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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 jaundiced earlier than we are necessarily comfortable with. For reasons that we do not understand, but it comes in very handy, babies get yellow from the top down. Once you are home, we would expect that your 2-3 day old baby may look yellow in the face and whites of the eyes, but if he starts to look yellow on his belly or legs and feet, please call our office so we can see him, check the level and treat if necessary. There are certain situations in which we take jaundice more seriously and treat more aggressively: blood group incompatibility, small babies, preterm babies, etc. You will be aware of these special situations before you leave the hospital with your newborn.

Don’t worry! All babies lose weight over the first several days of life, especially bigger babies or babies born via cesarean section. Babies usually regain weight once mom’s milk is in and they establish good feeding patterns. Babies are usually back to birth weight between 10 and 14 days of age. It is important to bring your baby in for a newborn check a few days after you are discharged from the hospital. At that visit, your pediatrician will discuss whether your baby is on track or whether adjustments need to be made to the feeding schedule.
You do not need to change the thermostat setting in your home for your newborn. A baby is comfortable in whatever you are wearing plus one additional layer. So if you are wearing shorts and a t-shirt, your baby does not need a thick, insulated outfit. Smaller babies who go home quickly may need a hat or double swaddle, but again, we will let you know if this applies to your baby before you leave the hospital. Generally, if your baby is sweaty behind his neck, he is too hot. If the baby seems to try to curl up in a ball, he may be a little cold.
Yes! Babies sound like little piglets most of the time, with grunts, snorts, squeaks and other noises. In general, particularly with noises associated with breathing, if it comes and goes by itself (meaning, you did not intervene) and doesn’t bother the baby (she is eating, vigorous, waking to feed normally, etc.), then it is nothing to worry about. Of course, if you are concerned about your baby’s breathing, please call and speak to one of our nurses or the doctor on call.
This is normal in newborns and has nothing to do with the baby’s actual temperature. You may think his hands and feet look a little purplish for the first few weeks. This is generally normal and in an otherwise healthy baby no cause for alarm.
The first day or so, your baby’s stool will be a very dark blackish green. Then as your baby feeds, it will turn a brownish yellow and usually after 4-5 days will be consistently yellow, loose sometimes with small solid “seedy” elements. However, this is just a guideline; there is wide variability especially in babies who are breastfeeding. Please do not get overly concerned about the color of the stool. It will vary even on formula-fed babies when the diet never changed. If your baby seems ill, distressed or if you see blood in the stool, of course give us a call. Otherwise the color of the stool alone is rarely going to be a problem.
This is normal in newborns. They are not in control of their hands. So if they get milk, lint or mucus in their nose, they sneeze to clear it out.
The easiest way to take your newborn’s temperature is under the arm. Put the end of the thermometer high in the armpit in the folds of skin. This gives a very accurate temperature. Sometimes it is half a degree or lower than it would be if taken rectally, but for most circumstances this is fine. The rectal temperature is the most accurate and is also very easy. Lay the baby on her belly across your knees, coat the end of the thermometer in vaseline or lubricant, and insert it an inch or so into her rectum. If you hold the thermometer and the baby’s buttocks with the same hand you will not worry that you will hurt your baby if she wiggles while you are doing this. The rectal temperature is the most accurate, actual temperature.

Your baby is fine to go for a walk, go outside with you (weather permitting, both hot and cold) as soon as he comes home from the hospital. When we say this, we really mean do not take your newborn out to public places—especially crowded ones—for the first 6-8 weeks. Of course, there are situations in which this is unavoidable, particularly when you have older kids. Just try to be smart, especially during cold and flu season or if your baby was premature. There are several reasons for this:

  1. If your baby gets a fever in the first month or so, there is a high likelihood that we will have to send you to be admitted with blood tests and IV antibiotics
  2. If your baby gets a cold in the first few months, you are going to be miserable because your baby really only knows how to breathe comfortably through his nose. So if he is very congested, he is going to fight and struggle particularly when he tries to eat or sleep.
  3. Your baby has not had any vaccinations yet, and is therefore more susceptible to infections of all kinds including airborne respiratory infections such as pertussis (whooping cough).
This comes up very frequently. Although we strongly recommend that all household contacts of a newborn—including parents and grandparents who live in the house—get a Tdap booster, it is often not feasible to enforce this for every person who comes into your house. An easy way to prevent your newborn from becoming ill with pertussis (and other things) is to simply not allow any sick people to come over. Remember, a person who is coughing FOR ANY REASON (regardless if they had the booster) should not come over to visit your newborn. Similarly, if you take your newborn to visit family, simply do not go if anyone is sick.
Although many of our mothers used powder on us when we were babies, there are a lot of problems, especially with talcum powder. Talc is actually a mineral and the fibers get into the baby’s lungs. There is also now some evidence that it may contribute to malignancies later in life, especially in females. The pure cornstarch powder is less problematic, but if you want to use it, put it in your hand and then apply to your baby instead of creating a cloud of powder over your baby. Although there are certainly exceptions, generally, powder causes more problems than it solves.
If your baby has a fever—100.5 or more in the first 2 months of life—call us right away, even in the middle of the night. Depending on the circumstances, we may ask you to take your baby to the emergency room to be admitted. This will be most likely if it occurs in the first month. Fever is something we treat very differently in newborns compared to older kids or even in babies older than 2 months.
If the mucus is not bothering your baby (she is eating and sleeping fine) you can leave it alone. She will deal with it by sneezing if she needs to. If you think it is bothering your baby, you can use some nasal saline spray and the suction bulb that you may have from the hospital to clean her nose. Spray the saline first then use the bulb to suction it and the excess mucus from her nose. Try not to do this too often, as it will irritate her nose, make it swollen and she will be more uncomfortable.
No, not at all. You can wash, comb and brush your baby’s hair normally. Though this area does not yet have a bony covering, the brain is protected by the skin and several layers of tissue, which we all have specifically for this purpose.

Upper Respiratory Infection

Viral upper respiratory infections account for the most office visits of any other diagnosis. Most often, these are mild, self-limited infections that make us and our children feel miserable—but they are not dangerous. We commonly advise to increase fluids and use a cool mist vaporizor. Older kids should take a long shower and use nasal saline drops followed by nasal suctioning as needed. Older kids can also use over-the-counter cough and cold medicines, but the most you can expect is a mild reduction in symptoms. These medicines do not shorten the duration of the illness, nor do they do anything to prevent secondary bacterial infections. Though these cough and cold medicines are generally not recommended for younger children, your child’s doctor may recommend them in certain situations, and even in those circumstances, they are not necessary. Often TYLENOL® or ibuprofen will help with sore throats and headaches that can accompany these illnesses.
Most upper respitory infections last 7-14 days, often with the peak of the symptoms being around days 3-7.
We never prescribe antibiotics for viral upper respitory infections. We do, however, use them frequently for secondary bacterial infections that can accompany or follow these viral illnesses. The most common example is an ear infection (otitis media). These are most often seen in younger children and babies and commonly start several days to a week into the cold. You should suspect your child has an ear infection (or other bacterial secondary infection) if he has had a cold for a few days with a low grade or no fever and starts to be irritable, fever goes up, he’s waking at night crying or pulling at his ear. If you suspect this is happening in your child, please call and schedule an appointment to be seen so we can examine him and make the best decision regarding antibiotics. We do not call in antibiotics for suspected ear infections without seeing your child, except in very unusual circumstances.

RSV stands for respiratory syncytial virus and is the most common winter respiratory virus. When you walk into your child’s kindergarten class and the kids have drippy noses, most of that is RSV. This does, however, sometimes get into kids’ (mostly infants) lungs and make a wheezy-type viral pneumonia that will occasionally become severe enough that we need to admit a child to the hospital. If your child was born premature or has asthma, it’s smart to be more vigilant. Yet even in those situations, the vast majority of kids do great. Generally RSV causes a cough, runny nose and sometimes a low grade fever that is at its worst around day 3-7, then slowly gets better. The cough can often linger for 6-8 weeks, but the child is usually feeling otherwise pretty well by that point. There is no reason to panic if your child is “exposed to RSV.” They would have been if they are in school or daycare. This virus is just one that can be identified by a rapid test, which is why it receives a lot of attention.

You can always call if you are worried about your child. If your baby will not eat (or he’s consistently eating less than normal), is unable to take a bottle or breast because the virus has moved into his chest, or if he has signs of respiratory distress including the skin sinking in between the ribs, the belly moving in and out with each breath or nasal flaring, these are signs he may be having trouble moving air due to chest symptoms. Babies in particular are very bothered by nasal congestion because they do not prefer to breathe through their mouth. If you are worried, try to bring the fever down, suction the nose and then judge how he is doing. If your child is less than 2 months and you are worried, we recommend that you call us, as these babies are harder to judge We recommend that you call us if you are worried about your baby less than 2 months, as respiratory issues can be harder to judge in these babies.

Urinary Tract Infection

In general, people with infection in the urinary tract will show symptoms related to irritation of the urethra (the tube from the bladder out of the body). The most common are pain with urination, needing to go often (with small amounts of urine) or the inability to hold the urine (accidents in potty trained kids). In some cases, there will be fever or pain in the flanks (lower back on the sides). UTIs are much more common in girls and women because they are generally caused by bacteria found in the stool and the structures are closer together. It is not unusual, for example, to see a UTI in a little girl still in diapers after she has had diarrhea. We do see them in boys—more often in boys who are not circumcised—but this is still much less common than in girls.

Please call the office and make an appointment to be seen. This is generally not a reason to go to the emergency room in the middle of the night. If your child has a high fever and is vomiting with signs of a UTI, this could be an exception; so give us a call and our nurse can help you decide if it’s okay to wait. Children with congenital abnormalities of the kidney, bladder or other parts of the urinary tract are at higher risk, and parents need to be especially watchful in these children.
In general, the best thing to do is to put her in the bathtub in warm water and allow her to urinate into the water. This will make it much less uncomfortable. You can also give her TYLENOL® or ibuprofen for pain. Thankfully, antibiotics start working very quickly and in older children, there are medicines to numb the urethra (like OTC AZO). It is very important that we see your child before starting antibiotics so we can send the urine for culture to assure we are treating her with the appropriate antibiotics. For this reason, our triage nurses will not call in antibiotics for a UTI without your child being seen first.
In some cases (always in boys), we do tests of the urinary tract to check that your child does not have an abnormality that has predetermined her to a UTI. In boys, we do this with the first UTI because they are much less likely to occur in males. In girls, it depends on age and the number of infections. Do not get overly worried; these tests are very often normal and when they are not, the common issues are easily dealt with in most circumstances.
Yes, we always follow up to recheck the urine, usually 3-4 days after the end of the antibiotics. We will always call you to let you know the result of the initial culture and discuss whether your child actually had an infection, and if so, if the antibiotic we used was appropriate for the bacteria in the culture.
Some children have a sensitive gag reflex and the pressure from coughing or mucus in the back of the throat will trigger emesis. If he is otherwise well—breathing comfortably, no fever and simply having some mucus drainage associated with a “cold”—there’s no reason to worry.

Teething & Dental

Around 2 months of life, salivary glands develop at the front of the mouth—that’s likely the reason for the drool. But remember, infants are also very oral and begin to suck on their hands around this age. On average, teething begins is after 6 months.
Losing an infant tooth usually doesn’t require a trip to the emergency room. Check his mouth and if there is no additional trauma to the mouth that requires attention, he should be fine. Of course, if you are concerned or worried, give us a call and we can recommend a pediatric dentist.
Oral hygiene is an important component of your child’s care. Start wiping down her gums and tongue before any teeth erupt, in order to wipe away any residue from milk or purees. Once teeth start erupting, use a finger brush with fluoride-free toothpaste and brush her teeth twice daily. Once she has at least 4 teeth and is a year old, she is ready to see a pediatric dentist. Ask your pediatrician for specific advice regarding your child. Certain babies may need to see a dentist earlier, such as those babies born with neonatal teeth.

Fluoride-free toothpaste is meant for infants and toddlers. You should start brushing your baby’s teeth as soon as they erupt. Use a small smear of fluoride-free toothpaste on a baby toothbrush and brush twice daily to start. Why fluoride-free for babies? Babies and infants 2-years-old and younger don’t really know how to spit out toothpaste; so they end up swallowing most of it. The problem with this is that too much fluoride is bad for the teeth and can lead to permanent teeth staining. Using fluoride-free toothpaste prevents this possibility.

Having said that, a pediatric dentist will coat your baby’s teeth with a tiny bit of fluoride dental varnish, which will be the perfect amount to help protect baby teeth from cavities. Once your child is older and knows how to spit out toothpaste, you can switch to regular kids’ toothpaste containing fluoride.

Allergies

If your baby is acting fine, then you can relax! Most foods (with the exception of honey for children under the age of one) are okay as long as they are presented to your child in an age-appropriate way—purees for 6-month-olds, chunkier-type table foods starting around 9 months. The latest recommendations from the American Academy of Allergy, Asthma and Immunology recommend introducing allergenic foods as early as possible in order to minimize the development of later food allergies. Common allergens include eggs, peanuts, tree nuts, fish and shellfish. We recommend discussing your child’s readiness for solids with your doctor at your baby’s well checks. Once your baby is developmentally ready for solids, you can start introducing them. Be sure to wait 3-5 days between introducing new foods in order to evaluate for allergies. One caveat: if your baby or his sibling is seeing an allergist for severe food allergies or eczema, check with your doctor before starting or introducing these and other solids.
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