VITAL STATISTICS

Name: _____________________________________________

Birthdate: __________________________________________

Birth weight: _______________________________________

Discharge weight: ___________________________________

Length: ____________________________________________

Head circumference: _________________________________

Hospital records & vaccinations:

� 1st newborn screen date _________________

� Vitamin k injection date _________________

� Erythromycin eye ointment date _________________

� Hepatitis B vaccination date _________________

� Other ________________________________________________

Blood type: _________________________________________

Insurance information: ________________________________

___________________________________________________

Notes: _____________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

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CONTENTS

In the Hospital 3

Feeding 4

Before You Go Home 11

Basic Baby Care 14

Home at Last 20

Important Items to Have 24

How to Tell if Your Baby is Ill 25

Ongoing Health Care 27

Have Questions or Need Assistance? 29

Helpful Hints 32

Phone Directory 34

Helpful Books to Read 35

List of Questions to Ask at Next Well Care Appointment 36

History of Office Visits 37

WELCOME BABY!

Congratulations on your new arrival! This is an exciting time for you and your family We hope that this booklet will answer many of your questions and help you provide the very best care for your new infant

Once you are home, you may want to visit the “Newborn / Baby Care” page of our website at www.AdvancedPediatricAssociates.com.

Our comprehensive website provides a helpful resource of provider-reviewed medical information, including articles on newborn behavior, illness, feeding, sleeping, colic, breastfeeding issues and more For your convenience, we have also added an easy to use “Newborn and Baby Care” pull down menu on our “Home” page, which provides quick access to many of the most common newborn care topics

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ABOUT US

For over 45 years, Advanced Pediatric Associates has been dedicated to providing quality health care to newborns and their families Advanced Pediatrics has four convenient neighborhood locations in Aurora, Centennial, Parker and Denver (Stapleton).

Advanced Pediatrics has taken special care to develop a model for pediatric care which combines the benefits and services of a larger group practice with the personalized care of a smaller physician office We strive to foster a caring partnership with families, working “hand in hand” with them to promote the best possible health for their children. Our goal is to provide a “Medical Home” to our patients, where families can expect compassionate and comprehensive care within our offices, convenient access to quality after-hours advice, and professional coordination of care between our providers and community specialists and services

Our providers bring many combined years of experience, a wide range of specialized interests, enthusiasm and devotion to providing the very best health care to our patients Our provider staff consists of physicians, nurse practitioners and physician assistants who specialize in pediatric health care for children from infancy through adolescence. All of our pediatricians are board certified by the American Board of Pediatrics and are members of the American Academy of Pediatrics The Pediatric Nurse Practitioners (PNP), and Physician Assistants (PA) employed by Advanced Pediatric Associates have received specialized graduate level education and training in pediatrics, and work in partnership with our pediatricians to provide primary health care services to patients They are licensed and / or certified in their specialty

To learn more about Advanced Pediatrics, please visit our website at AdvancedPediatricAssociates.com To read about each of our pediatric health providers, please visit “Meet Our Provider Staff” in the “About Us” section of our website

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IN THE HOSPITAL

Nursery nurses closely watch your baby for the first six hours of life This transitional period is very important as babies are proving they can successfully make it on their own outside their mother’s body Before your baby is discharged, hospital staff will do the first newborn screen to detect certain genetic disorders, and your baby will be examined by one of our physicians (or a hospital physician if you deliver at a hospital outside of our rounding area) We recommend that your baby receive a Vitamin K injection, Erythromycin eye ointment, and the first Hepatitis B vaccine while in the hospital.

If you had a baby boy and would like him circumcised by one of our physicians, please let the nursery staff or the Advanced Pediatrics’ physician who sees your baby in the hospital know of your interest. We recommend circumcisions be done as soon as feasible after birth, preferably in the first 7 days If your baby boy is not circumcised in the hospital, we can also schedule a circumcision in our office

When your baby is with you, feel free to unwrap and examine him or her closely, but remember that your baby’s body temperature is influenced by room temperature If the room is cool, your baby should not be kept unwrapped for very long However, if the room is quite warm, just a T-shirt and diaper may be enough covering A good rule of thumb is todress your new baby in one more layer than you are comfortable wearing

As soon as you are given a discharge date from the hospital staff, please call our Patient Care Line at 303-699-6200 to schedule your baby’s first well care appointment. We would like to see your new baby in one of our offices within 1–3 days of discharge from the hospital (Please let our care coordinator know if you would like to schedule a circumcision in our office )

Be sure to call your insurance company to let them know your baby has been born, and let them know that you have chosen one of our physicians as your baby’s primary care physician (PCP) if a PCP is required.

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FEEDING

Feeding time is your baby’s favorite time Both you and your baby should enjoy the closeness that feeding time brings Whether you are breast or bottle-feeding, relaxation is the most important factor A comfortable, quiet environment is important for successful feeding Breast milk or formula is all a baby needs for complete nutrition for the first six months of life

BREASTFEEDINGWe encourage breastfeeding as the most natural, satisfying and beneficial way to feed babies. In addition to maintaining a close mother-baby relationship, breastfeeding offers benefits to both mother and infant Moms experience quicker postpartum recovery, reduced health risks, and psychological benefits Breastfeeding provides your baby with the ideal milk, enhanced immunity (protection from disease), and a far lesser incidence of allergies Studies also show psychological, developmental and cognitive benefits for breastfed babies In addition, breastfeeding is less expensive and often more convenient

Before your milk comes in your breasts produce colostrum, which is yellow to orange in color and thick and sticky Colostrum is low in fat, and high in carbohydrates, protein, and antibodies to help keep your baby healthy Though it is low in volume (measurable in teaspoons rather than ounces), it is high in concentrated nutrition for your newborn

Breastfeeding is a learning process and does not always come easy. Be patient and confident that you can breastfeed your baby. It is often uncomfortable for the first few weeks until you and your baby learn to latch properly The best rule for breastfeeding is to nurse as frequently as your baby seems interested Babies do best on their own schedule As you feel up to it, nursing about every 1 to 3 hours the first 2 to 3 days brings your milk in more quickly and minimizes the breast engorgement that may accompany the arrival of your milk supply Most babies feed 10 – 20 minutes per breast, typically longer on the first breast You will know your infant is done when he or she either “pops off” your breast and doesn’t immediately root again or falls asleep with your breast in his or her mouth Though a baby will typically nurse from both

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breasts, he or she may occasionally be satisfied after nursing on just one side After nursing on the first breast, burp your baby, try to reawaken and offer the second breast When feeding your infant, watch your baby, not the clock You should see intermittent swallowing and a gentle ear wiggle with nutritive suckling Begin each new feeding on the breast that was nursed from last or not used at all in the previous feeding

To ensure successful breastfeeding first awaken your baby by fully unwrapping him or her, changing his or her diaper, or briskly rubbing his or her body or feet Next, if your baby is not already rooting, stimulate the sucking reflex by letting him or her suck on your finger or by stroking the cheeks If you need to, stimulate your nipple to get it erect When latching your baby you need to assist your infant with head control; this is easily achieved in the football position To achieve a good latch, baby’s mouth should be open wide and draw in an inch and a half of breast tissue into his or her mouth.

Nipple tenderness is frequently experienced in the first week of breastfeeding with the initiation of each feeding Pain that persists the entire feeding is not normal The very best way to prevent nipple soreness is by making sure your baby is properly positioned on your breast When properly positioned, your baby’s jaws go beyond the nipple to come together on the areola, about an inch and a half in, not on the nipple itself Babies who take enough of the areola into their mouths massage the breast which causes milk to be released from the ducts Babies who suck or chew only on the tip of the nipple do not empty the breast effectively and cause sore nipples You can soothe soreness by expressing breast milk onto your nipples and exposing them to air dry after each nursing You may also try lubricating sore nipples with lanolin (available at the pharmacy or grocery store) after each nursing You need only clean your breasts once a day when bathing with warm water

Once you are home from the hospital it is best not to let your baby go more than 2 to 3 hours between daytime feedings However, once your milk is in you may let him or her sleep one 5 hour stretch at night Encouraging your baby to nurse more often during the day may result in your baby sleeping a little longer at night

After the first f ew d ays o f n ursing t here a re s igns f rom b oth mother and baby that indicate breastfeeding is going well.

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For mother these include: • Milk “comes in” about 2 to 5 days after delivery

• Nipple tenderness gradually decreases

• Breasts feel full before nursing and become softer after feeding

• A “let-down” or tingly, pins and needles sensation including milkdripping and spraying (more typical after 2 to 3 weeks)

For baby these include: • Nursing 8 to 12 times in 24 hours (about every 2 to 3 hours) with

at most one 5-hour stretch at night

• Seeing / hearing swallowing during nursing

• Baby is relaxed and falls asleep after nursing

• Bowel movements that look like yellow, seedy cottage cheeseor mustard by the 4th or 5th day of life, and come either afterevery feeding or every other (frequency will decrease with time)

• Wet diapers 6 to 8 times a day with pale yellow, odorless urine

It is important that a breastfeeding mother eat regular, balanced meals. You will need 500 extra calories per day above your normal pre-pregnancy diet and should remain on your prenatal vitamins while nursing. You may eat any food that agrees with you, even spicy foods Avoid excessive amounts of caffeine and alcohol, but an occasional glass of either is all right Be sure you get plenty of fluids and drink when you are thirsty

If you need pain medication (such as acetaminophen or ibuprofen) during the first few days, you may take it Please consult our office before taking other medications while breastfeeding Your provider will recommend that your infant start vitamin D supplementation at two weeks of age. This is very important for all breastfed infants.

All new moms need plenty of rest and relaxation in order to recover from the birthing process Sleep when baby sleeps, including daytime naps, especially at first Allow family, friends and neighbors to do things for you around the house Remember that breastfeeding is a learning process for both baby and mother.

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Supplementary formula is not usually necessary as a baby is learning to breastfeed However, your provider may at times suggest that you give formula to supplement your breast milk until your milk comes in Breast pumps are easily accessible and can be very helpful in getting the breastfeeding process going

If you are concerned about your production of milk, your baby’s intake, or if you have any questions or problems, don’t hesitate to call our Patient Care Line at 303-699-6200 and speak with one of our registered nurses. A large part of successful breastfeeding is established in the first two weeks, and we want to be there to support you as needed.

After breastfeeding is well established (generally between 2 to 4 weeks of life), we encourage bottle feeding 2–3 times per week with either expressed breast milk or formula This helps your baby learn how to use the bottle if the need arises, or if you will be returning to work When returning to work, we suggest increasing bottle feedings and pumping during your work hours for 2 weeks prior to your first day at work to ease the transition

PUMPING & COLLECTING BREAST MILKMost new moms do not need to pump or collect breast milk until they are ready to introduce a bottle or are preparing to go back to work For moms needing to improve their milk supply, short and frequent pumping in the first 2 weeks of baby’s life can help Once you introduce a bottle, you may want to begin storing breast milk for later use It’s important to wash all bottles and pump parts in hot soapy water or in a dishwasher; rinse and dry on a clean towel Be sure to read and follow your pump instructions

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BREAST MILK STORAGE GUIDELINES

Where Temperature Time Comments

At room temperature (fresh milk)

66° to 78° F (19° to 26° C)

4 hours (ideal) up to 6 hours (acceptable)

Contents should be covered and kept as cool as possible; covering the container with a damp towel may keep milk cooler

Insulated cooler bag

5° to 39° F (-15° to 4° C)

24 hoursKeep ice packs in constant contact with milk containers; limit opening cooler bag

In a refrigerator <39° F (<4° C)72 hours (ideal) up to 8 days (acceptable)

Collect in a very clean way to minimize spoilage Store milk in the back of the main body of the refrigerator

Freezer (compartment of refrigerator)

5° F (-15° C) 2 weeks

Store milk away from sides and toward the back of the freezer where temperature is most constant Milk stored longer than these ranges is usually safe, but some of the fats break down over time

Freezer (compartment of refrigerator with separate doors)

0° F (-18° C) 3 – 6 months

Deep Freezer -4° F (-20° C) 6 – 12 months

Breast milk storage tips:

• Wash your hands before expressing or handling breast milk

• Store breast milk in clean screw-cap bottles or bags specificallydesigned for breast milk

• Freeze breast milk if you do not plan to use within 24 hours

• Label breast milk with the date and time it was expressed anduse oldest milk first If giving to caregiver, clearly label with yourbaby’s name

• Freeze breast milk in 2 to 5 oz portions to reduce waste

• Do not add fresh breast milk to previously frozen breast milk

• Thaw breast milk in refrigerator or by placing in warm bowl ofwater Do not microwave.

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• Use previously frozen breast milk within 24 hours or discard Donot refreeze

• If baby doesn’t finish breast milk, do not save for future feeding– discard it

BOTTLE-FEEDINGWe recommend that you use a formula with iron and DHA-ARA. Research has demonstrated that iron, DHA and ARA, all present in breast milk, are important for physical growth and development of the eyes and brain Talk to your care provider if you have questions about formula

When bottle-feeding your baby, make sure you are both settled comfortably Cradle your baby in your arms or hold him or her lengthwise in your lap, so that baby’s head and upper back are several inches higher than his or her hips. Hold the bottle at an angle to keep the nipple full of formula Babies should be burped after every 1 to 2 ounces Sitting your baby upright with his or her back straight for 20 to 30 seconds is long enough to produce a burp if one needs to come up Drinking more slowly and burping more often may help babies who tend to spit up After feeding, babies may be held or should be placed on their back

Bottle-fed babies usually drink 1 ½ – 2 ounces per feeding every 3 to 4 hours with a gradual increase to 3 to 4 ounces by the end of the first two weeks Sucking for 20 to 30 minutes should give your baby all he or she needs Babies who are feeding frequently and well during the day may sleep as long as they want at night

When making formula, be sure to follow the instructions to ensure proper concentration of formula Sterilizing water for the formula is not necessary (unless you use well water) If you make one bottle at a time and use warm tap water, there is no reason to heat the formula If you make a whole batch of bottles at once, you may refrigerate the bottles and use them up to 48 hours from time of mixing When heating cold formula it is best to use warm water and avoid microwaves. Microwaves heat unevenly and have caused exploding

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bottles, severe burns, and destruction of the nutrients in the formula After heating, make sure you mix the contents of the bottle to distribute all heat evenly and check the temperature before feeding your baby Bottles do not need to be sterilized Automatic dishwasher cleaning of bottles and nipples is adequate Plastic bottles are preferable to glass ones, as they will not break Due to concerns regarding the safety of BPA (bisphenol A) in many polycarbonate bottles, we recommend purchasing plastic bottles that are “BPA free.”

If you are concerned about your baby’s feeding or weight, or have any questions or problems, don’t hesitate to call our Patient Care Line at 303-699-6200 and speak with one of our registered nurses.

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BEFORE YOU GO HOME

SAFE TO SLEEPSudden infant death syndrome (SIDS) is the sudden and unexplained death of an infant under one year of age Since promotion of the “Back to Sleep” campaign in 1983, the rate of SIDS has fallen by over 50 percent Sadly, however, there are still over 2,000 deaths per year in the United States and thousands more throughout the world One of the most important things you can do to decrease the chance of SIDS is to put your baby on his or her back to sleep Some other suggestions include:

• Avoid soft mattresses, pillows, waterbeds and beanbag furniture Use a firm mattress in a safety-approved crib

• Keep your baby’s sleeping area clear of clutter, including stuffed toys and soft bedding

• Avoid smoking and keep your baby’s environment as smoke-free as possible

• Keep your baby’s room at a comfortable temperature (65º to 68º) A warm sleeper (if needed) is preferable to loose blankets

• Do not use a hat on a sleeping baby

• Bed sharing has not been found to protect against SIDS and according to the American Academy of Pediatrics can be hazardous to your baby’s health

CAR SEATS AND CAR SAFETYMotor vehicle accidents are the leading cause of death for children under the age of nineteen. Of the hundreds of thousands injured, many remain permanently disabled Accidents are all too often caused by the carelessness of others Ordinarily a parent’s arms are a very secure place for a child, but this is not so in a car Even if you are wearing a lap and shoulder belt yourself, your baby could be wrenched from your arms by the violent forces of a collision

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Beginning with the very first c ar r ide—the r ide h ome f rom t he hospital—your baby should be secured in a crash tested safety seat. Research on the effectiveness of child safety seats has found them to reduce fatal injuries by 71% for infants and 54% for toddlers If you do not already own a child safety seat, you can learn more about approved safety seats by picking up a child safety seat brochure in our office or visiting the “How to Find the Right Car Seat” page at nhtsa.gov/equipment/car-seats-and-booster-seats.

At a minimum, Colorado law states that babies must ride in the car-seat facing backwards until they are 12 months old and weigh at least 20 pounds. However, safety experts recommend that children remain in a rear facing “convertible” car seat as long as the car seat allows (at least 2 years) For a list of local car seat inspection services, see the “Newborn / Baby Care” page of our website

VITAMIN K INJECTION, ERYTHROMYCIN EYE OINTMENT & HEPATITIS B IMMUNIZATION We recommend that hospital staff give your newborn a Vitamin K injection (to prevent bleeding disorder), Erythromycin eye ointment, and the first Hepatitis B vaccine while you are in the hospital If you have any questions or concerns regarding this, please discuss with our rounding physician at the hospital Be sure to bring a record of the Vitamin K injection, Erythromycin eye ointment, and Hepatitis B vaccination to your first office visit.

IMPORTANT VACCINATIONS FOR PARENTS AND FAMILY MEMBERSPERTUSSIS (WHOOPING COUGH)Pertussis is a bacterial infection (spread through sneezing and coughing) which causes swelling and narrowing of the breathing passages and a severe, violent, and rapid cough, which can last for months Pertussis is most severe in infants under 6 months of age, particularly if premature Complications of pertussis include pneumonia, seizures and sudden death Because infants under 6 months are most at risk, those who will be around the infant - parents, siblings, grandparents, other family members and caregivers - should check with their physician to make sure they are up-to-date

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on vaccine protection against pertussis (The American Academy of Pediatrics recommends that ALL expectant mothers be vaccinated against pertussis during the third trimester of EVERY pregnancy Ideally others who will be around the infant should also be up-to-date on the pertussis vaccine at least two weeks before baby’s birth to best protect newborn from exposure to whooping cough )

INFLUENZABabies under 6 months of age are at a higher risk for serious complications from influenza, but are too young to receive the flu vaccine As a result, it is very important for parents, family members and caregivers to be vaccinated against influenza to help form a protective “cocoon” against the flu for newborns and young infants

NEWBORN OFFICE VISIT The first office visit for your baby is usually 1 to 3 days after discharge from the hospital unless you are told otherwise Please call our Patient Care Line at 303-699-6200 to schedule this appointment as soon as possible. (Please let our care coordinator know if you would like to schedule a circumcision in our office ) Also please bring any information about your baby that you are given from the hospital. At this visit your baby’s weight will be checked, a physical exam will be performed, and we will answer any questions you may have

Following this initial visit, we will see your baby regularly until feeding and weight gain are established and again at 2 weeks of age (at which time we will do the second newborn screen)

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BASIC BABY CARE

BABIES ARE BABIES! ALL BABIES . . . SNEEZE, COUGH, AND MAY SOUND CONGESTED Sneezing is how a baby cleans his or her nose of mucus, lint or milk curds Coughing is often baby’s way of clearing his or her throat Your newborn may also sound congested This is not only because newborns primarily breathe through their noses until they are about 4 months of age, but also because the humidity in Colorado is so low Using nasal saline drops and a cool mist humidifier may be beneficial (see “Home at Last” section)

HICCUPHiccups are little spasms of the diaphragm muscle Having your baby latch onto your breast for a few minutes or giving a few sips of formula from a bottle may stop them

SPIT UP Spitting up is very common with infants (some babies spit up after every feeding) This typically improves with age Spitting up is different than vomiting (see “How to Tell if Your Baby is Ill” section) Spitting up is not painful, does not cause crying, is smaller in amount, and is usually caused by poor closure of the valve at the upper end of the stomach and overfeeding If you are concerned that your baby may be sick, or about the frequency or forcefulness of spitting up, please call our office.

Here are a few tips to help manage spit up:

• Feed baby in calm and quite environment, free from anyinterruptions, sudden noises or bright lights

• If your baby spits up frequently, try giving smaller amounts perfeeding

• Hold baby in upright position when bottle feeding Do not feedwhile baby is lying down

• Burp baby 2 or 3 times during each feeding (every 3 – 5minutes for bottle fed babies) Burp each time for less than a

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minute, even if no burp occurs Babies don’t always need to burp

• When bottle feeding, make sure hole in nipple is correct size If it is too large, the formula will flow too fast, and if it is too small your baby will get frustrated and gulp for air To see if hole is correct size, invert bottle and then stop A few drops should come out

• Hold baby upright for 20 – 30 minutes after each feeding Sometimes it is helpful to use a front-pack, backpack or swing for up to 60 minutes after feedings

• Decrease time baby spends in sitting position (such as infant seats) After 6 months of age a jumpy seat is helpful The newer ones are stable

• Wait 2 – 2 ½ hours between feedings, but not so long that baby is frantically hungry

ARE UNCOORDINATEDExcept for sucking, baby’s actions are poorly coordinated Arms and legs twitch, tremble and move without purpose Breathing is often irregular and noisy Babies respond to sudden movements or stimulation with jerky arm and leg movements and crying

CRYIn most instances crying babies need to be held They need someone with a soothing touch and voice During the early months of life too much holding cannot spoil babies It is, however, normal for a newborn to cry occasionally without reason (Babies are often fussiest in the evening and crying generally peaks when baby is around 6 weeks old) In fact, some babies cry in order to fall asleep When your baby cries make sure that he or she is not hungry and is dry and comfortable (no sign of illness, pain or fever) Then if holding your baby does not console him or her, it is fine to let your baby cry for 10 to 15 minutes to see if he or she will fall asleep

FUSSY BABIESWhile all babies cry, some cry more than others One in five babies is fussy – difficult to comfort and may have trouble feeding and sleeping For parents, caring for a fussy baby can be exhausting and frustrating

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If you have concerns about your baby’s fussiness, please call our Nurse Line and discuss your concerns with one of our registered nurses. No matter how tired and frustrated you may be, NEVER shake your baby. Shaking a baby can cause severe brain damage and other serious disorders – even death If you find yourself overwhelmed by crying, put your baby in a safe place like a crib, close the door, and check back when you’re calm For more information on calming a crying baby, see www.CalmACryingBaby.org and www.FussyBabyNetworkColorado.org

BATHING BABY AND SKIN CAREClear water sponge baths should be given until the umbilical cord has fallen off and the navel is completely dry. Then you can tub-bathe your baby with water and a mild soap such as “Dove ” Avoid deodorant and highly scented soaps Since Colorado has a dry climate, baths normally need to be given only every 2 to 3 days Wash your baby’s hair once or twice a week with a mild baby shampoo Do not use cotton swabs in ear canals. Normally, baby’s skin does not need any ointments or baby oil If, however, your baby’s skin is dry or cracked, apply a white non-scented lotion, cream or ointment such as Aveeno, Aquaphor, Moisturel, Eucerin or Keri once or twice a day to damp skin

DIAPERS AND DIAPER CAREDisposable diapers and cloth diapers are both fine for baby If you choose cloth diapers, make sure the diaper is pre-rinsed and soaked in a vinegar solution or Diaperene It is also important to do two rinses following washing to eliminate soap and ammonia residue, which are two of the causes of diaper rash

Your baby’s diaper should be changed whenever it gets wet or soiled. After removing the diaper, rinse baby’s bottom with a warm wet washcloth (or alcohol free baby-wipes) If your baby had a stool, it is ideal to wash him or her in a tub of warm water using a mild soap to make sure that your baby is clean

Proper diaper care can prevent most diaper rashes If your baby does get diaper rash, most respond to 3 days of warm water cleansing

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and air exposure If you have tried this or the rash is bright red, your baby may have a yeast infection which can be treated with an over the counter anti-yeast cream such as Lotrimin three times a day Please call our office if rash doesn’t improve after 3 days of using anti-yeast cream, or if you notice pimples, pustules, yellow scabs, spreading redness or the rash is very raw or bleeds.

FINGERNAILS AND TOENAILSTrim your baby’s nails once a week after a bath when they are soft Use clippers, baby scissors or a nail file Round off the corners of the fingernails so that your baby won’t scratch himself or herself Cut toenails straight across to prevent ingrown toenails It is often easiest to trim fingernails and toenails while your baby is asleep

UMBILICAL CORD CARETry to keep the cord dry It may take from one to three weeks for the cord to fall off If during this time you smell a foul odor or there is redness surrounding the cord, please call our office. There may be some oozing of fluid or blood that is harmless If so, you may clean the area with alcohol and a cotton ball twice daily for one day If the area continues to ooze or is raw for more than 5 days, please call our office. Clear water can be used to clean the cord base once cord has fallen off Do not give your baby a submersion bath until the umbilical cord has fallen off.

CIRCUMCISION AND MALE GENITALIA If your baby is uncircumcised you do not need to retract the foreskin of the penis any further than it does naturally Retraction usually occurs gradually over the first four years of life

If your baby was circumcised using a plastibell (a small plastic ring encircling the end of the penis), you do not need to apply creams or Vaseline to the penis Clean the area with warm water until the plastibell falls off, usually within 7 to 14 days

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If your baby is circumcised without a plastibell, use Vaseline jelly on the tip of the penis for the first couple of days to keep it from sticking to your baby’s diaper During the healing process it is normal to see yellowish patches over the head of the penis and tiny spots of blood on the diaper

FEMALE GENITALIABaby girls sometimes have a bloody or mucous discharge from the vagina for the first week or two of life This is normal It is also normal to have a thick white substance in the inner labia Some girls have a hymenal tag, an extra tag of skin in the vaginal area This is also normal When changing a diaper or bathing your baby, clean the entire labial folds and creases by wiping from front to back It is not necessary to remove the thick substance

BABY’S STOOLSBaby’s stools initially are sticky, dark greenish-black (meconium) After a few days the stools become yellow-green and seedy (transitional) Formula-fed babies stools become yellowish curdy to semi-solid about the third day Breast-fed babies have mustardy, very liquid stools The normal number of stools varies from one every feeding to one large, soft stool every second or third day

CONSTIPATIONMany parents are concerned their baby is constipated when they turn red and appear to be straining while passing stool This is very normal—as long as the stool is normal, your baby has an appetite and the stool is not hard Constipation is hard, dried-out pellets of stools Infrequent stools do not mean that a baby is constipated If your baby has gone for longer than four to five days with no bowel movement (assuming all else is well), try taking your baby’s temperature rectally This often stimulates a stool If that stool is hard and dry or if this does not produce a stool, call our office. Breastfed babies may go 7 to 10 days without having a stool

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DIARRHEADiarrhea is a marked increase in both the amount of liquid in the stool and / or the frequency of the stools A diarrhea stool appears to be mostly fluid that soaks into the diaper Call our office if true diarrhea persists over several hours or if you see blood in the stool.

TAKING TEMPERATURETemperatures measured rectally are the most accurate However an armpit temperature is the safest and may be helpful for screening If the armpit temperature is above 99° F (37 2° C), check again with a rectal temperature To take a rectal temperature, lubricate a clean rectal thermometer with petroleum jelly, then lay your baby stomach down on your lap Gently slide the thermometer into the opening of the anus for about ½ inch (inserting until the silver tip disappears) Hold your baby still and leave the thermometer in 2 minutes with a glass thermometer, or about 20 seconds with a digital electronic thermometer (until it beeps) If the temperature is over 100 degrees (or less than 97.5 degrees), please call our office.

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HOME AT LAST

SLEEPINGNewborns normally sleep 14 to 17 hours per day Babies generally do not have regular sleep cycles until they are around 6 months old. As babies get older they need less sleep and take more regular naps Every baby is different, but the sleep chart below may give you a general idea for how much sleep your baby may need per day during the first 2 years of life

AVERAGE SLEEP PER DAYAge # of Naps Length of Naps Total Hours Sleep

Newborns 0 - 3 months inconsistent inconsistent 14 - 17

Infants 4 - 11 months 1 - 4 30 min - 2 hrs 12 - 15

Toddlers 1 - 2 years 1 1 - 3 hrs 11 - 14

Research shows that swaddling helps keep newborn babies calm and asleep longer because swaddling mimics the coziness inside the womb It is important that swaddling be snug around baby and not come loose – but not too tight Only swaddle baby when it is time to sleep, because a swaddled baby will often sleep longer and not wake as easily To reduce the risk of SIDS (sudden infant death syndrome), always put baby to sleep on his or her back. Stop swaddling baby by 2 months of age, or once baby starts trying to roll over. See our "How To Swaddle" video on our website!

CRIB SAFETYIf possible, have your baby sleep in a standard-sized crib with a firm mattress Since your baby will spend much of his or her time in the crib, make certain it is safe Crib bars should be no more than 2 3/8inches apart (If you are using an older crib, please make sure you check the distance between the crib bars ) All cribs should be checked for loose or defective crib bars before using The mattress should be the same size as the crib and should be waterproof Bumper pads and wedges are unnecessary and can even pose a safety threat Stuffed toys, pillows and other items should be removed from the crib, as they

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also pose a hazard to a sleeping baby Co-sleeping (sharing sleep time in bed with your newborn) can also be dangerous, especially in households where there is smoking.

CLOTHINGYour baby will generally be comfortable in one more layer of clothing than you require at any particular time of year Light loose-fitting cotton or synthetic fabrics are best Avoid wool or silk fabrics and wash all new clothing and blankets before using them

PACIFIERSA pacifier can be useful for soothing babies The shield should be at least 1½ inches in diameter and the pacifier should be one single piece Recent studies have shown that babies who use pacifiers at naptime and bedtime throughout the first year of life may have a reduced risk of SIDS

GOING OUTDOORSYou may take your newborn outdoors whenever the weather is pleasant Babies born in the summer may be taken out after they are about a week old; you may want to wait awhile longer to take a newborn out in the winter Make sure your baby’s head is covered—especially in the cold, wind, and sun Avoid direct sun—babies sunburn easily and that can be very dangerous.

ROOM TEMPERATURE & HUMIDITYTry to keep an even, comfortable temperature in the house Ventilation is important in warm weather A thermostat setting that is comfortable to you is acceptable as long as baby is wearing an extra layer of clothes and booties When baby is sleeping, it is preferable to dress baby in sleeper warm enough for the room temperature, rather than covering baby with loose blankets

A cool mist humidifier is highly recommended for baby’s room. This is useful for dry winter months and for treatment of many

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respiratory illnesses No additive fluid or medicine is advised Steam humidifiers should be avoided because of the possibility of burns It is important to wash the humidifier with vinegar and soapy water at least once a week to prevent a build-up of minerals and mold Water in the humidifier should be changed daily

VISITORS AND CROWDSIt is best to keep your baby inside, away from a lot of contacts, especially in the first two months of life. If your baby goes with you to crowded places during the first two months of life, a Snugli type carrier is ideal These carriers keep your baby next to mom or dad and away from other people

Everyone wants to hold, feed and play with your new baby Unfortunately, some of these people, especially other children, may have a cold or other infection Your baby should not be passed around from person to person—you may have to be very firm about this Make sure that those who will be around your baby have been vaccinated against Pertussis (whooping cough) and the flu. Good hand washing is essential for anyone who will be touching or holding your baby.

Crowds of people are not healthy places for new babies This includes supermarkets, churches, department stores, restaurants, and schools Babies less than two months of age should not be taken to places where there is an increased risk of exposure to germs.

When you need a babysitter, a supportive family member or a good friend is often the best solution Try to avoid leaving your newborn at a place that has older toddler children because of the increased risk of exposure to germs If your baby gets ill, he or she should always remain at home or in the care of immediate family

FRIENDS AND HELPERSEveryone needs help during the first few weeks Welcome help from family, friends, or neighbors, but make sure that they understand that it is your job to take care of your baby They can help best by taking care of household chores, shopping or errands

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POSTPARTUM BLUESMore than 50% of new mothers experience postpartum blues, which can begin shortly after delivery and last one to three weeks. Symptoms include sadness, crying, moodiness, exhaustion, and difficulty thinking clearly These symptoms may be due to a number of factors, including a sudden decrease in hormones, interruption to normal sleep patterns, and adjusting to the new responsibilities of motherhood Some things to try if you are feeling down:

• Make sure you are getting adequate nutrition, physical activityand healthy sleep

• Get help with taking care of household chores, cooking,errands, and, if needed, your baby’s needs

• Keep in contact with friends and family so that you do not feelisolated

Between 10 – 30% of new mothers experience more serious postpartum depression. Symptoms of postpartum depression are more intense and longer lasting than that of the baby blues and include loss of appetite, irritability and anger, insomnia, lack of joy, feelings of inadequacy, difficulty bonding with baby, and withdrawal from family and friends

The providers at Advanced Pediatrics do a routine screening for postpartum depression with all new mothers at their baby’s 2 week well care visit New moms experiencing symptoms of postpartum depression are encouraged to seek the help of a medical provider or therapist.

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IMPORTANT ITEMS TO HAVE

• Rectal thermometer In a normal infant and child, thetemperature should range from 97 5 to 100 Ear thermometersare not accurate in children less than three years of age

• Petroleum jelly to lubricate thermometer when using rectally

• Nasal bulb syringe A syringe with a soft rubber or plastic blunttip can be used for cleaning your baby’s nose

• Normal saline nasal drops to help clean a stuffy nose

• Infant car seat See “Before You Go Home” section

• Smoke detector located near your baby’s room

• Cool mist humidifier See section on “Home at Last: Room Temperature & Humidity”

HELPFUL ITEMS TO HAVE • Automatic swing A swing can be helpful for soothing fussy

or crying babies Be sure the swing has a sturdy base andcrossbars

• Snugli or baby carrier These carriers keep your baby close tomom and dad and safely away from others If your baby mustgo with you into crowded places during the first two months,this is a good item to have

UNNECESSARY ITEMS • Baby scales These scales tend to be inaccurate There are

other better ways to determine if your baby is getting enough toeat

• Bottle warmer or infant feeder

• Walker Walkers are dangerous and can cause seriousinjuries. Once a baby can sit independently, without usingarms for balance (typically around 6 or 7 months), a stationary(without wheels) exersaucer may be helpful

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HOW TO TELL IF YOUR BABY IS ILL

Your infant’s behavior is the best way to tell when he or she is ill If you suspect your infant is ill, please call our Patient Care Line at 303-699-6200. The following behaviors are good indicators of illness in infants:

POOR FEEDINGOccasionally your baby may not want to eat as soon as you expect, but a baby who completely refuses to eat over a period of 6 to 8 hours is concerning Poor feeding can also mean a decreased interest or sluggish sucking at times when a baby should be hungry If poor feeding persists for two or more feedings, please call our office.

DROOPINESSDroopiness frequently accompanies poor feeding, but can occur by itself Instead of being active or alert, a baby may seem less strong and vigorous If limpness or lack of alertness occurs over several hours, please call our office.

JAUNDICEAlthough many babies get a slight yellowish tinge to the skin, this ordinarily disappears in the first week of life Assess the true color of your baby’s skin by pressing gently on baby’s chest or back While the blood is blanched out, note the color of the skin A truly jaundiced baby will have a noticeable yellow hue Yellowness in the eyes is not a good indicator of the degree of jaundice If you are concerned about your baby’s color, please call our office. Sometimes babies will need to be seen in our office several times within first few weeks until jaundice has cleared.

IRRITABILITYBabies often have a certain time of day when they are fussier (usually in the evening) It is unusual for a newborn baby to cry continuously for

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several hours without stopping Even though fussy, most babies can be temporarily calmed True irritability occurs when a baby cannot be consoled by rocking or holding, or is fussy with any movement If your baby is irritable, please call our office.

PIMPLES AND PUSTULESYour baby may have pimples on his or her face, neck and shoulders during the first weeks of life Pimples or blisters in the diaper area, near the base of the umbilical cord, or on arms or legs are not normal True pimples and pustules are different from erythema toxicum, a normal newborn rash that looks like flea bites and comes and goes If you see pimples and pustules, please call our office.

FEVERIf your baby feels hot and is not overdressed, check his or her temperature rectally If the temperature is over 100 degrees (or less than 97.5 degrees), please call our office. Tell the person you talk to the temperature you measured and how you took that temperature

RESPIRATORY DISTRESSBabies often sneeze, cough or sound congested Using saline drops, a nasal bulb syringe, and a cool mist humidifier can help Please call our office immediately if your newborn shows ANY of the following: persistent coughing, rapid breathing, retractions (sucking in the muscles between the ribs with each breath), flaring of the nostrils, grunting while breathing, or blue skin coloring.

VOMITING OR DIARRHEATrue vomiting is different than “spitting up” A baby who is vomiting appears uncomfortable; the vomiting is forceful and may contain bile (green color) A diarrhea stool appears to be mostly fluid that soaks into the diaper If you are concerned that your baby is vomiting or has diarrhea, please call our office.

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ONGOING HEALTH CARE

IMPORTANCE OF A MEDICAL HOMEConsistent continuity of care is important to providing your baby with optimal health Advanced Pediatrics prides itself on being a “Medical Home” and recognizes the importance of providing a wide variety of services for our families to meet their varying needs Each time your baby is seen for an appointment in one of our offices, or you speak with one of our nurses or the after-hours service, information is integrated into your baby’s medical record to ensure it is complete and care is consistent. When we are closed, our after-hours service through Children’s Hospital Colorado extends the same advice patients would receive from our office

WELL CARE VISITSRoutine well care exams and immunizations play an important role in keeping your baby healthy Our providers look forward to getting to know you and your baby better at these important visits and encourage you to bring a list of any questions you would like to discuss. In addition to a thorough physical exam and recommended immunizations, well care exams provide an opportunity for our providers to monitor your baby’s growth and development and discuss age specific health, behavior and safety issues To assist us in assessing your baby’s development, we will ask you to fill out an “Ages & Stages” developmental screening questionnaire for all well care visits between the ages of 2 months through 5 years

Your baby should be seen in our office within 1 – 3 days of being discharged from the hospital for a “First Well Baby Visit.” (Some newborns will need to be seen in our office several times during the first few weeks of life until weight gain is established or any jaundice has cleared ) Consistent with the American Academy of Pediatrics, we recommend the following schedule for well baby care exams (*indicates routine immunizations):

1st Visit 2 months* 6 months* 12 months* 18 months*

2 weeks 4 months* 9 months 15 months* 2 years

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Well care visits may be made three months in advance, so we recommend making an appointment for your next well care when you are in our office.

IMMUNIZATIONSPrior to the creation of today’s vaccines, thousands—and sometimes millions—of children became infected with diseases that resulted in lifelong disabilities or death Childhood vaccines are safe and save lives. In accordance to the schedule published by the Centers for Disease Control and the American Academy of Pediatrics, we require all children to be up to date with their vaccines by ages 2, 5, and 11.

1ST YEAR VACCINES PROTECT AGAINST:Hepatitis B • Diphtheria • Tetanus • Pertussis (whooping cough)

• Haemophilus Influenzae B • Polio • Pneumococcal Disease • Rotavirus• Measles • Mumps • Rubella • Chickenpox • Hepatitis A

Approximately 25% of children have temporary symptoms after receiving vaccines These temporary symptoms may include pain, swelling, redness, itching or hives at the injection site, fussiness and fever for up to 2 days These common reactions mean that your baby’s body is producing new antibodies to protect against disease Applying a cold pack to the area for 20 minutes as needed may help with pain and swelling If you are concerned about fever, pain, hives or other immunization symptoms, please call our Nurse Line at 303-699-6200. Please consult our Nurse Line (or After-Hours Service) before giving Acetaminophen (Tylenol) to babies under 3 months of age. Ibuprofen (Motrin) should not be given to babies under 6 months of age.

Scientific-based studies and current literature have proven that vaccines do not cause autism or other developmental disabilities In order to have enough time allocated during well care visits, we request that parents schedule a separate “immunization consultation visit” if they wish to discuss concerns regarding vaccinating their baby according to the recommended schedule Parents who choose not to vaccinate their baby will be discharged from the practice. For more information on well care and immunizations, please visit the “Well Care / Immunizations” page of our website or www.immunizeforgood.com.

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HAVE QUESTIONS OR NEED ASSISTANCE?

AdvAncedPediAtricAssociAtes.comWe recommend you check our website first whenever you have questions regarding newborn care, symptoms, our practice or policies. We believe that you will find our website a very valuable resource! It contains comprehensive information regarding our providers, offices, and the wide variety of services we offer to our patients In addition, it features a special “Newborn / Baby Care” page and an extensive “Pediatric Health Library.” For your convenience, our “Home” page features an easy to use “Newborn and Baby Care” pull down menu, which provides quick access to many of the most common newborn care topics This convenient information is available 24 hours a day and can be bookmarked, printed and referred to later should you have additional questions you might think of

CALLING US—(303) 699-6200Our centralized Patient Care Line is all you need to make an appointment, speak to our staff, or reach our after-hours service Please select the appropriate option (shown below) to reach specific services

DURING NORMAL BUSINESS HOURS Our telephone lines are open at 7:30 a.m. Monday through Saturday to make early morning appointments or speak to any of our staff. We see patients from 8–12 and 1–5, Monday through Friday In addition, our Centennial office is open from 8 a m to 11 a m on Saturday mornings to see newborns and sick children

MAKING AN APPOINTMENT—OPTION 1If your baby is sick, we recommend that you call as soon as you realize you may need an appointment. If you are calling for a well care or consultation visit, please consider calling us later in the day when the phones are less busy

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NURSE LINE—OPTION 2Our registered nurses are available during business hours to answer questions or discuss concerns regarding your new baby’s health They use nationally recognized pediatric protocols to give medical advice and can recommend whether an appointment is necessary, or if some home care advice might be a better option Through our electronic medical records, our nurses have immediate access to your baby’s medical record in order to provide the most up-to-date advice For routine questions, we ask that you check the “Newborn / Baby Care” and “Is Your Child Sick?” pages of our website first before calling our nurse line

PRESCRIPTION REFILL LINE—OPTION 3 OR 720-870-0244You may request a refill of a prescription for most medications by simply calling our automated refill line during business hours We are usually able to have a refill processed within 48 hours when calling during normal business hours Prescription refill requests may also be made online 24 hours a day through our “MyChart” patient portal. (See “Helpful Hints” Section)

EMERGENCIES—OPTION 9In the event of a life-threatening emergency, always call 911. For other emergency situations you may select our Emergency Line for immediate assistance Our registered nurses will assess the situation and recommend whether your baby should be seen in our office or a local emergency department If appropriate, our nurses can schedule an urgent visit in one of our offices for special circumstances such as respiratory distress, lacerations, injuries and other urgent needs Please do not select our emergency line for non-urgent calls. Callers who select this line for non-urgent calls will be transferred to our Patient Care Line.

AFTER HOURSOur physicians work with Children’s Hospital Colorado After Hours Service to provide assistance for urgent needs after normal business hours If your baby appears ill when our office is closed, please call our Patient Care Line at 303-699-6200, and our after-hours service will ensure that you receive the advice and care that you need. Our answering service will take some brief information and then

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have one of the registered nurses from Children’s Hospital Colorado After Hours Service call you back to answer your questions and determine the best course of action for you and your baby One of our physicians is always on call to help deal with your concerns in conjunction with the Children’s Hospital Colorado After Hours Service.

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HELPFUL HINTS

INSURANCE INFORMATIONIt is extremely important that your baby be added to your insurance policy as soon as he or she is born, and that one of our physicians is chosen as your baby’s primary care physician (PCP) if a PCP is required. The first year of life can be expensive because of recommended well-care visits and immunizations, so it is important that you understand your insurance benefits If you have any questions regarding your insurance coverage please contact your health care plan

COST OF WELL CARE AND IMMUNIZATIONSWe recommend that you visit the “Newborn / Baby Care” page of our website and review the average “First Year of Life Costs” for well care and immunizations Unfortunately, not all insurance plans cover all well care and immunization costs Patients with no insurance are eligible to receive vaccines from the State of Colorado’s “Vaccines for Children” (VFC) program at a reduced cost For patients whose insurance does not cover vaccines, our staff can provide names of community resources that may offer vaccines at a reduced cost

SIGN UP FOR APA E-NEWSWe request that ALL new patients sign up to receive our E-News announcements Make sure you don’t miss out on important news regarding pediatric health and safety, by visiting our website “Home” page and clicking on the purple E-News Sign Up button Simply enter your name and email address and you’re all set!

ONLINE SERVICESWe recommend that all patients take advantage of the online services we offer on our website at www.AdvancedPediatricAssociates.com! Secure online payments can be made directly to your child’s account through our website Our MyChart patient portal allows you

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to communicate with our office, request prescription refills, download copies of your child’s immunization records and more Visit our website to learn more about MyChart or request a MyChart activation card from our reception staff the next time you visit our office.

CONNECT WITH APA ON FACEBOOKAre you on Facebook? We are too! We encourage you to Like Us on Facebook so you don’t miss out on important pediatric news, reminders or updates from our offices! Find us on Facebook at: facebook.com/advancedpediatricassociates

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PHONE DIRECTORY

Life Threatening Emergencies Dial 911

Poison Control 1-800-222-1222

Patient Care Line 303-699-6200

Option 1 – Make an appointment or leave a message for a provider

Option 2 – Speak with a registered nurse

Option 3 – Request a prescription refill

Option 4 – Request a referral

Option 5 – Find lab or x-ray results

Option 6 – Request copies of immunization forms / medical records

Option 7 – Access general information / staff directory

Option 8 – Speak to business / administrative office

Option 9 – Emergency line

Non-urgent calls made to the emergency line will be redirected to the proper extension.

When our offices are closed, all calls to 303-699-6200 will be connected with our AFTER HOURS SERVICE.

Prescription Refill Line 720-870-0244

After Hours Service 303-699-6200

Patient Financial Services 720-870-4740, option 1

Central Fax 303-766-6903

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HELPFUL BOOKS TO READ

Heading Home With Your Newborn: From Birth to Reality, 3rd Edition. Laura A Jana, MD, FAAP & Jennifer Shu, MD, FAAP, The American Academy of Pediatrics, 2015

Your Baby’s First Year, 4th Edition. S P Shelov (ed ), The American Academy of Pediatrics, 2015

Caring for Your Baby & Young Child: Birth to Age 5, 6th Edition. Steven Shelov (ed ), The American Academy of Pediatrics, 2014

Mommy Calls: Dr. Tanya Answers Parents’ Top 101 Questions About Babies and Toddlers. Tanya Remer Altmann, MD, FAAP, American Academy of Pediatrics, 2008

Baby 411: Clear Answers & Smart Advice For Your Baby’s First Year. Denise Fields & Ari Brown MD, 2013

The Happiest Baby on the Block. Harvey Karp, 2007

New Mother’s Guide to Breastfeeding. Joan Younger Meek, MD, FAAP American Academy of Pediatrics, 2011

The Nursing Mother’s Companion, 7th Edition. Kathleen Huggins, RN, MS, 2015

My Child is Sick: Expert Advice for Managing Common Illness and Injuries. Barton D Schmitt, 2011

Dad to Dad: Parenting Like a Pro. David Hill, 2012

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LIST OF QUESTIONS TO ASK AT NEXT WELL CARE APPOINTMENT

1. _________________________________________________

2 __________________________________________________

3. _________________________________________________

4. _________________________________________________

5. _________________________________________________

6. _________________________________________________

7. _________________________________________________

8. _________________________________________________

9. _________________________________________________

10. ________________________________________________

11. ________________________________________________

12. ________________________________________________

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HISTORY OF OFFICE VISITS

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

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Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

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Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

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Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

Date Physician / Provider

Purpose of Visit

Immunizations

Notes

NOTES

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