Frequently Asked Questions

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Nursing & Formula Feeding

I’m trying to breastfeed but it’s just not working. What should I do?
While breastfeeding is a very health way to feed your baby, we know it’s not always easy. It’s very common for the baby to have difficulty latching to the breast and for the whole process to seem likes it’s ‘just not working’ for the first several days. In fact, your body doesn’t produce milk until usually day 4 or so. Until then, your body makes a thick yellow substance called colostrum that is full of bioactive healthy substances that boost your child’s immune system and line the gut offering protection. If you don’t feel like your milk has come in or you don’t think your infant is adequately removing milk from your breasts, it’s important to come see us to assess your child’s hydration status.
For the most part, if your baby is having an adequate number of wet diapers and not losing in excess of what we consider normal ounces in the hospital, then we assume your child is getting enough colostrum until your milk comes in. A few days after you leave the hospital, we ask you to bring your breastfed baby to the office for a weight check. This is the most important marker of intake is the weight on a scale.

After you go home from the hospital, it can be very beneficial to work with a lactation support consultant either in a group setting or one-on-one. Many insurance companies offer this service. You can call your insurance company and ask if they offer this and who specifically is covered.

Additionally, The Lactation Foundation is a superb local clinic funded through a grant by The University of Texas. They take appointments and offer expert advice one-on-one. Texas Children’s Hospital and The Woman’s Hospital of Texas offer breastfeeding support groups that many new moms find helpful.

The American Academy of Pediatrics recommends no cow’s milk until after the first birthday. Babies under the age of 1-year-old need the nutrition provided by infant formula or breast milk. Cow’s milk and goat’s milk are poor substitutes for breast milk and formula, and early intake makes babies more prone to anemia (low blood count), vomiting and diarrhea. Stick to formula or breast milk until your baby’s first birthday!

Breast milk is a fantastic source of nutrition and immunity. The one thing it does lack, however, is vitamin D. We recommend giving your breastfed baby vitamin D drops once your feeding pattern is established. Newborns who are getting more than 32oz of infant formula every day do not usually require vitamin D supplementation. Your baby may need other vitamins if he was born premature or has other medical conditions. Check with your baby’s doctor at his next well check up.
Nutritionally? No, they are the same. Certainly, powder formula is cheaper and the ready-to-feed can be more convenient. You are welcome to use either or both with your baby according to your preference. Occasionally, we hear from parents that their baby prefers one to the other but this is not predictable in any way and varies widely from one baby to the next.
Any formula that you can buy in the United States is fully nutritionally complete and safe to give your baby. Some parents prefer one brand to another—and there are absolutely situations in which we advise you to use a certain formula for your baby—but these discount or generic brands are fine for general use.

For the first couple of weeks after your baby is born, it is important to wake your baby every 2-3 hours to feed. Breastfed babies tend to nurse fairly frequently, while formula-fed babies may feed less often. A good rule of thumb is to aim for between 8 to 12 feedings during a 24-hour period. Once your baby is back to his birth weight, you no longer have to wake him at night to feed. Always wake him at regular intervals during the day, so that he isn’t sleeping all day and awake all night. You should aim for at least 8 feeds per day.

Baby-led weaning has been around for a while and is entirely a personal choice. In certain cultures around the world, this is the primary way babies start eating solid foods. If you choose to do baby-led weaning, it is important to wait until your baby can sit in a highchair unassisted and is able to move his jaws in an up-and-down position. Start with softer finger foods such as cooked egg yolks, ripe fruits, cooked pasta and puffed cereals.

Bowel

Yes, this is completely normal. In fact, at around 3-4 weeks of age, some newborns—especially those who are breastfed—don’t stool every day and can go several days without a stool. As long as you are having a good number of wet diapers and your infant is comfortable with soft stool, there is no need to worry.

If your child is experiencing frequent constipation, diet is the first thing to attempt to change. Foods such as starches, milk products and bananas can make constipation worse and should be limited. Increase the intake of prunes, pears and plums in your child’s diet. Make sure she is drinking plenty of water, too. A daily probiotic can sometimes help to keep your child more regular as well. If this still doesn’t work, your child may need to take MiraLAX daily for a few weeks.

Skincare

It is best to make sure you use fragrance-free and dye-free products, including detergents, to treat your child’s eczema. Try Tide-Free or All-Free as good alternatives. Using non-fragranced soaps is also helpful, such as Dove unscented, CeraVe, Cetaphil and AVEENO. Be sure to moisturize frequently, three to four times per day. Bath time should also be limited to less than 10 minutes.

This is most likely newborn acne. It can appear anywhere where teenagers get pimples, including the face, chest, back, upper arms, scalp, etc. This occurs for a very similar reason: hormones in flux. Your newborn has maternal hormones in his system. Over the first 6-8 weeks, these go away and his levels become those of a baby. The acne comes and goes over this time period, usually flares badly around 6-8 weeks and then fades away. You can use some over-the-counter hydrocortisone cream sparingly if you want to calm it down a little, but it will not make it go away completely.
All babies’ skin peels, usually around 38-43 weeks gestation. This occurs at this time even in babies born prematurely. You can put some lotion on the skin if you’d like, but the peeling will continue until it’s over regardless.

No, these products are mostly for when the skin gets irritated or inflammed. The purpose of diaper rash medicine is to protect the skin from further irritation and allow it to heal.

Acute hives are a common allergic condition of the skin. Hives occur when the body’s immune system responds to something in the body or in the environment. However, about half the time, it is hard to determine what is actually causing the hives. Hives can occur as reactions to new medications, foods or as a response to a recent viral infection. Mild cases of hives can be treated with over-the-counter antihistamines such as Children’s BENADRYL®. Talk to your doctor or one of our triage nurses about the appropriate dosing. If the allergic response is severe, your child may have swelling of the face, hands or feet. If you notice that your child has severe swelling or is having difficulty breathing or swallowing, please seek medical care immediately. Call our office and one of our triage nurses will help determine whether to bring your child in for an office visit or if your child needs to be immediately assessed in an emergency room setting.
It often concerns parents to see how swollen insect bites can become, especially those on eyelids, feet, hands and ear rims. One quick way to know if an insect bite is infected is to apply pressure to the swollen area and note if it is tender or bothersome to the child. If this doesn’t bother the child, there’s nothing to do! If they are itchy, a cortisone ointment, ice and BENADRYL® are good options. Full body reactions to a bite or bites and/or breathing changes/coughing are emergencies. Such strong reactions can be seen with wasps, hornets, bees and ant bites.

Newborns

Your baby will always be seen within the first 24 hours, but most often, much sooner. It often depends on when you deliver. Babies who are born overnight will be seen first thing in the morning. Those born during the day are usually seen after we finish at the office. Don’t worry—all of the Medical Center hospitals where we see newborns have neonatologists (hospital-based newborn specialists) on standby in case there is an urgent issue. We work cooperatively with these doctors if your infant continues to require specialized care. Many times, your obstetrician will ask them to attend the delivery. Most often, this is a “better safer than sorry” consult, but they are available in case of any urgent medical situation with your baby.

Our doctors will see your baby and talk with you each day. Your baby will receive her first newborn screen and blood test for jaundice by a heel prick usually between 24-36 hours of life. She will get an ointment in her eyes to prevent infection and a dose of vitamin K by injection in the first several hours. Remember, vitamin K is not a vaccine of any kind; it is given as an injection because newborns do not readily absorb vitamin K given orally. This is important medicine to prevent hemorrhagic disease of the newborn which you likely have never heard of because vitamin K is essentilly 100% effective in preventing this scary situation. This injection has no side effects for your baby.

Almost all babies get somewhat jaundiced; it is normal and expected. However, some babies get more <