ASK THE DOCTOR: ‘Dr. Dad's' new-baby care tips
By DR. JIM MITTERANDO
The Patriot Ledger

With many babies born this time of year, I wanted to review tips for newborn care that I have found useful - both as a physician and as a parent.

The first few weeks of parenthood can be overwhelming and confusing. There is a lot to learn as well as a sense of great responsibility, sleep deprivation, hormonal fluctuations and recovery from childbirth or surgery.

People often complain about receiving conflicting information from health care providers, family members and baby books. Just remember, there is no one ‘‘right'' way of raising a child. Parents want to do what is best; but often what is ‘‘best'' may depend upon your values and your child's disposition. Be wary of anyone who tells you that you ‘‘must'' do something a certain way.

Advice from your parents can sometimes conflict with current recommendations from doctors or parenting books. Parenting continues to evolve and what was thought ‘‘best'' when they raised you may now be thought to be unnecessary or even, rarely, harmful. But don't sweat it. Despite your parents doing things differently, you made it this far and turned out OK. Your children, when grown, will undoubtedly go through the same conflicts with you when they become parents.

I recommend that every new parent-to-be go to the bookstore, review books on newborn care and choose two books that fit your philosophy. If you plan to breastfeed, purchase a book on breastfeeding, too.

Ideally, read these books during pregnancy to feel prepared and pack them in your hospital bag. Also, try to pick a mentor such as sibling or friend who has had children recently to answer your questions, take you shopping to pick out useful, practical baby care items and help you to compile your list of baby shower items.

For dads-to-be who may not have much experience with infants, South Shore Hospital offers a ‘‘Boot Camp'' class to learn from veteran dads the basics including holding a baby and changing a diaper.

Breastfeeding tips

If you plan to breastfeed, you also can take a prenatal breastfeeding class and do your homework by reading a breastfeeding manual before you deliver. My favorite book is ‘‘The Nursing Mother's Companion'' by Kathleen Huggins. Consider buying a semi-circular pillow designed for nursing, such as a Boppy, that helps support the baby while feeding and makes nursing easier. Also buy a nursing bra; you will buy additional nursing bras after your milk has come in and your bra size changes. Pack these items in your hospital bag.

Breastfeeding, initially, can be very difficult. Stick with it and after several weeks it will certainly get easier. In fact, breastfeeding is simpler and cheaper than bottle feeding, as well as healthier. Realize that breastfeeding does not work for everyone and you are not a bad mother if you do not breastfeed.

If you do have breastfeeding problems, make sure you use the many resources available, which include a daily drop-in breastfeeding support group at South Shore Hospital on weekdays, individual meetings with the lactation consultant at the hospital and your health care provider. There are also breastfeeding support groups in the community such as La Leche League.

Avoid supplements or formula the first few weeks. They are unnecessary and may simply decrease the baby's nursing and your milk supply. Frequent breastfeeding is the key to good milk production. Initial colostrum milk production is a small amount, which leads mothers to worry about their child is getting enough milk. Remember that Nature has built reserves into babies to hold them over until the breast milk comes in around Day 3 or 4, postpartum. As a result, newborns initially lose 10 percent of their weight, but regain their birth weight by 10 to 14 days old.

Naturally, parents worry early on whether their infant is getting enough breast milk. They further get stressed counting wet diapers to ensure adequate intake. A good general rule for the first week is that the number of days old corresponds to the number of wet diapers in a day. For example, a 4 day old should have at least 4 wet diapers.

Breast pumps are used more frequently these days so that moms can store breast milk for future use and enable dad or a babysitter to feed the child. This gives moms more freedom.

Consider renting a breast pump at the hospital which tends to be more efficient than store-bought brands; this way you can try it out before spending several hundred dollars on a pump. Hand pumps are slow and not very practical. Have the nurse or lactation consultant demonstrate how to use a breast pump before you leave the hospital.

Formula tips

The first few days of life, newborns cannot tolerate large feedings and only require one half to one ounce per feeding. The formula bottles provided in the hospital contain 4 ounces and it is easy to give too much, which may lead to spitting up. By the end of the first week, most infants will take 3 to 4 ounces per feeding.

If your child seems to spit up quite a bit, make sure to burp more frequently, consider changing the type of bottle and consider decreasing the amount fed by an ounce.

Don't boil the water: In the past, people were advised to boil water for formula and sterilize the bottles and nipples. This is no longer recommended. Bacteria counts in your municipal water supply are low and safe to drink. You can simply take water from the tap and mix it with powdered formula in the bottle.

Contrary to popular myth, babies like formula at room temperature and you do not need to warm it. If you are making a large amount of formula for the day, the powder dissolves easier if you warm the water.

Bottles and nipples simply need to be cleaned, and not boiled or sterilized. You may want to initially purchase several kinds of nipples to see if your infant prefers a certain shape. Newborns typically prefer a shallower nipple that is more similar to the breast and less likely to gag them. Make sure you purchase slow-flow nipples. As babies get older, they will use higher-flow nipples. I prefer silicone nipples over latex (rubber) nipples to decrease the risk of developing latex allergies - and silicone lasts longer.

When preparing formula, keep the kitchen counter clean, wash your hands, and avoid placing parts of the body or bottle in contact with anything (i.e. sponges) that has touched raw meat or poultry, since the bacteria in meat can be dangerous to infants. You should wash sponges or dish towels every day or two since they often harbor bacteria.

Feel free to change brands of formula if you find a good sale at the store. Formula companies try to get you started on their brand while you are in the hospital, knowing that parents are hesitant to change brands. The differences between formulas seem to be more marketing than science. Generic brands are just as good as brand names and all are regulated by the FDA.

When traveling, it is easier to put water in the bottle and add the powder when you need it rather than preparing formula and carrying it in a cooler. Carry the powder in Tupperware with pie-like divisions, or toss a measured scoop in a regular Tupperware. This keeps it neat and is cheaper than buying travel packets of powder. New parents are often tempted to purchase ready-made formula. This turns out be more expensive than powder formula, is heavy to carry around, and provides minimal convenience.

Cereal added to a baby's bottle does not help the baby sleep longer and should be avoided those first few months. Rice cereal is sometimes added under a doctor's supervision to thicken the formula when infants have significant reflux (very spitty babies).

Grandparents sometimes push to start solid foods early. Solids do not need to be introduced before 4 to 6 months of age. There is no rush; breast milk and formula provide all the necessary nutrients for the first 6 months. Your parents may recall how you started eating solids at one month of age, but infants are not developmentally ready to eat solid foods until 4 to 6 months.

My next column in two weeks will review further newborn care topics.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2005 The Patriot Ledger
Transmitted Tuesday, May 24, 2005