Your New Baby

· Your Amazing Newborn
· Your Baby's First Exam
· How Do I Get Health Care For My Child?
· At The Hospital
· The Premature Baby
· Feeding Your Baby
· Breastfeeding: Getting started
· What to Expect
· Formula Feeding: Getting Started
· Bringing Your Baby Home
· Looking Good And Feeling Good

Your Amazing Newborn

When your baby is born, there is so much he can do!
A newborn can:

· See your face clearly when you hold him in your arms
· Look into your eyes
· Tell your voice from other voices

At birth, your baby enters a brand new world. He is aware of many changes.
He feels, sees, hears, and tastes strongly. Usually, he is very awake for the first
hour or two after birth. There are some things you can do during that time
for your baby:

· Gently touch your baby- stroke or massage him and hold him next to your skin
· Make eye contact with him
· Talk softly to him while you look into his eyes

Your baby already feels very connected to you. Take time to get to know each other and enjoy being together.

Your Baby's First Exam

During the first 24 hours, a doctor or a nurse will do a physical exam.
You can ask to watch. They will:

· Weigh and measure your baby
· Listen to your baby's heart
· Check your baby's body and reflexes
· Check for jaundice
· Check your baby's blood

At the newborn exam, your baby may get her first hepatitis B immunization.
You will get a small blue book called the Massachusetts Lifetime Immunization
Record. All the immunizations will be recorded in it. Bring this record to every health
care visit. It is very important. Your child will need it for going to child care, school,
and camp.

Talking With the Doctor or Nurse

The doctor or nurse will talk to you about your baby. He or she will talk about feeding, caring for the belly button, car safety seats and what position your baby should sleep in.
This is a time to ask your questions. No question is silly or dumb. If you do not understand something , ask your doctor or nurse to explain to you. Writing down your questions may help you remember. Your doctor or nurse will not know that you have a question unless you ask it. If there are possible problems that need follow-up, he or she will tell you about them.

How Do I Get Health Care For My Child?

Choosing a Doctor or Nurse

Many people choose a doctor or nurse for their baby before she is born .If you have not already done that, now is the time. You can get help from the hospital, your own doctor, your local health care center, or your adoption agency. Your baby will need her first check-up when she is 1-2 weeks old.

Your doctor or nurse is your partner in keeping your child healthy. It is to be able
to:

· Talk comfortably
· Get to appointments
· Research your doctor or nurse by telephone
· Make decisions together

Paying For Health Care

Sometimes your choice of doctor or nurse is limited by the health insurance plan. Well- child visits may be covered by your health insurance plan. If you have insurance, call the phone number on your insurance to find out:
· If your child is covered
· What services are covered
· Which care providers you can go to be sure to register your child.

If your child is not covered or you have no health insurance, you be able to get free or
reduced-fee health care for your child through sate and city programs. You can call:

· MassHealth (Medicaid) 1-800-682-1062
1 -800-841-2900
1-800-497-4648 (TTY)

· Children's Medical Security Plan 1-800-909-2677
· Community health centers
· Hospital clinics
· Local boards of health
If have problems getting health care for your child or
yourself, call the Health Care for All Helpline at 1-800-272-4232
In addition, immunizations are provided free of charge at many doctors' offices.
For more information call: 617-983-6800.

At The Hospital

While you are at the hospital, ask the nurses about baby care. They can show you how to bathe and diaper your baby, and help you with breastfeeding. Many new parents do not know what to do. Do not be afraid to ask questions. It will take time for you to get to know your baby. Try to limit visitors, so you can rest and spend time with her.

Your stay in the hospital may be short. By law, you have the right to stay for at least 48 hours after a vaginal birth or 96 hours after a Cesarean delivery. If you decide to go home before that time, you may be eligible for home visit from a nurse. If you feel that you are being discharged from the hospital too soon, you may file an appeal by calling
1-800-436-7757, 1-800-439-2370 (TDD\TTY).

Some insurance plans must cover the hospital cost during your 48 hour (or 96 hour) stay.
They are:

· Medicaid/MassHealth
· Healthy Start
· any other state regulated plan

If you are discharged early, make the first well-child appointment for the first week.

The Premature Baby

If your baby was born 3 or more weeks before your due date, he may need to be cared for in a special nursery. Ask the nurses any questions you have and for help touching and holding your baby.

Premature babies will grow and develop as well as other babies. Talk to your doctor or nurse about how to care for your baby and make sure he is growing okay. If have any questions or concerns about your baby's development, you and your doctor can call 1-800-905-8437 for the name of an Early Intervention (E.I.) program in your community. The E.I. program can arrange a free screening or evaluation of your baby.

Premature babies may need to be fed more often than other babies. Small babies need extra help to stay warm. Rather than keeping the room warm, use layers of clothes, so that he will not get too warm or too cold.

Feeding Your Baby

Breast milk is a perfect food for your babies. It has everything your baby needs. It is easier to digest than formula. Your body will make the right amount of milk for your baby. Breastfed babies:

· Tend to have fewer colds, infections, and other illnesses
· Gain weight more quickly in the first three months
· Have less constipation and fewer allergic reactions
· Have lower risk of Sudden Infant Death Syndrome (SIDS)

Breastfeeding helps your uterus return to your pre-pregnant size faster. It may also reduce your risk of breast cancer.

You may choose to or need to give your baby formula. There are many why parents use formula. Make a decision that feels right for you. You can talk with your doctor or nurse to help you make the best decision for you and your baby.

You can combine breastfeeding and formula feeding. Babies should have ONLY breast milk or formula until at least four to six months old.

Your partner can help with feeding by bringing the baby to you. Partner can also prepare and give the baby a bottle. A bottle does not have to be formula-it can be breast milk that you have pumped.

Breastfeeding: Getting Started

For the first 2-3 days, your body makes a special kind of breastmilk called colostrums. Then your regular breastmilk will come in. It may take a while for you and your baby to learn how to breastfeed. Do not get discouraged. There are people to help you: maternity nurses and breastfeeding counselors, Call:
· Women, Infants and Children (WIC) Program at 1-800-WIC-1007
· Nursing Mothers' Council at (617) 244-5102
· La Leche League at 1-800-LA-LECHE.

In the Hospital

· Let the nurses know that you are going to breastfeed and would like help getting started.
· Tell the nurses not to give sugar water, formula, or a pacifier to your baby.
· Ask to have your baby stay with you in your hospital room at night or be brought to you when he cries. This way you will know when he is hungry and ready to breastfeed again.

The First Feedings

· Try to nurse your baby within the first hour after birth. If your baby is sleepy or does not want to nurse right away, try again in a little while.
· If you have had a Cesarean, ask the nurses for extra help with breastfeeding.
· Practice breastfeeding on both sides.
· Remember, breastmilk is the only food your baby needs right now.

How to Breastfeed

· Breastfeed your baby when he shows signs of hunger, like lip or mouth movements or sucking motions
· Breastfeed at least 8-12 times in 24 hours
· Find a comfortable position. Use pillows for support.
· Hold your baby facing you, tummy to tummy.
· Support your breast by placing your fingers under your breast, and your thumb on top.
· Stroke your baby's lips with your nipple.
· Bring your baby to your breast when his mouth opens wide.
· Give your baby as much part of your areola (the dark part of your breast around the nipple) to latch on to.
· Listen for suck and swallow sounds.
· When your baby sucks slower (after about 10-15 minutes), you can switch sides. Slide one finger into the corner of your baby's mouth, and he will let go of your breast. You can then offer the other breast.
· Some babies may need to be burped during or after feeding.
· Allow your breasts to air dry after nursing,
· Try other nursing positions.
· Try to drink a glass of milk, water or juice each time you nurse.
· Remember, the more often you nurse, the more milk your body will make.

What to Expect

· In the beginning, your breasts will feel full and heavy. Frequent nursing helps keep your breasts from becoming swollen. If you are very uncomfortable, ask a nurse or breastfeeding counselor what to do.
· Breastfed babies often need to be fed every 1-2 hours - this is normal.
· If your nipples get sore, gently rub a little breast milk on them. Do use soaps or creams or your nipples. If you are concerned about the pain call your doctor or nurse.
· At times your baby may want to nurses more often. This could be a growth spurt. Feed her more often for a few days, and your body will make the extra milk she needs.
· If you want to use bottles also, wait for 4-6 weeks. Then introduce a bottle of pumped breast milk or formula. For more information on pumping and storing breast milk call the Nursing Mothers' Council or WIC.
· If you are going back to work or school, you can combine breastfeeding and bottle-feeding. You can breastfeed your baby at home. The caregiver can give your baby pumped breast milk or formula when you are away.
· Avoid caffeine, nicotine, alcohol, and drugs. They get into breast milk and may cause problems for your baby.
· Check with your doctor or nurse before using prescription or over-the-counter medications while you are breastfeeding.

Formula Feeding: Getting Started

If you are not breastfeeding, formula is your other choice. Formula is made to have many of the nutrients found in breast milk. Start by selecting an iron fortified formula. Formula comes as powder, concentrated liquid, and ready-to-feed. Powder or concentrate are the least expensive. Use only properly prepared formula.

When preparing formula:

· Always wash your hands. Clean bottles, nipples, and utensils with hot soapy water. Rinse well before using or use a dishwasher.

· Follow the directions on the can. If water is needed, run it for two minutes before using. Once you open and prepare the formula, use it or refrigerate it immediately. Use prepared formula within 48 hours.

· Use powdered formula within one month of opening the can. Use concentrate within 48 hours after opening.

If you warm bottles for your baby, do it in a pan of hot water. Always check the formula to make sure it is not too hot. Shake some on your wrist. It should not feel hot. Do not use a microwave oven. This may cause serious burns.

Make sure that everybody who gives the baby formula follows these directions.

How To Give A Bottle

Always hold your baby while she is drinking from the bottle.
· Hold her in a comfortable position.
· Tilt the bottle so that the nipple fills with milk.
· Most babies finish a bottle in 15-20 minutes.
· Burp your baby half-way through the feeding and at the end. If she spits up a lot, it may help to burp her more often.
· If the bottle is not finished when your baby is done, throw away the leftover formula. Do not save it for the next feeding.
· Prevent "baby bottle tooth decay". Do not give bottles filled with formula or juice at bedtime or naptime.

It may take a while for breastfed babies to get used to drinking from a bottle.

How To Tell If Your Baby Is Getting Enough Milk

At first, a breastfed baby will only have a few wet or soiled diapers each day. After five days, he should have 6-8 wet diapers a day. He should also have at least 2-3 bowel movements a day for the first six weeks. Older breastfed babies may have as many as 8 bowel movements a day, or as few as 2-3 a week. Their bowel movements are soft and yellowish.

Formula fed babies have darker and more formed bowel movements. Your doctor, nurse or nutritionist will tell you how much formula to give your baby.

If you have any questions or concerns, call your doctor, nurse, nutritionist or breastfeeding counselor.

Burping Your Baby

Burping makes your baby more comfortable by getting the air out of his stomach. Here are three ways to burp your baby:

· Put his head over your shoulder, and gently rub his back.
· Lay him over your lap, stomach side down, and gently rub his back.
· Sit him on your lap, with your hand supporting his chest and head. Gently rub his back.

It is common for babies to spit up a little milk when being burped. After burping, you can clean your baby's gums with a soft, clean cloth.

Bringing Your Baby Home

Safety Seats - Make Sure Your Baby Travels Safely

To keep your baby safe, put her in a safety seat every time she rides in a car or taxi. Holding your baby in your arms will not protect her. Even though you might you might think you can hold onto your baby during a crash, the force of a crash makes it impossible.

A safety seat cannot protect your child unless you use correctly. To make sure you install your seat correctly, follow the directions that come with it, or call 1-800-CAR-SAFE. Make sure your baby seems comfortable and her head and her body are well supported. You should wear a seat belt, too.

Infant safety seats should face backwards until the baby is at least 20 pounds and one year old. Children should ride in the back seat whenever possible. While it is natural to want to be close to your baby, no baby or young child should be in the front seat. Never put a baby in the front seat if there is a passenger side air bag.

If you do not own or can not afford a baby safety seat, call 1-800-CAR-SAFE to find out about loan programs. Be sure that everyone your baby rides with uses a safety seat correctly.

For more information about safety seats, call the Auto Safety Hotline at 1-800-424-9393.

A Safe Crib.

At first, you may want your baby to sleep in a bassinet or cradle by your bed. As she grows, move her to a regular crib. Most new cribs meet safety standards, but you should still check your crib. Avoid using an older crib, if possible. If you are not sure your crib is safe, call 1-800-83-DANNY. Check to see that:

· The slats are no more than 2 and 3/8 inches apart.
· The paint is not peeling and is lead-free.
· The mattress is firm and flat.
· The mattress fits snugly-no more than two adult fingers should fit between mattress and crib.
· The rail height is at least 26 inches above the mattress.

Keep the crib sides up and locked whenever your child is in it. Place the crib away from windows, window cords, curtains, space heaters and shelves with things that could fall on the baby. Do not use pillows or quilts in the crib. To reduce the risk of Sudden Infant Death Syndrome (SIDS), put your baby to sleep on her back.

Bathing and Dressing

For the couple of weeks, give your baby sponge baths. Avoid the tub until the umbilical cord has fallen off and the belly button has healed. For a sponge bath, wash your baby on a firm, flat surface such as a changing table or a counter with a towel on it. Keep your baby warm by covering the areas you are not washing.

Babies get burned easily. Make sure the bath water is not too hot or too cold. Test it on the inside of your wrist or use a bath thermometer. Be sure the hot water heater in your home is set at 120 degrees F. or less.

Have all your bath supplies ready before you begin.

· Soft, clean wash cloth
· Towels
· Gentle soap and shampoo
· Clean
· Fresh cotton balls

Once or twice a week, shampoo your baby's scalp. Rinse well-keep shampoo out of his eyes.

After the belly button has healed, your baby can have a bath in a tub. Hold your baby securely. Wet babies are slippery. Support his head the whole time. Some babies get upset when put in water, so be patient.

Remember never leave your baby alone, even for a minute. A baby can drown quickly in very little water.

To Give Your Baby a Sponge Bath or a Bath in the Tub:

1. Begin with the eyes. Use a cotton ball soaked in warm water and no soap. Gently wash around his eyes, wiping from the nose outward.

2. Use a wash cloth to clean his face. A gentle soap is fine on the face, just not near the eyes. Wipe around his ears but not inside.

3. Clean his neck, chest, arms and legs. Be sure to wash around the arms and between skin folds.

4. Clean his genitals and bottom last.

5. Dry him gently with a clean towel.

Dressing Your Baby

Your baby may squirm while getting dressed. Use clothes that are easy to put on and take off. Clothes with wide neck openings, snap closings, and stretch or knit fabrics are good choices. Open the neck wide before pulling it over your baby's head. Then reach through each sleeve, and pull your baby's hands through. Stretch and pull at the clothes, not at the baby. Dress your baby as warmly as you are dressed. Keep the temperature where your baby sleeps the same as the rest as your home.

Diapering

Your baby may need a new diaper before or after feeding, and after every bowel movement. This can mean at least eight changes a day. Parents can choose disposable or cloth diapers. Some children have an allergic reaction to disposable diapers or to soaps used to wash cloth diapers. If your child has a reaction, try another brand or type of diaper or soap.

Umbilical Cord Care

To prevent infection:
· Keep the cord clean and dry.
· Fold the front of the diaper down, so it is below the cord.
· Gently clean the area where the cord attaches with rubbing alcohol.

The cord usually falls off between 1-3 weeks after birth. If the area around the cord looks red, irritated, bleeds, oozes or has a bad odor, call your doctor or nurse.

Circumcision Care

If your baby has been circumcised, there may be some soreness and bleeding. Put a little petroleum jelly on a gauze pad and wrap around his penis. Change the gauze pad each time you change the diaper. Staying in a wet diaper will irritate the penis. Healing takes 1-2 weeks.

To Change a Diaper

Change your baby often to avoid diaper rash. You will need a clean diaper and a soft clean wet cloth.

· Wash your hands
· ALWAYS keep your hands on your baby.
· Take off the old diaper, set aside diaper pins.
· Clean your baby:
? Girls should be cleaned from the front to back to avoid spreading germs.
? Do not pull back the foreskin of a boy who is not circumcised.
· Dry the baby well.
· Put on a clean diaper; wet or soiled diapers should not be re-used.
· Rinse used cloth diapers and place in a diaper pail with a lid.
· Put used disposable diapers in bags and throw them away.
· Wash your hands again

Diaper Rash

Most babies get diaper rash at one time or another.
1. Wash the area using gentle soap and water, instead of wipes.
2. Dry thoroughly.
3. Use a diaper rash cream.
If the rash does not get better in a few days, call your doctor or nurse.

Sleeping

Newborns sleep from 12-20 hours a day. Each baby's sleeping pattern is different. At first, babies often sleep more during the day than at night. Your baby may take many short naps or a few long ones. It may take some time for your baby's sleeping pattern to become regular.

When parents lose sleep, it is stressful for the family. If you are too tired, you cannot care for your children well. Try to sleep when your baby does. To encourage your baby to sleep at night, you may need to keep daytime naps short. If have questions about your baby's sleep talk to your doctor or nurse.

Sudden Infant Death Syndrome (SIDS)

SIDS is the unexplained death of a healthy baby. SIDS is very rare. It happens most often to infants between two and four months. We do not know the cause, but some things may reduce the chances of SIDS.

· Put your baby to sleep on her back.
· Burp your baby before putting her down to sleep.
· Do not overdress your baby.
· Do not overheat the room.
· Do not use a waterbed. Use a firm flat mattress.
· Do not put pillows, quilts, comforters, or soft toys in her bed.
· Do not let anybody smoke near your baby.
· Breastfeed.

For more information, call the 24-hour SIDS Hotline at 1-800-641-7437.

Protect Your Baby from Second-Hand Smoke

Caring for your baby also means protecting her. Keep your home smoke-free. Ask people not to smoke around your child. Babies who are exposed to smoke have more:

· asthma attacks
· ear infections
· colds
· flu
· risk of SIDS
· pneumonia
· feeding problems
· allergies
· hospitalizations

Smoking takes away your energy and reduces the amount of breastmilk a mother makes. If you stopped smoking while you were pregnant, try not to start again. You may be tempted to smoke by the stress of being a new parent. There are many programs that can help you and your family members quit smoking. Ask your doctor or nurse, or call the Smokers Quitline at 1-800-TRY-TO-STOP.

You should never smoke while holding or feeding your baby. Make sure that people do not smoke inside your home.

Smoking causes illness and injury. Fires happen more often in homes where people smoke. In a fire, babies are hurt more often than anyone else.

Taking Care of Yourself

It is easy to forget about your own health when caring for a newborn. Remember, your baby needs you to be healthy. Ask your doctor or nurse how to take care of yourself after the birth of your baby. Give yourself time - it takes at least 6 weeks to recover from childbirth. It takes longer if you have had a Cesarean delivery. Limit visits from friends and family.

You may have some discomfort, such as constipation, hemorrhoids, painful urination and soreness. Call your doctor or nurse right away if you have any of the following:
· Bleeding that soaks more than one pad an hour for more than a few hours.
· Bright red bleeding after the fourth day after delivery
· New or severe pain
· A temperature of over 400.4 for eight hours
· Any temperature over 101

Postpartum Check-Up and Family Planning

Six weeks after delivery is time for your postpartum check-up. Your doctor or nurse will check your recovery. He or she can help you decide about the best method of family planning for you.

You can get pregnant right after your baby is born. Condoms are the best way to prevent another pregnancy before you have your check-up.

Be sure to get a check-up for yourself every year.

You Are Not Alone

Taking care of a baby can be stressful. You may feel exhausted. You will have less time for housework and other things. Caring for your baby and yourself comes first.

All new parents need help and support. You can get help at home, answer to your questions and emotional support. You can find a home visiting program by calling the Children's Trust Fund at 1-800-252-8403. Many other resources are available:
· Your baby's doctor or nurse
· The nurses in the hospital where your baby was born
· Adoption support services, such as the Open Door Society
· Your childbirth instructor or breastfeeding counselor
· Your local Visiting Nurse Association
· New Mother's support groups
· Breastfeeding support groups
· Parenting classes
· Postpartum exercise groups
· Parental Stress Line at 1-800-632-8188

If possible, ask family and friends to help out. They can bring a pizza, buy some groceries, take care of your other children or watch your baby while you take a nap.

Postpartum Depression

New mothers do not always get the help they need. They do not get enough sleep. Taking care of a baby can be lonely. It may be different from what you expected. Adjusting to the changes in your life takes time. You may feel depressed. Some mothers feel guilty about feeling bad.

You need care, just as your baby does. Emotional support can come from friends, family, other mothers, and support groups. You are doing a very important job. You need support to do it.

Sometimes, new mothers have depression that does not go away quickly. Talk to someone you trust, if you:

· Think about hurting yourself or your baby
· Feel like you cannot take care of your baby or yourself
· Lose interest in life
· Feel anxious, scared, or hopeless
· Have sleeping problems
· Have a hard time thinking clearly
· Do not want to eat
· Cry easily

Call your doctor or nurse, or the Depression After Delivery Hotline at 1-800-944-4PPD. If is important for both you and your baby to get help.

Looking Good Feeling Good

Eating Right

It is important to eat regularly. Try to eat the recommended number of servings each day. Choose a variety of food from the picture below:

Vitamins

Continue taking the vitamins you were taking while you were pregnant. To protect your health and the health of future pregnancies, make sure to get 400 micrograms of folic acid every day from the food you eat and a vitamin. Foods high in folic acid are:
· Asparagus
· Black-eye peas
· Broccoli
· Cereals with folic acid added
· Collard greens
· Dried beans and peas
· Orange juice
· Spinach

Staying Fit

Exercise is a great way to relieve stress and get more energy.

Walk. It is one of the easiest ways to keep fit. Take your baby for walks.

Use an exercise video. There are videos especially for new moms. They may be available at your local library. While you work out, put your baby in an infant seat or on a blanket on the floor. She will probably enjoy the music and your movements.

Join an exercise class. Many HMOs, YMCA/YWCAs and health clubs offer postpartum exercise classes. Some programs also offer child care.

Your New Family

Everything changes when a new baby joins the family. There are new roles and responsibilities for everyone. It takes time for partners and older children, friends and extended family to adjust to the new baby. Your own sense of who you are changes as you become a parent to this child.

Your baby needs lost of attention from you. Others family members may feel left out. Let your family and your baby get to know each other right from the start. If you have a partner, let him or her spend time caring for the baby. Ask them to hold or rock the baby, change a diaper or give a bottle.

Other children in the family may feel that they are not getting enough attention. Try to take special time with your other children. Tell them that you still love them very much, even though you are busy with the baby. Try to include them in your baby's routine and care. You can also read or draw a picture together. A few minutes will mean a lot to a child.

A baby takes a lot of time and energy. It is hard for partners to find time for each other. Try to respect your partner's feelings. Talk to each other. Tell your partner what you need.

There will be some adjustments, but before long, your baby will not feel like a newcomer-she will be family.

Growing Up Healthy was adapted with permission from the Massachusetts Department of Public Health, Bureau of Family and Community Health, Division of Maternal, Child and Family Health. Growing Up Healthy (Creciendo Sano in a Spanish adaptation) was originally developed with support from the Maternal and Child Bureau, Health Resources and Services Administration, US Department of Health and Human Services. We would like to acknowledge Gail Ballester and Steve Shuman, the Managing Editors from the Massachusetts Department of Public Health, and the many Massachusetts contributors and reviewers.