Birthmarks:  Many birthmarks are present at birth, some actually show up months later but are still called birthmarks. The most common are:

• Angel's Kisses:  Flat, reddish areas on the eyelids, forehead, nose, or upper lip.  They fade over time.
• Stork Bites:  Similar reddish areas on the nape of the neck or back of the head, sometimes along the spine.  They fade over time.
• Mongolian Spots:  Purplish areas most commonly in darker pigmented babies.  They tend to be over the sacrum (tailbone) but can be anywhere on the body, sometimes extensive.  They fade over time.
• Hemangiomas:  Reddish areas that start flat but grow, sometimes to large sizes.  They are called "strawberries" because they resemble strawberries growing out of the skin.  They are not treated unless they obstruct vision or obstruct the airway/breathing.  Most grow the first 18 months of life and then shrink until gone by school age.
• Cafe au Lait:  Tan, flat areas that develop during life.  Most people develop 1-2 of these.  More than 6 may be associated with medical conditions, especially if the child has freckles in the armpits or groin or there is a family history of neurofibromatosis.

Bowel Movements:  Newborns have the thick, black, tarry meconium the first week or so.  It transitions into a greenish color before becoming yellow after feeding is established.  Babies may grunt and turn colors (red or purple face) as they try to pass stool.  This is normal.  In babies not eating solid foods, constipation is defined by the consistency of the stool, not the frequency or behaviors associated with stooling.  Any formed stool is constipation.  Talk with our staff during office hours if you think your baby is constipated.  Normal stool colors may change from yellows to browns to greens.  Formula fed babies transition from the meconium stool to yellow stools faster than breast fed babies since they get food from the beginning.  Their stools are pasty yellow/brown and usually 1-3 times per day.  Breastfed babies take longer to develop the transition stools, then their stools typically are yellow, watery and seedy (looks a lot like watery yellow cottage cheese).  Stool color changes depending on what the mother eats.  They may poop every time they eat (plus in between) or may stretch out their bowel movements once their gut matures to once every 2 weeks.  That's right:  Once every 2 weeks is normal as long as the stool is soft!

Breastfeeding:  Breastfeeding is discussed on our Nutrition pages.

Breastfeeding and Mother's Medications:  This is discussed on our medications page.

Car Seats:  All infants must be rear facing in the back seat of the car in an approved car seat.  For car seat information, see the Car Seat Guide.  Do not put baby in too many layers or thick clothing, as the seatbelt cannot be tight enough.  If cold, put blankets on top of the seatbelt.  Ask our staff for a car seat identification sticker.  Do not use any head rests or other products that were not sold with (and therefore tested with) your seat.  If baby's head needs support, roll a couple blankets and put them on the sides of baby's head.

Chest Bump:  At the bottom of the breastbone is the xyphoid process (near the bottom of the ribs).  This sticks out in many babies and is perfectly normal.

Circumcision:  After a baby's circumcision, it takes about a week to heal.  It will look bright red and swollen initially, then less swollen and heal with pinkish areas and yellow areas.  These yellow areas may resemble pus, but it is normal granulation tissue and is part of the normal healing process.  We recommend putting petrolatum jelly on the head of the penis during the healing process to keep it from sticking to the diaper.  Most often you don't even need to wash the head of the penis during diaper changes.  If stool gets to the area, simply drizzle water over it to wash it off, then replace the petrolatum jelly.  Do not use soap or diaper wipes to the area as it is healing.  They would sting the raw area.  Once it has no more raw spots, you can clean it like any other area and stop the petrolatum jelly.  Do not use any creamy products or lotions on the healing penis, as they cause irritation.  For more on circumcision, including a picture of a normally healing penis, click here.

Cloth Diapers:  Click here for information on cloth diapers.

Congestion:  Many newborns seem to have sniffles "all the time", worsening with sleep or feeding.  Positioning the head above the heart, by elevating the head of the bed about 45 degrees, can often help with this.  (Never put baby's head on a pillow!  Place folded towels under the mattress of a bassinette or elevate one half of the crib and put a rolled blanket in a "U" shape under baby's knees/around his buttocks to keep baby from slipping.)  If baby has mucus in the nose, put saline drops in the nose (1-2 drops per nostril).  Sometimes this makes the baby sneeze out mucus:  Great!  Sometimes you have to use the bulb syringe to try to get mucus out.  Using the syringe a few times a day is ok, but excessive use may cause the inner nose to swell, resulting in more congestion.  Most often, there is no visible mucus causing the noisy breathing.  As long as the baby is feeding well and not working hard to breathe or breathing fast, it is usually not cause for concern.  Bring it up at a routine check up.  If it is causing problems with feeding or breathing, your baby should be seen for an evaluation.

Diaper Rash:  Delicate skin and frequent stooling predispose to diaper rashes.  Some parents prefer to prevent them with routine use of a diaper cream.  Some might just pay close attention to when the diaper is soiled and change frequently.  Diaper wipes irritate the skin, even if they are alcohol free.  If there is a rash, wash with water on a soft cloth.  Air dry the buttocks before putting cream or the diaper on.  A hair dryer on cool setting can be helpful if used carefully.  (Don't underestimate the power of air!)  Applying a layer of diaper rash cream helps to protect the skin from the next stool.  Zinc oxide heals the skin well, but may burn when applied to open or irritated skin.  Using a petrolatum jelly based diaper cream works well in this instance.

Eye Discharge:  A common problem in babies is a clogged tear duct in one or both eyes.  Tears are made in the upper eyelid and drain into the nose through a duct on the lower eyelid.  A blocked tear duct causes the eye to appear to water excessively.  This is calld lacrimal duct disorder.  Sometimes a thick, yellow drainage occurs.  Unless the white of the eyeball looks red, this is not pink eye.  Treatment for a blocked tear duct is massaging the area over the duct with clean hands.  Firmly rub the area between the lower eye and the nose.  The area will be red when you are finished if you rubbed hard enough.  Use a wet cotton ball or clean cloth to wipe any goo out of the baby's eye.  Babies fuss with treatments, but it does not hurt them at all.  Repeat this process 3-4 times daily until all symptoms are gone for a few days.  You may notice that when the baby gets a cold, symptoms return.  This is because the tear duct swells again along with other mucus membrane swelling.  Simply massage the area again.  This problem commonly lasts up to 9 months of age.  If it persists at 9 months, we refer to an ophthalmologist (eye specialist) to have the tear ducts probed. 

Feeding:  Feeding and breastfeeding are discussed in our Nutrition section under patient education.  If you are concerned that your baby cannot properly latch due to tongue tie, click here.

Fever:  Newborns may either get too cold or too warm if they are ill.  Usually this is accompanied by poor feeding, excessive sleepiness, or irritability.  Dehydration can make the baby's temperature high.  Environmental temperature, if too hot or too cold may artificially alter your baby's temperature.  Keep room temperature 68°F to 72°F.  If baby feels cool, put another layer of blankets on.  If baby feels too warm, take off a layer or 2 of blankets/clothing.  If after 30 minutes your baby still is too hot or cold, a rectal temperature is most accurate.  Do not use any fever reducers/medications.  If your newborn baby's temperature is abnormal, call the office or doctor on call.

Fussiness:  Fussiness is common in babies and has many causes. 

• Gas:  Babies can fuss and turn red or purple in the face when trying to pass gas.  Burping more frequently during feedings may help.  Using Dr. Brown's bottles, if bottle feeding, may decrease the amount of swallowed air.  Gas drops containing simethicone are safe and effective for many babies.  Give them 10 min before each feed for a few days to see if they help. 
• Formula intolerance:  If a baby is formula fed, sometimes switching formula can help, but talk with the office staff first.  Lactose-free milk base formula, soy formula, and formulas with broken down proteins (GoodStart, Ailmentum, and Nutramigen) may help, but knowing which will help an individual baby is trial and error.  Please visit our page on how to choose what to feed your baby by clicking here.
• Breastfeeding mothers can alter their diet to eliminate (at least temporarily) certain foods (only dairy has shown evidence of causing gas, but legumes, broccoli, cabbage, tomatoes, caffeine, and chocolate are also sometimes blamed).  If the elimination diet works, slowly re-introduce foods one at a time to see if that is tolerated.  If baby remains happy after a few days to a week, add another food in.  If baby begins being fussy again, stop that food again.  After a few months you can try that food again, as baby's gut matures. 
• Colic occurs between 3 weeks and 3 months.  It has no known cause, but babies tend to cry for hours, usually in the evenings, at least 3 times per week.  Changing rooms, wrapping tightly, putting in a vibrating seat, taking a car ride, rocking, holding, singing, and massage have all been helpful, though none is full proof.  Gripe Water is an herbal solution that many claim to help fussiness and colic.  Ask your pharmacist if they carry it.  A great resource is the website The Period of Purple Crying. Click here to be redirected to the site.
  

Hair:  Hair only needs to be washed 1-2 times per week.  The scalp (and even face) may develop scales, otherwise known as cradle cap.  You can use a soft brush to massage the scalp.  Unless the baby scratches it a lot, it does not need to be treated.  In that case, using hydrocortisone cream twice a day for a week usually helps.  After 6 months of age, use a dandruff shampoo containing selenium sulfide twice a week to loosen the scales.  Do not get this shampoo in the eyes!

Head Shape and Contour: 

• Molding:  The head is often molded from birth, and the cone head disappears within a few days. 
• If there is a hematoma from birth (soft, squishy, bruised part of the scalp) this may take months to go away completely and sometimes hardens first. 
• The soft spot typically is open until about 2 years of age to allow for rapid head growth the first 2 years.  It sometimes appears to pulsate, this is normal.  If you touch the soft spot, it is ok, you will not hurt the brain. 
• Lymph nodes:  Often you can feel pea-sized bumps under the scalp (most commonly behind the ears).  These are lymph nodes and are normal in infants. 
• Flat head:  Prevent flat head by alternating the side of the head your baby sleeps on.  Tummy time also prevents flat head.

Hiccoughs:  All babies tend to hiccough often (many begin in the womb, and mothers complain of a repetitive pounding on their bladder).  This is caused by an immature neurologic system and usually does not bother the baby at all.  If it does, feeding or burping may stop the hiccoughs.

Postpartum Depression:  Postpartum depression (PPD) is the most common complication of childbearing.  The Edinburg Postpartum Depression Scale is a simple questionnaire to screen yourself for PPD.  If you have concerns, even if you score in the normal range, please speak with your doctor.

• The sleep surface should be firm, ideally a firm crib mattress, covered by a sheet.  Soft materials, pillows, quilts, comforters, or sheepskins should not be placed under a sleeping infant.  Soft objects, such as pillows, quilts, comforters, sheepskins, stuffed toys, and loose bedding, should be removed from the crib.  If bumper pads are used, they should be thin, firm, well secured, and not "pillow-like."  Loose blankets and sheets may be hazardous.  If blankets are used, they should be tucked in around the mattress to avoid having the infant's face covered by bedding.  One strategy is to allow the infant's feet to reach the foot of the crib, with the blankets tucked in around the mattress and reaching only to chest level.  Another strategy is to use sleep clothing or infant sleep sacks with no bedding over the infant to avoid head covering.
• Do not smoke during pregnancy, because this is a major risk factor in almost every epidemiologic study of SIDS.  Smoke in the infant's environment after birth may also be hazardous, but the risk is less clear.  However, numerous reasons in addition to SIDS risk warrant avoiding exposure to second-hand smoke.
• The infant should sleep separately from the parents, but nearby.  Having the infant sleeping in the same room as the mother reduces the risk of SIDS.  The crib, bassinet, or cradle should conform to the safety standards of the Consumer Product Safety Commission and ASTM (formerly the American Society for Testing and Materials).  Although "co-sleepers," or infant beds that attach to the mother's bed, provide easy access for the mother to the infant, especially for breast-feeding, safety standards for these devices have not yet been established.  Because bedsharing is more hazardous than the infant sleeping on a separate sleep surface, the guidelines recommend that infants brought into bed for nursing or comforting should be returned to their own crib or bassinet when the parent is ready to return to sleep.  The statement also warns against bedsharing with other children, bringing the infant into the parent's bed when the parent is excessively tired or using medications, and sleeping with an infant on a couch or armchair.
• Consider offering a pacifier at naptime and bedtime because pacifier use during sleep is associated with a reduced risk of SIDS.  The evidence that pacifier use inhibits breast-feeding or causes later dental complications is not compelling.  During the first year of life, the pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep.  If the infant refuses the pacifier, he or she should not be forced to take it.  The pacifier should not be coated in any sweet solution, and it should be cleaned often and replaced regularly.  For breast-fed infants, pacifier introduction should be delayed until one month of age.
• Avoid overheating the infant, using light clothes and a bedroom temperature comfortable for a lightly clothed adult.
• Avoid commercial devices claiming to reduce SIDS risk because none have been tested sufficiently to show efficacy or safety.
• Home monitors should not be used as a strategy to reduce the risk of SIDS, except for selected infants with extreme cardiorespiratory instability.
• Avoid development of positional plagiocephaly (flat head) by encouraging "tummy time" when the infant is awake and observed, reducing time in car-seat carriers and "bouncers", encouraging upright "cuddle time," and altering the head position during sleep.

Sleep:  Babies should sleep on their backs on a firm surface without soft bedding to reduce SIDS (Sudden Infant Death Syndrome).  Amount of sleep varies greatly, but all newborns should be awake long enough to feed at least 8 times per 24 hour period.  Some seem to have alert times for a few hours per day (often in the middle of the night).  To encourage your baby to sleep at night and be alert during the day:  Talk, sing, coo, and play during the day when baby is up for feeds.  At night just feed and change diapers.  Swaddling babies tightly often helps encourage sleep.  Baby will eventually learn that you want to play more during certain times and rearrange sleeping schedules.  Be patient and take naps during the day if possible.  Baby 411 by Denise Fields and Dr. Ari Brown gives a great review of various books on encouraging your baby to sleep.  A good reason to read the reviews is to see what the advice is before buying the book.  If you will never co-sleep, do not buy books that encourage 24/7 contact with the baby!  If you cannot listen to your baby cry, do not rely on a method that supports crying it out.

Tongue Tie:  If your baby seems to have trouble latching or effectively breastfeeding, we should evaluate for possible tongue tie. 

Tummy Time:  Start putting baby on his or her tummy for play time from day one.  The earlier you start, the less baby hates it.  Some even enjoy it.  The more awake time they spend on their tummies, the earlier they roll and crawl.  Be sure to keep a close eye on baby whenever doing tummy time, and roll baby to the back for sleep.

Umbilical Cord:  The regular use of alcohol to clean the umbilical cord is no longer recommended.  Simply keeping the cord dry is all that is needed.  Be sure the diaper doesn't cover the area, or it will stay moist.  If the cord gets goopy, it is ok to use rubbing alcohol to clean the area by pulling back on the cord and wiping around the base of it.  Cords often bleed a little when they fall off.  Unless the blood soaks into the clothing or diaper, this is ok.  Cords typically fall off by 2 weeks of age.  If not off by 2 months, discuss options with your doctor at the 2 month visit.  It is common to have a grey/brown dark area at the base of the belly button once the cord falls off.  This is not dirt and does not need to be cleaned.  It fades over time.

Urine:  Before babies get feeding well established, they are at risk for dehydration.  Count to be sure they urinate 3 times a day the first day home, then at least 6 times a day after the 4th day of life.  Putting a square of tissue paper in the diaper helps to identify the urine, since the diapers are super absorbent.  One of the early signs of dehydration is urate crystals in the urine.  These look red, pink or orangish on the diaper.  These crystals go away when your baby feeds well and rehydrates.  If your baby urinates less than twice per 24 hour period or is feeding poorly after leaving the hospital, please call the office.  As babies soak their diapers, some of the diapers lose gel-like crystals onto the skin.  This is actually part of the diaper itself and of no concern.

Vaginal Discharge:  Most female newborns develop a mucousy vaginal discharge.  Some even have vaginal bleeding, similar to a period.  This is all normal from the mother's hormones acting on the baby's uterus.  It may be prolonged in breastfeeding babies since they get hormones through the milk, but is not a cause for concern.

Yellow Jaundice:  60% of newborns have at least some amount of yellow jaundice.  That is why all hospitals in this area currently check a level before discharge.  It is caused by the normal breakdown of red blood cells making bilirubin (similar to when your bruise breaks down into a yellow-green color).  Until the liver matures at about 4 days of age, the newborn's bilirubin level can rise.  Low levels are very safe, even helpful in some ways for the newborn, but high levels are dangerous.  For whatever reason, the yellowness shows first in the eyes, then the face, then progresses down the body.  If the upper body (above the breasts) is the only place that shows the yellow color, it is generally low enough.  As it is seen on the abdomen and legs, it is high enough to monitor with labs and possibly need treatment.  Treatment of higher levels may include phototherapy with blue lights and improving hydration.  Many people place babies in front of a sunny window to let sunlight fall on exposed skin.  While this can be helpful, similar to the phototherapy with blue lights, babies are at risk of getting too cold from exposure.  Keep baby warm by placing him on your abdomen.  Direct outdoor sunlight is not recommended because of sunburn.