The Hospital Follow-up: 2 weeks of age

Now the questions begin with parents feeling the responsibility for this young child they have at home.

You have your beautiful new baby.  You realize that this new little human is totally dependent on you for their health and welfare.  When should the first visit be after the hospital?

Okay:  what are the top questions parents ask about at the 2 week visit:

And what are the top advice items you cover at this visit:

Let’s talk about gas—body functions are always funny for kids


How about spitting up—it seems like parents of newborns are always covered in baby spit up—should parents just wear ponchos for a year? 

Okay, so we covered gas and reflux, and what if their baby is still super fussy?  What could be going on?

One of the biggest ongoing challenges if feeding the baby.  So many young moms have their value as a mom connected to being able to breastfeed their baby.

Do you ever try to recommend a routine for feeding babies?  Does it make a difference for how they sleep?

What about cradle cap—how should we manage that?

And while we are on the topic of skin, what are some baby rashes like baby acne and when do they show up?

What about skin and nail care?

Parents often notice that a baby’s eye is goopy but it doesn’t otherwise look infected

That is a long list of questions that parents usually bring—are there any other advice items still to cover once they bring in their lists of questions?

Transcript

Episode #4—First visit after the hospital, 48 hours for newbie parents and 2 weeks for more experienced parents

You have your beautiful new baby.  You realize that this new little human is totally dependent on you for their health and welfare.  When should the first visit be after the hospital?

48 hours for first-time parents and 2 weeks for experienced parents.  Always an open door for sooner follow-up for any concerns like jaundice or weight gain or not voiding or stooling

Okay:  what are the top questions parents ask about at the 2 week visit:

I get a LOT of questions at this first visit, especially from new parents.  And I encourage them to make lists of questions on their phones before them come in because they will forget about their good questions when they are tired.  The usual list is pretty long and includes:

• Gas
• Reflux
• Fussy babies with colic
• Blocked Tear ducts
• Breast vs. bottle feeding
• Baby Acne
• Cradle Cap
• Pacifiers
• skin and nail care—file nails, vaseline where their skin

And what are the top advice items you cover at this visit:

• •Top advice items:
   
  • Bottle-feeding
•  
  • Cook them evenly—explain later
•  
  • Sibling Safety
•  
  • Daytime vs. nighttime feeding
•  

Let’s talk about gas—body functions are always funny for kids

• •Gas 
• •How about spitting up—it seems like parents of newborns are always covered in baby spit up—should parents just wear ponchos for a year? 
• •Reflux is super common—I talk about medication only if the child is not gaining weight well or is in pain when they eat—otherwise it is a Tide or Cheer laundry problem
   
  • If they are “happy spitters” then no medication—Feeding—put some speed bumps in the routine; I don’t care about how much to eat, but I do care how fast;
     
    • hold them upright for a time after they eat
  •  
    • have their bed slightly angled upright to have gravity on your side while they are sleeping—not enough that they slide down to the bottom of the bed while sleeping

Okay, so we covered gas and reflux, and what if their baby is still super fussy?  What could be going on?

• •Colic, purple period, university of Washington—do we get a website that we can reference?  Colic refers to fussiness that is not explained by another reason.
   
  • Kids crying doesn’t mean you are neglecting them, just not getting what they want  
  • Usually starts after 3 weeks of age, happens after 3 in the afternoon, and lasts until about 3 months old
  • Work on gas pain.  Work on any reflux pain.
  • Have a literal list of things that seem to be helpful.  Compile this list from things that people suggest to help.
  • This list may include: feeding baby, changing diapers, going for a walk in a stroller, go for a ride in the car, having a bath, baby massage, time in the swing, keeping baby in a wearable baby carrier, etc.
  • Allow other people to help you do items on this list when you are tired.
  • If all else fails, it is okay to allow the baby to cry in a room for awhile with the door closed while you spend some time away where you are out of ear shot, get a drink of water, as an alternative to getting mad at the baby.
  • No shaking baby—I would get upset and frustrated—36 hour shifts, Mom tired, can only sing I am a Child of God to you so many times 
  • PARENTAL WELL-BEING: The following items were discussed today: accept help—ask for help especially from your spouse—people want to help but may not know how—especially a new dad, baby blues and sleep when baby sleeps.
  • PUPRPLEPERIOD Website--UW--University of Washington.  

One of the biggest ongoing challenges if feeding the baby.  So many young moms have their value as a mom connected to being able to breastfeed their baby.

• •We encourage breastfeeding as best for a baby.  But there are so many variables that impact how that is going.  My goal is first that the baby gets food for growth and hydration, next is that they get breast milk, and next is that breastfeeding is going well.  That is in order of what we can control and also help a mother who is struggling with feeding her baby.
• •Bottles every day or two, pumped milk or formula; don’t wait too long or only mother can feed them; cute kid but mother needs a break of more than two hours sometime in the next year and no one will watch your child if they can’t feed them if needed  
• •Breast feeding alone may not be sufficient to support normal weight gain in this case
   
  • Please get with lactation specialist from birth hospital at your earliest convenience
  • Breastfeed for a set amount of time then have spouse or grandparent or other offer supplementing from a bottle while you pump for 5-10 minutes
  • Options:
  • Offer formula ad lib after each breast feeding attempt.
  • Make up a volume of formula and warm some of it while breast feeding and offer afterward.
  • Learn what times of the day patient wants to eat more (usually morning breastfeedings are the most productive when milk supply is the most abundant but supply decreases sometimes during the day and doesn't keep up with patient demand/need).  You can do supplementing after those feedings that need more help.
  • May alternate breast feeding with formula feeding
  • May try to increase milk supply through herbal supplements (mother's milk tea) or through prescribed medications like reglan from OB.

Do you ever try to recommend a routine for feeding babies?  Does it make a difference for how they sleep?

• •Day and night—get lots of 24 hour feedings in during day time—every 2 hours start to start if you can, deposits in liver to make withdrawal later, pay check to pay check, feeding to feeding means being up lore at night  
  • feeding q2 hours during the day and allow them to sleep at night; 24 hour calorie need, living pay check to paycheck doesn’t allow for any savings; feeding every 2 hours allows them to save energy in their liver to make withdrawals during the night rather than eating even 2-3 hours even through the night  
  • Daytime bright and loud and nighttime quiet and not stimulating, “don’t ring doorbell sign” why?  If they wale up more during the day and eat then they will sleep lire at night. No lights at night. Don’t binge watch show since you are both up anyway.   

What about cradle cap—how should we manage that?

• •Cradle Cap: Dandruff shampoo of your choice.
   
  • Massage in at the start of bath, leave on for duration of bath, rinse off at the end.
  • Takes about 4-6 weeks to see resolution.
  • Maybe once weekly with dandruff shampoo for maintenance if needed.
  • Consider daily over the counter hydrocortisone 1% ointment for cases where cradle cap isn't improving with dandruff shampoo.

And while we are on the topic of skin, what are some baby rashes like baby acne and when do they show up?

• •newborn acne: Observation only
   
  • Last from about 3 weeks until 3 months of age
•  
  • Can see other rashes along with it--heat rash (transient and goes along with sunshine and warmth) and eczema (flaky and dry).
•  

What about skin and nail care?

File nails to prevent them from scratching their face—Brock with a permanent scar.  

Babies are very flaky after being in the hot tub for 9 months—they look like they have leprosy.  Especially bad

Parents often notice that a baby’s eye is goopy but it doesn’t otherwise look infected

• •NLDO: Very common problem.  Should resolve over the first year of life.
   
  • If not resolved by 9 months then I will refer to eye specialist.
  • Massaging often recommended but research shows it is not helpful to resolve problem.
  • Clean your fingers before doing if you want to do massaging.
  • If there is more eye discharge than usual or eye has "pink eye" appearance then let me see patient for possible bacterial eye infection treatment.
  • I recommend Michael Bullard to follow-up.  

That is a long list of questions that parents usually bring—are there any other advice items still to cover once they bring in their lists of questions:

• •Safety with siblings—never alone together, always kind-hearted to want to carry the baby or share fruit snacks with them.
• •Sleep positioning—“cook them evenly”;
   
  •  SIDS risk—back to sleep positioning, soft bedding, bumper irony, mental status—over tired parent  

Any last items to cover?

Just a few check list items:

• •Owlette—useful for getting data when child is sick, many became comfortable doing this during the pandemic  
• •Always use a car seat for your infant
• •Call for any signs of illness
• •Remember your post-partum checkup with your OB
• •
• •
• •FOLLOW-UP AT 2 WEEKS or 2 MONTHS OF AGE.