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Pediatrician - New York
1125 Park Avenue (at E. 90th Street) 
New York, NY 10128
(212) 289-1400

Info@Carnegiehillpediatrics.com

Congratulations on your new family member!
Your baby is an individual from the day he or she is born.  As a parent, you will come to know him/her best.  Trust your instincts, and try not to take too seriously the advice of well-meaning friends and relatives.  Caring for your baby in a way that seems sensible to you will help you to strengthen your confidence as a parent and will enable you to meet your infant’s needs for love, comfort and security.

If you have a helper or nurse, try to reserve for yourself the exclusive care of the baby.  Let your helper relieve you of other household chores.

NEWBORNS
It is normal for all babies to sneeze, yawn, burp, hiccup, spit-up and pass gas.  Sneezing is the only way your baby can clear his nose of mucous.  Hiccups may last 5-10 minutes or more and do not usually require intervention. Crying is your baby’s way of communicating.  Newborns cry when they are hungry, wet, thirsty, too cold or too hot or if they just want to be held or hugged.  Sometimes there is no discernible reason for their crying.  You will gradually come to know what your baby means when he cries, and you will learn which measure will comfort him. Remember that responding appropriately to their cries cannot spoil babies.

Many infants have fussy periods that occur regularly each day, often during the late afternoon or evening.  This is not necessarily colic, but a common developmental variation that usually passes by the end of the third month.

Many babies like to suck even when not hungry.  Use of a pacifier will allow the baby to indulge this normal behavior and prevent over-feeding.

There are numerous physical variations that are present in many normal newborns.  Your infant’s head may appear elongated due to changes that occur during deliver. This elongation will improve in the first few days of life.  The shape of the head should be normal within a few weeks.   The baby’s eyelids may appear puffy, and you may notice red spots on the white area of the eye.  These are harmless and will soon go away.

The newborn’s skin may appear loose and wrinkles, and may begin to crack and peel in the first weeks of life.  No treatment is necessary (creams, lotions and oils on the skin do not help).  You may also notice tiny whitish spots, called Milia, on or around the nose.  Milia disappear within a few weeks.  The skin may also be marked by minute blood vessels that appear as red stain, usually on the forehead, eyelids or at the base of the neck.  These birthmarks will fade with time.

Breast engorgement can occur in full-term infants of either sex.  Typically, it is noticed at 2-4 weeks of age and disappears in a matter of weeks.

Newborn girls may have a vaginal discharge in the first few days of life and may have small amount of bleeding on the fourth or fifth day.  Also, the labia may appear enlarged.  All these changes result from the action of the mother’s hormones on her newborn, and they will soon disappear.

HOMECOMING
You will want to do everything possible to ensure a safe environment for your newborn.  There are many simple measures you can take to keep your baby sage and comfortable in your home.

  • VISITORS:  Your baby has not had the opportunity to build up resistance to infection, so do your best to limit visitors during the first 2-3 months.  We believe that only your closest relatives and friends should be allowed to hug and kiss the baby.  Looking at the baby from a few feet away is much less likely to spread germs.  Obviously, people who have coughs and cols should postpone their visit to your home.
     
  • CRIB SAFETY:  The slats on your crib or playpen should be no more than 2-3/8 inches apart to prevent your baby’s head from being caught between them.  The mattress should be firm, flat and fit snugly on all sides, and the crib should be kept free of pillows and toys in which the baby could become entangled.  Never leave your baby unattended with the crib side down.  Similarly, babies can fall off beds and changing tables, so be careful.  It is recommended that babies sleep on their backs but not on their side or in the prone (stomach down) position.
     
  • TEMPERATURE:  Try to keep the baby’s room temperature at approximately seventy degrees.  If you customarily keep your house temperature lower in the winter, do not let the baby’s room temperature fall below sixty-eight degrees.  It is all right to use air-conditioning in the summer, but keep your child away from a direct cold draft.
     
  • CLOTHING:  In general, your baby should be dressed with as many layers of clothing as you need in the same setting.  Indoors (70-72 degrees), a baby needs only a tee-shirt and light blanket.  In hot weather, even less is needed.  However, he may need one more layer of clothing than you do when in a cold environment.  No matter what the weather is like, avoid overdressing your child.

FEEDING
You and your baby should be as comfortable as possible during feedings.  RELAX!

Most babies are quite sleeping and not very hungry for the first two or three days of life.  Until this initial period is over, it is normal for the baby to intermittently fuss and have little interest in feedings.  Try not to worry if the baby doesn’t feed well at first.  It is normal for your baby to lose 5-10% of his birth weight in the first week, and he will regain this by the end of the second week.

Feed your baby on demand whenever she is hungry.  Don’t expect her to be on a schedule – initially most babies are quite the opposite.  Many babies still have day and night confused for up to 6-8 weeks.  They will revert to a normal schedule spontaneously after this time.  Remember that not every cry signals hunger.  Try picking up your baby and holding him, changing his diaper if necessary or allowing him to suck on a pacifier is desired. If these attempts do not quickly calm him down, then assume that he is hungry and feed him.

  • BREAST-FEEDING: The first rule of breast-feeding is “Be Patient and Persistent.”  Have confidence in yourself and your baby.  It may take 5-10 days for you and the baby to become “experts”.

During the first few days of nursing, a yellowish fluid called colostrum is produced by the breasts in small quantities.  Colostrum is a good source of antibodies that will help to protect your baby against infection.  This is all the baby usually needs until your breast milk supply comes in on day 3 or 4.  Once your baby latches on, let him finish feeding completely on the first breast and then transfer him to the second if he is still awake.  If not, he will go on the other breast at the next feeding.  Alternate the breast you begin on at each feeding and allow the baby to completely empty the breast before switching to the other side.  Try not to time the feeds or the period between feedings but rather follow your baby’s demands.  You will know that your baby is getting enough it he is content after feeds, has 3-8 stools in a day,is voiding and gains weight adequately.

Sore nipples are common initially.  To alleviate this, make sure that your position of the baby is correct.  After feeding, massage the nipple and areola with colostrum or breast milk and allow to air dry.  Contact your doctor if this persists.  Try not to supplement the baby with bottle-feeds until after the first visit.  We will discuss introducing a relief bottle with you at that time if you so desire.

  • BOTTLE-FEEDING:  We recommend that you use a newborn formula with iron (not “low iron”).  You may use the powder, liquid concentrate or ready-to-feed form.

It is not necessary to sterilize bottles or nipples.  Use soap and water or a dishwasher.  Similarly, you do not have to boil water (unless it comes from a well).  Use the same tap or bottled water that you yourself drink. (Let tap water run for 2 minutes before using).

When your child is hungry let her take as much (or as little) as she wants.  There is no maximum or minimum volume to give, and the amount consumed will vary from feeding to feeding.  Fill bottles with one ounce more formula than your baby usually takes. If she is still hungry after finishing the whole bottle, you may offer her more. Always end a feeding with some formula remaining in the bottle so you will know she has had all she wants.  When she stops, she is full.  Resist the temptation to urge her to take more. Remember, hungry babies cry; babies who are satisfied do not want any more formula and stop sucking.

Left over formula may be discarded or may be saved in the refrigerator for the next feeding.  While feeding, hold your baby’s bottle so that the nipple is always filled with formula, not air.  Never leave your infant alone to feed with a propped bottle because it can easily slip into the wrong position.  You child will also enjoy the pleasure and security of being held at feeding time.

  • WATER: Your baby receives enough fluid from formula or breast milk, so it is not necessary to give water between feedings (even in hot weather).
     
  • VITAMINS:  Formulas contain all the vitamins a healthy baby needs.  However, because some mother’s milk may not contain enough Vitamin A, C or D, we usually prescribe a vitamin supplement for breast-fed infants at the first office visit.
     
  • FLUORIDE:  Fluoride has a profound effect upon decreasing the incidence of dental caries (cavities).  If your water supply is fluoridated (as in New York City) and your baby is bottle fed, mixing liquid concentrate or powered formula will provide the recommended amount of fluoride.  Ready-to-feed formulas and formula mixed with non-fluoridated water do not contain sufficient amounts of fluoride, and a fluoride supplement is recommended.

Like some of the vitamins, fluoride enters breast milk unreliably.  So, in addition to vitamins, breast-fed babies will need fluoride too.  Please use fluoride exactly as directed by your doctor because too much can be harmful.

  • BURPING:  Burping helps your baby to remove swallowed air.  Although many babies will not burp after each feeding, you should try to burp your infant when a feeding is completed.  Your baby can be burped by holding him upright over your shoulder, by placing him face down in your lap, or by holding him in a sitting position with your hand supporting his chest.  Gently rub or pat your infant’s back to help remove the air.  It is not unusual for infants to spit up a small amount of breast milk or formula while being burped. 

BOWEL MOVEMENTS
For the first day or two after birth, your baby’s bowel movement will consist of meconium, sticky greenish-black material.  After this is passed, bowel movements may vary in color (green, yellow or brown), consistency (loose, soft or pasty), and frequency (ten times a day to only one time every few days).  A breast-fed baby usually has several bowel movements a day, sometimes during or after feeding.  Their stools are usually soft, mustard-colored and have small curds in them.  Formula-fed infants usually produce stools that have a more pasty consistency.  The number of bowel movements in all infants will decrease after a few weeks.

Bowel movements that occur less frequently but still have a soft consistency are considered normal and do not require intervention.  In fact several days may pass between movements.  Straining and pushing while producing a soft stool is also common.  Dietary modification maybe required if you baby begins to produce hard stools that are difficult to pass.  Please contact the office if this problem arises.  You may use either cotton balls and water or commercially available “wipes” to clean the diaper area when your child is wet or dirty.  Using a diaper ointment is optional, but we do not recommend using baby powders or corn starch.  Girls should be wiped from front to back, keeping germs  from the anus away from the bladder opening.

BATHING
Bathing the baby daily is common practice; however, you may also bathe her as little as twice a week.  You may use a mild soap right away and can also use baby shampoo/wash on the baby’s hair.

UMBILICAL CORD
A tub bath should not be given until your baby’s umbilical cord has fallen off and the navel is completely healed.  Until then, a sponge bath every day or two is sufficient to keep your baby clean and comfortable.  In about two weeks, the cord will fall off. A small amount of blood or mucous may be present as the cord separates from the skin and may continue to appear for several days.  You may apply rubbing alcohol with a clean cotton ball to the umbilicus until the navel is dry and healed. When no more debris is seen for 24 hours, you can give a tub bath.

CIRCUMCISION
If your baby boy has been circumcised, the head of the penis may appear red and swollen.  It is also common to see mucous around the incision, and you may see spots of blood on the diaper for several days.  Change your baby frequently and gently clean his penis with a fresh cotton ball and warm water.  Petroleum jelly, A&D or  antibiotic ointment should be applied liberally to the head of the penis at each diaper change.  A snug diaper will help to prevent unnecessary rubbing or irritation.

SLEEPING
Initially, the baby may be expected to sleep 2-4 hours at a time.  Most babies do not sleep throughout the night until at least 3 months of age.  The American Academy of Pediatrics recommends that all newborns should be placed on their backs for sleeping in order to decrease the incidence of SIDS.

PREVENTIVE HEALTH CARE
Your child will be examined routinely throughout infancy, childhood, and adolescence to evaluate general health, growth and development, and to receive immunizations.  Your doctor will tell you how often your baby should be examined.  Generally the first office visit is 2-4 days after leaving the hospital.

Call us immediately if in the first two months:

  1. Your baby has  difficulty with feeding
  2. The baby develops vomiting or diarrhea, inconsolable crying or extreme lethargy
  3. The baby has a rectal temperature above 100.5F.  Take the temperature only if the  baby is acting sick or feels warm to the touch

CALLING HOURS
Of course, there will be other questions.  We will try to answer them as they arise.  We prefer to be called on weekdays between 7 and 8 o’clock in the morning for routine questions.  Needless to say if there is some problem that cannot wait, do not hesitate to call at anytime.

Call the office well in advance to arrange check-ups.  Please come in to your appointment on time so that we can stay on schedule for other patients.  Leave extra time in case a last minute feeding or diaper change is necessary.  If you cannot keep your appointment, please let us know right away so we can give that time to someone else.

CONGRATULATIONS ON THE BIRTH OF YOUR INFANT!
This happy event marks the beginning of a new phase in your life, filled with a great deal of satisfaction and joy.  It is also hard work, so try to rest whenever possible.

View the KidsDoc Symptom Checker from HealthyChildren.org

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