A fever is defined as a rectal temperature greater than or equal to 100.4^oF (38.0^oC). The presence of a fever in an infant younger that 2 months old is a very concerning symptom and needs further medical evaluation.

Call us immediately if your infant has a fever of 100.4^oF (38.0^oC) or greater. Do not give any fever medication, as this will affect the ability of the doctor to make the best decision concerning your baby’s medical care.

Jaundice

Jaundice is a yellow discoloration of the skin. This yellow coloring is created by a substance in the blood called bilirubin. Many healthy newborns have jaundice. However, there are certain acceptable levels for jaundice based on the age of the infant and whether your baby was born full term or early.

A bilirubin level is measured by using a special machine to scan the skin or taking a small sample of blood from your baby. Most cases of jaundice are mild. However, there are some instances where the levels reach a concerning range. A high bilirubin level can be dangerous to an infant’s brain, resulting in damage, if it is not treated early.

Bilirubin levels are generally measured in the hospital to ensure it is within an acceptable range before a newborn is sent home. However, those levels may reach its highest point for a newborn, sometime between 3 and 5 days of life. So, if an infant leaves the hospital before he/she is seventy-two hours old, it is recommended, he/she is seen by a pediatrician within 2 days of discharge. In some cases, an earlier follow up may be needed if bilirubin results prior to hospital discharge were in a borderline range.

Though high bilirubin levels cannot be avoided for some infants, due to other risk factors involved, there are some things you can do to help keep levels low:

• Feed your baby every 2-3 hours, or 8-12 times every 24 hours.

• After 3 days of life, make sure that your infant is producing at least 3-6 diapers in a twenty-four hour period. During the first 2 days of life, babies should have a minimum of 2 wet diapers over a 24 hour period.

• Monitor for any signs that the yellow tinge to the skin may be worsening. Jaundice typically starts on the face and travels down the chest/abdomen, followed by the limbs, as the levels become higher in the blood. Call us immediately for an appointment at the earliest sign that the yellowish color may be starting to “travel” down your baby’s  body.

Feeding and Elimination

Breastfeeding

Breastfeeding is recommended for at least the first year of life and has tremendous benefits for both mother and baby. To maximize these benefits, exclusive breastfeeding for about 6 months is recommended.

During the first month of life, your baby will need to be fed every 1 to 3 hours (about 8-12 times a day). It is important to wake your baby to feed if more than 3-4 hours has passed since his/hers last feeding. After a month old, as long as your infant is gaining weight well, it is alright to let him/her sleep longer. 

Both breastfed and partially breastfed infants should receive daily vitamin D supplementation. A total of 400 IU per day, starting in the first few days of life, is recommended. Vitamin D plays an important role in the development of healthy bones. If the body becomes deficient, a condition called rickets may develop. There are a number of options for Vitamin D drops readily available over-the-counter. Drops should be continued until 12 months old. If your baby is weaned to formula and is taking at least 1 liter (about 32 ounces) daily, you may discontinue the use of Vitamin D drops.

Formula Feeding

There are a number of infant formula options available to promote optimal growth for your baby. Selecting a brand or type of formula is often a combination of personal preference, the presence of certain allergies or conditions, and any advice your pediatrician may offer. No matter which option you decide on, it is important to feed your infant with an iron-fortified formula. The iron-content in formula does not cause constipation. In fact, iron-fortified formula is important in the prevention of iron-deficiency anemia.

Infant formula may come as a concentrated liquid, powder, or ready-to-feed. It is important to follow the package directions when preparing each type of formula, unless instructed otherwise by your pediatrician. For instance, when using powdered formula, you must mix 1 scoop of powder in every 2 fluid ounces of water. Mixing formula improperly may result in nutritional deficiencies or other problems for your infant.

Urination

Newborns should urinate at least once within the first 24 hours of life. Thereafter, with adequate feedings, the number of wet diapers will steadily increase over the first week of life. Once an infant is at least 5 days old, you should expect to see an average of 5-6 wet diapers over a 24 hour period. In the event that you feel your infant is not urinating enough, please notify our office.

Bowel Movements

Newborns will have their first bowel movement sometime within the first 48 hours of life. Initial bowel movements appear as a thick dark-green or black colored substance called meconium. After the third day of life, the stools change, becoming a yellowish or greenish brown color. At this time you may also notice a change in how often your infant has a bowel movement.

Variation in the frequency and color of bowel movements is often connected to whether your baby is breast or formula-fed. Breastfed infants will have stools that are mustard yellow in color, while formula-fed infants have stools that are usually light brown to yellow in color. In the first few weeks of life, breastfed infants have at least six stools each day but after a month of age, may have as little as one large stool every 3 to 7 days. Formula-fed infants have a wide range in their stooling pattern. There are some babies who will have a bowel movement after each feed, while others may have one stool every few days.

It is not uncommon to notice that your baby grunts, appears to be straining, or even turn red while having a bowel movement. No need to worry. These are all signs that your baby is figuring out how to have a bowel movement, which takes a tremendous amount of coordination and practice.

The combination of infrequent stools and noises during bowel movements may prompt concern for constipation. However, as long as your baby is having soft stools, is feeding normally, and growing well, this is not a sign of true constipation. Should your infant progress to having hard stools or blood is seen in the stool, please call our office to schedule further evaluation.