ASK THE DOCTOR: Caring for newborns
By DR. JIM MITTERANDO
The Patriot Ledger

There are many new babies expected in the coming month, since September is nine months after the winter holidays when many pregnancies occur. This article addresses some of the basics regarding newborn care.

Care of the newborn is different than the rest of infancy or childhood. Newborns’ nervous, gastrointestinal and immune systems are not quite fully developed making them somewhat more delicate.

Take your newborn out
Doctors used to recommend keeping a newborn baby at home for several weeks. There is no threat in going outdoors - even in the winter - just dress the child appropriately. Infants cannot catch a ‘‘cold’’ by going out in the cold weather; what they wear will not cause or prevent a ‘‘cold’’ since colds are caused by viral infections. You can take the baby to malls and anywhere else. I often point out that a newborn child that goes home to a house full of young siblings will get exposed to a lot more germs than in any mall or airplane.

Dressing your child
Dress your newborn in similar layers that you wear. In the winter, your child may require an extra layer; but avoid overdressing or overbundling an infant, which can cause a fever. Hats only need to be worn outdoors during the winter. Infants are often dressed in hats in the hospital because they may have trouble maintaining their temperature when first born but mostly because of cosmetic reasons to cover up their cone-heads.

Care of the umbilical cord
Many parents are intimidated by the black, dried umbilical cord. Don’t worry - the umbilical cord is just dead protein that has no feeling. The umbilical cord commonly falls off by two weeks of age. The key is to keep it dry so it will fall off. Fold the diaper down, so you expose the umbilical cord to the air. Alcohol wipes also help to dry out the cord. Give the cord a gentle tug and twist when changing the diaper to help it fall off sooner.

Bathing
Avoid baths until the umbilical cord falls off. Newborns do not get very dirty and do not need to bathed more than every two or three days. Frequent bathing can remove oils from the skin and dry it out.

Skin care
Newborns often shed a first layer of skin after birth. This is normal and does not mean the skin is dry or needs lotion. In fact, avoid baby wipes and creams during the first month because they contain chemicals and scents that may irritate delicate, new skin and may cause a rash. Instead, use soft paper towels or cotton square pads used to remove cosmetics. Apply water from a squirt bottle to the towel and wipe the dirty area. After a month, you can try baby wipes and moisturizing creams. If a rash develops, wait several more weeks and try again.

Rashes
Newborns commonly get what I call itty-bitty-baby rashes that come and go quickly and are of no concern. Some infants get newborn acne that are a small white bumps which will go away with time and require no treatment. Cradle cap is a rash with thick flakes of skin peeling from the scalp that is often treated with frequent baby shampooing. If it does not go away, your doctor may recommend dandruff shampoos or hydrocortisone cream.

Behavior
You cannot spoil a newborn. If your newborn cries it is most likely because they feel hungry or cold or have a dirty diaper. By holding your infant, they know they are in a secure, loving environment. After the age of six months, infants can be ‘‘spoiled’’ and you may need to let them ‘‘cry it out.’’ But during the first few months, this is not the case.

Signs of illness
Call your health care provider if your newborn:

• Refuses two or more feedings in a row
  
• Cries for over two hours despite feeding, changing, rocking, etc.
  
• Breaths rapidly when not crying (more than 60 breaths a minute for an hour)
  
• Has a fever of 100.5 degrees or greater
  
• Fevers in older infants and children are, generally, not worrisome. It is a sign that they are fighting an infection and is a normal response of the immune system.

Fevers in newborns (especially when they do not have cold symptoms) can be a sign of a serious infection that requires prompt evaluation by their health care provider. Newborn’s immune systems are not quite fully developed and that makes them more prone to a serious infection. If your newborn feels warm or does not behave normally, you can check a rectal temperature. Ear thermometer and armpit (auxiliary) temperatures are not as accurate and are not recommended during infancy. You can use these other methods when the child is older. In newborns, you should avoid Tylenol, Motrin, etc unless advised by your physician. These medications can mask a fever.

This a short and not a complete list of items. I recommend new parents buy or borrow two parenting books. Go to the bookstore or library and find ones that match your style and tastes.

There are many good web sites that provide good parenting and medical tips including Babycenter.com, and Kidshealth.org.

Your family, friends and health care provider also are great resources.

Dr. Jim Mitterando is a family doctor at Health Care South/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 2002 The Patriot Ledger
Transmitted Tuesday, August 27, 2002