Download Caring - Catholic Medical Center

THE
MOM’S
BOOK
L A B O R A N D B I RT H
welcome
ARE JUST THE BEGINNING!
Congratulations on the birth of
your new baby! We know that being
a new mother can be difficult at times,
especially in your baby’s first few weeks,
so we’ve written this guide to give you lots
of useful information and helpful hints
about caring for yourself and your baby.
Whether this is your first baby or your fifth,
this guide is an easy-to-use reference to
postpartum. It is not intended to replace the advice of
your obstetrician, midwife or pediatrician.
If you have questions or concerns
about your health or your baby’s health,
please contact your care provider.
Table
OF CONTENTS
C ARIN G FOR YOURSELF . . . . . . . . . . . . . . . . . . . 1
Mothering the mother. . . . . . . . . . . . . . . . . . . . . . . . 2
How your body has changed. . . . . . . . . . . . . . . . . . 3
Staying well. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
F E E DI N G YO U R N EW B O R N . . . . . . . . . . . . . . . . . 1 2
Breastfeeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Nutrition while breastfeeding. . . . . . . . . . . . . . . . 19
Troubleshooting breastfeeding. . . . . . . . . . . . . . . 19
Pumping and storing breast milk. . . . . . . . . . . . 21
Feeding your baby. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
CA R I N G F O R YO U R N EW B O R N. . . . . . . . . . . . . 2 6
Baby sleeping positions. . . . . . . . . . . . . . . . . . . . . . 27
Caring for your baby . . . . . . . . . . . . . . . . . . . . . . . . 27
Crying. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Immunizations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Screening tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
CAT H OL I C M ED I C A L S ERV I C ES. . . . . . . . . . . . 3 8
ASK-A-NURSE® . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Breast Care Center . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Outpatient Medication Management and
Counseling Program . . . . . . . . . . . . . . . . . . . . . . . . 39
Pregnancy Care Center . . . . . . . . . . . . . . . . . . . . . . 40
West Side Neighborhood Health Center. . . . . . 40
Women’s Cardiac Center. . . . . . . . . . . . . . . . . . . . . 40
Primary Care Practices . . . . . . . . . . . . . . . . . . . . . . 41
Additional resources. . . . . . . . . . . . . . . . . . . . . . . . . 45
Caring
F O R YO U R S E L F
MOTHERING THE MOTHER
H OW YO U R B O DY H A S C H A N G E D
S TAY I N G W E L L
MOTHERING THE MOTHER
It took 9 long months to get your body ready to birth your baby and it’s going to take a
while for you to feel like yourself again.
Babies require LOTS of care, but you can’t take care of your baby until you first take
care of yourself. Your body has just been through a marathon event so be sure you give
yourself time to rest and heal from the work of birth!
This is a great time for friends and family to care for you, so don’t be shy about
accepting help wherever you can get it. Meal preparation, housework and laundry are
wonderful ways that family and friends can help care for you so that you can better
care for your baby. There are lots of resources available to help you with questions and
concerns about your baby.
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HOW YOUR B ODY HAS CHANGED
UTERUS
During pregnancy your uterus grew from about 3 ounces to almost 3 pounds! Right
after birth, your uterus began the process of shrinking back to its pre-pregnant size
(called involution), but the whole shrinking process takes about 4-6 weeks.
Afterbirth Pains
As your uterus shrinks, you might feel some mild cramps called “afterbirth
pains,” especially in the first few days after birth. Uterine cramping is a normal
part of postpartum recovery. Cramps seem to be more painful for women
who have previously given birth. You might notice them more if your baby is
breastfeeding because your uterus contracts every time your baby latches on and
nurses. Breastfeeding is nature’s way of helping your uterus to shrink, which helps
minimize blood loss after birth. Uterine discomfort can be relieved by using a
heating pad, warm tub baths and attempting to urinate every 3-4 hours. You
may want to consider taking over-the-counter medications that your provider
has recommended for discomfort. Avoid the use of aspirin.
Vaginal Flow
When the placenta detaches from your uterus after the birth of your baby, it
creates a wound that bleeds. After a few days, the vaginal flow becomes thinner
and more brown in color and, after a couple of weeks, it becomes yellowish and
more like a heavy vaginal discharge. Depending on your activity level, your flow
may last up to 6 weeks. A sudden or slow increase in flow is your body’s way of
reacting to excessive activity. Continue to use your peri bottle as long as you have
vaginal flow and change your pads frequently. Refrain from using tampons or
douching until discussion with your provider at your 6-week postpartum visit.
You may resume sexual intercourse after your vaginal flow stops completely.
Call your provider if you have any of the following symptoms:
Persistent, heavy bleeding (more than 1 pad in an hour)
n
n Pass a clot larger than a plum
Fever
n
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Signs of Infection
You may have an infection if you are experiencing any of the following:
Fever that is over 100.4 degrees
n
n Redness, heat, drainage, foul odor or pain from Cesarean section incision
Chills
n
n Generalized achiness and flu-like symptoms
Headache
n
n Tenderness, heat, redness in breast with fever
Return of your period
Most women who do not breastfeed have a period within 2 months
following the birth of their baby, however, women who breastfeed may
not have a period until their baby is weaned. Remember that even if you
don’t have a period, breastfeeding does not prevent pregnancy.
VAGINA
If you had a vaginal birth, your vagina will take a few weeks to get back to normal.
Your vaginal and pelvic floor muscles may take 6 to 7 weeks to return to
pre-pregnant condition.
Vaginal discomfort may be relieved by using your peri bottle or taking warm tub
baths (sitz baths). You may also continue to use Benzocaine spray, Cortisone cream,
witch hazel pads or ice. Over-the-counter pain relievers recommended by your
provider may also be helpful. Call your provider if vaginal pain is unrelieved or
increases.
When you go to the bathroom it may be painful to wipe yourself. Use the peri
bottle to wash your vagina after you urinate instead of wiping yourself. Continue
to use the peri bottle until your vaginal flow has stopped. After using the peri bottle,
pat yourself dry from front to back.
Change peri-pads often. Do not use tampons as they may cause infection.
n
n Do not douche.
Use sitz baths to help with swelling and soreness; sit in a clean tub of warm
water for 15-20 minutes.
n
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Kegels
You may help your vagina regain some of its tone by doing Kegel exercises. These
exercises may be started as soon as you feel able. Kegels are the contracting and
relaxing of your pelvic floor muscles, and are easy to do: tighten the muscles as
you would if you were going to stop the flow of urine. Hold that for 10 seconds
and then release. Repeat this 3-5 times and work up to holding the Kegel for 20-30
seconds and repeating that 10-20 times. Kegels will help you for the rest of your life;
they help you maintain bladder control when you get older, so do them every day!
BLADDER
It’s important to try to urinate every 3-4 hours. Your body will be getting rid of excess fluid
for the first week or so, so you’ll be urinating often. You might find that you don’t feel an urge
to urinate, so to help remind you to empty your bladder, urinate before you feed your baby.
Sometimes women experience urinary tract infections following birth so watch
for the following symptoms:
Fever, chills
n
n Burning or pain with urination
F eeling like you have to urinate but not much urine comes out
n
n Lower back pain
If you suspect that you might have a urinary tract infection,
call your provider.
BOWEL MOVEMENTS AND HEMORRHOIDS
Hormones, medications and lack of activity after birth can all
be players in making you constipated.
Ways to avoid constipation include eating a diet high
in fiber such as whole grain breads, cereals, fruits
and vegetables. You may also drink fluids to satisfy your
thirst. Water is the best source of fluid for your health and
well-being. Try to avoid sodas and caffeinated drinks. Use a
stool softener, as directed by your provider to prevent straining.
If you have not had a bowel movement by 3-4 days, notify your
provider.
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Many women experience hemorrhoids during pregnancy and birth. Hemorrhoids
may be uncomfortable and even painful, but they will usually go away within a month or
so. Hemorrhoids are usually treated in several different ways: cold compresses, topical
ointments and medication. Be sure to ask your nurse for help with this.
BREASTS
Your breasts will begin to make milk after your baby is born. Even if you choose not to
breastfeed your body will make milk, and most new mothers experience some breast
engorgement as their breasts produce milk.
If you’re not going to breastfeed, then you’ll want to wear a tight bra and use cold
compresses to help with the engorgement. It will take your body a little while to get
the message that it doesn’t need to make milk, so in the meantime don’t do anything to
stimulate your breasts/nipples. If you are breastfeeding, see the section on breastfeeding
for more details.
CESAREAN BIRTH INCISION
If you had a Cesarean birth, you will be recovering from major surgery as well as from giving
birth and you’ll need to take extra care.
Rest and gradually increase your activity as tolerated. Shower daily and air dry your
incision. Inspect your incision daily and report any redness, heat, pain, drainage or foul
odor to your provider. If you have steri strips over your incision allow them to fall off on
their own. Consider pain relievers as prescribed by your provider.
SEXUAL ACTIVITY
Some midwives and doctors advise women to wait 6 weeks before having sexual intercourse
and others say that you may resume sexual activity whenever you’re ready.
Avoid placing anything in the vagina until your vaginal flow stops. Check with your
provider to see what they recommend is best for you.
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STAYING WELL
NUTRITION
A new mom not only needs to take care of her baby, she also needs to take care of herself.
Remember that good nutrition and a healthy diet are very important in the postpartum
recovery period. Women with special needs may be referred to a registered dietitian.
Good nutrition will help you to recover, regain strength and stay healthy and active.
The weight gained during pregnancy provides stores for recovery and for breastfeeding.
A woman’s need for water, energy, protein, vitamins and minerals are increased.
The following are some general nutrient guidelines:
Fluid
Drink plenty of liquids. Drink to satisfy thirst or enough to keep urine pale
yellow or clear.
Energy
Calories are important to maintain energy to care for your baby and lose the
excess weight gained in pregnancy. Typically 1800-2000 calories a day meet the
daily requirements for new moms.
Protein
Additional amounts are needed in the diet to replenish maternal protein stores.
Following a C-Section, protein can aid in healing. Good sources of protein
include meat, fish, poultry, eggs, cheese, soy milk, yogurt and tofu.
Calcium
Whether breastfeeding or not, calcium stores must be replenished. Consumption
of at least 1000 mg per day is required. When breastfeeding, if a mother’s calcium
levels are low, calcium from her bones will be used for milk production. Good
sources of calcium include dairy products, cheese, calciumfortified orange juice, almonds, leafy greens, broccoli,
legumes (beans) and blackstrap molasses.
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Other Vitamins and Minerals
Eat a variety of foods to assure maternal stores are replenished and maintained. If
you are not eating well, talk to your provider about a multivitamin supplement.
Nutrition Pearls
n Eat a wide variety of foods with high nutrient density.
Avoid high fat fast foods.
n
n Drink plenty of liquids such as water, milk and soups.
Avoid fad diets for weight loss.
n
n Avoid harmful substances – tobacco, alcohol, illegal drugs.
Avoid excessive intakes of salt, sugar, fat, caffeine, artificial sweeteners.
n
n Avoid mega-doses of vitamins and minerals.
Use caution with herbal supplements.
n
EXERCISE
Having a new baby in the house can be difficult in the beginning. New parents often feel
overwhelmed by the amount of work a new baby creates. Therefore, it is essential to try not
to overdo it.
Focus on caring for yourself and the baby the first 2 weeks. It is okay to let others do for
you. Limit stairs and don’t lift anything heavier than your baby. Avoid driving a car for
1-2 weeks and drive only when you feel comfortable. Try to sleep when the baby sleeps.
It’s okay to gradually resume your pre-pregnancy fitness routine based on your
personal capabilities, although your doctor or midwife may ask you to wait until your
six-week postpartum checkup.
Take it easy at first! Start out slowly to help conserve your energy, which will help you
recover more quickly. Here are some basic exercises that can be done right after birth,
with your provider’s okay.
Pelvic Tilts
Lie on your back, knees bent and feet flat. Contract abdominal muscles and tilt
your tailbone under you until your hips come off the floor. Finish the move
by contracting your buttocks. Release in reverse: buttocks, hips and abdominal
muscles. Repeat. You can do 5 sets of 5 repetitions each. Strengthens your
abdominal muscles and stretches the muscles of your lower back.
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Single Knee to Hamstring Stretch
Lie on your back, right knee bent, right foot flat and your left knee pulled in
towards your chest. Place your hands behind the thighs above the left knee.
Gently pull your left knee towards your chest, stretching buttocks. Hold for
3 breaths. Now extend the left leg in the air, still holding your thigh, flex the
left foot and hold for 3 breaths. Repeat with the other leg. Stretches buttocks
and rear of thighs.
Walking
You can begin walking as soon as you feel able, even if it’s only 10-15 minutes at
first. The intensity of your walk may allow you to talk but not sing. As you get
stronger, you may walk longer and faster. As you walk, don’t over-stride, let your
arms swing naturally by your sides. Before walking, do 5-10 minutes of warm-up
activities such as marching, side to side lunges, shoulder rolls and arm circles.
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EMOTIONS
This is a big topic! There are lots of things to talk about concerning your emotions
following birth.
The Baby Blues
About 3 days after birth your body will experience a hormonal crash; the
hormone levels in your body will fall dramatically and the result can be quite
an emotional rollercoaster! You may feel sad, you may cry easily, you may feel
overwhelmed by even the smallest decision and of course you’re sleep deprived.
Sometimes it’s hard to believe that such a little baby can require SO MUCH
CARE! This is called the “baby blues” and it usually occurs 3 to 5 days after
birth and can last 7 to 10 days.
Postpartum Mood Disorders (PPMD)
There are 4 emotional conditions that women can experience during the
year following birth and these are all kinds of PPMD:
n Postpartum Anxiety and Panic Disorder
Symptoms of this PPMD are the common symptoms for panic/anxiety:
rapid heartbeat, shortness of breath, chest pain, and lightheadedness. You
may feel an overwhelming fear of being alone, of dying, of your baby dying
or of leaving your house.
Postpartum Obsessive-Compulsive Disorder (OCD)
Women who experience OCD in postpartum have recurring thoughts and
rituals that they repeat over and over. Obsessive thoughts in postpartum might
include a fear of harming the baby, of being a bad mother, of germs or things
that might harm the baby. Obsessive rituals are things like compulsive house
cleaning, excessive hand washing, and constant and excessive checking on the
baby. Obsessive rituals interfere with daily living.
n
n Postpartum Depression
Somewhere around 10% of all women who give birth experience postpartum
depression, and it’s totally different than the “baby blues.” Postpartum
depression is more serious, longer lasting and is a physiological as well as
a psychological disorder. If you have experienced depression in the past
you may be at a higher risk of becoming depressed after your baby is born.
Postpartum depression most commonly occurs between the sixth week and
the sixth month following birth. Symptoms of postpartum depression
include: loss of interest in the baby, feelings of hopelessness, extreme feelings
of inadequacy/low self-esteem, thoughts of hurting yourself or your baby,
inability to sleep, extreme weight gain/loss, and constant crying.
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n Postpartum Post-Traumatic Stress Disorder (PTSD)
A traumatic birth experience can cause postpartum PTSD, as can a traumatic
experience during pregnancy or after birth. Women who have frightening
or difficult births, insensitive care providers, illness during pregnancy and
unexpected problems after birth are more likely to experience postpartum
PTSD. Birth can also trigger memories of a traumatic experience from your
past; physical or sexual abuse, a difficult or frightening hospitalization or any
other traumatic event in your life. Symptoms of postpartum PTSD include:
recurring nightmares, recurrent memories of the trauma, anger, feelings of
anxiety or panic, and overprotecting the baby to the extreme.
Do you have risk factors for PPMD?
n A history of depression, obsessive-compulsive disorder, post-traumatic stress
disorder or emotional problems.
n A history of physical, sexual or emotional abuse.
A history of drug or substance abuse or living with someone who is currently
abusing alcohol or drugs.
n
A difficult pregnancy and/or birth experience.
n
n A lack of support from partner, family and friends.
An unplanned or unwanted pregnancy.
n
n Recent stresses such as marriage, separation, divorce, death in the family,
change in jobs, moving, change in/loss of job, financial pressures, etc.
n Low self-esteem.
If you’re an over-achiever with high expectations of being perfect.
n
n Thyroid disease.
If you have had an eating disorder.
n
Treating PPMD
It’s important to treat PPMD as soon as possible; waiting may make symptoms
worse which can rob you, your baby and your partner of quality time together.
Talk to your provider about your symptoms and ask if they can give you the name
of a therapist who specializes in PPMD, or you can contact Catholic Medical
Center’s Outpatient Psychiatric Medication Service at 663.6200.
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Feeding
YO U R N EW B O R N
BREASTFEEDING
NUTRITION WHILE BREASTFEEDING
TROUBLESHOOTING BREASTFEEDING
PUMPING AND STORING BREAST MILK
F E E D I N G YO U R B A B Y
BREASTFEEDING
Breastfeeding provides the best nutrition for your baby and has long lasting benefits for
both of you.
During pregnancy and right after birth, your breasts will contain colostrum, a yellowish
substance that is your baby’s first food . Colostrum is a protein and antibody-rich fluid .
Your body makes colostrum in small amounts, which is exactly right for your baby’s
marble-sized stomach .
DEMAND FEEDING
Breastfeeding is best done “on demand.” This doesn’t mean nursing every time your baby
cries, but instead learning to recognize your baby’s feeding cues.
These cues may include licking his/her lips or putting his/her hands to his/her mouth .
Your baby may also become more awake and alert . Crying is a late sign of hunger . Feed
as often and for as long as your baby shows signs of feeding cues . This will help establish
a good milk supply
supply .
HOW OFTEN DOES A NEWBORN FEED?
Babies feed 8-12 times a day, although they may
be sleepy a few days after birth and feed less.
Babies may feed every few hours or every hour (cluster
feeding) . These are normal variations . Babies are typically
more interested in feeding at night . W
Waking the baby
every 2 to 3 hours during the day may help to reverse
this feeding pattern . Feeding your baby frequently does
not mean you have an inadequate milk supply, or that
you are spoiling him/her, it is the way breastfeeding
works . You will know your baby is getting enough to
eat by watching for 6-8 wet or soiled diapers a day
day .
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HOW WILL I KNOW IF I HAVE ENOUGH MILK?
This can be a little frustrating at times but there will be lots of signs that your baby is
getting enough:
You can hear your baby swallowing during feedings.
n
n Your breasts feel less full after a feeding.
The baby is satisfied and falls away from your breast at the end of a feeding.
n
n Your baby is gaining weight – your provider will follow your baby’s weight gain
but if you have any concerns, call The Mom’s Place and ask to bring the baby in
for a weight check.
Your baby is eating frequently (8-12 times in 24 hours).
n
n Your baby is having regular wet/soiled diapers (6-8 times in 24 hours).
You may expect that your baby will initially lose a little weight after birth. Once
the feedings are more regular, babies will usually gain 4-7 ounces, so your baby’s
weight may be back to birth weight by the second week.
BREAST CARE, COLOSTRUM AND BREAST MILK
A mother’s milk transitions from colostrum to milk on day 3 to five, although
it may be earlier if you’re not a first time mother.
Engorgement
Some women experience engorgement or hard swollen breasts. Feeding the
baby frequently, using cool compresses and over-the-counter medication
recommended by your provider may help to relieve discomfort. You may also
express milk by hand or with a pump to soften the nipples if the baby is having
difficulties latching. Engorgement is caused not just by milk in the breasts, but
also by blood or lymph fluid in the breast tissue. The discomfort of engorgement
usually subsides within 24-48 hours.
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During engorgement, your areola may become swollen, making it difficult for
your baby to latch on.
Soften your breasts by standing in a warm shower for a few minutes or applying
warm, moist compresses to your breasts before you begin feeding your baby.
n
Massage your breasts gently to express a little milk, making the nipple softer
and latch-on easier.
n
Cold raw cabbage leaves may ease the discomfort of engorgement; just slip the
leaves into your bra against your skin.
n
Breast milk is produced by supply and demand, meaning what you remove your
body replaces. Nurse your baby on one side until the baby pulls off. This will
provide opportunity for baby to receive the rich creamy hind milk at the end of
the feeding. Once your baby falls off the breast, burp or change the diaper and
offer the second breast. If the baby falls asleep within a few minutes, start the next
feeding on the breast you last fed with.
BASICS OF BREASTFEEDING
Calm and Quiet
If possible, nurse in an atmosphere of calm and quiet. This will help you relax
and help your baby focus on the feeding without being distracted.
Comfortable Position
Take the time to find a comfortable position
with your back well supported. Use pillows to support your arms
and your baby or use a breastfeeding pillow.
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Feeding
Begin feeding with the fuller breast. Cup your breast with your free hand against
your body below your breast, lift your breast, bring your baby toward you with the
mouth level to your nipple.
n
n Stroke your baby’s lower lip with your nipple until the mouth is open wide. When
open wide, pull or roll the baby gently towards you and hold close so the mouth
latches onto your breast and the belly is against your belly. Be patient, sometimes it
takes many tries to open wide enough to latch onto your breast. Just keep stroking
the lower lip.
Once latched on, check to be sure the jaw is open wide and the mouth is full of
your breast. The baby should take as much of your areola into the mouth as
possible. The baby’s nose may be touching your breast, but unless your breasts
are very large he/she will still be able to breathe.
n
Let your baby nurse at the first breast for as long as you hear swallowing and then
offer the other breast. Watch your baby for end-of-feeding signals such as drifting
off to sleep and slipping off your breast.
n
POSITIONS FOR BREASTFEEDING
Cradle Hold
Your baby’s head is “cradled” in the bend of your
arm. Your forearm supports the body and your
hand is under his/her bottom or upper legs. Your
baby is facing your breast and the tummy and chest
are turned towards your abdomen. Use your other
hand to support your breast – your fingers cup
your breast underneath.
Cross or Alternate Cradle Hold
Put a pillow under the baby’s body for support.
If you’re feeding from the right breast use your
right hand to cup your breast and your left hand
under the nape of the baby’s neck with your fingers
below the baby’s ears. Your left forearm supports
the baby’s back and bottom.
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Football Hold
Place a pillow under the baby’s body for support.
If you’re feeding from the right breast your right
hand cradles the nape of your baby’s neck and your
left hand supports your breast. The baby’s body
is tucked beside your body, under your arm, with
the bottom against what you’re resting your back
against, and feet up in the air. Use your right hand
to move the baby’s head and chest towards your breast.
Side Lying
Lie on your side and place a pillow between your
knees for comfort. Place another pillow or rolled
blanket behind your baby’s back to tilt the tummy
towards your abdomen. Your lower arm is either
behind your baby’s back or supporting you behind
your head. Your upper arm supports your breast.
BREASTFEEDING LOG FOR THE FIRST WEEK
Circle the hour when your baby nurses.
Circle the W when your baby has a wet diaper.
Circle the S when your baby has a soiled diaper.
During the first week, you will increase the number of diapers you use each day.
Birth Date:____________________
Birth Time:_________________
DAY ONE
GOAL
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 6 – 8
Wet diaper
W 1
Black tarry soiled diaper
S
1
DAY TWO
GOAL
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12
Wet diaper
W W
2
Brown tarry soiled diaper
S S
2
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DAY THREE
GOAL
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12
Wet diaper
W W W
3
Green soiled diaper
S S
2
DAY FOUR
GOAL
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12
Wet diaper
W W W W
Yellow/Green soiled diaper S S S
DAY FIVE
4
3
GOAL
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12
Wet diaper
W W W W W
5
Yellow soiled diaper
S S S
3
DAY SIX
GOAL
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12
Wet diaper
W W W W W W
Yellow soiled diaper
S S S
DAY SEVEN
6
3–4
GOAL
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12
Wet diaper
W W W W W W
6 – 8+
Yellow soiled diaper
S S S
3 – 12
It is OK for your baby to have more wet diapers or more soiled diapers. Call our
Lactation Consultant at The Mom’s Place at 663.6686 if your baby has less than the
number on the log.
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NUTRITION WHILE BREASTFEEDING
During your pregnancy, your body prepared for breastfeeding in the form of 5-7 pounds of
extra fat that you don’t lose initially after birth. Your body will draw from those stores for
the first few weeks as you nurse your baby.
You’ll also find that you’ll probably be very thirsty and it is best to drink to satisfy that
thirst. Your body takes water from your system to make breast milk, so if you don’t
replenish that fluid, you could become constipated.
No foods are routinely restricted when you breastfeed; your baby will let you know if
something you are eating is not tolerated. Food that you eat affects your milk 4-24 hours
after it is eaten, so if your baby is especially fussy, you may try eliminating the foods that
you think might be causing the problem (if this happens consistently).
Your diet while breastfeeding needs to include extra protein, some calcium-containing
foods, extra vitamins and extra fluids. Water is the best fluid for your health and well being.
TROUBLESHOOTING BREASTFEEDING
Here are some common situations that may arise for breastfeeding mothers. If any of these
persist or if you have questions, please don’t hesitate to call a Lactation Consultant at
The Mom’s Place at 663.6686.
BREASTS LEAKING MILK
During the first few weeks after birth, your breasts may leak milk. This will usually slow
down and stop altogether as your body figures out just how much milk your baby needs.
It’s not uncommon to have a let down when you hear your baby or another baby crying,
it’s just your body responding to your baby’s needs. Sometimes when you’re sexually
aroused, your breasts may leak…this is normal and a little unsettling but don’t worry;
leaking usually becomes less of a problem with time!
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What to do
When you feel the milk let down, press your hands or forearms firmly against your
breasts. This slows the milk flow and can be done in public if you’re discreet!
n
If one breast leaks while your baby is nursing from the other, press the heel of your
free hand on the nipple for a minute or two.
n
W
ear pads to absorb the leaking milk, changing them when they get wet or damp.
Keeping wet or damp pads close to your skin can cause your nipple tissue to break
down, which can cause nipple soreness.
n
n
Avoid the use of breast pads with plastic liners, instead choose thin, flexible silicone
pads or washable cotton ones. Ask your nurse or Lactation Consultant.
SORE NIPPLES/CRACKED NIPPLES
Some women experience tenderness by the second or third day of breastfeeding,
but it may resolve by day 7 to ten.
Usually extreme soreness is caused by improper positioning or an ineffective latch, both
of which are easy to fix. Don’t let the soreness persist – call a Lactation Consultant at The
Mom’s Place at 663-6686.
Try some of these suggestions to correct the situation:
n Check the baby’s latch – make sure the baby is taking as much of the areola into
the mouth as possible and the lower lip is full.
n Feed often – putting off feedings makes your breasts fuller and that makes it harder
for the baby to latch on.
n Hand-express or pump a little milk before the baby latches on to soften the areola
and make latching on easier.
n Begin nursing on the side that is the least sore, since babies nurse more vigorously
at the start of a feeding.
n Remember to take the baby off the breast by putting your finger into the mouth to
break the suction so your nipple comes out easily.
n Air dry your nipples after nursing.
Wash your breasts with water only. Soap may dry your skin, perfume may irritate it.
n
n Rub a little breast milk onto your nipples after each feeding.
Change breast pads when they become wet, or dab some expressed breast milk
onto the area and allow it to air dry.
n
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PUMPING AND STORING BREAST MILK
Expressing milk from your breasts may be done by hand or with a breast pump. Talk to a
Lactation Consultant at The Mom’s Place about selecting a pump that best fits your needs.
The ability to pump your breasts gives you great flexibility
and allows others to share in the experience of feeding
your baby. It’s also important if you are trying to build or
rebuild your milk supply, or if you need to return to work
or to travel.
5 hours on the counter, 5 days in the refrigerator, 5 months in the freezer (See below)
REFRIGERATOR STORAGE
FREEZER STORAGE
Expressed Store for 5 days in the coldest
Breast milk part of refrigerator. Do not store
in door of refrigerator.
Store for 5 months in the
back of freezer. Do not store
in door of freezer. Store for up
to 6 mos. in deep-freezer.
Frozen
Breast milk
Do NOT refreeze breast milk
Thawed breast milk that is
unopened or unused is fine in
the refrigerator for 24 hours.
Be sure to throw out any breast milk that is left over or not used from a feeding after it
was thawed and warmed, or if it comes into contact with the baby’s mouth.
NEVER MICROWAVE BREAST MILK!
Store pumped milk in clean glass or plastic bottles or in plastic bags designed for
breast milk storage. Leave room at the top of the bottle or bag for expansion of milk
as it freezes.
n
n Label the container with the date the milk was collected. Use the oldest milk first.
Thaw frozen milk by placing the container in warm water. As the water cools,
change it for warm water until the milk is at room temperature or slightly warmer.
Shake before using to mix fat which rises during storage.
n
WHEN SHOULD I INTRODUCE A BOT TLE?
Babies drink from a breast or bottle for at least the first 6 months of their lives. If
you want to add a bottle of breast milk or formula, it’s best to wait 3-4 weeks until
your milk supply has been established.
n
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n Feeding milk from a bottle is very different for your baby than feeding milk from
a breast, and some babies may have difficulty adjusting to those different sucking
patterns.
Some babies won’t accept a bottle from a breastfeeding mother. Once your milk
supply is well established and your baby is nursing well, try letting your partner
offer the baby a bottle when you are not in the room.
n
FEEDING YOUR BABY
GOOD NUTRITION FROM THE START
One of the most important aspects of caring for your new baby is to provide wholesome
nutrition. Since your baby will be growing and developing rapidly during the first year,
nutrient needs will be high.
A diet appropriate for your baby’s level of development is the cornerstone of future good
health. Weight gain will be one of the best indicators of an adequate intake. While every
baby is a unique individual, there are some general guidelines for feeding during the first
twelve months.
BREAST MILK
Breast milk is an excellent food for the first year. Advantages to breastfeeding are many
including nutritional, immunological, psychological and economical.
Breast milk provides 100% of your baby’s nutritional needs through the first 4-6
months. Your baby may nurse 8-12 times per day (on demand). By 4 months, your baby
will likely cut back to 4-6 times per day taking more at each feeding. At the beginning,
fluid needs are met with breast milk. If extra fluids are required, talk to your pediatrician.
FORMULA FEEDING
Formula fed babies usually eat every 2-4 hours, and your pediatrician or family care doctor
will advise you about which formula to feed your baby and how much your baby is likely to
eat at each feeding.
Formula is available in ready-to-feed, concentrated and powdered form. Powdered
formula is the most economical way to bottle-feed your baby. Always read the label for
preparation directions.
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BOT TLE FEEDING GUIDELINES
n
Check expiration date on the formula before use.
n
Always follow formula manufacturer’s directions carefully.
City water may be safely used to prepare formula, whereas well water should be
tested for arsenic prior to using.
n
We recommend boiling the water and slightly cooling prior to adding to the
powdered formula. Be sure to cool the formula and test the temperature before
feeding your baby.
n
n Newborn babies may take between 1 to 3 ounces every 3 to 4 hours. Always prepare
more than your baby is taking and increase as needed.
n Make bottles for use within 24 hours, cap the bottle and refrigerate.
Warm formula by placing in a pot of warm (not boiling) water, do not microwave.
n
n Always test the temperature of warmed formula on the inner arm, before feeding
your baby. Test temperature of the formula on your wrist by tilting the bottle. If
the formula runs out, the hole in the nipple is too big and the baby could choke.
Formula should drip out of the nipple when you tilt the bottle.
n Always throw away any formula left over at the end of a feeding – bacteria in the
baby’s saliva will contaminate the formula.
n
Discard unused opened powered formula after 1 month.
Consult with your baby’s provider before changing formula or for any suspected
intolerance to formula.
n
SOLID FOODS – WHEN AND WHAT
By age 6 months your baby may be ready to be introduced to solid foods.
When making this transition, it is important to not start too soon.
Your baby’s gastrointestinal tract may not be ready and food allergies may develop. Babies
younger than 4 months use an in-and-out tongue movement for sucking which makes it
very difficult for them to swallow from a spoon. Some developmental milestones to look
for before starting your baby on solids include: birth weight doubled, good head and neck
control, ability to sit up with some support and interest in food when others are eating.
Around 6 months of age, solid foods are added to the diet. By adding food, however,
the number of breastfeedings or the amount of formula may not decrease. The first
food is typically iron-fortified rice cereal. 1 to 2 tablespoons mixed with breast milk or
formula may be offered twice a day. Have your baby in an upright position and offer
the cereal with a spoon. When rice cereal is taken regularly, other fortified cereals may
be tried at an interval of 1 new cereal per week while watching for food allergies.
Signs of food allergies are intolerance of food, hives or rash.
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INTERACTIVE PARTICIPATION – ADDING MORE FOODS
By age 6-8 months, your baby will take a more active role with eating. At this stage of
development, he/she will have better posture through the neck and shoulders and will be able
to coordinate hand movements to start self-feeding.
Begin with pureed foods and then
offer soft-textured ones. Start
pureed vegetables first and then
add pureed fruits. Offer finger
foods in small amounts, such as
soft cooked vegetables, peeled
fruits, Melba toast or cooked
noodles. Your baby will now take
more solid foods and less breast milk or
formula (nursing 3-5 times a day or consuming
24-32 oz. formula/day).
INDEPENDENCE
By age 9-12 months, your baby will take a more independent
role with eating. Because a baby has a small stomach capacity,
3 meals plus 3 snacks should be offered daily.
Your child may get messy while eating. He or she is just
experiencing the food. Give small soft pieces of foods, but
avoid those foods that can fully block the opening to the
airway. Examples of foods to avoid are whole grapes, hot
dogs, peanuts, nuts, raw carrots and raisins. Cups
of breast milk, formula or water should be given
at meal time. This can aid in the transition
from bottle to cup use. Small amounts of juice
or water can also be offered by cup. Introducing
your child to new foods may be a challenge and can
take as many as 10 trials of a food to do so.
As your baby grows, so does the need for good
nutrition. Follow the cues and developmental
milestones when progressing with eating during the
first year. You and your baby have a special bond.
Enjoy the process from the start.
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NUTRITION PEARLS
When combining breast and formula feeding, do not introduce formula until a few weeks
before returning to work.
If your baby is not eating enough during the day or is underweight, waking
to feed at night may be needed. Check with your doctor.
n
Too much plain water can be harmful.
n
n Commercially bottled “baby water” with fluoride is not to be used for babies
less than 6 months old.
n Never put your baby to bed with a bottle. It may cause “bottle mouth” resulting in
tooth decay.
n Do not feed cereal in a bottle.
Safe and sanitary food preparation techniques are very important.
n
n Fat is not to be restricted for babies.
Pasteurized whole cow’s milk or goat’s milk should not be introduced until about
12 months of age.
n
Un-pasteurized milk has viral and bacterial contamination risk.
n
n Formula should not be made with evaporated cow’s milk, soy milk or rice milk
as none meet the requirements of babies less than 1 year old.
n After 12 months of age, 12-16 oz. of whole milk or other
500 mg calcium equivalent per day should be provided.
n Give whole milk until age 2 to provide the needed calories
for proper growth.
n Avoid added sugar and salt when preparing food.
Honey and corn syrup are not recommended for children under
2 years old. They may contain Clostridium Botulinum spores.
n
Delay feeding orange juice until 9 months if there is a family
history of allergy present.
n
Some babies may be sensitive to egg whites
thus give yolk only until 1 year old.
n
For families with history of food allergies,
delay introduction of the following for 12-18
months: egg whites, cow’s milk, citrus, wheat
products, chocolate, fish, shellfish, tree nuts,
peanuts, and peanut butter.
n
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Caring
F O R YO U R N EW B O R N
BABY SLEEPING POSITIONS
C A R I N G F O R YO U R B A B Y
BABY SLEEPING POSITIONS
REDUCING THE RISK OF SIDS (Sudden Infant Death Syndrome)
n ALWAYS PLACE YOUR BABY TO SLEEP ON HIS/HER BACK.
Babies sleep on a firm mattress, not on a waterbed, sofa or other soft surfaces.
n
n Pillows, comforters or sheepskins are not to be used under a baby or anywhere
in the crib.
n Remove all stuffed animals and toys from the sleep area.
Keep your baby’s head and face uncovered during sleep.
n
n If you use a blanket, be sure that your baby’s feet are at the bottom of the crib
and that the blanket is no higher than the baby’s chest. Tuck the blanket in around
the mattress.
Maintain your baby’s sleep area at a room temperature that should be comfortable
for an adult, be sure not to overheat the room.
n
The 2005 AAP recommendation states that babies should sleep in a crib or
bassinet in the same room as the parents. Babies may be brought into bed for
nursing or comforting, but should be returned to their own crib or bassinet when
the parents are ready to return to sleep. If parents choose to have their baby in
bed, remember to never sleep with your baby if you have been drinking alcohol,
smoking, using drugs or medications that make it difficult to become awake, are
obese or extremely exhausted.
n
n Sometime between 3-4 months of age your baby will begin to roll to the side on
his/her own.
CARING FOR YOUR BABY
BATHING YOUR NEW BABY
It is not necessary to bathe your newborn every day; twice a week is
ideal. However a bath at the same time each day can be relaxing
and provide a routine in your day. Babies may be
immersed in warm water up to the chin even if
the cord hasn’t fallen off.
Use a mild soap or plain water. Start with the
eyes, then wash the face and end with the diaper
area. Powders, creams and lotions are not necessary.
Remember to be ready before you start the bath
including towels and a clean diaper!
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CORD CARE
Your baby’s umbilical cord will dry and
fall off usually within 7-10 days. Try to
keep the cord dry by keeping it out of
the diaper.
When the cord falls off there
may be a few drops of blood
and some yellowish drainage
for a day or two afterwards.
If you notice redness, swelling or
puss-like drainage, notify your baby’s
provider.
FINGERNAILS/TOENAILS
Babies’ fingernails usually need cutting
right after birth, but it’s not a good idea.
Cutting may damage a membrane that is growing there, so for the first few weeks, use an
emery board to keep nails short. Since babies love to clench their hands into fists, wait
until they are sleeping and their hands are relaxed before trying to trim his/her nails!
BABY ’S TEMPERATURE
Obtain your baby’s temperature if you suspect that your baby is sick. Signs of illness may
include excessive sleepiness, irritability or feeding poorly.
You may notice that your baby feels hot to the touch. Use a digital thermometer and
place under the newborn’s armpit. Make sure you have good skin contact. Hold the
baby’s arm down gently while waiting. A normal newborn temperature is between 97.6
and 99.6 degrees. If your provider requests a rectal temperature, use the sleeve provided
with the thermometer, lubricate the probe tip with Vaseline and insert gently, about
½ inch into the rectum. The baby is positioned on his/her back with the feet held up.
Notify your baby’s provider if the rectal temperature is greater than 100.4 degrees.
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DIAPERING
The baby’s diapers need to be changed when soiled. This may be frequent in the beginning.
Use alcohol-free, fragrance-free wipes or warm water when changing the diaper. Ointments
may be used if a diaper rash is present. Daily use of creams and powders is not needed.
If a diaper rash persists for more than a few days, notify your baby’s provider. A girl baby
is wiped from front to back. It is not necessary to separate the labia and clean discharge
unless stool is present. A mucous or blood tinged discharge in a baby girl is normal. Boys
that are not circumcised need no special care in the beginning. Your provider will discuss
care when your child is older. Breastfed babies generally have mustard-like yellow stools
with a mild odor. Bottle fed babies have firmer stools with a stronger odor.
CIRCUMCISION CARE
After your baby boy has been circumcised, the glans of the penis will have a long piece of
Vaseline gauze wrapped around it and a “tent” made out of gauze and Vaseline over the top.
The long piece stays on the penis for the first 24 hours and the “tent” is changed with
every diaper change. Your nurse will show you how to do this. After 24 hours, all the
gauze is removed and you may continue to apply Vaseline for a day or two to prevent the
glans from sticking to the diaper. During the 24 hours after surgery, if your baby is fussy
or irritable, you may give him pain medication. Your nurse will tell you how much to
give him based on his weight. Call your baby’s provider if you notice bleeding, drainage,
swelling, redness, fever or no urination within 24 hours.
USING THE BULB SYRINGE
Babies are nose-breathers for the first 3-4 months and they
often need assistance to clear their noses.
To use the bulb syringe, depress the bulb, insert it in one
nostril while blocking the other nostril. Release bulb. Once or
twice into each nostril is adequate. Do not force the bulb and use
only as needed, excessive use can irritate the baby’s nasal mucosa.
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CAR SEATS
Always buckle your baby in an approved car seat according to the manufacturer’s recommendations, even for short trips. If the baby is in the car, the seat should be secured and buckled up.
Newborns need to be in a rear-facing seat until they are 1-year-old and 20 pounds.
A 5-point safety harness restraint is recommended. The car seat is never placed in front
of an airbag. Accessories that do not come with the car seat are not to be added, as the
seats are not safety tested with added-on items. Never use a seat that has been in an
accident or one that you do not know the age or history. Refrain from using a seat that
is 6 years old or more. Plastics break down over time and are not strong. Always read all
directions carefully before installing the seat including the car’s operating manual.
Many cities and towns in New Hampshire have safety technicians in their police and
fire departments. They are trained to check the seat and instruct parents in correct
installation and proper newborn placement in the seat. Before you leave the hospital,
The Mom’s Place staff will check to see if your baby is correctly placed in his/her car seat.
You will need to perform any adjustments to obtain proper fit, so knowledge of how to
do so is imperative to ensure your baby’s safety in the car.
JAUNDICE
Jaundice is the yellow color seen in the skin of many babies. It is caused by the buildup
of bilirubin in the blood as a result of the normal breakdown of fetal red blood cells.
Bilirubin is removed by the mom’s liver prior to birth.
After birth, the new baby’s liver sometimes takes a few days to effectively remove the
bilirubin. Low levels of bilirubin are harmless for your baby and may even have some
antioxidant effect. Very high levels however may be harmful and are watched carefully.
Your baby’s provider and your nurse will observe your baby’s color and perform lab
tests to determine the bilirubin level. Since jaundice usually peaks on day 4 or 5, your
provider will request you follow up with them within 2-4 days of discharge.
Bilirubin is excreted in the bowel and urine. Feeding your baby frequently means more
output and more bilirubin excreted. Sometimes, however, increasing levels of bilirubin
may make your baby sleepier and harder to feed. If you are breastfeeding and your baby
will not latch, express your breasts and feed expressed milk in a bottle. When your baby
is home, observe frequently. Holding your baby up to light may make jaundice easier
to see. Call your baby’s provider if your baby’s skin turns more yellow, including the
abdomen, arms, legs and eyes. Also, call if your baby is hard to wake, fussy or not feeding
well. When your baby’s jaundice levels are high your provider may order phototherapy.
Your baby will be treated with special lights. This may be done either at home or in the
hospital. Phototherapy works fairly quickly and usually only lasts 1-2 days.
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CRYING
Crying is the way babies communicate with us. They may cry for many reasons. They may be
too hot or cold, hungry, sick or need their diaper changed. Sometimes you’ve checked all these
things and your baby still cries. Here are some techniques you can try to soothe your baby.
n
Wear your baby Many different styles of slings are available now and your baby
will love being close to you.
n
Skin to skin
Place your undressed baby on your bare chest.
n
Swaddling
Wrap your baby securely in a blanket with his arms down.
n
Movement
Babies love movement, a rocker ride, swing, stroller or car ride.
n
Massage
Massage your baby’s lower abdomen in a clockwise manner.
n
Warm bath
Move your baby back and forth in the water or get into the
bathtub with him and lay him on your chest.
n
White noise
Make a shushing noise near your baby’s ear or turn on a hair
dryer away from the baby.
Sometimes babies will cry no matter what you do . If your baby’s
crying is upsetting to you or you feel yourself becoming angry
or frustrated, you need to stay calm and separate yourself from
your baby
baby . Your baby should be laid gently on her back, in her
crib .
Call a friend, have a warm drink, do something for yourself
yourself .
Remember never shake a baby . Babies can have serious medical
consequences from being shaken .
IMMUNIZATIONS
Infants and children need to be vaccinated because they
are more likely to develop complications or die from
vaccine-preventable diseases. Immunization is one of the
most important things a parent can do to protect their children’s health. Today we can
protect children from 14 serious diseases. Failure to vaccinate may mean putting children
at risk for serious diseases.
Source: United States, Department of Health and Human Services, Centers for Disease Control
and Prevention. National Infant Immunization Week Frequently Asked Questions.
Questions
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COMMON QUESTIONS ABOUT INFANT IMMUNIZATIONS
Is it okay for my baby to have so many shots at once?
Yes. Studies show that kids’ bodies – even infants – can handle many shots at
once. Having several vaccines at once is safe, even for a newborn. Combination
vaccines protect your child against more than one disease with a single shot.
This reduces the number of shots and office visits your child would need.
It’s not your imagination; there are a greater number of shots now than even a
few years ago. That’s because as science advances, we are able to protect your child
against more diseases than ever before.
Don’t infants have natural immunity?
Babies get some temporary immunity (protection) from mom during the last
few weeks of pregnancy – but only for the diseases mom is immune to. These
antibodies do not last long, leaving the infant vulnerable to disease.
Haven’t we gotten rid of most of these diseases in this country?
Thanks to vaccines, most diseases prevented by vaccines are no longer common
in this country. Even the few cases we have in the U.S. could very quickly become
tens or hundreds of thousands of cases if we stopped vaccinating.
It’s not uncommon to have measles outbreaks, whooping cough outbreaks,
chickenpox outbreaks, and other diseases when vaccination rates drop. Kids
that are not fully vaccinated can become seriously sick and spread it through a
community.
I heard that some vaccines can cause autism. Is this true?
No. Scientific studies and reviews have found no relationship between vaccines
and autism. Groups of experts, including the American Academy of Pediatrics
and the Institute of Medicine (IOM), also agree that vaccines are not responsible
for the number of children now recognized to have autism.
Can’t I just wait until my child goes to school to catch up on immunizations?
Many of the diseases vaccines protect against can be very dangerous to infants.
Newborns, babies and toddlers can all be exposed to diseases from parents and
other adults, brothers and sisters, on a plane, at child-care or even at the grocery
store. International travel is easier than ever – your baby can be exposed to
diseases from other countries without you knowing.
Don’t wait to protect your baby and risk these diseases when he or she needs
protection now. It is easier to stay up to date than to catch up!
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Why does my child need a chickenpox shot? Isn’t it a mild disease?
Chickenpox can actually be a serious disease for kids if the blisters become
infected. Before vaccines were available, about 50 kids died every year from
chickenpox, and about 1 in 500 kids who got chickenpox were hospitalized.
My child is sick right now. Is it okay for her to still get shots?
Yes, usually. Talk with the doctor, but children can usually get vaccinated even
if they have a mild illness like a cold, earache, mild fever, or diarrhea. If the doctor
says it is okay, your child can still get vaccinated.
Where can I get more information?
Centers for Disease Control and Prevention (CDC)
www.cdc.gov/vaccines or 800-CDC-INFO (232-4636)
American Academy of Pediatrics
www.aap.org
The Children’s Hospital of Philadelphia
www.vaccine.chop.edu
Immunization Action Coalition (IAC)
www.immunize.org
Every Child By Two
www.ecbt.org
Source: United States, Department of Health and
Human Services, Centers for Disease Control and
Prevention. Common Questions Parents Ask About
Infant Immunizations.
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RECOMMENDED IMMUNIZATION SCHEDULE
FOR PERSONS AGED 0-6 YEARS UNITED STATES 2008
n
Age
1 2 4 6121518
19-23
2-34-6
Vaccine
Birth monthmonthsmonthsmonthsmonthsmonthsmonthsmonths years years
Hepatitis B HepB HepB
Rota HepB
Rotavirus Rota Rota
Diphtheria, Tetanus,
Pertussis DTaP DTaP DTaP
aemophilus H
influenzae
type b Hib Hib Hib
Hib
Pneumococcal PCV PCV PCV
PCV
I nactivated Poliovirus IPV IPV
DTaP
DTaP
PPV
IPV IPV
Influenza
Influenza (yearly)
Measles, Mumps,
Rubella
MMR
MMR
Varicella
Varicella Varicella
Hepatitis A
HepA (2 doses) Meningococcal
Range of recommended ages
HepA Series
MCV4
Certain high-risk groups
This schedule indicates the recommended ages for routine administration of currently licensed
childhood vaccines, as of December 1, 2007, for children aged 0 through 6 years. Additional
information is available at www.cdc.gov/vaccines/recs/schedules. Any dose not administered
at the recommended age should be administered at any subsequent visit, when indicated and
feasible. Additional vaccines may be licensed and recommended during the year. Licensed
combination vaccines may be used whenever any components of the combination are indicated
and other components of the vaccine are not contraindicated and if approved by the Food
and Drug Administration for that dose of the series. Providers should consult the respective
Advisory Committee on Immunization Practices statement for detailed recommendations,
including for high risk conditions: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm. Clinically
significant adverse events that follow immunization should be reported to the Vaccine Adverse
Event Reporting System (VAERS). Guidance about how to obtain and complete VAERS form is
available at www.vaers.hhs.gov or by telephone, 800-822-7967.
Source: United States, Department of Health and Human Services, Centers for Disease Control and
Prevention. The Recommended Immunization Schedule for Persons Aged 0-6 Years 2008.
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NEWB ORN SCREENING TESTS
Why does my baby need newborn screening tests?
n
Most babies are healthy when they are born.
n
We test all babies because a few babies look healthy but have rare health problems.
n
If we find problems early, we can help prevent serious problems like mental
retardation or death.
How will my baby be tested?
n
n
Before you leave the hospital, a nurse will take a few drops of blood from your
baby’s heel.
The hospital will send the blood samples to a newborn screening lab.
How will I get the results of the test?
n
Parents are notified of test results if there is a problem.
n
Ask about results when you see your baby’s health professional.
Why do some babies need to be retested?
n
Your baby may be retested if you leave the hospital before 24 hours.
n
Some states require a second test on all babies.
n
Some babies need to be retested because there is a problem with the blood sample.
n
A few babies need to be retested because the first test showed a possible health
problem.
What if my baby needs to be retested?
n
n
n
Your baby’s health professional or the State
Health Department will contact
you if your baby needs to be
retested. They will tell you
why the baby needs to
be retested and what
to do next.
If your baby
needs to be
retested, get
it done right
away.
Make sure that
your hospital and
health professional
have your correct address
and phone number.
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MOMS (6667)
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There may be other tests besides those required in your state. More helpful
information is available by contacting:
National Newborn Screening and Genetics Resource Center
512.454.6419
www.genes-r-us.uthscsa.edu
or
NH Department of Health & Human Services
Division of Public Health Services
Maternal & Child Health Section
New Hampshire Newborn Screening Program
29 Hazen Drive
Concord, NH 03301
603.271.4225
1.800.852.3345 ext. 4225
LEAD POISONING
Effects of lead poisoning
n Learning disabilities
Difficulty with memory
n
n Trouble paying attention
Behavioral problems in children
n
n Slowed growth rate
Hearing loss
n
n Coma or death in serious cases
Those at risk for lead poisoning
Pregnant women
n
n Children under six
Adults exposed at home or work
n
n Pets
Children are at risk for lead poisoning
n Growing bodies absorb more lead.
Lead paint dust gets on small hands and toys. Children put hands and toys into
their mouths.
n
Children may eat lead paint chips that peel off the wall.
n
n Children can eat lead dust created by opening and closing windows and doors.
CATHOLICMEDICALCENTER.ORG
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Protect yourself and your family if you are exposed to lead on the job
Call the Northern New England Poison Center at 1.800.222.1222 for information.
Sources of lead poisoning
n Lead paint used in homes or buildings built before 1978
Water that runs through plumbing with lead solder
n
n Older toys and furniture with lead paint
Dust created when furniture with paint is sanded
n
n Hobbies that use lead (pottery, stained glass and reloading shotguns)
Food or liquids stored in lead crystal or lead-glazed pottery
n
n Firing ranges
Lead dust on clothes and shoes carried home from work
n
Risk factors in homes built before 1978
Peeling or chipped paint
n
n Hard-to-open doors or windows
Home remodeling
n
Testing your home for lead:
New Hampshire: Call 1.800.698.3624 or
visit www.dhhs.nh.gov/DHHS/CLPPP?default.htm
Protect your family if your house has lead paint
Talk to your doctor about a blood test for lead.
n
n Do not let children/pets chew on painted surfaces.
Wash hands, children’s bottles, pacifiers and toys often.
n
n Avoid vacuuming or sweeping areas that may contain lead dust.
Mop or wipe down surfaces with water instead.
n Report chipping or peeling paint to your landlord if you rent a house,
condominium or apartment.
n Hire a certified lead renovator if you plan to remodel or disturb lead paint.
If you choose not to use a certified professional, call the Northern New England
Poison Center at 1.800.222.1222 for safety information.
603.663.MOMS (6667)
37
Catholic
Medical Center
SERVICES
ASK-A-NURSE®
BREAST CARE CENTER
O U T PAT I E N T M E D I C AT I O N
MANAGEMENT AND
COUNSELING PROGRAM
PREGNANCY CARE CENTER
WEST SIDE NEIGHBORHOOD
H E A LT H C E N T E R
WO M E N ’ S C A R D I AC C E N T E R
PRIMARY CARE PRACTICES
ADDITIONAL RESOURCES
CMC SERVICES
ASK-A-NURSE®
a community health service of Catholic Medical Center
603.626.2626
ASK-A-NURSE is CMC’s 24-hour health care information hotline. When you call,
you will speak directly with a specially-trained registered nurse who will listen carefully
to your questions and help you make an informed decision about
you or your baby’s health care question.
All ASK-A-NURSE services are free and confidential, 24-hours
a day, 7 days a week.
BREAST CARE CENTER
at Catholic Medical Center
100 McGregor Street, Manchester, NH 03102
n
603.663.5270
The Breast Care Center at Catholic Medical Center serves as a comprehensive,
streamlined place of comfort offering treatment, care, support and education
for women all under one roof. Services include prevention, clinical breast exams,
screenings, diagnosis, treatment, consultation and educational
resources. High quality, comprehensive breast health care services
are easily accessible and cost effective. The Breast Care Center is
committed to creating an integrated and focused system of care
in a compassionate environment, providing hope and healing.
The Breast Care Center is located inside Catholic Medical Center
To make an appointment, call the Breast Care Center at 663.5270.
OUTPATIENT MEDICATION MANAGEMENT AND
COUNSELING PROGRAM
at Catholic Medical Center
88 McGregor Street, Manchester, NH 03102
n
603.663.6200
The Outpatient Medication and Counseling Program is staffed by 2 psychiatrists, an
advanced registered nurse practitioner and a licensed clinical social worker. This outpatient
program offers evaluation, assessment, psychopharmacologic management and treatment
of a broad range of psychiatric disorders. The Outpatient Counseling Program assists
individuals needing help with personal changes, stress, anxiety or other life challenges.
Patients are seen by appointment. To schedule an appointment, please call 663.6200.
Office hours: Monday through Friday, excluding holidays.
603.663.MOMS (6667)
39
PREGNANCY CARE CENTER
88 McGregor Street, Manchester, NH 03102
n
603.663.6661
At the Pregnancy Care Center at Catholic Medical Center, we provide comprehensive,
supportive prenatal care to all women and their families regardless of their ability to
pay. Prenatal care has been identified as playing a significant role in improved pregnancy
outcomes. Our mission is to serve those most in need and those unable to access services
in traditional prenatal settings.
The Pregnancy Care Center is located in the medical office building adjacent to
Catholic Medical Center.
Office Hours: Monday through Thursday, 8 AM to 4 PM, by appointment.
WEST SIDE NEIGHBORHOOD HEALTH CENTER
at Catholic Medical Center
88 McGregor Street, Suite 302, Manchester, NH 03102
n
603.663.5382
Catholic Medical Center and Dartmouth-Hitchcock Manchester have come together
to create a full-service primary care setting on the West Side of Manchester. As the
new home for the Family Center for Pediatric and Adolescent Care, the West Side
Neighborhood Health Center specializes in caring for the entire family, from newborns
to elderly. We continue to provide comprehensive, supportive well-baby and well-child
care, ill child care and adolescent care to the age of 18. Our expanded services will
include general internal medicine for those over the age of 18.
The West Side Neighborhood Health Center
is located in the Medical Office Building
adjoining Catholic Medical Center.
Office Hours: Monday through Friday, 8 AM to
5 PM by appointment.
WOMEN ’S CARDIAC CENTER
New England Heart Institute of Catholic Medical Center
100 McGregor Street, Manchester, NH 03102
n
603.663.5299
The Women’s Cardiac Center offers a comprehensive program that identifies a woman’s
risk for heart disease and provides recommendations for reducing these risks.
One out of every 2-1/2 women die from cardiovascular disease and nearly 60
percent of women experiencing a heart attack have no prior symptoms. Factors used to
determine a woman’s risk of cardiovascular disease include age, smoking habits, HDL
CATHOLICMEDICALCENTER.ORG
40
cholesterol, total cholesterol and systolic blood pressure.
Women may self-refer or be referred by their physician
to the Center for a risk assessment and screening. To sign
up for better heart health, call the Women’s Cardiac Center
at 663.5299.
PRIMARY CARE AT CATHOLIC MEDICAL CENTER
At Catholic Medical Center, we understand how important your relationship is with your
doctor. You want a doctor who not only understands your specific medical needs, but who
will take the time to listen to your concerns and make you a full partner in your care.
AMOSKEAG PRIMARY CARE GROUP
a department of Catholic Medical Center
16 High Street, Manchester, NH 03101 603.623.3343
n
Amoskeag Primary Care Group, as a family practice, specializes in caring for the entire
family, from newborns to the elderly.
We provide hospital care at Catholic Medical Center and have spent several years in
specialized medical training to provide you with expert, personal care. We appreciate the
opportunity to serve your health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
DARTMOUTH-HITCHCOCK BEDFORD
25 South River Road, Bedford, NH 03110
n
603.629.1793
Dartmouth-Hitchcock Bedford is a primary care practice that includes family practice,
internal medicine and pediatrics. We specialize in caring for the entire family. We have
quick and easy access to specialty care from within the Dartmouth-Hitchcock system,
including Norris Cotton Cancer Center and CHaD, the Children’s Hospital at Dartmouth.
Our providers also have privileges at Catholic Medical Center to see their patients when
hospitalization is needed.
For provider information, visit Dartmouth-Hitchcock.org/Manchester.
Office Hours: Monday through Friday, 8 AM to 5 PM.
603.663.MOMS (6667)
41
FAMILY HEALTH & WELLNESS CENTER AT BEDFORD
a department of Catholic Medical Center
188 Route 101, Bedford, NH 03070
n
603.663.8052
The Family Health & Wellness Center at Bedford specializes in family medicine and
general internal medicine with an emphasis on holistic and complementary care. Our
philosophy is to treat the whole person, mind, body and spirit. Our practice cares for the
entire family, from newborns to the elderly, and provides hospital care at Catholic Medical
Center. We have spent several years in specialized medical training to provide you with
expert, personal care. We appreciate the opportunity to serve your health care needs.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
FAMILY PHYSICIANS OF MANCHESTER
a department of Catholic Medical Center
57 Webster Street, Suite 110, Manchester, NH 03102
n
603.622.6491
Welcome to Family Physicians of Manchester, where our purpose is to provide you
with the best health care possible. Our providers are certified by the American Board
for Family Medicine. We specialize in caring for the entire family, from newborns to the
elderly, and provide hospital care at Catholic Medical Center. We have spent several years
in specialized medical training to provide you with expert, personal care. We appreciate
the opportunity to serve your health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
GOFFSTOWN PRIMARY CARE
a department of Catholic Medical Center
17A Tatro Drive, Suite 201, Goffstown, NH
n
603.314.4500
Goffstown Primary Care is a group of health care professionals who specialize in general
internal medicine and provide hospital care at Catholic Medical Center. We have spent
several years in specialized medical training to provide you with expert, personal care.
We appreciate the opportunity to serve your health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
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42
GRANITE STATE INTERNAL MEDICINE
a department of Catholic Medical Center
53 Goffstown Road, Manchester, NH 03102
n
603.206.1380
Granite State Internal Medicine is a primary care practice with 2 physicians and one
nurse practitioner certified by the American Board of Internal Medicine. We have spent
several years in specialized medical training to provide you with expert, personal care.
We appreciate the opportunity to serve your health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8AM to 5PM.
MEDICAL GROUP OF MANCHESTER
a department of Catholic Medical Center
Dartmouth Commons, 775 South Main Street, Manchester, NH 03102
n
603.663.7300
The Medical Group of Manchester is a group of physicians certified by the American
Board of Internal Medicine. We specialize in general internal medicine and provide
hospital care at Catholic Medical Center. We have spent several years in specialized
medical training to provide you with expert, personal care. We appreciate the
opportunity to serve your health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
QUEEN CITY MEDICAL ASSOCIATES
a department of Catholic Medical Center
Dartmouth Commons, 769 South Main Street, 3rd Floor, Manchester, NH 03102
603.625.6198
n
Welcome to Queen City Medical Associates, where our purpose is to provide you with
the best care possible. Our physicians specialize in general internal medicine and are
certified by the American Board of Internal Medicine. We provide hospital care at
Catholic Medical Center. We have spent several years in specialized medical training
to provide you with expert, personal care. We appreciate the opportunity to serve your
health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
603.663.MOMS (6667)
43
WEBSTER STREET INTERNAL MEDICINE
a department of Catholic Medical Center
57 Webster Street, Manchester, NH 03104
n
603.668.6489
Webster Street Internal Medicine is a group of physicians who specialize in general
internal medicine and who provide hospital care at Catholic Medical Center. We have
spent several years in specialized medical training to provide you with expert, personal
care. We appreciate the opportunity to serve your health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
WILLOWBEND FAMILY PRACTICE
a department of Catholic Medical Center
20 Washington Place, Bedford, NH 03110
n
603.663.8060
Welcome to Willowbend Family Practice, where our purpose is to provide you with the
best health care possible. Our providers specialize in family medicine and are certified
by the American Board for Family Medicine. We provide hospital care at Catholic
Medical Center. As a family practice, we are specialized in caring for the entire family,
from newborns to the elderly. We have spent several years in specialized medical training
to provide you with expert, personal care. We appreciate the opportunity to serve your
health care needs.
For provider information, visit catholicmedicalcenter.org.
Office Hours: Monday through Friday, 8 AM to 5 PM.
In an emergency, our answering service will contact us after regular business hours.
OBSTETRICS & GYNECOLOGY
Dartmouth-Hitchcock Physicians and Nurse Midwives
88 McGregor Street, Suite 301, Manchester, NH 03102 603.629.1799
n
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44
PEDIATRIC OFFICES
Bedford Pediatrics
Pine Tree Place, 360 Route 101, Unit 7-B, Bedford, NH 03110
n
603.471.0831
Dartmouth-Hitchcock Bedford Pediatrics
25 South River Road, Bedford, NH 03110 603.695.2572
n
Dartmouth-Hitchcock Manchester Pediatrics
100 Hitchcock Way, Manchester, NH 03104 603.695.2750
n
ADDITIONAL RESOURCES
Child and Family Services
800.640.6486 cfsnh.org
n
Children’s Alliance of NH
603.225.2264 childrennh.org
n
Early Hearing Detection and Intervention Program,
State of New Hampshire Health and Human Services
603.271.1037 dhhs.nh.gov/DHHS/MCH/ehdi.htm
n
Family Resource Connection of the NH State Library
800.298.4321 nh.gov/nhsl/frc/maindirectory.html
n
Mental Health Center of Greater Manchester
603.668.4111 Available 24 hours/7 days a week
n
n
mhcgm.org
NH Family Voices – Families and friends speaking on behalf
of children with special health needs.
800.852.3345, x4525 nhfv.org
n
NH Healthy Kids Corporation
877.464.2447 nhhealthykids.com
n
Parent Information Center
800.947.7005 parentinginformationcenter.org
n
USA National Suicide Hotline
1.800.SUICIDE (784.2433)
VNA Child Care and Family Resource Center
603.666.5982 manchestervna.org/childcare.asp
n
603.663.MOMS (6667)
45
MAKING A TRIBUTE TO YOUR BABY OR A CAREGIVER
Remember your special experience at The Mom’s Place.
Some families like to recognize a caregiver they have had during their time at The Mom’s
Place. The nurses and staff at The Mom’s Place are highly qualified, compassionate
people who focus on providing a positive birthing experience for you and your family.
Donations can be made in honor of your favorite nurse or caregiver. Your donation will
be used in support of advanced training opportunities for nurses.
The “Legacy of Children” program is another way to commemorate a child’s birth
and support The Mom’s Place at Catholic Medical Center. With a gift of $500, a
commemorative plaque is permanently installed on the “Legacy of Children” display,
part of The Mom’s Place giving wall located on the unit. As names are added, a visual
story of birth at Catholic Medical Center is created, reminding all who see it of our rich
and long history. Your gift will directly support the ongoing delivery of exceptional care
that has become the standard at The Mom’s Place.
If you would like to make a donation to The Mom’s Place or any other area of
Catholic Medical Center, you can call the Philanthropy Office at 603.663.6056,
send a check made payable to Catholic Medical Center, or donate online by visiting
www.catholicmedicalcenter.org. Send your check to Philanthropy Office, Catholic
Medical Center, 100 McGregor Street, Manchester NH 03102.
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NOTES
603.663.MOMS (6667)
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