You’ve got questions, we know. There’s lots to think about when taking care of a newborn. Our Pediatricians have taken the time to answer some of your most frequently asked questions below. If you need more help, don’t hesitate to call us at (908) 850-7800 to speak with a qualified Pediatrician today.

What about nursing/formula feeding?
  • Nursing is the gold standard against which all other infant feeding is held. It is good for your baby and it is good for you. It helps prevent infant infections, it gets your uterus back to normal size, and it is protective against breast cancer; but you don’t get graded on it. Breast feeding does not and should not define you as a woman and a mother. Generations of babies have grown and thrived on a variety of infant formulas that were far less complete than the ones we have today.
  • Nursing a baby for the first time can be a little unnerving. We instinctively worry that the baby will starve, we can’t measure the amount of colostrum or milk he is getting, and there are all sorts of well meaning relatives and experts offering conflicting advice. We need to remember that breast feeding is not under conscious control; learning all about it is not the same thing as doing it. Sometimes we need to turn off our thinking brain, relax, and trust our bodies.
  • Suckling is the stimulus that causes your body to produce and release milk; so frequent nursing is the best way to “bring your milk in.” However some babies seem indifferent or outright disinterested, and prolonged nursing right after delivery can result in cracked, sore nipples (even if your baby latches on properly). Pain is not a great inducement to keep nursing a baby. It has become common for new moms to use a breast pump to collect breast milk which is then fed to the baby in a bottle. A pump doesn’t require your baby’s participation and is easier on your skin; but it does not induce milk production and sometimes you end up formula feeding your baby…not a crime but maybe not what you intended.
  • Before nursing wash your hands with plain soap and water, wipe your nipples with plain water and pat them dry. Don’t scrub them!
  • Most women hold the baby in one arm so a hand is free to support the nursing breast and make the nipple accessible, but you can position the baby any way that is comfortable for you.
  • Guide the nipple into the baby’s mouth; at the same time keep the breast from interfering with her breathing. You may need to encourage her to nurse by gently stroking the cheek nearest the breast. Usually this will make her turn her head and hunt for the nipple (rooting). You may have to stroke her feet or wipe her forehead with a moist cloth to rouse a sleepy baby.
  • Your milk may not come in for 3-4 days. This is normal. Your body is producing colostrum during that time which primes the baby’s gastro- intestinal system.
  • Some newborns are feeding machines, but many babies don’t know how to nurse and it can take them a frustratingly long time to figure it out. Be patient. Keep him at or near the breast even if he isn’t feeding. Have your baby nurse equally from both breasts for the first day or two. After the first few days let him nurse 5minutes on one breast, 10-15minutes on the other and reverse it at the next feeding. If you go longer than 20-30 minutes on a breast you may not be accomplishing much more than making your nipples sore.
  • After the first few weeks you can substitute a bottle feeding. It’s a good way to involve dad. You will appreciate the sleep if you can get him to take a night feeding.
  • You can eat anything you normally eat, in moderation. Drink plenty of fluids, especially during the summer. Do not drink alcohol. If you are a smoker this is a good time to quit.
  • You should continue taking your pre-natal vitamins. We will prescribe a fluoride/iron vitamin for your baby at the six month visit. Acetaminophen and Ibuprofen are safe for you and your baby. Please check with us before taking other medication.
  • For you men: Nursing is hard physical and psychological work for a new mom. Your wife/partner may get a little cranky. You had better be a great cheerleader, all around support guy, and have a pretty good sense of humor.
What about formula?
  • There are several very good cows’ milk formulas on the market. They are all vitamin and iron enriched and have DHA and probiotics added. Most major brands also have modified cow’s milk formulas that may help babies with feeding problems. There are also highly modified and synthetic formulas, but they are expensive and seldom necessary. We very rarely use soy based formulas.
  • Some of our families exclusively use organic formulas. Beyond the general concept that production additives or contaminants could have unintended or adverse effects on your baby there is no data that these are safer or better in any measurable way. They are usually a little more expensive. Every manufacturer has an organic line.
  • Formulas are available in ready to feed, concentrate, and powder forms. The latter two must be mixed (bottled water is not necessary.) ALWAYS FOLLOW THE MANUFACTURERS INSTRUCTIONS.
  • Most newborns feed 1-3 ounces at 3-4 hour intervals, but there can be enormous variation. Once she has established an average amount you can keep about ½ ounce more in successive bottles and let her adjust upward.
  • Your baby may be uncomfortable if she sucks in belly full or air while feeding. Bubble or burp her after each 1 ½-2 ounces.
  • Bottled water with or without nutrients or fluoride is completely unnecessary.
Does my baby need to be circumcised, how is it done, who does it, how do I take care of him if I do/don’t have it done?
  • Circumcision is the surgical removal of approximately 1/2-3/4 inch of foreskin from the end of the penis. The American Academy of Pediatrics considers it safe, and effective for disease prevention. However, aside from ritual observance among Jews and Muslims newborn circumcision is elective. When done with appropriate anesthetic it is a painless procedure.
  • Circumcision is performed by different specialties in different parts of the country; in the NY metropolitan area it is frequently done by obstetricians. However, Dr. Menkin has privileges to perform circumcisions at Morristown Memorial and St. Clare’s Hospital. He is also a certified Mohel.
  • As with any elective procedure, you should choose the doctor who does it. Regardless of whom you choose we suggest you encourage the use of pharmacologic anesthesia jointly recommended by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics; a sweetened pacifier does not meet current recommendations. If you wish, we can perform safe, painless circumcision in the Hackettstown office after your son’s discharge from the nursery.
  • The relative benefits and disadvantages of this procedure have been endlessly debated. (We are presently experiencing a wave of irrational anti-circumcision propaganda.) It is the clear consensus policy of the American Academy of Pediatrics that circumcision significantly lowers the risk of infection with HIV and other STD’s. Circumcised men have a lower incidence of urinary infections. Their sex partners have a lower incidence of cervical cancer. There is no clear data that circumcision either improves or detracts from sexual performance or pleasure. However, circumcision is a surgical procedure. Complications can include bleeding, infection, or damage to the penis. If done badly it can require re-operation. It does not eliminate the need for good hygiene.
  • Your circumcised baby will be checked for bleeding or other complications before he is released to you. Doctors have individual recommendations for post-op care. Some will keep him in hospital until he voids. Some apply sterile dressings; many just advise copious amounts of Vaseline at every diaper change for the first week. The doctor who performs the surgery should give you detailed instructions for initial care and we will give you follow up instructions at your first visits.
  • Your uncircumcised baby needs no initial care of his penis. In the past we have advised gentle retraction and replacement of the foreskin at diaper changes with the eventual goal of it being fully mobile for purposes of hygiene by age 5. Current recommendations are to do absolutely nothing at all to it; almost 100% of them should be fully retractile by 5-6 years of age. You should never force the foreskin back.
What do I do with the umbilical cord?
  • Keep it from getting infected and encourage it to come off. We just can’t get a consensus on how to accomplish that. The umbilical stump is a fairly good portal for bacteria to enter your baby’s blood stream. In the past we have had epidemics of this. That is why some nurseries apply blue antibacterial dye to the cord; fear mongers have attributed all sorts of risks and hazards to this. We have been using the dye for over 30 years, and as far as anyone can tell it carries no risk or hazard of any kind. Some hospitals no longer apply the dye because they no longer keep babies very long and don’t really have nurseries. We are sufficiently impressed with the incidence of resistant bacteria in all hospitals to support its continued use.
  • Most pediatricians agree that you should leave the cord alone for the first several days. After that we can’t decide whether you should keep it dry or clean it with alcohol. Experientially, it seems to come off more easily if you clean it with alcohol. Don’t be afraid to take hold of the cord and manipulate it; nothing terrible will happen and it does not hurt your baby. If the cord doesn’t come off in two weeks, if it has a heavy drainage, or if it smells terrible let us know right away.
What about bathing my baby?

All you need is mild soap (bar soap is best), water and a light cotton bath towel. The room should be warm and free of drafts. Sponge your baby until the cord is off and the circumcision is healed, then you can tub bathe. Your baby’s hair only has to be washed about once a week. If your baby has dry skin apply non-scented baby oil after bathing; lotions almost always contain irritants.
Our experience as Pediatricians and as parents long ago made us subliminally aware of the almost ritual aspects of baby bathing. Along with feeding and bed times it can either be a chore or a discrete moment when you can bond as a family.

What temperature should I keep the house?

68-72 degrees Fahrenheit is fine. If you keep the house a little cooler in the winter it’s not usually a problem. Within reasonable limits babies do better with a cool environment that with a hot one. Encourage ventilation in hot weather and minimize drafts when it is cold. As a rule your baby doesn’t need to be dressed more heavily than you are. Air conditioning is fine.

When can I take the baby out?

“Out” is a moving definition. There is nothing particularly healthy or harmful about being outside on a nice day. Insects can be a problem, sun exposure and overheating need to be avoided. If “out” means exposure to a lot of people (supermarket, parties, public transit) you should probably avoid it for the first 1-2 months .

How can I tell why my baby is crying? (And how can I make her stop?)

Babies do a lot of things that seem strange. They sneeze, yawn, hiccough, twitch, pass gas, and strain at stools. (Actually, we all do most of the same things but no one is watching us.) They startle at noises and position changes, have tremors, and get blue in the hands and feet; and they cry… long and hard. Often they cry the most and hardest at night…just when you are exhausted. It’s what they do! Try not to get too upset. If your baby is eating, voiding, having bowel movements, and not running a fever he is probably alright.
After a while you can usually distinguish between crying from hunger, a dirty diaper, pain, and just fussing. You eventually develop a mental checklist of things to look for and tricks you can try to settle your baby down, but some babies can be challenging. Doctors (and parents) have known for decades (at least) that swaddling, blank noise, motion, and position change can settle a crying baby. Your mother may tell you how she put you in the car and literally drove you to sleep, or how you couldn’t sleep without a vacuum cleaner running somewhere in the house; or how she rocked you non-stop until finally you fell asleep..but only wrapped like a mummy and laying head down on her legs. If your baby just never stops crying get someone to relieve you for a while; she will be alright and you need a break!
If you have no one to relieve you, and you get so UPSET that you think of harming your baby STOP, PUT THE BABY DOWN IN THE CRIB, AND WALK AWAY FOR TEN MINUTES. You need time to regroup and crying a bit longer won’t hurt him. NEVER SHAKE THE BABY out of frustration. It can cause permanent brain damage. IF YOU EVER GET SO UPSET THAT YOU JUST DON’T KNOW WHAT TO DO CALL US!!

How many wet and dirty diapers should my baby have; what is a normal bowel movement?

When insurance regulations mandated early discharge after delivery it became obvious that new parents would have to do some of the monitoring that was traditionally done in the nursery. So we have you counting and charting soiled and wet diapers, (and maybe raise your anxiety level in the process.) Dirty diapers are only proxies for your baby’s intake and state of hydration, not measurements of your success or failure as parents. If your baby has one or two dirty diapers and half a dozen wet diapers in 24 hours you are probably doing fine. We are going to see you two days after you go home to check her weight and nutrition. (We rarely look at the sometimes elegantly graphed data or hermetically sealed stools parents bring along.) Some babies poop after every feeding, some every day, some (even breast fed) only once in several days. Normal stool can be yellow, brown or green and vary from soft and mushy to more formed. Formula fed babies will have a firmer stool. Straining is normal.
You may see a little blood in your baby’s diaper. In girls it is often vaginal, estrogen withdrawal bleeding. In boys or girls a little blood streaking in stool can be from a juvenile polyp and very rarely indicates anything serious.
If your newborn baby develops diarrhea (frequent water stools that soak into the diaper) you can substitute an oral electrolyte solution for a feeding. If it persists call us.

What is SIDS and what has sleeping on their backs got to do with it?

Sudden Infant Death Syndrome used to be the leading cause of death in infants under a year of age. Data indicated that keeping infants on their backs significantly lowered its incidence. Now all babies sleep on their backs and we see this tragedy far less frequently. Sleeping in the parental bed and many socio-economic factors increase the incidence of SIDS.