CONGRATULATIONS!! We welcome you and your baby to Pediatric Physicians, PC. This information
is designed to help answer the most frequently asked questions regarding the
care of your new baby as well as give you some information about our office and
our office procedures. We hope it will be helpful to you and that you will read
it carefully and refer to it in the future. At Pediatric Physicians, PC our
goal is to keep your children Happy, Healthy, and Safe!
Table of Contents
Philosophy
In
the hospital
Weight
loss
Spitting
up
Gas
Hiccups
Bowel
movements
Loud
breathing
Head shape
Eyes
Jaundice
Skin
Genitalia
and breasts
Feedings
Nursing
Bottle
feeding
Solid
Foods
Vitamins
Going home
Visitors
Clothing
& outdoors
Bathing
Umbilicus
(navel)
Circumcision
Diaper care
Pacifiers
Crying
When
to call us
Fever
Vomiting
and diarrhea
Nasal
congestion
Lacerations
Bone and joint injuries
Burns
Head
injuries
Nose
bleeds
Poisonings
Automobile
safety
Home
medicine cabinet
Emergency and after hours calls
Routine
examinations
Office and financial information
Recommended
reading
Philosophy
We
encourage parents to discuss any aspect of infant care with us. All the
doctors, practitioners, nurses, and office staff are part of our team, and we
look forward to getting to know you and your children. We encourage you to
develop a relationship with one of our physicians as your primary doctor. In
other words, it is best to schedule all of your routine well child visits with
the same doctor or practitioner when possible. This helps to develop a
close relationship and improved follow up. Though our practice has two
locations, your child’s records are available to any provider at either
location at all times.
Relatives, friends and
neighbors will offer you advice on child care, but you are the one who is
ultimately making the decisions about the loving care that your child should
receive. You are the one who will know your child’s needs and what has worked best,
and will have to do the things that make you feel comfortable and feel right to
you. Each child is unique and no general rule always applies. Use your own judgment,
but we encourage you to feel free to call us for advice and guidance.
Since all newborns are
different, they can be quite perplexing and sometimes cause you unnecessary
worry. In this booklet, we’ll discuss some information that will describe what
is characteristic of normal newborns. Hopefully, this will relieve some of your
concerns and help you enjoy your baby more.
In the hospital
While you and your baby
are in the hospital, one of our doctors will thoroughly examine your baby and meet
with you within the first 24 hours (this has likely already happened since you
are reading this book). We usually make our rounds between 7:00-8:30 AM. If you
will be staying overnight, we will make another visit before your discharge. We
will let you know when to make your next appointment in our office.
Prior to
your discharge, the nurses at the hospital will perform a blood test called the
Newborn Metabolic Screen, sometimes referred to as “the PKU test”. Your child’s
heel will be stuck to obtain a few drops of blood that will be sent to the
Georgia state lab to be tested for several medical conditions (PKU, thyroid
disorders, metabolic problems, etc.). This test is required by Georgia state
law and is also a good idea, since it is the best way to pick up these very
rare diseases that require early treatment.
Weight loss
Your baby is born with extra
stored energy and water which serves to nourish him for the first day or so. For
this reason, the baby may not want or need much to eat during the first few
feedings. A weight loss of up to 10% is expected within the first week, but we
do expect them to regain their birth weight by the 2 week visit. By the fourth
to fifth day, the baby should be eating well and starting to regain weight.
This is when your breast milk will usually come in.
Spitting up
Spitting up is
non-projectile regurgitation of food or liquid not associated with any signs of
illness. Many parents become unduly worried because their baby spits up during
feedings. Especially within the first few days, extra fluid may remain in their
stomach from birth causing spitting. Also, it is not unusual for him to bring
up food during the first few months, whenever he burps or has been active. Although
spitting up is an inconvenience, it seldom is a serious problem in a child who
is otherwise healthy and developing normally. Usually time and patience on your
part will best handle this problem. However, if your baby seems to be in pain
with spitting up, we may suggest additional steps to help.
Gas
Babies pass gas freely
without control due to a combination of swallowed air and fermentation of food
in the digestive process. This is normal and is not necessarily associated with
colic. Though the gas may upset or worry your baby, keep in mind that it
doesn’t hurt—it just feels “funny” to a newborn. Gentle reassurance from Mom
and Dad is the best “medicine” for newborn gas.
Hiccups
Many infants have
hiccups after each feeding; others only occasionally. This is not disturbing to
your baby and will stop spontaneously after 10-15 minutes. No remedy is needed.
Bowel
movements
Just as your baby develops
a feeding pattern, he will develop a schedule for bowel movements. Normal stool
patterns can include a movement after each feeding or one every second or third
day.
Initially, the stool is
a tar-like, black, sticky material called meconium. With the introduction of
milk feedings, the stool becomes yellow and can be pasty, semi-formed, or loose.
Formula fed babies may appear to have curds or seeds in their stool while breast
fed babies may have thin, smoother stools. The consistency and color is highly
variable. Stools, however, should not be small, hard or bead-like stool. This
could be a sign of constipation, which is hard pellet-like stools, NOT
infrequent stools.
Diarrhea means frequent
(8-10 times a day), loose, and very watery stools. You may have noticed that your
baby’s muscles are generally weak; that is why he does not sit up or control
his head well yet. The same applies to the abdominal muscles which, in older
children and adults, provide the force to move the bowels with control. Your
baby has to work harder and longer to have a normal bowel movement. It is not
unusual for a baby to grunt, fuss, and turn red when he is preparing to have a
bowel movement. Instead of becoming anxious or trying to help, be patient and
keep him secure and comfortable. This is a process that will get easier with
practice.
Loud
breathing
It is quite common for
your baby’s nose to become slightly congested or stuffy during the first few
months of life. Sneezing is a way of clearing this congestion from the tiny
nasal passages. While at rest, babies breathe only through their noses for the
first few weeks. Sometimes the breathing sounds noisy because the air
turbulence caused by mucus in the nasal passages is amplified by the chest
cavity. Babies can become cranky and may feed poorly if their noses are too
stuffy. Salt water nose drops can be dropped in the infant’s nose and a nasal
aspirator (bulb suction) can be used to clear the secretions. Salt water drops
can be purchased at the drug store (e.g. Ocean spray) or be made at home with 4
oz of sterile water and 1/4 tsp. of salt. A vaporizer may also be useful to
help keep the mucus thinner. Remember, this is a normal condition and does not
require any treatment unless the baby is feeding poorly or unable to sleep. If he
starts to exhibit any other symptoms of illness (fever, coughing, fast
breathing, etc.) please contact our office for advice.
Head shape
The baby’s head shape
usually changes as a result of labor. Molding or elongation of the head is
present to some degree in all babies. In some newborns, there is a goose egg
type of swelling on one side, or sometimes both sides of the head. This is
called a cephalohematoma. It is common and resolves by itself by 6-8 weeks of
age without any permanent effect on the baby. It has no direct connection to
the baby’s brain since it involves only the skin and coverings of the skull. Treatment
or special attention is rarely required. Please call our office if a sudden
swelling occurs during the first week or so after your newborn arrives home.
Eyes
After birth in the
hospital, erythromycin ophthalmic ointment is used to prevent eye infections. If
your baby develops a discharge from the eyes, he may require treatment if it
persists more than one to two days or is excessive. Please call our office if this
is the case.
Jaundice
On about the second or
third day of life, many normal full term newborns will develop a degree of
jaundice or yellowing of the skin. The color of the skin results from a
combination of two normal processes which involve the immaturity of the infant’s
liver and the breakdown of red blood cells. Bruising of the skin
and the presence of a cephalohematoma make the occurrence of jaundice more
likely and more pronounced. A blood test determines the level of the
jaundice by measuring a substance called bilirubin. Please do not become
apprehensive if a test is ordered on your child. We will discuss the results
with you and explain their significance. At times, jaundice is more prolonged
in breast fed babies. Usually, nothing has to be done. If any treatment is
necessary we will discuss it with you. Some jaundiced babies require
phototherapy or “bilirubin lights.” This
therapy helps to reduce bilirubin levels in the blood stream. The treatment is
painless and will be fully explained to you if the need arises.
Skin
A newborn’s skin is often a source of concern for parents because
of the numerous variations and rashes that occur. Understanding these
variations will save you from needless worry. At birth, the baby’s skin is
purplish-red in color. With their first breath, it brightens to a deep red. Occasionally,
a baby’s hands and feet will remain somewhat bluish during the first few days
or whenever the baby is exposed to the cold. This is known as “acrocyanosis”
and is completely normal. Within a day or two, the redness fades and peeling of
the skin occurs. Although the peeling skin may be unsightly, in no way does it
harm or disturb the baby and requires no treatment, lotion, or oil. Bruising
which might have occurred on the face, scalp, or limbs, will also clear.
Some babies will have
blue marks over their buttocks or lower back which are called Mongolian spots. These
are not bruises. They may fade but do not always disappear.
Many babies, while still
in the hospital, develop a rash characterized by areas of redness with small
white centers called “erythema neonatorum.” It usually appears during the first 24 hours
on the trunk, face, and diaper area. This rash can last 5-7 days, is harmless
and requires no treatment.
There are also a number
of other facial rashes that usually appear during the first few months. These
rashes do not represent an illness and do not require treatment. These include:
- Milia - tiny, shiny, white, pimple-like bumps without
any surrounding redness.
- Infant acne - collections of small red spots or
pimples on the cheeks, chest, and back. This rash can come and go for up
to 12 weeks of age.
- “Angel kisses” – red, flat splotches or lines often
on the eyelids, back of the neck, and scalp. These birthmarks usually fade
away by the first year of life.
- “Stork bites” – a flat, red area on the nape of neck
or top of the head. These don’t fade away, but won’t be noticeable once
your baby has more hair.
Genitalia
and breasts
During pregnancy, mother’s
hormones can stimulate the baby girl’s uterus and vaginal lining. After
delivery, the “withdrawal” of mother’s hormones can lead to a white mucous
discharge that lasts about a week or even some bloody discharge. Breast tissue in babies of both genders are also stimulated, and
may be enlarged at birth. Some babies may even have some milk secretion. This
breast enlargement should not cause concern, unless the skin is red or warm.
Feedings
Feeding is one of the
most important functions of the new parent-infant team. During feeding periods,
many of the infant’s basic needs are satisfied. These are both physical and
emotional needs including:
- Oral stimulation and gratification.
- The pleasant, contented feeling of fatigue and a full
stomach.
- The warmth and love from being held and cuddled.
- Proper nutrition and hydration to ensure normal
growth and development.
A feeding is successful
when the infant has some sucking needs satisfied, is pleasantly exhausted, has
a tummy full of nutritious mixture, and feels comfortable, loved, secure and
ready for a nice period of sleep. During this sleep, the baby regains strength,
digests food, empties the stomach, and awakens ready to repeat the performance.
These needs can be met well by breast or bottle feeding.
Nursing
For many mothers, breast
feeding is a satisfying and fulfilling experience. It requires a minimum of
equipment, and is no doubt the most inexpensive form of infant feeding. There
are at least two other advantages of breast feeding. First of all, breast fed
babies are less susceptible to infections in the early months of life. This is
because the milk contains antibodies from the mother’s body which help prevent
some infections. Bear in mind, we cannot guarantee your breast fed baby will
not get sick, but his chances of avoiding diarrhea, vomiting, and colds will be
enhanced. Second, while the vast majority of babies tolerate commercial
formulas well, a small number will be sensitive to either cow’s milk or soybean
formulas or both. If you have a strong family history of allergies, especially
if you had allergies to formulas as a baby yourself, breast feeding can delay or
prevent this problem in your infant. There is an initial period of learning,
when the mother and child are both inexperienced. Until the milk is in the baby
may be become impatient and lose weight. Soon the milk flow begins, the baby
learns to nurse well and the two of you are on your way to success. Not
everyone chooses to breast feed- either because of preference or medical
reasons. In these cases there are formulas available that your baby should do
well on. We will be happy to discuss any feeding questions with you.
If you are breastfeeding
you should gradually increase the nursing period as your nipples become more
conditioned. As you progress, the goal is to have at least one breast emptied
per feeding, alternating sides each time. In this way, supply meets demand,
since the more you are emptied, the more you produce. At the beginning nipple
discomfort is normal early in each feeding. However, as the feedings progress,
this should subside. Continued and intensified pain is not common, and we
should be told about it. The nipple must go into the infant’s mouth and rest
between the tongue and roof of the mouth. The gums and lips should cover almost
all of the dark area of the breast. This way, minimal soreness occurs and
emptying is more complete. Usually, 10 - 15 minutes of active sucking will
empty a side. Do not spend more than 15-20 minutes per side. Very little air is
swallowed at the breast, so breast fed babies require little burping. The flow
of milk is controlled by many factors, including your emotions. Success,
therefore, requires family support and tranquility. In addition, your diet must
be adequate and well balanced. Your fluid requirements are higher than usual,
and vitamins and calcium are essential. Some medications cross into the milk
and can affect the infant. If you are taking any medications, let us know.
Bottle
feeding
If you’re
going to bottle feed, use expressed breast milk or a commercial formula. Most
commonly used formulas are based on cow’s milk with modifications to make them
more like human breast milk, more digestible, and more nutritious. An
occasional infant will be intolerant of cow’s milk and require a milk-free substitute
such as soy formula. The nutritional value of all of the major formulas is
essentially equal. Occasionally an infant is intolerant of both cow’s milk
formula and soy based formula. In this case, a hypo-allergenic formula may be
prescribed. Hypoallergenic formulas may be a good first choice in highly
allergic families if nursing isn’t possible. These formulas are much more
costly when compared to the first two types. Most formula is available in
powder, concentrated liquid, ready-to-feed liquid and ready-to-feed bottles. Each
form that is increasingly more convenient is also more costly. What the infant
actually gets with each is the same. If powder or concentrate is used and mixed
with city water, no supplemental fluoride is needed (since Atlanta city water
contains fluoride).
Types of Bottles: There are glass bottles, hard plastic bottles and plastic shells
designed to hold plastic liners. All of these are able to fit the standard sized
screw-on caps that hold the nipple. There are a variety of nipples available in
many shapes and many degrees of firmness. You may need to experiment to find
the bottle and nipple combination that suits your baby best. In general, there
is no special benefit to the more expensive bottle systems.
Sterilization: If proper
precautions are used, sterilization of the bottles, nipples, milk or water is
no longer necessary (unless well water is used.) Your dishwasher is an
excellent way to clean your baby bottles and nipples. If hand washing, be
certain that all parts of the bottle and nipple are carefully washed and rinsed
and that no dry milk remains. Milk that has not been sterilized is much more
easily spoiled, so prompt refrigeration and proper handling of the formula is
important. If the feeding has been warmed and partially fed, the remainder of
the feeding must be discarded if it has been kept warm over 30 minutes. If it
has been warm less than 30 minutes, it may be reheated one additional time.
Water: Newborns do not
need water. Breast milk and/or formula supply all the water your baby needs.
Solid Foods
For the first four to
six months of life, your baby’s nutritional needs are met by the milk you are
feeding. Solid foods are not needed yet. Please discuss feeding recommendations
with us prior to instituting major changes.
Vitamins
An infant multivitamin
is recommended starting at birth for breastfed infants to ensure
adequate levels of vitamin D. If using a mix of breast and formula, no
additional vitamins are needed once a baby is taking 16 oz or more of
commercial formula. Breastfeeding mothers should stay on their prenatal
vitamins unless advised otherwise. If using breast milk, ready-to-feed formula
or formula mixed with non-fluorinated water, a fluoride supplement will be
prescribed after 6 months of age to help make the teeth more resistant to
cavities.
Going home
Have your baby
comfortably dressed according to the weather conditions when you leave the
hospital. We recommend that you transport your baby safely in an approved
protective car seat with seat belts buckled. It is not possible to adequately
protect a baby in your arms, even if you should only have a minor accident.
Every baby must adapt to
new surroundings, and parents should not expect the first 24 to 48 hours at
home to always be smooth.
Your baby should have his
or her own room if possible. Furnishings should be easily cleanable, so they
will not collect dust. All painted items should be lead-free. The baby may
sleep in a bassinet, or you may use a crib from the start. The mattress should
be firm and flat and protected with a water proof cover. No pillow should be
used. Bumpers may be used to keep heads, arms, and legs from getting caught
between the bars of the crib. Try to keep the temperature about 72 degrees. Provide
adequate ventilation, but avoid drafts. Usually a single baby blanket will be
enough covering even in cold weather.
Visitors
Having a baby can be
physically stressful, and most new mothers need time to rest and become
accustomed to their new routine. Babies are quite susceptible to infections and
should not have exposure to many people in the early weeks of life. In
addition, the baby and family need time to adjust to one another with a minimum
of stress. We suggest that visitors be limited in the first several weeks.
People who do visit must wash their hands or use an alcohol-based hand
sanitizer.
Clothing
& outdoors
Your baby requires no more clothing than an adult.. Make an effort to dress him according to the temperature
without overheating him. If the baby perspires, the baby is too warm. Clothing
should be loose fitting, lightweight, and soft. Infants lose much body heat
from the head, therefore put on a hat if it is cold.
When the weather is
pleasant, you may take your baby outdoors as soon as you feel able. Avoid
crowds and people who will want to touch your newborn, and bring a bottle of
hand sanitizer with you.
Bathing
Until the navel (and circumcision) is healed, the baby
should be sponge bathed. The face, ears, and nose should be washed with a soft
cloth and plain water. There is no need to clean the inside of ears, nose, or
mouth. Wash the baby’s head with mild baby soap. On the skin, wash in the
creases, rinse thoroughly, and pat dry. In general, it is wise to avoid
deodorants, perfumes, creams or beauty soaps. Oil should not be used,
especially on the head. If a scaly, oily, dandruff-like area (cradle cap)
appears on the scalp, an anti-dandruff shampoo (Selsun Blue or Head and
Shoulders) along with gentle scrubbing with a soft brush can be used until the
condition is cleared, and then every 2-4 days to keep the flaking from
returning.
Umbilicus
(navel)
The navel usually heals when the cord separates in ten to twenty-one
days. Occasionally, you may see a few drops of blood when the cord separates. This
is normal and harmless. Do not worry if the belly button protrudes. Belly bands
are not recommended. Many hospitals recommend “dry cord care,” meaning that
nothing needs to be applied to the navel. At other hospitals, it is recommended
that the cord area be cleaned with alcohol after diaper changes. Either method
is acceptable, though dry care does lead to a quicker separation of the cord
stump.
Circumcision
Circumcision is not a
medical necessity, though many families choose to have their sons circumcised. In
the Atlanta area, circumcisions in the hospital are performed by a doctor from
your obstetric practice.
Diaper care
Change your baby’s diaper as soon as possible after
each bowel movement. Wash the area thoroughly with soap and water or a non-alcohol
baby wipe. When cleaning girls, always wipe from front to back to avoid contamination of the
vaginal area.
Because babies have
sensitive skin, they are prone to have rashes and irritations, especially in
the diaper area. Usually irritation is due to prolonged periods of wetness or
contact with fecal material. Both prevention and treatment of diaper rash require
frequent diaper changes. Exposure of the rash to air for several hours a day,
avoidance of plastic or rubber pants, and thorough cleansing of the area will
heal most rashes. A cream containing zinc oxide can be used with each change. If
the rash is severe or, if after a day or two of such treatment, the rash
persists, we should be consulted.
Pacifiers
All babies have an
instinctive need to suck. This need goes beyond the sucking that accompanies
feedings, and is often confused with a need for more food. If your baby has
been fed, but is busily chewing the thumb or fingers, you may wish to
substitute a pacifier. Do not over-feed the baby in an attempt to satisfy the
sucking. At first, a pacifier may not be acceptable to the baby, but usually
with persistence or trying different types, it will be taken. Of course, there
are some babies who outgrow this need to suck and will voluntarily give up the
hand or pacifier.
Crying
All normal newborn babies cry a certain amount of the time.
During the first few weeks, crying is one of the ways they have of expressing themselves
and of telling you their needs. Babies may cry when they’re hungry, too cold, too warm, have an “un-burped” burp, have a wet or soiled
diaper, want to be held, or just because they feel out of sorts. It is very
common for a baby to cry or fuss at about the same time each day, often in the
evening, and this may go on for quite a while for no apparent reason. This
period of fussiness often causes concern for new parents because they usually
think that their baby is still hungry. It is tempting to keep offering him more
milk, but this seldom really helps for more than a short time. Taking a ride in
the car or stroller, swinging, being given a warm bath, or lying near a running clothes dryer to feel the vibrations may calm
the baby. An infant carrier which attaches over mother’s shoulders may also
help. Babies who fuss for inordinately long periods of time (often many hours)
may have colic. Usually, no cause for colic can be found. There are a few
treatments that can help. Call us if your baby has this problem. Anxiety on the
parts of parents may increase the baby’s crying, so try to stay calm. A
reassuring fact about crying is that it causes no physical harm to the infant. Many
new babies fuss for fifteen or twenty minutes after each feeding before going
to sleep.
When to
call us
The following are some
guidelines about when to call the doctor regarding your newborn. Even if you’re
not sure you need to call, it’s always OK to call if you are worried.
- Persistent lethargy and inactivity.
- In a young infant, refusal to take any milk or fluid
for several hours.
- Fever—Call us if a measured rectal temperature is over
100.4 degrees in a baby less than two months old.
- Difficulty breathing.
- Unusual rash (especially large welts, hives, or small
spots that look like blood under the skin).
- Repeated vomiting (not just minor spitting up).
- Stiff neck.
- Persistent screaming or crying that cannot be
soothed.
- If you are very worried about your child for any
reason.
Fever
Babies
over two months of age commonly run fever with illness, with temperatures
usually higher than in adults with similar illnesses. Temperatures as
high as 103-104 degrees are not rare in children and do not necessarily mean a
serious illness. If your child appears ill or has a fever of 104 degrees or higher,
call us for instructions.
If your baby is less than 2 months of age and runs any fever >100.4
rectally, please call us immediately. Though most fevers are caused by
viruses and will not harm your baby, children who are very young have a much
higher chance of a serious problem.
Acetaminophen (Tylenol)
is recommended babies of any age with fever. It can be given every four hours
while the fever lasts, up to five doses in a 24 hour period. Acetaminophen is
also available in suppository form without a prescription. Ask the pharmacist
to help locate this if needed.
Ibuprofen is available
without a prescription to help control fever in children over six months.
Do not use aspirin
unless you have discussed this with us.
The following charts include the medication dosages:
Vomiting
and diarrhea
Illnesses causing these
problems are common in infancy and childhood. Usually they are relatively minor
infections caused by viruses.
An infant will vomit
over a time period of a few minutes, then feel better for a while, after which
the sequence may repeat itself. This could happen several times until the
infection improves. It is good to rest the infant’s stomach by giving nothing
to drink for 1-2 hours. Then give a prepared infant electrolyte solution in one
ounce frequent feedings. Examples of these solutions are Pedialyte, Ricelyte
and Rehydralyte. Do not use apple juice as this may worsen the diarrhea. Never
use a diet drink as a clear liquid. Advance diet to bland foods as tolerated. Call
us if the vomiting persists for more than about two hours or if the child looks
very ill.
Mild diarrhea that lasts
for a few days does not require any changes in an infant’s or child’s diet. More
severe diarrhea may be treated with the same fluids as detailed above. In
infants, the electrolyte solution is continued for 24 hours, then 1/2 strength formula for 24 hours (made by
mixing 4 oz of full strength formula and 4 oz of unflavored Pedialyte together),
advancing to full strength formula after that.
If you are
breast-feeding, most infants can feed through an illness with vomiting or diarrhea
episode. At times, however, we may suggest a prepared infant electrolyte
solution if the diarrhea is severe. In this case, a breast pump should be used
every four hours to maintain your milk supply. Do not use diet drinks for
diarrhea because the lack of sugar may cause low blood sugar.
When vomiting and
diarrhea occur together, follow the same directions as for vomiting above. Bear
in mind that the infant may be more likely to become dehydrated if he/she
cannot hold down enough liquids to replace what is lost in the stools.
The following are suggestions for when to call the
doctor:
- When
signs of dehydration occur such as listlessness, lack of urination for
several hours, eyes appearing to be “sunken” into the head or dry mouth
and tearless eyes.
- When
an infant has bloody diarrhea, especially associated with fever.
- When
an infant less than six months has persistent vomiting for more than four
hours or diarrhea for 12 to 24 hours, especially if associated with fever.
- When
there is bile stained (dark green) vomit, especially if associated with
abdominal pain and swelling of the abdomen.
- When
a child has severe vomiting along with behavioral changes such as
disorientation, hallucination or extreme listlessness.
Nasal
congestion
This is another problem
that all infants will have at some time. Young infants may have some trouble
breathing or taking their feedings if they become severely congested. This is
because they breathe best through their nose until they are about four months
old. A few simple treatments can usually improve the situation.
Give plenty of fluids,
and use a humidifier to help keep the mucus thin and runny. Put some salt water
nose drops in the nose and suction with a bulb suction (see under “Loud
Breathing”). This can be done several times a day, especially before feedings.
EMERGENCY AND FIRST AID INSTRUCTIONS
Lacerations
Stop bleeding by applying firm pressure directly on the
wound using a dry, clean cloth or handkerchief for about 10-15 minutes at a
time. If not severe, you may wash it with mild soap and copious amounts of tap
water. Go to the emergency room if sutures are needed after office hours. If
there has not been a tetanus booster within the past five years, one will have
to be obtained within 48 hours.
Bone
and joint injuries
Apply ice to reduce
swelling and a cold compress intermittently after that for the first 24 hours. If
a fracture or dislocation is possible or obvious, do not move the injured part.
Immobilize it with a splint until the doctor checks it. Do not move the child
if there is a question of serious neck or back injury.
Burns
Immerse in cold water
immediately for about 15 minutes. If it is first degree (redness without
blisters) usually no medical treatment is required. Cool, wet compresses may
help. For second degree burns with blisters, call the doctor or emergency room.
Try to keep the blisters from breaking. If your child has not had a tetanus
shot within the last five years, he/she will need one within the next 48 hours.
Head injuries
If unconsciousness or loss of memory about the accident
occurs, or if the injury appears to have been more than a very minor one, call
us. If the injury is not severe, watch for the following signs and call us if
these or other worrisome findings occur:
- Pupils should be round and equal in size and should
become smaller when light is directed into them.
- One to two episodes of nausea and/or vomiting are
normal. Give only clear liquids in small amounts. If vomiting persists
more than two times, or is forceful, notify us.
- Seizures or convulsions.
- Discharge from the nose or ears.
- Paralysis of arm(s) or leg(s).
- Persistent crying or headaches.
- Crossed eyes (when awake) or staggering when walking.
- Inability to be aroused.
- Acting unusual.
Nose bleeds
Place nose between thumb
and index finger, keeping steady and tight pressure for at least 10 minutes.
Poisonings
It is
important to have on hand the number for Poison Control (404) 616-9000. If your child ingests a non-food
substance, he may need medical care. Identify the substance and estimate the
amount taken. Next, call Poison Control. Begin following their instructions, then call us.
Automobile
safety
Each year more children
are killed by automobile accidents than by any other disease or injury. Your
first expression of love for your child can be given prior to the baby’s birth,
by acquiring an approved car seat. To protect your child in the car, be sure
the infant is buckled in the seat whenever the car is in motion.
Holding a baby on your
lap is the most dangerous way to transport a child in a car. The best place for
your child is in the back seat in an approved child seat. Infants should be
rear facing until 12 months old. Children should remain in car seats/booster
seats until they reach at least 80 pounds or 8 years old. Do not put a child
that is under 12 years old in a seat that has an airbag device as it may cause
serious injury.
Home
medicine cabinet
These are medicines
every family should have at home. They should be stored in a safe place out of your
child’s reach.
- For fever or pain, either acetaminophen (e.g.
Tylenol) or ibuprofen (e.g. Advil or Motrin) can be used. There is also a
suppository form of acetaminophen (e.g. Feverall) if needed. This is not a
prescription, but is in the pharmacy refrigerator.
- Salt water nose drops are very helpful when treating
stuffy noses. Pre-packaged saline drops are available at the pharmacy
without a prescription. You can also make your own drops by placing 1/4
tsp. table salt in 4 oz. of water. The dosage is 3-4 drops in each nostril
as needed followed by bulb suctioning.
- For cuts or scratches, Bacitracin or Polysporin
ointment can be helpful after thorough cleaning.
- A cool-mist humidifier is recommended for colds,
croup, and dry
hacky night coughs. Do not use any medications in the humidifier.
- A thermometer is a necessary part in evaluating your
child.
- A nose bulb syringe is used for nasal suctioning.
- An oral rehydration liquid such as Pedialyte or
Rehydralyte should be available in case of vomiting or dehydration.
Emergency
and after hours calls
Please note that at night,
on weekends, and holidays, you may still call by using our regular office
telephone number. If you have anonymous call rejection on your phone,
deactivate it with *82 so that we can return your call. Routine questions,
minor problems, and prescription refills should be deferred until regular
office hours so that we may have your child’s medical record available. After
hours calls should be reserved for urgent or emergency situations. If your
child is extremely ill and you cannot wait for a return call, call 911 and go
immediately to the hospital.
Your call will initially
be taken by the answering service. The information is then given to the
Children’s Healthcare of Atlanta nurse advice line. A trained pediatric nurse
will return your call and evaluate the situation. She will advise you on the
care of your child. If necessary, she may recommend that you take your child to
an emergency room or may have our doctor on call discuss the problem with you. If
you do go to an emergency room or after-hours clinic, you must call our office
and your insurance company on the next business day to insure proper
verification by your insurance company.
When you call, please be
sure to leave your line open and have the following:
- pen and paper for instructions
- phone number of a pharmacy that is open
- your child’s temperature and weight
- a list of your child’s symptoms and any medications
the child is taking
- a list of medications on hand
Routine
examinations
Please
call as far in advance as possible to schedule check-ups. The following is the
schedule for routine check-ups. We recommend vaccinations according to the
guidelines of the American Academy of Pediatrics. Please consult with our web
site, www.PediatricPhysiciansPC.com, for the latest schedule of immunizations
and recommended tests.
- Within 1 week
- 2 week
- 1 month
- 2 month
- 4 month
- 6 month
- 9 month
- 12 month
- 15 month
- 18 month
- 24 month
- 30 month
- 3 years old and yearly after that
- After 10 years old, check-ups should be done every
1-2 years depending on the individual situation. Participation in some
sports requires yearly physicals.
Office
and financial information
Our normal office hours
are from 8:30 AM to 5:00 PM Monday through Friday (both offices) and 8:30 AM to
11:00 AM on Saturdays (Roswell only.) Office visits are made by appointment
only. If you are unable to keep a scheduled appointment, please let us know at
least 24 hours prior to that time so that we may allow another child to be seen
then.
Copies of our Financial
Policy are available at our office. We encourage you to obtain one during
your first visit.
Recommended
reading
- The
American Academy of Pediatrics. Birth to 5 y.o.
The Complete and Authoritative Guide.
- Karp,
Harvey. Happiest baby on the block.
- T.
Berry Brazelton. Touchpoints.
- Benaroch,
Roy. Solving health and behavioral
problems from birth through preschool.
- Meyers,
Martin. Do vaccines cause that!? A
guide for evaluating vaccine safety concerns.
Please visit our web page, www.PediatricPhysiciansPC.com,
for an extensive updated list of recommended reading and helpful web sites.
IMPORTANT TELEPHONE NUMBERS:
Pediatric Physicians, PC .......................................... (770)
518-9277
Poison Control.............................................................. (404)
616-9000
Scottish Rite ................................................................. (404)
785-5252
Northside Hospital........................................................ (404)
851-8000
AMBULANCE............................................................................... 911
Pharmacy:
______________________________________________