Newborn Care Frequently Asked
By Michael Schoenwetter, M.D. and
Loraine Stern, M.D.
most frequently asked questions in my practice from parents of newborns
are discussed in detail in the newborn care video. These topics include
congestion, skin disorders and many others.
One topic not discussed in the video is
medication usage by nursing mothers. A breast-feeding mother should not
take any medication unless discussed with her physician. Although most
are safe, a great resource to answer questions regarding medicines and
practice in Southern California so I get a lot of questions regarding
sun exposure. A newborn's skin is very sensitive and can burn easily.
When outside with a newborn, direct sun should be avoided and the baby
should wear appropriate clothing to cover his/her skin, including hats.
Remember, babies can get sunburn in the shade. It is okay to apply a
small amount of sunscreen to an infant if sun exposure is unavoidable.
Since the "Back to Sleep" campaign was
initiated - putting a baby on its back to sleep - the incidence of
Sudden Infant Death Syndrome (SIDS)
has dramatically decreased. Due to this recommendation, we have seen an
increase in head shape asymmetry, as prolonged pressure on the same spot
on the newborn's head can result in shape change. Occipital flattening,
where the back of the head flattens, and plagiocephaly, when the side of
the head flattens, are now frequent issues. Make sure your baby can
easily turn its head in both directions and also give the baby tummy
time when not sleeping. If you feel that your newborn always lays its
head on one side or its head shape is flattening, you need to see your
pediatrician. Intervention, which might include physical therapy,
repositioning the head, or a specialized helmet, can help the majority
of head asymmetry, especially if acted on early.
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A common concern for parents is when their baby runs a fever. I have
addressed some important information below:
In a baby under 3 months, any temperature
over 100.4 is a fever. Because small infants cannot fight infection as
well as older infants and children, you should call your pediatrician
immediately. For older infants and children, a temperature of 101 or
above is considered a fever. Body temperature can be raised by playing
in the hot sun or by overdressing. Unless your child is acting sick,
wait a few minutes and repeat the temperature after cooling off. Again,
a newborn should go to the pediatrician immediately when having a 100.4
What's True about Fevers
Fever is a part of the body's natural response to invasion by germs. The
reason to lower fever is for your child's comfort, so that drinking
fluids is easier.
What's Not True
Treating fever does not interfere with the body's ability to fight
pediatrician immediately or go to the emergency room if:
Your child has a
quiet with a vacant stare
Is difficult to
Is grunting or
The fever is
associated with a rash
Your child was
recently exposed at to a serious infection, such as meningitis.
Again, if your newborn
runs any fever, call your pediatrician immediately.
Should You Have Your Baby Sleep
Although the American Academy of Pediatrics and other newborn
organizations do not recommend co-sleeping, many parents still find it
convenient and loving to have their newborn in bed with them. Breast
feeding your newborn is easier if you don't have to get up, for example.
The safer way to have your newborn with you
is to use a co-sleeper that attaches to your bed. Then you will only
need to roll over and take the baby out. There are also sleepers that
contain baby in a safe space between parents.
If you fall asleep while nursing your
newborn, be sure the baby cannot fall off the bed, get tangled in the
blankets or bury his or her face in or under a pillow. Remember that you
may be exhausted and it is important to make sure your newborn is in a
safe sleeping environment.
We hope these frequently
asked questions are helpful and please check back as we will be adding
more new information regarding newborn care.
Insurance for Newborn
Medical insurance can be a very confusing
topic for new parents. In most states, the newborn is automatically
under the mother's medical insurance when born. With some insurance
plans, the parent does have a responsibility to add the newborn to their
policy if they want the coverage to continue. This is a step that is
sometimes forgotten and can cause problems at the doctor's office,
billing issues and even lapses in medical coverage for the newborn.
Usually, which doctor you choose is based on
the type of medical insurance you possess. Remember, just because the
doctor is in your plan or takes your insurance carrier does not always
mean that everything that is done at the doctor's office is a covered
benefit. There might be certain exclusions or limitations of your
particular policy. I find in my practice that well child care benefits,
including vaccine coverage, are the most common areas of coverage where
families do not completely understand what is covered and what is not.
I strongly recommend reading your insurance
policy from cover to cover and understanding exactly what your benefits
are. This will avoid confusion at the doctor's office and prepare you
for medical expenses you are likely to incur.
Post-partum Depression in Fathers
A study published in the Journal of American
Medical Assn. found that over 10% of men experienced depression at some
point between the first trimester and one year after birth. This is
double the rate for men in general.
In the past, post-partum depression has been
viewed as a disorder of motherhood and how the father was affected has
been largely overlooked. The more contemporary father has different
stressors than fathers of the past, as the number of women joining the
workforce has significantly increased. This has changed expectations on
the father to increase household responsibilities.
Marital problems, financial issues and an
ill or colicky baby can increase the risk of depression. Also, sleep
deprivation plays a large role. Even healthy men and women will start to
show signs of depression after one month of inadequate sleep. Paternal
depression can be harder to recognize. A woman will most likely be sad
and withdrawn while a man might become more angry, irritable or
Be sure to consult with your doctor if you
suspect depression in either the mother or father.
Chord Blood: To Bank or Not To
If you are pregnant you have probably
received solicitations from for profit companies offering to arrange to
save your baby's cord blood. It may be touted as "biological insurance."
I recently received an email from a former patient who moved away.
(Grand patients are one of the blessings of a long career.) She wanted
to know whether she should opt to bank her new born's cord blood. She
was confused because she couldn't find any consensus among
authorities. The reason she could not find a consensus is that as of now
there is none.
Should you do it?
Cord blood contains stem cells, that can be transplanted to treat blood,
metabolic, immunologic or malignant disorders. They are not useful for a
vast array of medical conditions yet although in the future that will
probably change. As of now, the disorders for which stem cells are
useful are a few specific conditions. If a child develops leukemia, for
example, his or her own cells are not useful because those are already
programmed to turn into leukemia; those of a matched sibling without
leukemia might be.
There are various studies around the country
examining the usefulness of cord blood stem cells in other conditions.
For example, the Medical College of Georgia is studying whether
infusions of stem cells can help children with cerebral palsy.. As more
and more of these are reported to be successful, cord blood will be more
Saving cord blood for possible future use is
a highly individual decision. If your family has a history of certain
genetically transmitted diseases or malignancies, talk with your
pediatrician and/or a genetic counselor. Seek information from a
specialist treating the disease that runs in your family. If you are not
at high risk, the choice is not clear. The chance of needing these cells
with no risk factors is estimated anywhere from 1 in 5,000 to 1 in
100,000. Not zero but not high.
There is an initial cost and a yearly
maintenance fee, which is not inconsiderable. What we should have is a
national cord blood bank similar to the traditional blood bank but that
is not generally available yet. There are only a handful of
not-for-profit cord blood banks. One is one through the National
Institutes of Health for families with a close relative that has a
possibly treatable condition. The American Academy of Pediatrics
(AAP.org) has a detailed section for parents with a list of questions
and answers (Healthy Children.org/cord blood banking).
If you want to save your new born's cord
blood you must prepare for it before your due date so the delivery room
is set up to capture it. Several weeks before give the information to
your obstetrician and to the hospital where you will deliver. If there
is a life threatening emergency for you or your baby around your
delivery the procedure may fall by the wayside. If you have a good
amount of disposable income and want to do it without a medical reason,
fine. But if it is a sacrifice and you do not have a medical history
that makes it advisable, think twice.
Pregnancy and Exercise
Pregnant women who exercise on a regular
basis are not putting themselves or their newborn to be in harmís way, a
new study finds.The study found that a motherís exercise lowered her
unborn babyís resting heart rate, a sign of good health. The researchers
also found that pregnant mothers who performed 30 minutes of moderate
exercise had lower heart rates than moms who did not exercise or only
exercised a little. The findings of the study support existing
recommendations that most pregnant women begin or continue an exercise
regimen. Make sure to talk with your obstetrician regarding an exercise
program that is right for you and your newborn to be.
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