Martin D Rudloff, MD.

What is jaundice? Most babies are temporarily jaundiced which is seen as a yellow tint to their skin. Jaundice comes from a breakdown of red blood cells that are no longer needed. It is usually not present at birth but increases and peaks on the third or fourth day of life in full term babies and a few days later in preterm infants. It is more common in babies whose blood types differ from the mother; those who are poor feeders; those whose initial feeds are delayed by problems at birth; babies who are breast fed; and the chances of it increase with increasing prematurity in the infant. Occasionally this may require treatment. Only in rare instances would it be a serious problem. Generally, the treatment is phototherapy--a blue light which in many ways is reminiscent of a sun lamp. Commonly this is now done at home with the use of either a blanket that wraps around the baby or a bed that has a lite as a mattress. The need for any evaluation or intervention may be evident before you leave the hospital. If the mother is discharged early or the baby has some problems feeding, an infant may develop jaundice at home. If your baby's skin is bright yellow or orange as a pumpkin, his eyes are yellow, or a yellow tint extends below the waist, then call the your physician during office hours to see if this needs to be checked.

After decades of telling mothers to place infants on their stomachs, we now recommend that they be placed on their backs--backs, not sides. A number of years ago it was discovered that having an infant sleep on its stomach was associated with an increase risk of Sudden Infant Death Syndrome or SIDS. It is not the sole cause but it is a risk factor. Initially, it was suggested that infants could be placed on their sides. Now we have data that suggests the back is a safer position that the side also. So...BACK TO SLEEP. Contrary to what doctors told parents a generation ago, infants laying on their backs do not spit up more and are not more likely to choke if they do spit up. An infant develops a sleeping preference early on so start from early on laying your baby on his back. It is also important that babies sleep in a bassinet and not the parents' bed. Sleeping in the parents' bed can lead to accidental suffocation.

My baby has his days and nights mixed up what can I do? Your infant came from a place where it was dark, warm, never hungry, and, if anything, probably more comfortable at night when you were off your feet. Day and night have had no meaning and it may take some time before he develops a day-night cycle. Often this is not until the baby is about 4-6 weeks old and increasingly aware that you as his parents are more attendant during the day. Commonly, some people try to keep babies awake during the day so they will sleep better at night. This may only make for a more tired, more fussy infant. Much to the contrary, one common cause of infants keeping their eyes shut during the day is too much noise or too much light. Babies attempt to block these out by keeping their eyes closed. Remember, for 9 months it was dark and quiet except for one monotonous tone and too much light, sound, or variety of either may adversely affect or overload a very young infant.

How can I get my baby on a regular schedule? The idea of a schedule brings up the issue of infant temperament. Temperament is something that is inborn and of which regularity is one trait of your child's temperament. We all know a variety of people who are easy going and never riled, some who are easy going unless provoked (at which time they will go on a rampage), and others who are predictable only by their unpredictability. Some of our friends are easily adaptable; some are not. The same is true of babies. Some babies are regular, predictable and easy going no matter what. Others are upset and sleep poorly at the least little change in routine. If you have a laid-back, easy going baby, you can probably do anything you want, enforce any schedule you want, and she will have no problems. On the other hand, if your infant is more vocal, less regular, or not as quick to adapt, attempting a schedule will only lead to maternal-child clashes at a very young age. Rather than impose an artificial "schedule" on an infant, it is probably better as a parent to adapt to the infant's own internal rhythm.

My baby always seems to be hungry? Does he need cereal? Some babies seem like they want to eat all the time--particularly in the evening. With these infants it is important to remember that all infants have inborn sucking needs and feeding helps meet these needs. Often such infants are unable to use pacifiers or their fingers. Whenever you feed such infants, your help in keeping the bottle in their mouth helps to meet their sucking needs. It is not necessarily hunger. So try to encourage self calming sucking using his hand or a pacifier.

Your baby really doesn't need cereal until he is much older. It won't hurt him to give him rice cereal but he really doesn't need it. On the other hand, introducing other solids too early (about 4 to 6 months) is associated with food allergies.

Is there a medicine that I can give for gas? As previously mentioned, much of a baby's gas is swallowed air. Feeding him upright, making sure that he's not getting air from the nipple, and using some of the bottles or nipples made to reduce gas may be helpful. If your baby still seems trouble by gas, simethicone (brand names Mylicon or Phazyme) can be used. Simethicone is a medicine without side effects.

How often do I need to burp my baby? Although some doctors would recommend burping every ounce, this depends a little bit on each baby and probably trial an error will tell you. Keep in mind, however, that a lot depends on your baby's personality. If you have a baby who is really hungry, almost attacks the bottle, and cries when you take the bottle out of his mouth when you burp him, then attempting to burp him every ounce may only result in him swallowing more air while he cries that he is hungry.

Does my baby need water? Water is no longer recommended for infants until about 4 months of age. There have been cases where infants were unintentionally given too much water and had seizures.

My baby seems to be constipated. What can I do? Keep in mind that infants do not have much in the way of belly muscles and in an effort to move stool along and out, many strain and cry a bit when they poop. True constipation will be hard little rabbit pellet like stools. Often babies may go through a week or two of such stools and it may resolve on its own with no treatment. However, if you feel that you baby is bothered by this you may give one ounce of apple or apple prune juice with one ounce of water and see if this helps. If necessary you could give up to 2 ounces of straight juice.

My baby's nose always seems to be stuffy. Is he sick? Some infants may be snorty or sound like their noses are always stuffy. It seems that preemies are particularly snorty and grunt. Other infants, seem like they have nasal congestion but not much comes out or can be suctioned out with a bulb syringe. There are a number of possibilities for this. Some infant seem to have small nasal passages that doesn't take many secretions to block up the nose and make the baby seem congested. Generally these infants will sound this way until about 6 months. Infants who spit up, particularly if it at times it comes out the nose will sound congested. (This is call GE reflux). In a similar mechanism, some infants will get some nasal reflux from the mouth when they are fed and will sound congested immediately after eating. This may be helped by feeding the infant in an upright position. If a baby is unfortunate enough to get a cold or upper respiratory infection in the first few weeks of life, they often can take a month to totally resolve. Finally, at times chronic nasal congestion can be a sign of a food allergy.

How often should I bathe my baby? Although a baby does not need a daily bath, it is probably worthwhile to wipe off the diaper area with mild soap and water daily. . It is recommended you turn down your water heater to a low setting such as 120 degrees to avoid accidental scalding of an infant.

When can I give my baby a tub bath? This has never been really studied to know the answer for sure, however, most doctors and hospital recommend waiting until the umbilical cord is off and the umbilicus healed. If the cord takes a long time to fall off and you want to bathe your baby while the cord is on, it would be worthwhile to take a cotton ball to the cord and dry it off afterwards.

Can I use diaper wipes? Mild soap and water with a wash rag is what is recommended, however, diaper wipes are very convenient. One option is to try a non perfumed wipe and if your baby breaks out stop using them.

What's good for diaper rash? What to use on a diaper rash depends on the cause. With most parents using disposable diapers, diaper rash is not as much as a problem as it once was. There are 2 main types of diaper rash. Irritant rashes that come from loose stools and yeast rashes. Irritant rashes are most often seen in cases where the stools are loose such as diarrhea or young breast fed babies. There are a great many products for this, all of which are designed to protect the skin. Desitin, A&D ointment, and Super Dooper Diaper Goo are common ones. Aquaphor is among the best. Think of yeast rashes when the baby has been on antibiotics, or the rash is bumpy, or over the labia or scrotum, or if the baby has recently had thrush. For yeast rashes use an antifungal cream such as nystatin or lotrimin.

My baby seems to spit up a lot, is this bad? Almost all babies spit up. Some even have occasional episode of forceful vomiting. A bout of vomiting here or there isn't a sign of illness even if its is projectile. However, be aware that a condition called pyloric stenosis slowly comes on to affect infants at about 4 weeks of age and is a cause of repeated forceful emesis several times a day. As far as spitting up goes, you should be concerned about this if it seems to cause the baby discomfort, is accompanied by gagging and choking, or your baby is fitting feeds. Under these circumstances it may be significant gastroesophageal reflux and there may be some form of treatment.

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