Newborn Handbook

Congratulations on the birth of your new baby! We are happy to welcome him or her into our practice. This pamphlet contains some very basic information about newborns, but remember every baby is different. Please do not hesitate to call our office with any questions or problems you might have.

Being a new parent or adding a new family member is a big life change. Remember to take good care of yourself too. Sleep when baby sleeps. Eat a healthy diet and drink lots of fluids. Don’t expect to get much done those first few weeks. Taking care of a new baby is a full time job!!


The pediatricians in our office support the American Academy of Pediatrics policy statement recommending breastfeeding as the primary source of nutrition for the first year (with the addition of baby foods around 6 months). Your pediatrician and lactation specialist (if needed) can help you in reaching this goal. We understand that some mothers choose not to breastfeed, and some medical problems make it undesirable. We will support whatever choice you make, and help make it a healthy choice for your baby.


Breastfeeding has many benefits for mother and baby. It helps mothers to return to their pre-pregnancy weight faster, decreases blood loss after birth, and decreases the risk of breast cancer and osteoporosis. Babies benefit from breastfeeding with decreased risk of SIDS (Sudden Infant Death Syndrome), ear infections, allergies, asthma, diarrhea, and other illnesses. As wonderful and natural as breastfeeding is, it is a learning process for mother and baby. There can sometimes be problems that need special help. There are lactation specialists at Mary Washington Hospital and other organizations who are available to give you this help. They also have breast pumps and other equipment if needed.

Initially your baby will want to nurse 8 to 12 times daily. It is best not to try to put him or her on a schedule, but to follow your baby’s cues. Breast milk usually “comes in” approximately three days after delivery. Before then, the baby is getting colostrum, which contains lots of antibodies to fight off infection. Babies do not need much in these first few days, since they are born with extra fluid in their bodies. Your baby does not need anything more than breast milk. If you plan to give your baby a bottle (if you are going back to work, for example), it is best to wait until 4 to 6 weeks of age. Giving a bottle before then can lead to “nipple confusion” and cause your baby to be less interested in breastfeeding.

Your baby may have only 1 or 2 wet diapers per day in the first 2 days. This should increase as the milk comes in, up to 5 to 8 each day. Stools will start off being thick and green, then become brown, and eventually yellow “seedy” stools after the milk is in. There is a wide range of normal number of stools daily.


If you decide to give your baby formula instead of breastfeeding, we recommend a cow's milk based formula with iron, such as Enfamil Lipil with iron or Similac Advance with iron. We do not recommend using a low iron formula. This can cause anemia within a few months, and can be dangerous to your baby’s brain development. Although it might seem like it, low iron formula does not help constipation. If your baby is constipated, call our office for help with that. Formula fed babies normally have darker and thicker stools than breastfed babies. It is not considered constipation unless stools are hard.

Be sure to follow the directions on the can when mixing the formula. Do not use more or less water then recommended. If you have trouble buying enough formula for your baby, WIC can help you. It is best to boil the water that you use to make formula until your baby is six months old.


Most babies spit up occasionally. Some babies spit up after every feeding. If the baby is otherwise acting well and gaining weight, this is usually not a problem. Some spitting up can be prevented by careful burping and positioning. If you are breastfeeding, burp your baby after nursing on the first breast. If you are giving formula, burp after 1 to 2 ounces. Keep your baby in an upright position for 20 to 30 minutes after each feeding. You should call our office if spitting up seems excessive, if there is forceful vomiting, or if there is any vomiting of a green substance (bile).


Eyes – It is normal for newborns to look “cross-eyed” at times. This should resolve by four months of age. At birth they can focus on your face when you are about one foot away.

Breasts – Boy and girl babies can have swollen breasts at birth due to hormone changes. This usually resolves in a few months. Some babies may even have a small amount of milk come from the breasts.

Naval – A small piece of the umbilical cord will be left on when you go home. This will fall off 10 to 14 days. Keep it dry and exposed to air as much as possible. There is no need to clean it with alcohol. Please call our office immediately if you see redness or swelling around it. Your baby should have sponge baths keeping the umbilical cord dry until it falls off. After that, you can bathe him or her completely.

Vagina – Baby girls will normally have some mucous discharge from the vagina for the first few days. There may be some blood in this mucous as well, due to the hormonal changes of birth.

Penis – If your baby is circumcised, your Ob/Gyn or pediatrician will discuss how to care for it, depending on the method used. If your baby is uncircumcised, no special care is needed. Do not try to retract the foreskin for cleaning until you duscuss with your pediatrician.

Skin – There are several types of birthmarks that you might notice on your baby. Ask your pediatrician about these. Babies’ skin often peels in the first few weeks. No lotion or cream will prevent this. It is best to clean with water or a very mild cleanser. Zinc oxide or Aquaphor are good to protect the diaper area. Call our office if your baby develops a rash that doesn’t improve with over the counter creams.


It is normal to have some jaundice (yellow color of the skin) in the first few days of life. This usually begins to resolve after 3 to 5 days. Please call our office if your baby is very jaundiced, if jaundice is not resolving as it should, or if the baby is not feeding, urinating or stooling well.


Babies cry a lot, for many different reasons. He or she may be hungry, wet, cold, hot, tired, etc. You will learn your baby’s cries and what they mean. Remember, you can’t spoil a baby. If you’ve made sure your baby isn’t hungry or needing a new diaper, maybe he or she just wants to be cuddled. Don’t be afraid of picking up, carrying, rocking, and cuddling as much as your baby needs. Swaddling also is calming for most babies. Front carries and slings can be helpful for babies who need extra cuddling time. This will allow you to have your hands free to get other things done.

Please get help if your baby’s crying is frustrating you. Get a family member or friend to take your baby for a short time if you need a break. Never shake or hit your baby.


It will be a while before your baby is walking and getting into things, but there are some safety measures you should take now to prevent injury and illness:

1) Do not allow smoking in your home or car. It can cause SIDS (Sudden Infant Death Syndrome), ear infections, asthma, and other medical problems.

2) Place your baby on his or her back to sleep. Do not have blankets, loose bedding, stuffed animals, pillows or lambskin in the crib (these can cause suffocation). If you sleep with your baby, be sure that bedding cannot cover the baby’s head. Do not put your baby where he or she could slip between a wall and the bed. Do not sleep with your baby if you smoke, use drugs, drink alcohol, or are obese.

3) When in a vehicle, place your baby’s car seat in the center of the back seat. The car seat should face backwards until the baby is at least on year old and at least 20 pounds. The backseat is always the best place for your baby, even if you do not have airbags. If you do not have a backseat, place the baby facing backwards in the front seat. If you do this, be sure to deactivate your airbag in the front passenger seat, as airbags have injured and killed many babies and small children in the front seat.

4) Set your water heater at 120 degrees Fahrenheit to prevent burns.

5) Do not use your microwave to heat formula or breast milk, as it can cause hot spots. Place the bottle in warm water instead.

6) Never leave your child alone on the changing table, bed or couch. Even before they know how to roll, they can wiggle around enough to fall off.

7) Never shake your baby.


If any of the following warning signs, please call our office:

1) Fever (rectal temp 100.4 or underarm temp over 99.4)

2) Forceful vomiting, or any bile (green color) in vomit

3) Diarrhea (stools more frequent or watery than usual)

4) Poor feeding

5) Discharge from eyes

6) Cough or rapid breathing


Your pediatrician will tell you when to come in, but normally your first visit will be 2 to 3 days after discharge, then again at 2 to 4 weeks of age, 2 months, 4 months, 6 months, 9 months, and 12 months.


There are so many excellent books and websites available (and some not so good). Some that we like are:


  • Caring for your Baby and Young Child, Birth to Age 5, American Academy of Pediatrics, June 2004
  • AAP Guide to your Child’s Symptoms, Donald Schiff, January 1997
  • Your Baby’s First Year, AAP, June 1998
  • The Baby Book, William Sears, March 2003
  • What to Expect the First Year, Anne Eisenberg et al., October 2003
  • AAP Guide to Your Child’s Sleep, George Cohen, December 1999
  • The Happiest Baby on the Block, Harvey Karp, May 2003