baby - Sapphire Pediatrics
Wgt _______ ______%
Hgt ______ _____% Head ______ _____%
Tylenol________ (4h)
Motrin _____ (6h)
Welcome, baby ________________ !
Enclosed is a packet of reading material for your parents.
It includes information on breast-feeding, bathing, and keeping you warm.
It also has facts about the fuzzy hair on your shoulders, your crossed-eyes, your
itty-bitty fingernails, and care of your tender tushie.
Baby, most importantly, you need to eat at least every 3 hours, sleep on your
back, and avoid all illnesses. If you are feeling sick, your parents should take a
rectal (sorry!) temperature and call us immediately if it is over 100.4F (38.0C).
As your doctor, we are here to keep you healthy and to educate your parents so
Please remind your parents to do their homework (read all this stuff we give them),
check our website for more information (www.
www., and
know that we are here for you and your family when you need us!
Robin Larabee, MD
Molly Gilpin, PA-C
And the staff of
Sapphire Pediatrics
4500 E. Ninth Avenue Suite 740 Denver, CO 80220
720-941-1778 fax 720-941-1783
Schedule of Well Child Visits
2-3 days
exam, growth, development
2 weeks
state newborn screen
exam, growth, newborn screen
2 months
DTaP/IPV/HIB, HepB, Prevnar, RotaTeq
exam, growth, development
4 months
DTaP/IPV/HIB,( HepB*), Prevnar, RotaTeq
exam, growth, development
6 months
DTaP/IPV/HIB, HepB, Prevnar, RotaTeq
exam, growth, development
9 months
Blood Count, Lead and TB screen
exam, growth, development
12 months
Prevnar, HepA
exam, growth, development
15 months
exam, growth, development
18 months
Varivax, MMR
exam, growth, devel., autism screening
2 years
Hep A, Blood Count, Lead screen
exam, growth, devel, hearing
3 years
(*no HepB if received birth dose)
exam, growth, devel, hearing
4 years
MMR, Varicella
exam, growth, devel, vision, hearing
5 years
DTaP, IPV, Urinalysis
exam, growth, devel, vision, hearing
6 years
7 years
8 years
exam, growth, devel, vision, hearing
exam, growth, devel, vision, hearing
exam, growth, devel, vision, hearing
9 years
10 years
Cholesterol screen
exam, growth, devel, vision, hearing
exam, growth, devel, vision, hearing
11 years
TdaP, Menactra, UA
exam, growth, devel, vision, hearing, puberty issues*
Gardasil (girls only, series of 3 shots)
12 years
13 years
14 years
15 years
16 years
17 years
exam, growth devel, vision, hearing, puberty issues*
exam, growth, devel, vision, hearing, puberty issues*
exam, growth devel, vision, hearing, puberty issues*
exam, growth, devel, vision, hearing puberty issues*
exam, growth devel, vision, hearing, puberty issues*
exam, growth, devel, vision, hearing, puberty issues*
* Puberty issues: adolescent issues including sexuality will be discussed at these visits. These visits may
include one-on-one time for the Teen and the physician. Please prepare your child appropriately.
DtaP = Diptheria/Tetanus/Acellular Pertussis
HIB= Hemophilus influenza type B
HepB = Hepatitis B vaccine
IPV = Inactivated Polio Virus
Prevnar = Pneumococcal 7- conjugate
Varivax = Varicella (chickenpox)
MMR = Measles/Mumps/Rubella
RotaTeq= oral Rotavirus vaccine
TdaP = Tetanus/Diptheria/acellular Pertussis booster
Gardasil= HPV (cervical cancer) vaccine
Menactra = meningococcal vaccine
UA= urninalysis
Hgb= hemoglobin (blood count)
HepA = Hepatitis A
Sapphire Pediatrics 4500 E. Ninth Avenue, #740 Denver, CO 80220
Phone 720-941-1778
Fax 720-941-1783
Welcome to Sapphire Pediatrics!
We are pleased you are taking the time to visit with our providers before the birth of your
child. We are delighted to tell you about our office, our experience, and our philosophy
of care.
We hope our office is a place you can feel comfortable with your growing family. We
take the time to hear your concerns and address all issues thoroughly. We aim to provide
state-of-the-art pediatric care in a friendly and compassionate manner.
f questions to this or any appointment with your
child. We have literature available for you at every visit that will hopefully address all
your concerns, and can provide you with additional information as needed.
We aim to know your family well, know how your child responds to illness, and learn the
best ways to keep him or her healthy. In partnership with you, the parents, we will
provide outstanding healthcare for your child.
should your
child ever need to be hospitalized, Dr. Larabee will attend to their health care needs at
most local hospitals.
Hospital Affiliations: Rose Medical Center
Presbyterian/St. Lukes Hospital
St. Josephs Hospital
Robin M. Larabee, MD- Medical Training and Experience
Undergraduate Degree: B.S., Biology, Pennsylvania State University, 1991
Medical School: M.D, Medical College of Wisconsin, Milwaukee; 1995
of Wisconsin, Milwaukee; 1998
Pediatric Hospitalist/Emergency Dept: Franklin Square Hospital Center, Baltimore; 1999-2004
Dr. Larabee has owned and operated Sapphire Pediatrics since February, 2005.
She has two young children who constantly remind her of the joys and challenges of
Molly Gilpin, P.A.-C
Undergraduate Degree: B.S., Exercise Physiology/Chemistry; N. Arizona Univeristy; 2000
Physician Assistant Education: M.S., P.A.-C; Pacific University, Oregon; 2000-2002
Practice Experience: Denver Health Orthopedic Trauma; Family Medicine (Denver Area)
Ms. Gilpin has a young daughter and enjoys family, pets, and the outdoors.
Well Visits:
Children under age two years should schedule their next visit while at the office for the
current visit. For older children, please call 4 weeks in advance for your appointment, as
this ensures your choice of day and time will be available.
Sapphire Pediatrics follows the American Academy of Pediatrics guidelines for frequency of
well child visits and immunizations. Routine well visits and immunizations are
recommended for every child; if you have reservations about immunizations please speak to
a provider to make an informed decision.
A parent should accompany the child to all well visits; this allows us to provide the best and
most complete care to your child. Please schedule this visit for a date that one or both
parents can attend.
If your child is over four years old, we ask that you schedule their well visit for the spring or
summer months. This avoids pressure on our busy wintertime sick visit schedule.
Sick Visits:
All visits require appointments. Please call before coming in to the office. Some problems
can be treated at home, some can wait for the next available appointment, and others must
be seen immediately. By calling our office first, we can see all our patients in a timely
fashion based on their medical needs, or refer you to the emergency department if necessary.
policy maintains fairness to patients who have scheduled in advance, and keeps our waiting
room time to a minimum.
If more than one of your children needs to be seen, please schedule appointments for each
of them. This assures that the proper time is allotted each child for a complete evaluation,
and allows us to prepare their paperwork in advance.
While we prefer that parents bring the child for all visits, caretakers may bring the child in for
an urgent appointment with written consent for treatment from a parent.
Arrival Time:
Please arrive at our office at least 15 minutes in advance of your appointment. Your
appointment time is scheduled for the physician, and does not include the time required to
confirm insurance and fill out necessary paperwork. If you are late for an appointment, we
may need to reschedule you so that other patients may be seen on time. Please give 24
hours notice to cancel a well visit. A $25 fee is charged for missed visits.
Phone Calls, Questions, and Prescription Refills:
For emergencies 24 hrs a day: if you feel your child is having a life-threatening emergency,
please call 911 or proceed to the nearest emergency department.
During office hours: Sapphire Pediatrics has office staff dedicated to answering telephone
calls. If our office staff is unable to answer your questions, they will consult with a provider
and return your call, or have them return your call personally, when time permits. Please
have a pharmacy number at hand in case a prescription is necessary.
During off hours: Please save routine questions (refills, medication questions, appointments,
etc) for daytime hours. For emergency sick calls, call our main number (720-941-1778) and
your call will be taken by our answering service. Your call will then be forwarded to the
ce. Either way, your call will
be returned within 30 minutes.
way, telephone calls after hours, especially after 10 pm, are very costly for our office. Please
respect our request to use this service only for emergencies.
Medical Records:
We keep electronic medical records on every patient in the practice. This keeps track of all
medical information for your child, including immunizations, prescriptions, pharmacies,
and refills. It is not available to anyone on the internet.
If you are transferring care from another office, please provide us with complete medical
records (especially vaccine records) before or at your first visit. If for some reason this is not
possible, please sign a release of information at your first visit so we may obtain the records
for you. This ensures that our staff can evaluate your child appropriately.
Insurance, Billing, and Payment:
We bill your insurance as a courtesy to you. Any fees not covered by your plan are your financial
responsibility. Please assist us in billing your insurance in the following ways:
Newborns must be enrolled with your insurance immediately after birth. If not enrolled
by 30 days of age, your newborns visits and/or shots may not be covered by your
Any co-payments required by your insurance are due at the time of service. A $10
billing fee is charged if you cannot pay your deductible at the time of service.
Bring your current insurance card to every visit. This allows us to verify your insurance
Select us as your PCP (primary care physician). If your insurance requires you to select
card, your care may not be covered.
If you have Medicaid:
make sure to fill out all the required forms and do NOT accept assignment to
DenverHealth HMO or Kaiser HMO thru Medicaid.
United States
Environmental Protection
Indoor Environments Division (6609J)
Office of Air and Radiation
October 1996
Protect Your Family and
Yourself from Carbon
Monoxide Poisoning
Carbon Monoxide Can Be Deadly
high levels it can kill a person in minutes. Carbon
monoxide (CO) is produced whenever any fuel
such as gas, oil, kerosene, wood, or charcoal is
burned. If appliances that burn fuel are maintained
and used properly, the amount of CO produced is
usually not hazardous. However, if appliances are
not working properly or are used incorrectly,
dangerous levels of CO can result. Hundreds of
people die accidentally every year from CO
poisoning caused by malfunctioning or improperly
used fuel-burning appliances. Even more die from
CO produced by idling cars. Fetuses, infants,
elderly people, and people with anemia or with a
history of heart or respiratory disease can be
CO Poisoning Symptoms
Know the symptoms of CO poisoning. At moderate
levels, you or your family can get severe
headaches, become dizzy, mentally confused,
nauseated, or faint. You can even die if these levels
persist for a long time. Low levels can cause
shortness of breath, mild nausea, and mild
headaches, and may have longer-term effects on
your health. Since many of these symptoms are
similar to those of the flu, food poisoning, or other
illnesses, you may not think that CO poisoning
could be the cause.
Play it Safe
If you experience symptoms that you think could be
from CO poisoning:
doors and windows, turn off combustion
appliances and leave the house.
the physician you suspect CO poisoning. If CO
poisoning has occurred, it can often be
diagnosed by a blood test done soon after
DO Be prepared to answer the following
questions for the doctor:
Do your symptoms occur only in the house?
Do they disappear or decrease when you
leave home and reappear when you return?
Is anyone else in your household
complaining of similar symptoms? Did
same time?
Are you using any fuel-burning appliances
in the home?
Has anyone inspected your appliances
lately? Are you certain they are working
Prevention is the Key to Avoiding Carbon
Monoxide Poisoning
DO have your fuel-burning appliances -including oil and gas furnaces, gas water
heaters, gas ranges and ovens, gas dryers, gas
or kerosene space heaters, fireplaces, and
wood stoves -- inspected by a trained
professional at the beginning of every heating
season. Make certain that the flues and
chimneys are connected, in good condition, and
not blocked.
DO choose appliances that vent their fumes to
the outside whenever possible, have them
properly installed, and maintain them according
DO read and follow all of the instructions that
accompany any fuel-burning device. If you
cannot avoid using an unvented gas or
kerosene space heater, carefully follow the
cautions that come with the device. Use the
proper fuel and keep doors to the rest of the
house open. Crack a window to ensure enough
air for ventilation and proper fuel-burning.
1-800438-4318) or the Consumer Product Safety
Commission (1-800-638-2772) for more
information on how to reduce your risks from
CO and other combustion gases and particles.
idle the car in a garage -- even if the
garage door to the outside is open. Fumes can
build up very quickly in the garage and living
area of your home.
use a gas oven to heat your home, even
for a short time.
A Few Words About CO Detectors
Carbon Monoxide Detectors are widely available in
stores and you may want to consider buying one as a
back up -- BUT NOT AS A REPLACEMENT for proper
use and maintenance of your fuel-burning appliances.
However, it is important for you to know that the
technology of CO detectors is still developing, that there
are several types on the market, and that they are not
generally considered to be as reliable as the smoke
detectors found in homes today. Some CO detectors
have been laboratory-tested, and their performance
varied. Some performed well, others failed to alarm even
at very high CO levels, and still others alarmed even at
risk. And unlike a smoke detector, where you can easily
confirm the cause of the alarm, CO is invisible and
an alarm is false or a real
sense of security. Preventing CO from becoming a
problem in your home is better than relying on an alarm.
Second, if you shop for a CO detector, do some
of cost. Non-governmental organizations such as
Consumers Union (publisher of Consumer Reports), the
American Gas Association, and Underwriters
Laboratories (UL) can help you make an informed
decision. Look for UL certification on any detector you
ever use a charcoal grill indoors -- even
in a fireplace.
placement, use, and maintenance.
DON'T sleep in any room with an unvented gas
or kerosene space heater.
use any gasoline-powered engines
(mowers, weed trimmers, snow blowers, chain
saws, small engines or generators) in enclosed
ignore symptoms, particularly if more
than one person is feeling them. You could lose
consciousness and die if you do nothing.
If the CO detector alarm goes off:
Make sure it is your CO detector and not your smoke
Check to see if any member of the household is
experiencing symptoms of poisoning.
If they are, get them out of the house immediately
and seek medical attention. Tell the doctor that you
suspect CO poisoning.
If no one is feeling symptoms, ventilate the home
with fresh air, turn off all potential sources of CO -your oil or gas furnace, gas water heater, gas range
and oven, gas dryer, gas or kerosene space heater
and any vehicle or small engine.
Have a qualified technician inspect your fuel-burning
appliances and chimneys to make sure they are
operating correctly and that there is nothing blocking
the fumes from being vented out of the house.
Sapphire Pediatrics
Robin Larabee, MD
Molly Gilpin, PA-C
4500 E. Ninth Avenue, Suite 740
Denver, CO 80220
First Weeks at Home with a Newborn
Preventing Fatigue and Exhaustion
For many mothers the first weeks at home with a new baby are often the hardest in their
lives. You will probably feel overworked, even overwhelmed. Inadequate sleep will
leave you fatigued. Caring for a baby can be a lonely and stressful responsibility. You
may wonder if you will ever catch up on your rest or work. The solution is asking for
help. No one should be expected to care for a young baby alone.
Every baby awakens one or more times a night. The way to avoid sleep deprivation is to
know the total amount of sleep you need per day and to get that sleep in bits and pieces.
Go to bed earlier in the evening after your baby's final feeding of the day. When your
baby naps you must also nap. Your baby doesn't need you hovering while he or she
sleeps. If sick, your baby will show symptoms. While you are napping take the
telephone off the hook and put up a sign on the door saying MOTHER AND BABY
SLEEPING. If your total sleep remains inadequate, hire a babysitter or bring in a
relative. If you don't take care of yourself, you won't be able to take care of your baby.
The Postpartum Blues
More than 50% of women experience postpartum blues on the third or fourth day after
delivery. The symptoms include tearfulness, tiredness, sadness, and difficulty in
thinking clearly. The main cause of this temporary reaction is probably the sudden
decrease of maternal hormones. Since the symptoms commonly begin on the day the
mother comes home from the hospital, the full impact of being totally responsible for a
dependent newborn may also be a contributing factor. Many mothers feel let down and
guilty about these symptoms because they have been led to believe they should be
overjoyed about caring for their newborn. In any event, these symptoms usually clear in
1 to 3 weeks as the hormone levels return to normal and the mother develops routines
and a sense of control over her life.
There are several ways to cope with the postpartum blues. First, acknowledge your
feelings. Discuss them with your husband or a close friend as well as your sense of
being trapped and that these new responsibilities seem insurmountable. Don't feel you
need to suppress crying or put on a "supermom show" for everyone. Second, get
adequate rest. Third, get help with all your work. Fourth, renew contact with other
people; don't become isolated. Get out of the house at least once a week--go to the
hairdresser, shop, visit a friend, or see a movie. By the fourth week, setting aside an
evening a week for a "date" at home with your husband is also helpful. Take-out food
and a rental movie can help you tap back into your marriage. If you don't feel better by
the time your baby is 1 month old, see your healthcare provider about the possibility of
counseling for depression. If the blues are making it impossible for you to care for
yourself and your baby, get help as soon as possible.
Helpers: Relatives, Friends, Sitters
As already emphasized, everyone needs extra help during the first few weeks alone with
a new baby. Ideally, you were able to make arrangements for help before your baby was
born. The best person to help (if you get along with her) is usually your mother or
mother-in-law. If not, teenagers or adults can be hired to come in several times a week
to help with housework or look after your baby while you go out or get a nap. If you
have other young children, you will need daily help. Clarify that your role is looking
after your baby. Your helper's role is to shop, cook, houseclean, and wash clothes and
dishes. If your newborn has a medical problem that requires special care, ask for home
visits by a public health nurse.
The Father's Role
The father needs to take time off from work to be with his wife during labor and
delivery, as well as on the day she and his child come home from the hospital. If the
couple has a relative who will temporarily live in and help, the father can continue to
work after the baby comes home. However, when the relative leaves, the father can take
saved-up vacation time as paternity leave. At a minimum he needs to work shorter hours
until his wife and baby have settled in.
The age of noninvolvement of the father is over. Not only does the mother need the
father to help her with household chores, but the baby also needs to develop a close
relationship with the father. Today's father helps with feeding, changing diapers,
bathing, putting to bed, reading stories, dressing, disciplining, homework, playing
games, and calling the doctor when the child is sick. The father needs to be his wife's
support system. He needs to relieve her in the evenings so she can nap or get a brief
change of scenery.
A father may avoid interacting with his baby during the first year of life because he is
afraid he will hurt his baby or that he won't be able to calm the child when the baby
cries. The longer a father goes without learning parenting skills, the harder it becomes to
master them. At a minimum, a father should hold and comfort his baby at least once a
Only close friends and relatives should visit you during your first month at home. They
should not visit if they are sick. To prevent unannounced visitors, the parents can put up
FIRST. Friends without children may not understand your needs. During visits the
visitor should also pay special attention to older siblings.
Feeding Your Baby: Achieving Weight Gain
Your main assignments during the early months of life are loving and feeding your
baby. All babies lose a few ounces during the first few days after birth. However, they
should rarely lose more than 7% of the birth weight (usually about 8 ounces for a 7
pound birth weight). Most bottle-fed babies are back to birth weight by 7 days of age,
and breast-fed babies by 10 days of age. Then infants gain approximately an ounce per
day during the early months. If milk is provided liberally, the normal newborn's hunger
drive ensures appropriate weight gain.
A breast-feeding mother often wonders if her baby is getting enough calories, since she
can't see how many ounces the baby takes. Your baby is doing fine if he or she demands
to nurse every 1 1/2 to 2 1/2 hours, appears satisfied after feedings, takes both breasts at
each nursing, wets 6 or more diapers each day, and passes 3 or more soft stools per day.
Whenever you are worried about your baby's weight gain, bring your baby to your
healthcare provider's office for a weight check. Feeding problems detected early are
much easier to remedy than those of long standing. A special weight check 1 week after
birth is a good idea for infants of a first-time breast-feeding mother or a mother
concerned about her milk supply.
Dealing with Crying
Crying babies need to be held. They need someone with a soothing voice and a soothing
touch. You can't spoil your baby during the early months of life. Overly sensitive babies
may need an even gentler touch.
Sleep Position
Remember to place your baby in his crib on his back. As of 1992, this is the sleep
position recommended by the American Academy of Pediatrics for healthy babies. The
back (supine) position reduces the risk of Sudden Infant Death Syndrome (SIDS).
Taking Your Baby Outdoors
You can take your baby outdoors at any age. You already took your baby outside when
you left the hospital, and you will be going outside again when you take him or her for
the two-day or two-week checkup.
Dress the baby with as many layers of clothing as an adult would wear for the outdoor
temperature. A common mistake is overdressing a baby in summer. In winter, a baby
needs a hat because he or she often doesn't have much hair to protect against heat loss.
Cold air or winds do not cause ear infections or pneumonia.
The skin of babies is more sensitive to the sun than the skin of older children. Keep sun
exposure to small amounts (10 to 15 minutes at a time). Protect your baby's skin from
sunburn with longer clothing and a bonnet.
Camping and crowds should probably be avoided during your baby's first month of life.
Also, during your baby's first year of life try to avoid close contact with people who
have infectious illnesses.
Medical Checkup on the Third or Fourth Day of Life
Early discharge from the newborn nursery has become commonplace for full-term
babies. Early discharge means going home in the 24 hours after giving birth. In general
this is a safe practice if the baby's hospital stay has been uncomplicated. These
newborns need to be re-checked 2 days after discharge to see how well they are feeding,
urinating, producing stools, maintaining weight, and breathing. They will also be
checked for jaundice and overall health. In some cases, this special re-check will be
provided in your home.
The Two-Week Medical Checkup
This checkup is probably the most important medical visit for your baby during the first
year of life. By two weeks of age your baby will usually have developed symptoms of
any physical condition that was not detectable during the hospital stay. Your child's
healthcare provider will be able to judge how well your baby is growing from his or her
height, weight, and head circumference.
This is also the time your family is under the most stress of adapting to a new baby. Try
to develop a habit of jotting down questions about your child's health or behavior at
home. Bring this list with you to office visits to discuss with the healthcare provider.
Most physicians welcome the opportunity to address your agenda, especially if your
questions are not easily answered by reading or talking with other mothers.
If at all possible, both the mother and father should go to these visits. Most physicians
prefer to get to know both parents during a checkup rather than during the crisis of an
acute illness.
If you think your newborn starts to look or act sick between the routine visits, be sure to
call your child's healthcare provider for help.
Newborn's Normal Appearance
Even after your child's healthcare provider assures you that your baby is normal, you may find that he or
she looks a bit odd. Your baby does not have the perfect body you have seen in baby books. Be patient.
Most newborns have some peculiar characteristics. Fortunately they are temporary. Your baby will
begin to look normal by 1 to 2 weeks of age.
This discussion of these newborn characteristics is arranged by parts of the body. A few minor
congenital defects that are harmless but permanent are also included. Call your healthcare provider if
you have questions about your baby's appearance that this list does not address.
1. Molding Molding refers to the long, narrow, cone‐shaped head that results from passage through a
tight birth canal. This compression of the head can temporarily hide the fontanel. The head returns to a
normal shape in a few days.
2. Caput This refers to swelling on top of the head or throughout the scalp due to fluid squeezed into
the scalp during the birth process. Caput is present at birth and clears in a few days.
3. Cephalohematoma This is a collection of blood on the outer surface of the skull. It is due to friction
between the infant's skull and the mother's pelvic bones during the birth process. The lump is usually
confined to one side of the head. It first appears on the second day of life and may grow larger for up to
5 days. It doesn't resolve completely until the baby is 2 or 3 months of age.
4. Anterior fontanel The "soft spot" is found in the top front part of the skull. It is diamond‐shaped and
covered by a thick fibrous layer. Touching this area is quite safe. The purpose of the soft spot is to allow
rapid growth of the brain. The spot will normally pulsate with each beat of the heart. It normally closes
with bone when the baby is between 12 and 18 months of age.
1. Swollen eyelids The eyes may be puffy because of pressure on the face during delivery. They may
also be puffy and reddened if silver nitrate eye drops are used. This irritation should clear in 3 days.
2. Subconjunctival hemorrhage A flame‐shaped hemorrhage on the white of the eye (sclera) is not
uncommon. It's harmless and due to birth trauma. The blood is reabsorbed in 2 to 3 weeks.
3. Iris color The iris is usually blue, green, gray, or brown, or variations of these colors. The permanent
color of the iris is often uncertain until your baby reaches 6 months of age. White babies are usually
born with blue‐gray eyes. Black babies are usually born with brown‐gray eyes. Children who will have
dark irises often change eye color by 2 months of age; children who will have light‐colored irises usually
change by 5 or 6 months of age.
4. Tear duct, blocked If your baby's eye is continuously watery, he or she may have a blocked tear duct.
This means that the channel that normally carries tears from the eye to the nose is blocked. It is a
common condition, and more than 90% of blocked tear ducts open up by the time the child is 12 months
1. Folded over The ears of newborns are commonly soft and floppy. Sometimes one of the edges is
folded over. The outer ear will assume normal shape as the cartilage hardens over the first few weeks.
2. Earpits About 1 % of normal children have a small pit or dimple in front of the outer ear. This minor
congenital defect is not important unless it becomes infected.
The nose can become misshapen during the birth process. It may be flattened or pushed to one side. It
will look normal by 1 week of age.
1. Sucking callus (or blister) A sucking callus occurs in the center of the upper lip from constant friction
at this point during bottle‐ or breast‐feeding. It will disappear when your child begins cup feedings. A
sucking callus on the thumb or wrist may also develop.
2. Tongue‐tie The normal tongue in newborns has a short tight band that connects it to the floor of the
mouth. This band normally stretches with time, movement, and growth.
3. Epithelial pearls Little white‐colored cysts can occur along the gum line or on the hard palate. These
are a result of blockage of normal mucous glands. They disappear after 1 to 2 months.
4. Teeth The presence of a tooth at birth is rare. Approximately 10% are extra teeth without a root
structure. The other 90% are prematurely erupted normal teeth. The distinction can be made with an X‐
ray. The extra teeth should be removed, usually by a dentist. The normal teeth need to be removed only
if they become loose (with a danger of choking) or if they cause sores on your baby's tongue.
Swollen breasts are present during the first week of life in many female and male babies. They are
caused by the passage of female hormones across the mother's placenta. Sometimes the breast will leak
a few drops of milk, and this is normal. Breasts are generally swollen for 2 to 4 weeks, but they may stay
swollen longer in breast‐fed and female babies. One breast may lose its swelling before the other one by
a month or more. Never squeeze the breast because this can cause infection. Be sure to call your
healthcare provider if a swollen breast develops any redness, streaking, or tenderness.
1. Swollen labia The labia minora can be quite swollen in newborn girls because of the passage of
hormones across the placenta. The swelling will resolve in 2 to 4 weeks.
2. Hymenal tags The hymen can also be swollen due to maternal estrogen and have smooth 1/2‐inch
projections of pink tissue. These normal tags occur in 10% of newborn girls and slowly shrink over 2 to 4
3. Vaginal discharge As the maternal hormones decline in the baby's blood, a clear or white discharge
can flow from the vagina during the latter part of the first week of life. Occasionally the discharge will
become pink or blood‐tinged (false menstruation). This normal discharge should not last more than 2 to
3 days.
1. Hydrocele The newborn scrotum can be filled with clear fluid. The fluid is squeezed into the scrotum
during the birth process. This painless collection of clear fluid is called a "hydrocele." It is common in
newborn males. A hydrocele may take 6 to 12 months to clear completely. It is harmless but can be
rechecked during regular visits. If the swelling frequently changes size, a hernia may also be present and
you should call your healthcare provider during office hours for an appointment.
2. Undescended testicle The testicle is not in the scrotum in about 4% of full‐term newborn boys. Many
of these testicles gradually descend into the normal position during the following months. In 1‐year‐old
boys only 0.7% of all testicles are undescended; these need to be brought down surgically.
3. Tight foreskin Most uncircumcised infant boys have a tight foreskin that doesn't allow you to see the
head of the penis. This is normal and the foreskin should not be retracted.
4. Erections Erections occur commonly in a newborn boy, as they do at all ages. They are usually
triggered by a full bladder. Erections demonstrate that the nerves to the penis are normal.
1. Tight hips Your child's healthcare provider will test how far your child's legs can be spread apart to
be certain the hips are not too tight. Upper legs bent outward until they are horizontal is called "90
degrees of spread." (Less than 50% of normal newborn hips permit this much spreading.) As long as the
upper legs can be bent outward to 60 degrees and are the same on each side, they are fine. The most
common cause of a tight hip is a dislocation.
2. Tibial torsion The lower legs (tibia) normally curve in because of the cross‐legged posture your baby
was confined to while in the womb. If you stand your baby up, you will also notice that the legs are
bowed. Both of these curves are normal and will straighten out after your child has been walking for 6 to
12 months.
3. Feet turned up, in or out Feet may be turned in any direction inside the cramped quarters of the
womb. As long as your child's feet are flexible and can be easily moved to a normal position, they are
normal. The direction of the feet will become more normal between 6 and 12 months of age.
4. Long second toe The second toe is longer than the great toe as a result of heredity in some ethnic
groups that originated along the Mediterranean, especially Egyptians.
Many newborns have soft nails that easily bend and curve. However, they are not
truly in grown because they don't curve into the flesh.
1. Scalp hair Most hair at birth is dark. This hair is temporary and begins to shed by 1 month of age.
Some babies lose it gradually while the permanent hair is coming in; others lose it rapidly and
temporarily become bald. The permanent hair will appear by 6 months. It may be an entirely different
color from the newborn hair.
2. Body hair (lanugo) Lanugo is the fine downy hair that is sometimes present on the back and
shoulders. It is more common in premature infants. It is rubbed off with normal friction by 2 to 4 weeks
of age.
Published by McKesson Corporation.
This content is reviewed periodically and is subject to change as new health information becomes
available. The information is intended to inform and educate and is not a replacement for medical
evaluation, advice, diagnosis or treatment by a healthcare professional.
Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright © 2007 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
Special Instructions:
Copyright © Clinical Reference Systems 2007 Pediatric Advisor
Sapphire Pediatrics
Robin Larabee, MD
Molly Gilpin, PA-C
4500 E. Ninth Avenue, Suite 740
Denver, CO 80220
Normal Newborn Reflexes and Behavior
Some newborn behaviors that concern parents are not signs of illness. They are usually
due to an immature nervous system and will disappear in 3 or 4 months. Some common
reflexes and behaviors include:
trembling chin
quivering lower lip
having hiccups
passing gas (this is not a temporary behavior)
making noises when sleeping (from breathing and moving). Also during light sleep,
babies can normally whimper, cry, groan, or make other strange noises. If you use a
nursery monitor don't over-react to these normal variations in sleep sounds.
spitting up or burping
stiffening of the body after a noise or sudden movement (also called the startle reflex)
straining with bowel movements
clearing the throat (or gurgling sounds in the throat)
breathing irregularly (This is normal if your baby is content, the rate is less than 60
breaths per minute, any pauses are less than 10 seconds long, and your baby isn't turning
blue. Sometimes babies take rapid, progressively deeper breaths to completely expand
their lungs.)
trembling or jitteriness of arms and legs during crying is normal. Convulsions are rare.
During convulsions babies also jerk, blink their eyes, rhythmically suck with their mouths,
and don't cry. If your baby is trembling and not crying, it could be abnormal. Give her
something to suck on. If the trembling doesn't stop when your baby is sucking, call your
healthcare provider immediately.
Sapphire Pediatrics
Robin Larabee, MD
4500 E. Ninth Avenue, Suite 740
Denver, CO 80220
Newborn Skin Care (Normal)
You may bathe your baby daily, but for the first few months, 2 or 3 times a week is
often enough for a full bath. Clean your baby's drools and spills as they happen and
keep the face, hands and diaper area clean.
Keep the bath water level below the naval or give sponge baths until a few days after
the navel cord has fallen off. Submerging the cord could cause infection or interfere
with its drying out and falling off. Getting the cord a little wet doesn't matter.
Use tap water without any soap or with a nondrying baby soap. Don't forget to wash
the face and neck; otherwise, chemicals from dribbled milk and food can build up and cause an irritated rash. Also rinse off the eyelids with water.
Don't forget to wash the genital area. However, when you wash the inside of the
female genital area (the vulva), never use soap. Rinse the area with plain water and
wipe from front to back to prevent irritation. This practice and the avoidance of any
bubble baths before puberty may prevent many urinary tract infections and vaginal
irritations. At the end of the bath, rinse your baby well; soap residue can be irritating.
Changing Diapers
After you remove a wet diaper, just rinse your baby's bottom off with a wet
washcloth or diaper wipe. After soiled diapers, rinse the bottom under running warm
water or in a basin of warm water. You can't clean BMs off the skin with diaper
wipes alone. Millions of bacteria will remain and cause diaper rashes. After you
clean the rear, cleanse the genital area by wiping front to back with a wet cloth. In
boys, stool can hide under the scrotum, so rinse carefully there. If you have a girl,
carefully clean the creases of the vaginal lips (labia).
Wash your baby's hair once or twice a week with a special baby shampoo that
doesn't sting the eyes. Don't be concerned about hurting the anterior fontanelle (soft
spot on the head). It is well protected.
Lotions, Ointments, and Powder
Newborn skin normally does not require any ointments or creams. Especially avoid
putting any oil, ointment, or greasy substance on your baby's skin because this will
almost always block the small sweat glands and lead to pimples or a heat rash. If the
skin starts to become dry and cracked, use a baby lotion, hand lotion, or
moisturizing cream twice a day. Apply it within 3 minutes after a bath to keep
moisture in the skin.
Cornstarch powder can be helpful for preventing rashes in areas of friction. Avoid
talcum powder because it can cause a serious chemical pneumonia if inhaled into the
Umbilical Cord
Try to keep the cord dry. Put rubbing alcohol on the base of the cord (where it
attaches to the skin) twice a day (including after the bath) until 1 week after it falls
off. Although using alcohol can delay the separation of the cord by 1 or 2 days, it
does prevent cord infections, and that's what is most important. Air exposure helps
the cord stay dry and eventually fall off, so keep diapers folded down below the cord
area. If you are using disposable diapers, you can cut a wedge out of the diaper
scissors so the cord is not covered.
Fingernails and Toenails
Cut the toenails straight across to prevent ingrown toenails. When you cut
fingernails, round off the corners of the nails so your baby doesn't scratch himself or
Trim the nails once a week after a bath, when the nails are softened by the bath. Use
clippers or special baby scissors. This job usually takes two people unless you do it
while your child is asleep.
back; also cottage cheese with clumps also seedy.
or curds;
between meconium
and yellow mustard or cottage cheese like
yellow liquid mustard, but may be
brown, green, orange. Often runs out
of the diaper and down the legs or
Babies grunt and strain just
because. If the stools are not
small pellets, straining is not a
sign of constipation or a medical
mature; there is little waste in breast milk so stools may be
infrequent. Babies naturally
grunt and strain, even when
stools are soft.
Frequent stools at this age are a
sign of good milk intake
(baby-lax®, available over the counter)
; solid suppositories ok if liquid not available
Sapphire Pediatrics
Robin Larabee, MD
Molly Gilpin, PA-C
4500 E. Ninth Avenue, Suite 740
Denver, CO 80220
Breast Milk: How to Pump and Store It
Learning how to pump and store breast milk can make returning to work easier and
less stressful. It does require some work, but if you have a plan, it can be done.
When should I start to pump my breasts?
If you will be pumping your breasts, practice for 1 or 2 weeks before you go back to
work. You can try pumping just after your baby eats, or you can pump your breasts
between feedings.
Practicing at home will help you learn how your pump works. During this time, you
also can start to collect and store breast milk to be fed to your baby when you return
to work.
How much milk will I get when I pump?
You may not get much milk when you first start pumping. After a few days of
regular pumping, your breasts will begin to make more milk.
How long should I pump each time?
Pumping your breasts takes about the same time as breastfeeding, but with practice
and a good pump, you can pump your breasts in as little as 10 to 15 minutes. While
you are at work, try to pump as often as your baby usually feeds. To keep up your
milk supply, give your baby extra feedings when you are together.
Will there be times that my baby will need more milk?
Yes, your baby will probably want more milk during growth spurts. The best way to
increase your milk supply for a growth spurt is to breastfeed or pump more often.
How should I store my breast milk?
Breast milk can be stored in a plastic or glass bottle with a sealable top, or in a
sterile, sealable bag. Store your breast milk in amounts that you use every day to
avoid wasting it. For example, if your baby eats 4 ounces in a feeding, put 4 ounces
of breast milk in the storage container.
Where should I store my breast milk?
Pumped breast milk should be cooled in a refrigerator or other cooler as soon as
possible. The milk can also be frozen if you aren't going to use it right away.
How long can I store my breast milk?
The following are some general breast milk storage guidelines:
At room temperature (less than 77°F) for 4 to 8 hours
At the back of a refrigerator for 3 to 8 days
At the back of a freezer for up to 3 months
The breast milk I have in my refrigerator looks funny. Is something wrong?
Breast milk can vary in color. It can be blueish, yellowish or brownish. It is also
normal for breast milk to separate (the fatty part of the milk goes to the top). Shake
the bottle or sealed bag, and the fat will go back into the milk.
How should I thaw frozen breast milk?
Thaw the milk slowly by swirling the container of milk in warm water or by putting
the container in the refrigerator the day before it is to be used. Don't use hot water to
thaw breast milk. Never thaw frozen breast milk in a microwave oven. The milk
could get too hot and burn your baby. Microwaving can also destroy valuable
proteins in breast milk.
Thawed breast milk can be refrigerated for up to 24 hours, but it should not be refrozen.
Sapphire Pediatrics
Robin Larabee, MD
Molly Gilpin, PA-C
4500 E. Ninth Avenue, Suite 740
Denver, CO 80220
Breastfeeding mothers - self-care
Breastfeeding is often an enjoyable and rewarding experience for mothers. A breastfeeding mother
must continue to take care of her baby and herself, as she did during her pregnancy.
Alternative Names
Breast pump information; Nursing mothers - self-care
In general, lactating women should get nutrients from a well-balanced, varied diet, rather than from
vitamin and mineral supplements. Eat generous amounts of fruits and vegetables, whole and grain
breads and cereals, calcium-rich dairy products, and protein-rich foods (meats, fish, and legumes).
Make sure you are getting enough calories.
Milk, yogurt, and cheese -- eat at least 4 servings
Meat, poultry, fish, dry beans, eggs, and nuts -- at least 3 servings
Vegetables -- at least 3 to 5 servings
Fruits -- eat 2 to 4 servings (choose two foods high in vitamin C and folic acid, and one food
high in vitamin A)
Bread, cereal, rice, and pasta -- at about 6 to 11 servings
Fats, oils, and sweets -- go easy!
This is just a guide. You may need to eat more than this based on your size and activity level.
Nursing mothers need enough fluids to stay hydrated -- most experts recommend drinking enough
fluids to satisfy thirst. Eight 8-ounce servings (64 ounces) of fluid such as water, milk, juice, or
soup is a good goal.
Breastfeeding mothers can safely eat any foods they like. Some foods may flavor the breast milk,
but babies rarely react to this. If your baby is fussy after you eat a certain food, try avoiding that
food for a while, then try it again later to see if it is a problem.
Don't limit your diet excessively. Make sure you are getting enough nutrition for yourself and your
baby. If you become overly concerned about foods or spices causing problems, try to remember
that entire countries and cultures have diets that contain foods that are extremely spicy. In these
cultures, the mothers nurse their infants without problems.
It is possible that some highly allergenic foods (strawberries, peanuts) may be passed into breast
milk, increasing the risk of a later food allergy in the baby. If this is a concern, discuss food
allergies with your pediatrician.
A nursing mother can safely consume moderate amounts of caffeine (equal to 1 to 2 cups of coffee
per day) without causing harm to her baby. But any more caffeine than that may cause agitation and
difficulty sleeping for your baby.
Since alcohol has been found in human milk and can interfere with the milk ejection reflex, avoid
alcohol while breastfeeding. An occasional drink, not exceeding two ounces of alcohol, may be
safe, but you should consult your health care provider about the associated risks.
If you are a smoker, this is a great time to quit for yourself and for your baby. Nicotine and other
chemicals from cigarettes are found in breast milk. If you are unable to quit, try to limit the number
of cigarettes as much as possible, change to a brand with low nicotine, and visit your doctor
Many medications (prescription and over-the-counter medications) will pass into the mother's milk.
Check with your physician before taking any medications. Do NOT stop taking any prescribed
medication without speaking first to your doctor.
The American Academy of Pediatrics' Committee on Drugs releases a periodic statement with a list
of drugs and their compatibility with breastfeeding. Your obstetrician and pediatrician are both
likely to be familiar with this publication and can answer your concerns about breastfeeding while
taking medications.
Most breastfeeding women do not have normal menstrual periods (lactation amenorrhea). Although
the risk of pregnancy is less for a woman experiencing lactation amenorrhea, pregnancy CAN
occur during this time. Breastfeeding should not be used for contraception, since failure is likely.
Birth control choice should be discussed with your health care provider. Barrier methods (condom,
diaphragm), progesterone contraceptives (oral or injectable), and IUDs have all been shown to be
safe and effective. Progesterone contraception is generally not started until the milk supply is
established, usually at 4 weeks postpartum.
Estrogen-containing birth control pills are not recommended for breastfeeding women, because
they may affect milk supply.
Mothers face unique obstacles in maintaining adequate milk supply once they return to work. With
planning, commitment, and skilled use of a breast pump, breastfeeding mothers can maintain their
milk supply and continue breastfeeding even after returning to work outside the home.
A maternity leave is helpful for establishing your milk supply and breastfeeding skills before
returning to work. An ideal work place would provide a private room for breastfeeding moms, with
a comfortable chair and an electric breast pump for use by all nursing mothers.
However, many moms have had success using a hand breast pump and a bathroom stall for privacy.
Many women prefer the speed of the electric breast pump. Hospital-quality pumps are available for
rent through medical supply stores. Personal, portable models are available for purchase.
Here are some tips that have worked well for many breastfeeding mothers who work fulltime
outside the home:
If you plan to return to work, introduce your baby to bottle-feeding at 3 to 4 weeks of age.
This allows plenty of time to establish good feeding habits. Starting bottle-feeds before 2 weeks
of age often results in nipple confusion -- the baby has difficulty changing between the different
sucking patterns required for the different types of feeding.
Two weeks before you return to work, buy or rent an efficient and comfortable breast pump
and start building up a supply of frozen milk. If the day you return to work arrives and you
don't have a freezer full of breast milk, one bottle of formula fed to your baby will be an
adequate supplement. After returning to work, express milk 2 or 3 times a day, every 2 to 3
hours to continue exclusively breastfeeding. If you can only get one break a day and you are
unable to pump a full day's allotment in one pumping, a supplemental bottle of formula may be
needed. Be aware, however, that feeding formula decreases the need for breast milk, and your
milk supply will decrease accordingly.
Nurse your baby immediately before leaving in the morning and immediately upon return
from work in late afternoon. Many mothers find that their babies nurse more frequently in the
evenings on days they work. Feed on-demand when you are with your baby.
If possible, arrange to nurse your baby at lunch time.
Try to breastfeed exclusively when you are with your baby (evenings, nighttime, weekends).
Delegate and share household responsibilities with other members of the family.
There are a number of breast pumps on the market, with varying degrees of comfort, efficiency,
and cost. Most require time to develop the skills to use them. Pumps may be hand-operated
(manual) or work by battery or electricity.
The most dependable, efficient, and comfortable pumps are electric, have intermittent action
(creates and releases suction automatically), and require minimal training.
Your local lactation consultant can help you make realistic plans and guide you to a supportive
breast pump supplier.
Breastfeeding Common Concerns One of the most common concerns of breastfeeding mothers is: how can I be sure my baby is getting
enough milk? Well, there are several ways to tell. One is by the number of wet diapers he has in a day. Make
sure he has at least six wet diapers per day with pale yellow urine, beginning around the third or fourth day
of life.
Your infant should also have several small bowel movements daily (there may be one after every feeding in
the first few weeks). During the first week of life, your infant should have at least two stools per day. From
about 1 to 4 weeks old these should increase to at least five per day. As your baby gets older, bowel
movements may occur less often, and may even skip a number of days. Bowel movements of breastfed
babies usually smell somewhat sweeter than the stools of formula fed babies.
Your baby's feeding patterns are also an important sign that he is feeding enough. A newborn may nurse
every 1½ to three hours around the clock. If your baby sleeps for stretches of longer than four hours in the
first two weeks, wake him for a feeding. It is most important that your baby is latched-on properly during
feedings. Listen for gulping sounds to know that your baby is actually swallowing the milk and not just
sucking. Also look for slow, steady jaw movement.
Your baby should be steadily gaining weight after the first week of life. During the first week, some infants
lose several ounces of weight, but they should be back up to their birth weight by the end of the second
week. Your pediatrician's office will weigh your baby at each visit. Keep in mind that your baby may
breastfeed more often during growth spurts.
Signs that baby is getting enough milk are as follows:
At least six wet diapers per day and two to five loose yellow stools per day, depending on baby's age.
(Your baby's stools should be loose and have a yellowish color to them. Be sure your child's stools are
not white or clay-colored.)
Steady weight gain, after the first week of age.
Pale yellow urine, not deep yellow or orange.
Sleeping well, yet baby looks alert and healthy when awake.
Most breastfeeding babies do not need any water for at least the first 6 months. Human milk provides all the
fluids and nutrients a baby needs to be healthy. By about 6 months of age, however, you should start to
introduce your infant to baby foods that contain iron.
If your baby cannot or will not nurse, or if you are having problems with breastfeeding, it is important that
you call your pediatrician as soon as possible. Refusal to breastfeed may be a sign of illness that needs
prompt attention.
The information contained in this publication should not be used as a substitute for the medical care and
advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend
based on individual facts and circumstances.
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