackers, pretzels, or yogurt

Call your doctor if:

• Your child refuses to drink
• Your child’s diarrhea has not improved in 3 days
• Your child is running  fever for more than 72 hrs
• Your child has not urinated in 5-6 hrs
• Your child is listless or lethargic
• You see blood in the stool

GENERAL INFORMATION:
There are 2 main types of Earaches: Ear congestion and Swimmer’s ear. These are treated differently. 
Mild earaches are most commonly caused by ear congestion.  It is often described as having an intermittent stuffy or full feeling in the ear. A child may state they hear popping or clicking in the ear and muffled hearing.  It is often caused by fluid trapped in the middle ear due to Eustachian tube blockage by colds, seasonal allergies, or vigorously blowing of the nose. An earache that is particularly painful may be an indication of a middle ear infection or otitis media. These are almost always associated with a preceding history of congestion.
Swimmer’s ear is usually due to excess water in the canal that causes inflammation of the canal. These are quite painful with movement or touching of the ear.

EAR CONGESTION HOME CARE:
Having your child yawn frequently, chew gum, or swallow while the nose is pinched.
A warm or hot towel against the ear can also alleviate pain (the heat will expand in the middle ear and relieve the negative pressure).
Prescription analgesic ear drops (AB Otic, Auralgan) may also be used in a non-draining ear for relief.

SWIMMER’S EAR HOME CARE:
These generally need to be seen in the office for an Antibiotic-steroid drop prescription
For those who are going to spend many days in the pool in the summer (i.e. swim team), prevention is best.
Preventative drops made a home: Equal parts white Vinegar and Rubbing Alcohol (1/2 cup of each stored in a summer stock bottle). A few drops are placed in each ear by cotton ball at the end of a swimming session.

HAVE YOUR CHILD SEEN IF:
Severe pain develops
Fever develops
The ear begins to drain fluid

Eczema (atopic dermatitis) is a chronic skin problem that manifests as a red, very itchy rash that is most often on the inner surfaces of elbows, wrists, and knees. In infants, it often starts on the cheeks. Eczema can run in families and may be triggered by contact with irritating substances. It is not clear what causes eczema and there is no cure for it, but it is manageable with a daily skin care routine.

What to do?

• Bathing- keep baths short (5-10mins), use as little soap as possible and avoid hot water baths, pat your child dry instead of rubbing.  In fact it is best to bathe your child infrequently (every 3-4 days).
• Moisturizing- Hydrating the skin helps prevent flare ups of eczema. Soaps make eczema worse so using cleansers such as Cetaphil or Dove. Using a moisturizing cream after bath and several times through the day will also help the skin. Use a scent and dye-free moisturizer for your child’s skin
• Itching – Most of the time you can control your child’s itching by following the daily skin care plan. If the itching gets worse, consider giving your child an oral antihistamine like Benadryl.  Ask your doctor for the appropriate dose.
• Inflammation- If the skin becomes red and thickened, (but is not oozing and has no signs of infection) then apply a thin layer of 1% hydrocortisone cream twice per day for a maximum of 7 days. If inflammation is not improving, then call your doctor.
• Prevention- Avoid triggers that cause your child to flare. Dress your child in cotton clothes and use hypoallergenic detergents for laundry.

When to call?

• Your child’s skin becomes raw and open in places
• Your child’s skin looks infected (red streaks, swelling, blisters, pus, scabs)
• Your child has fever
• Your child’s skin is not improving, despite above care, over a 7 day period

WHAT IS A FEVER?

Elevation of normal temperature measured as:

                Rectal >100.4 F (38 C)
                Oral > 99.5 F (37.5 C)
                Axillary >99.0 F (37.2 C)
                Tympanic >100.4 F (38 C)
                Temporal Scan >100.4 F (38 C)

Mild increase in temperature can be caused by exercise, heavy clothing, a hot bath, or hot weather.  Cool/warm food or drink can also cause a change in the oral temperature; take the temperature again in half hour.
Fever helps the body fight infection. Most fevers are NOT harmful. Most may last 3-4 days.

TAKING CARE OF A CHILD WITH FEVER:
Give your child medicine only if they have fever >102 and your child is uncomfortable.  Remember that fever helps fight infection.
Sponge Baths with lukewarm water may also help bring your child’s fever down as well.
Do NOT give Aspirin.
For fever between 100-102F (Low-Grade Fever), giving plenty of fluids and having your child wear little or light clothing may be all that is necessary.

CALL YOUR CHILD’S PHYSICIAN IMMEDIATELY IF:
Your child is less than 3 mo of age with a temperature >100.5F
Your child has fever >105F (40.6C)
Your child looks or acts very sick

CALL YOUR CHILD’S PHYCISIANS OFFICE IN 24 HOURS IF:
Your child is less than 2 years of age and has had fever >102 for more than 24 hours
Your child greater than 5 years has a fever longer than 3 days.

What is head trauma?
Most head injuries hurt only the scalp not the brain.  Your child may develop a large lump even if the injury was minor because the scalp has a large blood supply. Similarly, small cuts on the scalp can bleed quite a lot.  Only 1-2% of injured children have a skull fracture with a head injury. A concussion can only occur if there is a period of unconsciousness, confusion, and amnesia.

Sometimes this kind of injury can be very serious, and problems may show up later. A responsible adult must watch your child closely for the first 24 hours after the injury. If you notice any change in your child’s condition, you must call your child’s doctor or the Emergency Center RIGHT away.

What to do?
Wound care- Clean any laceration with soap and water and apply pressure with a clean cloth for 10 mins to stop bleeding. If swelling occurs, apply ice for about 20 mins.
For the first 24 hours after your child’s injury:

• Keep your child at home.
• Keep him or her quiet.
• Do not let your child work or play hard.
• Do not let your child ride a bike or skateboard (or drive any vehicle if he or she is older).
• Wake your child every 2 hours during the first night and during naps to be certain he or she awakens as quickly as usual.
• Give your child acetaminophen (Tylenol) for pain. Do not give any stronger medicine unless the doctor prescribed it for this injury.

When to call the doctor?
If your child has one or more of the following symptoms, it may mean the head injury is causing serious problems. 

CALL IMMEDIATELY:

• If your child has a large wound with skin open that might need stitches
• If your child has a  headache that becomes severe
• If your child vomits more than 2 times in 24 hours
• If your child does not wake up as quickly as usual when you try to wake him or her
• If your child is sleepy at unusual times or becomes confused
• If your child’s vision is blurred or double
• If walking and talking become difficult
• If your child has seizures (fits or convulsions).

Remember, any time you think your child’s condition has changed, CALL!

After the first 24 hrs?
If your child does not have any problems during the 24 hours after the head injury, you can let your child return to his or her normal activities. Continue to watch your child for the next week. Call your child’s doctor or the Emergency Center if you notice any of the symptoms listed above.

According to current immunization schedules, infants will receive up to 27 immunizations in their first 24 months.  As you know, vaccines are important in preventing serious disease. It’s true that newborn babies are immune to many diseases because they received antibodies from their mothers. However, the duration of this immunity may last only a month to about a year.  Further, young children do not have maternal immunity against some vaccine-preventable diseases, such as whooping cough.  Immunizing individual children also helps to protect the health of our community, especially those people who are not or cannot be immunized. People who are not immunized include those who are too young to be vaccinated (e.g., children less than a year old cannot receive the measles vaccine but can be infected by the measles virus), and those who cannot be vaccinated for medical reasons (e.g., children with leukemia or after transplants). 

Diseases that are preventable by vaccine include:  Diphtheria, Tetanus, Pertussis (whooping cough), Meningitis (2 infant causes), Hepatitis A & B, Polio, Pneumococcus (causes ear, blood, and lung infections), Chicken Pox, Rotavirus (gastroenteritis), and Influenza.

Common reactions by vaccination:

DTaP/TdaP (Diphtheria, Tetanus, Pertussis) & Prevnar (Pneumococcal conjugate vaccine)

Common reactions:
Fever for 24-48hrs - Treat fever >102 with Tylenol. If it occurs, give your child Tylenol at the office at time of next DTaP and continue Tylenol every 4-6hrs for 24hrs.
Redness, pain, tenderness, swelling at site of injection for 24-48hrs  – Give Tylenol and apply cool compress at injection site. Painless lump at injection site 1-2 weeks later- observation only. Other symptoms: Drowsiness , Fretfulness , Poor Appetite

Call Immediately if: 
Fever over 105 degrees F, or 40.5 degrees C, Crying for more than 3 hours, High-pitched, unusual cry, Convulsions, Collapse with shock-like state, any other unusual reaction.

IPV (Inactive Polio):
*There are no reported common or serious reactions

HIB (Hemophilus Influenza type B):
Common reaction: Sore injection site or mild fever.
No serious reactions reported

HepB (Hepatitis B):
Common reaction: Sore injection site or mild fever.
No serious reactions reported

Influenza (Flu vaccine):
Common reactions: Pain, tenderness, or swelling at the injection site within 6 to 8 hours. Fever of 101 to 103 degrees F, or 38.3 to 39.5 degrees C. Fevers mainly occur in young children. Home care: Give your child acetaminophen for pain or fever over 102 degrees F (38.9 degrees C).   
           
CALL 911 IMMEDIATELY IF the following rare, but serious reaction occurs:
Anaphylactic (severe allergic) reaction if the child is allergic to the egg in the vaccine. Common symptoms of a severe allergic reaction are hives, shock, wheezing, stridor, and swelling of the mouth or throat beginning within 2 hours of the time your child received the vaccine.

MMR (Measles, Mumps, Rubella):
Common reactions (beginning 7-10 days after injection): Fever of 101 to 103 degrees F (38.3 to 39.5 degrees C) for 2 or 3 days. Home care: Give your child acetaminophen if the fever is over 102 degrees F (38.9 degrees C). Call your physician within 24 hours if the fever lasts over 72 hours or is over 104 degrees F (40 degrees C). Measles vaccine rash: a mild pink rash, mainly on    the trunk (5%) Home care: No treatment is necessary. The rash will last 2 to 3 days. Call your physician immediately if the rash changes to purple spots. Call within 24 hours if the rash becomes itchy or the rash lasts more than 3 days.
CALL 911 IMMEDIATELY IF the following rare, but serious reaction occurs: Anaphylactic (severe allergic) reaction if the child is allergic to the egg in the vaccine. Common symptoms of a severe allergic reaction are hives, shock, wheezing, stridor, and swelling of the mouth or throat beginning within 2 hours of the time your child received the vaccine.

Varicella (Chickenpox):
Common reactions:  Pain or swelling at the injection site for 1 to 2 days. Some children may have a fever that begins 2 to 4 weeks after the vaccination and lasts 1 to 3 days. Home Care: Never give your child aspirin for any symptom within 6 weeks of receiving the vaccine. (Reye's syndrome has been linked with the use of aspirin to treat fever or pain caused by a virus.) For fever or pain, give acetaminophen. A few children develop a mild rash at the injection site or elsewhere on the body. The rash begins 5 to 26 days after the vaccine, looks like a few (2 to 10) chickenpox sores, and usually lasts a few days. Home Care: Children with these rashes can go to day care or school. There is no evidence that the vaccine rash is contagious. If the vaccine rash contains fluid, cover it   with clothing or a Band-Aid. Avoid school if there are widespread, weepy sores (because this may be real chickenpox).
No serious reactions have been reported.

MCV4 (Meningococcal vaccine):
Common reactions: Redness, pain at injection site for 1-2 days. Fever can also occur. Home care: cool compress for injection site. Tylenol for pain or fever.
Serious reactions: A serious nervous system disorder called Guillain-Barré Syndrome (or GBS) has been reported among some people who received MCV4. This happens so rarely that it is currently not possible to tell if the vaccine might be a factor.
Even if it is, the risk is very small.
Please contact your doctor if your child is experiencing symptoms such as: weakness, tingling or loss of sensation starting in feet and legs and spreading to their upper body and arms.

Rotateq/Rotarix (Rotavirus):
Common reactions: Babies may be slightly more likely to be irritable, or to have mild, temporary diarrhea or vomiting after getting a dose of rotavirus vaccine.
No serious side effects have been reported.

HPV (Human Papilloma virus):
Common reactions:  Redness, pain at injection site for 1-2 days. Fever can also occur. Home care: cool compress for injection site. Tylenol for pain or fever.
Serious reactions: Dizziness, nausea, and fainting has been noted in < 1%

Skin Care:
Sponge baths only until the umbilical cord falls off.  You may use “Baby Bath” or baby shampoo on scalp; use “Baby Bath” on body and face.  Use lotion only on feet and legs if skin is dry and scaling.  Do not use creams of lotions on face and hands.  Do not use baby powder or baby oil. Red, bumpy rash or “newborn acne” on the face at one week of age is very common and may last for several weeks.  A red, “flea bitten” appearing rash that comes and goes anywhere over the body is very common in the first 2 weeks of life.

Umbilical Cord Care:
Keep the cord open to air and outside of the diaper to promote drying.  Put rubbing alcohol on where the cord attaches to the skin two times a day. Keep cleaning the cord with   rubbing alcohol until 1 week after the cord falls off.   It may take several weeks for the cord to fall off. There may be some slight bleeding from the cord from time to time which is normal.  There should be no redness of the skin around the cord.  If the cord gets moist, it will appear to produce a yellow discharge.  Should this happen, just clean the base and cord well with alcohol and keep open to air.  If the base continues to produce a yellow discharge and appear wet, contact the office for a visit to check the cord stump.

Social Contacts:
Keep the baby away from anyone who is ill.  If someone visits your home and has an ongoing illness – even a cold- they should have no contact with the baby.  Anyone who touches the baby should do good hand washing first.  This includes parents, grandparents, siblings, and all visitors.  Babies should not be kissed on the hands or face by anyone in the first eight weeks of life.  The bottom of the feet and the top of the head are excellent places for placing kisses.  Outings should be avoided in the first 8 weeks of life. This means no shopping malls, grocery stores, or church. NO cigarette smoke in the house or car with the baby.

Jaundice:
There is a normal expected amount of jaundice in the first few weeks.  Please follow the expected plan for follow up advised to you upon discharge from the hospital.  Should your baby’s skin appear more yellow than it was when leaving the hospital, call the office that day. 

Sleep:
Newborns usually sleep from 17 to 20 hours per day.  They cry and fuss about 1 to 4 hours per day.  They are alert and quiet about 2 to 3 hours per day.  The baby should be placed on the back or propped on the side for sleep.  Babies who spit up frequently should be placed on their side and propped well for sleeping using a commercially available sleep positioner.

Illness/Fever: 
Should your baby have a rectal temperature of 100.5F or greater before 2 months of age, call the office immediately (day or night).  If you suspect your baby has a fever, always take a rectal temperature before calling the office.  If you are taking an axillary temperature, a temperature of 99.5F or greater should be alerted to the office. Do not give acetaminophen or fever reducer under the age of 2 months until you have spoken to the physician.  If your baby stops feeding well or has any signs of illness, call the office that day.

Miscellaneous: 
It is normal for babies to get the hiccups and a little water may relieve them or just placing them back on the breast for a few minutes.  It is normal for babies to occasionally sneeze to clear out the nose.  You will know when the first real cold occurs.  Slight vaginal bleeding/discharge does occur in some newborn females which is normal. Never leave the baby anywhere, other than his/her bassinet or crib, unattended.

Circumcision Care: 
Circumcision care usually consists of gentle cleansing with water three times a day or when soiled.  Petroleum jelly should be applied to head of penis for 5-7 days.  Call if head turns blue or black, bleeds more than a few drops, looks infected, or urine dribbles out.

GENERAL INFORMATION:
The majorities of sore throats are cause by viruses and can be associated with colds. About 10% can be caused by the Strep bacteria. A culture or rapid strep test is the only way to know whether it is caused by virus or Strep.  Strep throat can have rare but serious complications if not treated with antibiotics.  Some children who sleep with their mouth open at night can also complain of sore throat upon awakening that is usually relieved with drinking fluids. Running a humidifier may alleviate this.  Post nasal drip from allergies or sinus drainage can also cause a sore throat due to frequent throat clearing.  Most sore throats last about 3-4 days when associated with colds. Hoarseness, croup, or coughs are often viral reasons for sore throats.

SIGNS OF A SORE THROAT:
Your child complains of sore throat. The throat looks red when you look with a light. Your infant refuses to eat or cries with feedings.

HOME CARE:

Children >1yr:
May give warm chicken broth or apple juice to soothe.
May run a humidifier at bedtime.

Children >4yr: May use hard candies (Butterscotch) or pectin lollipops for comfort.
Plenty of fluids (cool or warm) such as Fruit smoothies, popsicles
Soft foods if tonsils are swollen

*Do NOT use left over Antibiotic at any time as the medicine may interfere with finding out what is wrong with your child should he worsen.

*Remember that Rapid Strep Tests are only helpful if they are positive.  If they are negative and the child appears ill, a back up culture may be necessary to catch those that may be missed by the rapid tests.

CALL YOUR CHILD’S PHYSICIAN IMMEDIATELY IF:
Your child is drooling, having difficulty swallowing, or difficulty breathing
Your child is acting very sick

CALL YOUR CHILD’S PHYSICIAN DURING OFFICE HOURS IF:
You would like to make an appointment

The “terrible twos” refers to the second year of life (particularly between 18mos and 2 years of age). This is the age where the toddler will have a desire to be more independent and at times more negative (saying “no” or shaking their heads frequently). Because of this, they may exhibit tantrums when things do not go as planned. It is also a way for them to “test the waters”; try different behaviors, yielding different reactions from parents.

Parents are the authority figure, and children should view them as such. Children feel more secure when they know that someone else is in charge, and that someone is there to make sure that they are kept safe.”

It is best to pick your battles. Some normal negative behaviors such as hitting, kicking, and biting are ones that need to be addressed. The best way to address these is by stating in a firm voice, “No…” Follow by placing the child down and avoiding eye contact for a few seconds. This effectively tells the child that he/she will not receive parental attention for that kind of behavior and it is not tolerated. Other conflicts in behavior, such as feeding, sleeping, and potty training, should have minimal emphasis placed on them. Forcing a child to perform in these areas will likely result in a negative response such as choking and stool withholding. Rewarding positive actions/behaviors and ignoring negative behaviors, are good practices to exercise. Remember that discipline is not punishment but teaching your child between right and wrong and acceptable behaviors.

When it comes to discipline, parents need to remember the 5 D’s

1. Determine rules of behavior acceptable for your child
2. Demeanor changes- A parent, especially a mother, must lower their voice and firmly say “No…” As amusing the behavior is a parent must turn his/her head if they cannot resist smiling or laughter.
3. Displace the child. A child will learn best if the response to their behavior occurs immediately after the undesirable behavior. Quickly remove your child from the dangerous object or place the child down to the floor if biting or hitting the parent.
4. Distraction- Find something else for the child to do while removed from the area of behavior.
5. Diligence- Be consistent! Don’t let a child wear down the parent with begging, whining, or pleading. They will quickly learn how consistent you could be.

Contact your provider if the toddler is frequently throwing tantrums or appears angry often.

Vomiting is often caused by a virus. Your child may also have watery bowel movements (diarrhea). Most of the time, the vomiting stops in 6 to 24 hours. If your child has vomiting without diarrhea, and it lasts more than 24 hours, your child may have something more serious.
What to do?

1. Give clear fluids for 8 hours. Start to offer clear fluids only after allowing child to rest without offering anything for 1 hour. Then give 1 teaspoon to 1 tablespoon of clear fluid every 5 minutes. After 2 hours, double the amount each hour.
• For babies under 1 year old. Give your baby a clear fluid drink like Pedialyte. This fluid helps give your baby important electrolytes that can be lost when a child is vomiting.
• For breast-fed babies. If you are breast-feeding and your baby has thrown up more than once, continue breast-feeding, but nurse on only one side for 10 minutes every 1 to 2 hours. If your baby has thrown up 3 or more times, nurse for 2 to 5 minutes every 30 to 60 minutes. If your baby continues to vomit, then change to clear fluids as above.
• For toddlers over 1 year old. The best clear fluid is water or ice chips, but Pedialyte is a good choice as well.
• For children over 2 years old. Give your child water, ice chips, Pedialyte or Gatorade.
2. Offer bland foods 8 hours after your child stops throwing up.
• Babies who eat solid food can have applesauce, strained bananas and rice cereal.
• Older children can have saltine crackers, cereals, bland soups, and mashed potatoes, toast, bland pasta, etc.
• Give the bland foods for 24 hours.
3. Do not offer dairy products or milk based formula until 24 hrs has passed since last vomit.
4. Do not give medicine your child doesn't need. Do not give any medicine unless your doctor tells you to.

Signs of dehydration:

• No wet diaper in 4-6 hours; or if  potty trained and over the age of 3, your child must urinate once every 6-8 hours. This is the main thing to look for in dehydration.
• No tears when your child cries
• Your child’s mouth is dry and sticky to the touch
• Your child’s eyes look sunken or the soft spot on your infant’s head becomes sunken
• Child is extremely fussy, drowsy, or thirsty

Call your child's doctor right away if:

• Your child shows signs of not getting enough fluids (as listed above)
• Your child vomits repeatedly AND also has watery diarrhea.
• Your child is confused and is hard to wake up or starts to act very sick