Baby: Birth to 4 months

The first 4 months of life is usually a healthy time because babies are born with lots of immunity they get from mom. (Breastfed babies get even more after birth). When babies this young do get sick, however, it can be more serious and more difficult to evaluate than similar illnesses in older children. Prevention is best. All babies should see the pediatrician at about 3 days, 2 weeks, 2 months and 4 months of age. Sometimes we may want to keep a closer eye on something and ask you to come in more frequently. These visits are not just for shots, but are times when we screen for a variety of subtle problems and are a good opportunity for you to learn more about your baby:

• Your baby will get vaccines at the 2 and 4 month visits Always call if the baby gets a HIGH fever (more than 102.5°F) or is VERY irritable (not just fussy) after a vaccine. Very rarely, more serious side effects can occur, but the benefits of giving these vaccines outweigh the risks involved. If you want to know more about this, please refer to our office handout, Immunizations – Protection for your Child
• Washing hands with soap and water is the single most effective thing you can do to prevent the spread of colds and other infections to the baby.
• Symptoms not to worry about: stuffy nose, sneezing, hiccups, spitting up, bowel movements as frequent as every feeding or as seldom as every 4th day. Use a bulb syringe to clear a stuffy nose. Do not use over-the-counter cough/cold medicines in this age group. Use Acetaminophen for a fever only after talking to the doctor or after a shot. Don’t ever use bathing of any type to treat a fever.
• Possibly concerning symptoms: fever (over 100.4° rectally), cough, forceful vomiting, diarrhea
  (frequent watery stools). While all of these will become much less worrisome as the baby gets older, in this age group they should be evaluated by the pediatrician.
• Constipation means hard stools. Try a little extra water, 1 tablespoon of light Karo Syrup mixed with formula or water once or twice daily, or some prunes or prune juice. Don’t resort to suppositories unless told to by the doctor. If a constipated baby starts to vomit or becomes irritable, call.
• Unless we specifically instruct you otherwise, have the baby sleep on its back or side. Sleeping on the stomach increases the risk of SIDS.

Exposure to second-hand cigarette smoke also increases the risk of SIDS, as well as asthma, pneumonia and ear infections

• Get a government approved car seat and USE IT at all times. A car seat should face the rear of the car until the child is 2 years of age. Be sure it’s in good condition, especially if it is used, and installed according to directions. If you need help installing your car seat, there are certified CPS technicians & Child Seat Fitting Stations in your area. Visit www.nhtsa.gov or www.seatcheck.org for more information.
• Have a smoke detector on every floor of your home, as well as a fire extinguisher in the kitchen and any room in which someone often smokes. Test these items periodically to be sure they work..
• NEVER hold a baby while smoking or drinking a hot drink.
• Don’t put the baby in a walker. They lead to falls, poisonings, and choking. Swings, playpens, and “Johnny jumpers” are all much safer.
• Be sure all baby furniture is approved by the Consumer Product Safety Commission and all cloths are marked “non-flammable”.
• Crib mattresses should fit snugly and slats should be no more than 2-3/8″ apart. Paint should be non-toxic, lead free, and in good condition.
• Don’t leave the baby alone with a young brother/sister or with a pet.
• Check your hot tap water. Adjust the hot water heater for a maximum temperature of 110 – 115° F.
• Never turn your back on a baby in a bath, on a changing table or on a bed EVEN FOR A SECOND!
• Second Hand Smoke is very dangerous. Even if you or a family member smokes outside- the smoke is brought in on your clothing. Please consider quitting.

Feeling comfortable with what you’re doing is more important than whether you breast or bottle feed. Each has advantages and disadvantages. Both are healthy and natural, and neither is better or “right”.

• Intolerance to either formula or something in a breastfeeding mother’s diet could present as diarrhea, vomiting, rash, failure to gain weight normally, or any combination of these. Colic alone is rarely from food, although may accompany the above if food is the problem. If you suspect this, don’t change your baby’s milk yourself. Call and discuss it with us.
• There is no evidence to suggest restricting a mother’s diet while breastfeeding (for foods like wheat, nuts, eggs) decreases the chance of allergies, eczema or asthma and in fact may increase the risk.
  Babies never need extra water – there’s plenty in both breastmilk and formula.
• Avoid solids before four months of age. Younger babies can’t digest them. The old belief that solids make them sleep better has been proven untrue, indeed the opposite is the case. Solids usually aren’t needed by the baby until 4 – 6 months, so the majority of babies in this age group should get absolutely nothing except breastmilk and/or formula.
• Babies under one year of age should not consume honey.
• Babies should start a liquid Vitamin D supplement (D-vi-sol) around 2 weeks of age.

From the first moments of life, a baby needs to see, hear, and feel different things to begin to learn:

• Babies can see very well from the start. They instinctively recognize the human face and prefer looking at YOU to anything else. Look at and talk to your baby while feeding, changing diapers, etc. You are it’s best toy!
• Colorful mobiles and music boxes are also good toys for this age group.
• Pacifiers satisfy a baby’s natural sucking instinct (which is a need separate from feeding) and are preferable to thumbs in several ways. Be careful NOT to hang it on a cord around the neck, however, as this could strangle him.
• The first 2 months are a SOCIAL time; learning to focus, smile, coo, listen, and relate to the other people in the family. Babies are charmers at this age.
• From 2 – 4 months is more a MOTOR time; learning to hold up the head, roll over, bat at then finally grasp objects (and put them in the mouth).

Babies have sensitive skin and most rashes are benign. Lots of companies make lots of money selling you products to take care of them, however.

• Soap is soap. Baby soap is expensive soap with perfume in it to smell baby-like. Soap dries and irritates sensitive skin. Most babies can be cleaned quite nicely with water alone for the first few months. Once you feel you need soap, use a mild one like Dove.
• Sunlight is a threat to healthy skin. Avoid use of sunscreen less than six months of age, if necessary select a PABA-free preparation with SPF 15 or higher. Preferably keeping baby in the shade or with light long clothing and a hat.
• Ointments are best for protecting against diaper rash, but it really doesn’t matter which ointment you use. Powders can be dangerous & should be avoided. Consider cloth diapers. They are wonderful for the skin, and much cheaper than disposables even if you use a diaper service. They are less damaging to our environment as well.
• How do you know if a rash is a problem? If there are blisters of any size, any break in the skin or bleeding, or what looks like bruising or blood under the skin it might be a problem. Otherwise, it’s probably not serious.
• “Cradle Cap” is harmless to the baby, but unsightly. You can prevent it by scrubbing the baby’s scalp gently but firmly with a hairbrush and either baby oil or Dove soap. There are medicines to treat this, but they are reserved usually for severe cases.

A baby needs happy, satisfied parents. Don’t give up the other important things in your life for the baby. Set aside time to be alone with your partner regularly by leaving the baby with a babysitter or relative. Also set aside some of your time for older siblings when they won’t need to compete with the baby. Make sure you maintain your hobbies, interests, career, etc.

It is normal and very common for new parents to feel depressed, anxious, and overwhelmed. It may seem hard to cope with a screaming baby and you may even feel as if you’re about to lose control. Help is available. Call us or call Parental Stress Line at 1-800-882-1250.

Do you feel safe at home? You are not alone, to speak to someone in confidence call National Domestic Violence Hotline (800) 799-SAFE.

Other important telephone #’s to keep by your phone:

• Pediatrician: 978-975-3355
• National Poison Control Hotline: 1-800-222-1222
• Police/Fire/Ambulance: 911
• ‘Parents Helping Parents’: 1-800-882-1250