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ASK THE DOCTOR: Newborn know-how - A guide for parents
By Dr. JIM MITTERANDO
The Patriot Ledger

Editor's note: This is the second part of a two-part series on caring for your newborn.

Umbilical cord
Try to keep the umbilical cord dry to help it to fall off sooner. Typically, the cord will fall off by two weeks. Avoid baths until the cord falls off and instead ‘‘sponge bath'' the infant with a wash cloth. Keep the diaper folded down below the cord to avoid trapping moisture and to promote drying. Each time you change the diaper, give the umbilical cord a little tug and twist to help loosen it. Parents are often squeamish about touching the cord, but it has no sensation and is just dried up skin-like material. Applying rubbing alcohol to the umbilical cord to hasten drying is an optional step.

Bathing
You can give baths after the cord falls off. The small plastic, infant bath is safer than the bath tub and convenient since it fits in the kitchen sink or on the counter top. Months later, when the infant has more muscle control and can sit on her own, she can graduate to the bath tub.

Babies do not get very dirty and do not require daily baths. In fact, too frequent bathing removes the skin's oils and causes dryness and eczema. Bathing two or three times per week is sufficient. You can also clean the dirtier areas more frequently (such as skin creases under the chin whenever dribbled milk collects or the diaper area with each diaper change) with a baby wipe or a wet wash cloth. Remember, to go easy on the soap, which can cause dry skin.

Skin care
Newborns often will shed a layer of skin during the first week of life. This is due to transitioning from an amniotic fluid environment to drier air. This is not dry skin and do not apply moisturizing cream during the first month. Newborn's skin is very sensitive to scents and chemicals that may cause a rash. I recommend avoiding baby wipes during the first month for the same reason. Instead, you can use makeup removal, cotton pads or soft paper towels moistened by a water bottle at the changing table.

Newborns often have temporary rashes generally do not require evaluation if they only last for a day or so.

Diaper rash
Urine and stool irritate the skin and often cause diaper rash. Promptly changing a dirty diaper is the best preventative step. If you see the diaper area turning red or developing red dots, apply a cream such as Desitin or Vaseline.

Going out
Contrary to popular myth, it is OK to take your newborn out in public. Newborns do well going home to a house full of older kids who expose them to a lot more germs than any public area such as a mall.

What to wear
Dressing an infant involves the same number of layers as you would wear plus maybe an additional one (such as a onesie) if cooler weather. I am a big fan of the car seat cover in the winter, which only exposes the face, allows you to stuff it with blankets and does away with the need for dressing the infant in a coat. Always wear a hat outside in cold weather.

Overdressing or overbundling an infant can lead to a false fever. In hot, humid weather, dress newborns in lighter clothing since they lack the ability to sweat and may get prickly rash.

Bedtime
Get into the habit of putting the infant down to sleep while still awake. If a baby always falls asleep in your arms, bedtime can become difficult as they get older if they require rocking to sleep.

Crying
The most common way for a baby to communicate is to cry. Over time, parents will identify whether the cry is from hunger, pain, restlessness or anger. Newborns generally cry because they are either hungry, cold, have a dirty diaper or want to be held. Do not worry about spoiling an infant those first six or nine months by pampering. A newborn needs to know that you are there to meet his needs.

You can also comfort a baby with something to suck such as a pacifier or a breast. Give the baby more physical contact and movement. Wrap the baby snugly in the blanket. If all else fails, just let him cry (up to 10 or 20 minutes for newborns, older infants longer). He may need to let off steam. Often babies will fall asleep after a good cry. If a baby cries despite consoling for more than two hours, contact your doctor.

Breathing
Baby breath sounds can be deceiving. ‘‘Go by how a child looks not sounds.'' Rapid breathing (60 breaths a minute or more) is cause for concern. Do not be alarmed by loud breathing or rattling of the chest, which is common in an infant with nasal congestion or a cough. Older children and adults can simply clear their throats. Infants do not know how to clear their throat leaving harmless mucus in the upper airways that resonates causing that rattling sound.

Infants will not choke on their secretions. You can consider elevating the head of the crib or having the infant sleep in a car seat if they are having a tough time with their secretions during a cold.

Adults and kids will breathe through their mouth when the nose is congested. Infants breathe through their nose all the time - even when congested - causing alarming but not dangerous sounds. Avoid suctioning the nose, which just irritates the baby and does not help nasal congestion.

Fever
Because a newborn's immune system is still immature, the baby is at a greater risk of serious infections. Rectal temperatures are the only accurate measure of a fever in a newborn. Accuracy is essential in the first several months, since a fever in a newborn may prompt blood work, testing, injections and sometimes hospitalization. Doctors, generally, advise against a fever reducer (acetaminophen or ibuprofen) during the first two or three months unless under medical supervision (such as after vaccination), since they can mask a fever.

Call a doctor ...

  • If less than 2 months old, rectal temperature of 100.5 degrees F or greater.
  • If 2 or 3 months old, temperature of 101 degrees F or greater.
  • If older than 3 months, temperature greater than 102, especially if no associated cold symptoms.
  • If the baby is breathing rapidly (60 breaths a minute or more) for at least 20 minutes and is not crying.
  • If the baby appears blue in areas besides the hands, feet and lips. ... Refuses more than two feedings.
  • If the baby is inconsolable for two hours

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, June 07, 2005