Childbirth Support

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Breastfeeding (from ParentingWeb & ParentsPlace)

Most babies initially lose some weight (less than 10%) following the birth. By the second week most are back to birth weight. 4 to 8 ounces per week is considered to be a normal weight gain for a baby of this age.

What is colostrum?
This is the first milk made by the breasts and is usually present for about three days. Colostrum is very rich and slightly yellow in color. It is very important that babies recieve this "liquid gold" as it contains high levels of antibodies which help to build a strong immune system. It is also richer in protein, vitamins and minerals than mature milk and has slightly less fat and lactose. Colostrum is also rich in essential fatty acids. It acts as a laxative and helps to clear out the meconium (the initial dark-green b.m) from your baby's bowels which helps to prevent jaundice. Colostrum is only produced in a small amount but it is all a newborn needs until your mature milk comes in.

What is transitional milk?
3 to 10 days after birth, colostrum is replaced by a creamy white milk called transitional milk before the mature breast milk is established.

What is foremilk?
Milk production occurs constantly between feedings. The breast is never actually empty. Foremilk, a bluish-white milk that is is lower in fat than the hindmilk is the milk your baby receives in the first part of the feeding.

What is hindmilk?
The hindmilk, which follows the foremilk, is richer and higher in fat than the foremilk. The hindmilk provides most of the nutrients your baby needs to gain weight and grow, and it satisfies his hunger. That is why it is very important to allow your baby to finish one breast before moving him to the other breast.

How often should I feed my baby?
Breastfeed frequently.... at least 8-12 times in each 24 hour period when your baby is a newborn. This ensures an adequate milk supply and greatly reduces your chances of engorgement. Current research shows that limiting the amount of time at the breast or going too long between feedings can diminish your milk supply and reduce the fat content of your milk. This can leave your baby hungry, unsatisfied and can cause problems with growth. Occasionally, it can also cause your baby to have green, stinky b.m's and a tummy ache.

Do not let your baby sleep through feedings until your milk supply has been developed, which usually takes about 2 to 3 weeks. If your baby is not awake and wanting to feed, wake her if 3 to 4 hours have passed since the last feeding. If this persists, call your pediatrician. Once your baby is older, feed on her cue.

How long should I feed my baby?
Babies need different amounts of food at different times of the day. Since the composition of breast milk changes while you nurse, it's important to allow your baby to finish one breast untimed before switching her to the other breast. This will allow her to get to the rich hind milk which is important for growth. The average feeding time of a breastfeeding baby is 20 to 30 minutes but your baby may nurse for a longer or shorter time. When she is relaxed, content and satisfied she has probably had enough. Begin the next feeding on the breast that she took second.

How can I tell if I am producing enough milk?
Your baby is getting enough milk if:

she is nursing regularly, at least 8 times a day
she makes clear sucking and swallowing sounds
she is wetting at least 6 diapers every 24 hours by the fifth day after birth and her urine is pale.
she passes between 1 and 5 stools in 24 hours and those stools are soft or liquid, not dry or hard
she has regained her birthweight by 3 weeks of age
she is active, alert and has good skin color

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Routine procedures & tests, and the rare genetic disorders

Apgar test is performed at one and five minutes after birth by evaluating the infant's heart rate, breathing efforts, muscle tone, reflexes and color and assigning a score of 0, 1 or 2 to each category. A total score of 10 is the highest, and most babies will rate between seven and nine by five minutes.

Rectal temperature: "The deep body core temp. may be measured by ...esophageal or tympanic membrane thermometers.... the rectal temp using thermometer or thermistors must be inserted at least 5 cm to obtain a stable core temp. This insertion temp risks perforating the rectum in the neonate. The mortality from rectal perf in the neonate is approx. 70% in reported cases. Safer and more practical way to measure temp is ... the axilla [armpit] for 3 minutes, providing an accurate equivalent of deep body temp."
Merenstein and Gardner (1989), Handbook of Neonatal Intensive Care

"It is unwise to take the temp in the mouth in young children and it is undesirable to take a rectal temp - partly for psychological reasons, but also because of the slight though frequently described risk of trauma by fracture of the thermometer. The rectal temp varies with the depth to which the thermometer is inserted ... blood in the stool of a baby or older child may be due to the insertion of a thermometer into the rectum. This is an undesirable procedure and many cases of perforation of the rectum have been reported."
Illingworth (1991), The Normal Child

Jaundice is a yellow colour of the skin and is common in newborn babies. Babies become jaundiced when they have high levels of bilirubin in their blood. There are sound physiological reasons to argue for the benefits of elevated bilirubin, as it is an antioxidant.

There are two kinds of jaundice. The first is known as physiological jaundice and is common in newborn babies. It usually becomes noticeable during the baby’s first two to five days of life. Frequent breastfeeding can encourage bilirubin levels to remain manageable, but babies with physiologic jaundice may be more sleepy, and should be stimulated and woken in order to nurse frequently through the day and night. If breastfeeding is not going well, fixing the breastfeeding will improve the jaundice, whereas stopping breastfeeding even for a short time could destroy the breastfeeding. Exposure to sunlight is also good for jaundiced baby.

Pathological jaundice can occur at birth or within the first couple of days after birth. It can be caused by such things as Rhesus or ABO blood incompatibilities, metabolic disorders, gastrointestinal disorders, and infections, and will obviously require further investigation. Breastfeeding can and should continue in the vast majority of cases of pathological jaundice.

Newborn blood screening for rare genetic disorders:
"Currently all states require that newborns be screened for selected disorders, but requirements vary from state to state. For example, only a few states currently screen for cystic fibrosis, toxoplasmosis or HIV. Universal hearing screening is done in about half of the states [..]
before newborn screening, parents (on behalf of their children) have a right to be informed about screening, and have the right to refuse screening."
news release, 8/7/00, American Academy of Pediatrics (AAP)

The newborn blood screening, done with a "heel stick", is often refered to as the PKU test, but it's actually a combination of tests for numerous metabolic and other disorders - all of them quite rare but some very dangerous (which tests your baby gets depends on your state).

What's a "heel stick" or a "PKU"? A nurse or a lab technician will cut your baby's heel with a lancet, then squeeze continuously, milking for blood to fill both sides of several circles on a special form. They may have to make more than one cut to get all the blood they need. The whole process may take as long as 20 minutes. "The time it takes to squeeze the required amount of blood is an unbrearable enternity filled with the screaming of your brand new infant in pain." - New mother

Phenylketonuria (PKU): absence or deficiency of an enzyme that is responsible for processing the essential amino acid phenylalanine. Phenylalanine abnormally accumulates in the blood and is toxic to brain tissue. Without treatment, most infants with PKU develop mental retardation, and possibly additional neurologic symptoms.

Treatment consists of a carefully controlled, phe-restricted diet begun during the first days or weeks of life. Most experts suggest that a phe-restricted diet should be lifelong. A carefully maintained diet can prevent mental retardation as well as neurological, behavioral and dermatological problems.

PKU is inherited as an autosomal recessive trait. In other words, two people who conceive a child must both be carriers of the gene in order for there to be a chance that their infant will have PKU.

"Since human milk is lower in phenylalanine than cow's milk formula, a mother can continue breastfeeding while supplementing her baby's diet with the low-phenylalanine formula."
Terry Grossmayer, Breastfeeding a baby with PKU

Congenital Hypothyroidism (CH) occurs when a child's thyroid gland is absent, underdeveloped, or the is ubnormality in thyroid hormone production or release.

Most infants with congenital hypothyroidism appear to be clinically normal until three months of age, by which time brain development may be impaired. Delayed diagnosis or improper treatment of hypothyroidism can lead to growth failure and/or irreversible mental retardation. On the other hand, diagnosis and initiation of appropriate thyroid hormone treatment within about the first 4 weeks of life, followed by regular clinic visits with physicians experienced in the treatment of CH, can prevent mental retardation and growth failure.

Galactosemia is a rare disorder where milk sugar (galactose) cannot be processed by the body due to a deficiency of the liver enzyme required for its metabolism (breakdown).

The disease usually appears in the first days of life following the ingestion of breast milk or formula. Vomiting, liver enlargement, and jaundice are often the earliest signs of the disease, but bacterial infections (often severe), irritability, failure to gain weight, and diarrhea may also occur. If unrecognized in the newborn period, the disease may produce liver, brain, eye and kidney damage.

Symptoms include:

jaundice
vomiting
lethargy
irritability
convulsions or seizures
poor feeding
poor weight gain
white pupil

Treatment is based on elimination of galactose from the diet. This may be done in the early neonatal period by stopping breast feeding and by the administration of diets which contain no lactose or galactose. This diet should be compulsively followed, and continued for years, and possibly for life.

Hemoglobinopathy: A condition caused by a defect in the genetic code for hemoglobin synthesis. This defect affects the amount or the quality of the hemoglobin being produced. There are different types of hemoglobinopathies. Sickle cell anemia is one of the most common hemoglobinopathies. This disease causes misshaped (sickle) red blood cells which can clog small vessels disrupting the delivery of oxygen to the body tissues. This can cause such problems as pain, infection, lung complications, kidney problems, stroke, and other medical problems. In some cases, the complications can be life-threatening. Early intervention can greatly reduce complications. Ongoing treatment is important to decrease the risk of infection, minimize painful episodes, and improve the quality of life.

Cystic fibrosis (CF) affects the glands, damaging many organs including the lungs, the pancreas, the digestive tract and the reproductive system. The result is that people with CF are prone to constant chest infections and malnutrition. In the past, a baby born with Cystic Fibrosis was only likely to live for a few months, but now with the advances in research and treatment the majority survive well into adulthood. It is a chronic disease that currently has no cure. Early medical interventions may not benefit presymptomatic children and could instead harm them, because no therapy is without risk.

A suspicion of CF occurs when some of these symptoms are present:

Persistent cough, wheezing, or recurrent pneumonia
Good appetite, but poor weight gain
Loose, bad-smelling bowel movements
Chronic diarrhea
Prolonged jaundice
Rectal prolapse
A salty taste to the skin
Clubbing (enlarging) of the fingertips

Maple Syrup Urine Disease (MSUD): Signs and symptoms progress from poor feeding, irritability, and vomiting to lethargy and coma in the first weeks of life. Without rapid treatment, death or permanent neurologic damage may result.

Symptoms may include:

Distinctive Odor of Urine and Perspiration
Poor Coordination
Seizures
Coma

Long-term treatment consists of the administration of nutrition low in the branched chain amino acids. A protein-restricted diet will need to be maintained for life. Studies have shown that early diagnosis and appropriate long-term management may improve neurologic development.

Homocystinuria (HCU): If not detected, may cause dislocation of lenses, myopia (nearsigntedness), osteoporosis, blood clots and mental retardation.

Although no specific cure exists for homocystinuria, approximately half of the affected people can be helped by present therapy.

Biotinidase deficiency: leads to seizures, skin infections, poor muscle control, immune system impairment, hair loss, hearing and vision loss, mental retardation, and possibly coma and death. Usually symptoms are not noticeable at birth, but develop around three months of age. Treatment for the disorder is very simple and inexpensive. As soon as the disorder is diagnosed, infants are provided with oral biotin supplements. With biotin treatment, symptoms of the disorder disappear.

Adrenal hyperplasia: is a completely treatable medical condition. Other than having to take daily medication, the child with CAH can have a completely normal life. Untreated CAH can result in serious illness and, in some cases, death.

Signs may inclide:

low blood sugar
drowsiness
coma
salt imbalance
repeated vomiting
dehydration
extreme muscle weakness
weakness of the heart muscle
poor growth
external genitals of the female baby may take on a male appearance at birth

CAH is never "outgrown"; treatment is required for life. The treatment for CAH is by replacement with hormone medications. The amount of medication needed will be different for each child, and will need to be adjusted as the child grows.

Tyrosinemia is a genetic inborn error of metabolism associated with severe liver disease in infancy.

In the so-called acute form of the disease, abnormalities appear in the first month of life. Babies may show poor weight gain, enlarged liver and spleen, distended abdomen, swelling of the legs and increased tendency to bleeding, particularly nose bleeds. Jaundice may or may not be prominent. Despite vigorous therapy, death from hepatic failure frequently occurs between three and nine months of age. Children with this form of disease are excellent candidates for liver transplantation.

Some children have a more chronic form of tyrosinemia with a gradual onset and less severe clinical features. In these, enlargement of the liver and spleen are prominent, the abdomen is distended with fluid, weight gain may be poor, and vomiting and diarrhea occur frequently. Affected patients usually develop cirrhosis and its complications. In older patients, there is an increases risk of liver cancer. These children also require liver transplantation.

Toxoplasmosis: Signs of congenital infection may be present at birth or develop over the first few months of life. Infants may show signs of central nervous system disorders, enlargement of the liver and spleen, blindness , and mental retardation.

Measures to prevent infection include avoiding contact with cats, cooking meat thoroughly, and washing hands thoroughly after handling raw meat.

Newborn hearing screening: National Institutes of Health recommends that all babies have a hearing screen before the age of 3 months.

Most of the time, these children are not diagnosed as having this hearing loss until they are almost 3 years old. Children with unidentified hearing loss do not receive adequate sensory stimulation beginning at birth, and their language circuitry may never fully develop. The first two years of an infant's life are the most important.

Infants identified at birth, whose therapies begin immediately, who would otherwise fall far behind in language and social development, can now grow alongside their normal hearing peers.

Mandatory procedures: The hospital or birth center staff will tell you that certain procedures are mandatory. The list of these may vary from state to state, but might include newborn eye treatment, vitamin K shot, hepatitis B vaccination, and a newborn blood screen for various genetic disorders. The staff might tell you that you may not take your baby home until these things are done, and/or that you'll be reported to the government and/or persecuted for endangering your child's life if you refuse. Whether any of this true depends on where you live. There are people who will tell you that you really are obligated by law to allow these things to be done to your child, but there are also people who will say that it is the medical staff who are obligated by law to offer the procedures, but that you have the right to refuse.

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Vaccinations

In the first 2 years of your baby's life, American Academy of Pediatrics (AAP) recommends the following immunizations: hepatitis B, polio, measles, mumps, rubella (German measles), pertussis (whooping cough), diphtheria, tetanus (lockjaw), Haemophilus influenzae type b, pneumococcal infections, and chickenpox.

"We assume that the FDA would protect our children from exposure to any level of mercury through drugs. But that has not been the case. Thimerosal [..] has become the most widely used preservative in vaccines. It is present in over 50 licensed vaccines. The FDA recently acknowledged that in the first six months of life children get more mercury than is considered safe by the EPA. The truth is that sometimes kids go to their doctor's office and get four or five vaccines at the same time. My grandson received vaccines for nine different diseases in one day. He might have been exposed to 62.5 micrograms of mercury in one day through his vaccines. According to his weight, the maximum safe level of mercury that he should be exposed to in one day is 1.51 micrograms. This is 41 times the amount at which harm can be caused."
--Congressman Daniel Burton (R-Indiana)
House Committee on Government Reform's hearing on mercury and medicine on June 18, 2000 (From What about Mercury? Getting Thimerosal Out of Vaccines by Lisa Reagan, Mothering Magazine)

(From National Vaccine Information Center)

As you can see, immunization is an issue full of controversy. On one hand, by non-vaccinating your child, you may be expozing her to dangerous diseases. Also, your child may be required to receive certain vaccines before she or he can enter daycare, elementary school, high school, college, etc. On the other hand, these vaccines may endanger your child's health and even her life.

Personally, I think no vaccines should be administered to babies. They seem far too dangerous, and the childhood diseases they are meant to prevent don't pose that much risk in this day and age. If you are an intelligent and caring person taking the time to do research on the subject (and why else would you be here?), then concider not vaccinating. Of course, my views may be considered far too liberal for most people. Below are the more concervative recommendations.

Recommendations:

Tell your doctor not to use vaccines that contain thimerosal (mercury) as a preservative.
Tell your doctor not to use the oral polio vaccine.
Ask your doctor to schedule separate appointments for each vaccine.
If several vaccines usually come in one shot, like MMR (measles, mumps, rubella), you can ask your doctor to special order these vaccines as separate shots.
Ask your doctor to give your child a physical exam to make sure your child is healthy before you permit vaccination. A sick child can be at increased risk for having a vaccine reaction.
If your child has a fever, diarrhea, or other significant medical symptom at the time of an immunization appointment, you might want to postpone the immunization. For additional information, consult the CDC's Contraindications for Childhood Immunization.
Ask your doctor which post-vaccination symptoms are normal--and which warrant medical attention. Mild fever and fussiness are common consequences of vaccine-induced immune reaction. But a high fever or seizure is out of the ordinary.
Ask your doctor for the vaccine's parent information booklet and take time to read it before your child is vaccinated. You may also ask your doctor to show you the information insert provided by the drug company which manufactured the vaccine(s) your child is scheduled to receive.
Let your doctor know if your child had a bad reaction to a vaccination before, or has a personal or family history of vaccine reactions, convulsions or neurological disorders, severe allergies, or immune system disorders.
Get the vaccine manufacturer's name and lot number from you doctor. Ask for a copy of the doctor's record on vaccinations given to your child to keep for your records.
Monitor your child closely after vaccination. Call your doctor if you suspect a reaction. If your doctor is not concerned and you are, take your child to an emergency room.

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Childhood illnesses
(a more complete list can be found at kidshealth.org)

Note: Aspirin and other salicylate drugs should never be used in the treatment of chicken pox, influenza and other viral diseases. Aspirin is not recommended in any illness contracted by children younger than age 12.

Many conditions get better on their own and can be treated successfully at home. Here are some signs that you might want medical help:

Baby has trouble breathing
Convulsion (seizure)
Severe drowsiness
Difficulty waking up
Loss of consciousness
Prolonged coughing spells
Repeated vomiting
Diarrhea
Baby refuses fluids for more than 24 hours
Fever over 101°F
Baby seems more unwell with time

Note: Vomiting and diarrhea can cause dehydration in babies. The main "treatment" is making sure your baby stays hydrated. If you are breastfeeding, you don't need to stop, but you may want to offer additional fluids after the feedings.

High fever is our bodies' way of fighting infection. But how much of a good thing is too much? This is where the experts disagree and you will have to make your own decision. To bring down fever, give the baby a 30-minute warm bath.

Chickenpox (Varicella): Chicken pox blisters usually appear first on the trunk and face, then spread to almost everywhere else on the body, including the scalp and penis, and inside the mouth, nose, ears, and vagina. Chicken pox blisters are about 1/5 inch to 2/5 inch (5mm to 10mm) wide, have a reddish base, and appear in crops over a 2- to 4-day period. Some persons have only a few blisters, although others have several hundred. As blisters itch and break, scabs form and the blisters may become infected by bacteria (a "secondary" bacterial infection).

Some children have a fever, abdominal pain, or a vague sick feeling along with their skin blisters. These symptoms usually last for about three to five days, and fever stays in the range of 101 degrees Fahrenheit to 103 degrees Fahrenheit (38.3 degrees Celsius to 39.4 degrees Celsius).

Antibiotics are not prescribed to treat a chicken pox infection because it is caused by a virus. Antibiotics may be used if the child develops a secondary infection caused by bacteria.

Geman Measles (Rubella): It may begin with 1 or 2 days of mild fever (99 degrees F to 100 degrees F) and swollen glands that are usually found either in the neck or behind the ears. On the second or third day, a rash appears that begins at the hairline and spreads downward on the rest of the body. As the rash spreads downward on the body, it usually clears on the face. The rubella rash appears as either pink or light red spots, about 0.1 inches (2 to 3 mm) in diameter, which may merge to form evenly colored patches. The rash doesn't itch, and lasts up to 5 days (the average is 3 days). As the rash passes, the affected skin may be shed in flakes.

Other symptoms of rubella may include: mild conjunctivitis (inflammation of the lining of the eyelids and eyeballs); stuffy or runny nose; swollen lymph glands in other regions of the body; Persons with rubella are contagious from 1 week before the rash appears until 1 week after it fades. Rubella cannot be treated with antibiotics, since antibiotics do not work against viral infections.

Measles: is best known for its typical skin rash. It is, however, primarily a respiratory infection. The first symptoms are irritability, runny nose, eyes that are red and sensitive to light, hacking cough, and a fever as high as 105 degrees Fahrenheit (40.6 degrees Celsius).

Fever peaks with the appearance of the rash, which typically begins on the forehead, then spreads downward over the face, neck, and body. The child is particularly ill-looking during the first days of the rash. It usually takes about 3 days for the rash to make its way down to the feet. Once the rash appears on the legs and feet, symptoms usually subside within 2 days. There is no cure.

The rash itself looks like large flat red to brown blotches that often flow into one another to completely cover the skin, especially on the face and shoulders. The rash fades in the same order that it appeared, forehead first and feet last. The total time for the rash, from beginning to end, head to toe, is usually about 6 days. As the rash disappears, the healing skin may look brown temporarily, before it sheds in a finely textured peel.

One special identifying sign of measles is Koplik's spots. These are small, red, irregularly-shaped spots with blue-white centers found inside the mouth. Koplik's spots usually appear 1 to 2 days before the measles rash and may be noticed by a doctor looking for the cause of a child's fever and cough.

Infants are generally protected from measles for 6 to 8 months after birth, due to immunity that was passed on from their mothers. Children with measles should not read or watch television while their eyes are sensitive to light. They should rest and avoid busy activities.

After symptoms have begun, gamma globulin is not effective against measles, and antibiotics do not work against the measles virus.

Mumps: the parotid glands become increasingly swollen and painful over a period of one to three days. Pain gets worse when the child swallows, talks, chews, or drinks juices that are acidic (like orange juice). As the glands swell, there is often a fever of up to 103 degrees Fahrenheit (39.4 degrees Celsius), with headache and loss of appetite.

In some cases, signs and symptoms of mumps are so mild that no one suspects a mumps infection. Doctors believe that about one in four persons may have a mumps infection without symptoms. Because mumps is caused by a virus, it cannot be treated with antibiotics. Although an antimumps globulin is available, it does not always stop mumps infection.

Persons who have not been immunized, and who get the mumps infection, are usually protected against having mumps for the rest of their lives.

Diphtheria, in early stages, can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms. The toxin, or poison, caused by the bacteria can lead to a thick coating in the nose, throat, or airway. This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing.

Children and adults with diphtheria are treated in a hospital. After a doctor confirms the diagnosis through throat culture and blood counts, the infected person receives a special anti-toxin to neutralize the diphtheria toxin already circulating in the body, as well as antibiotics to kill the remaining diphtheria bacteria. Contracting this disease does not guarantee lifetime immunity.

Pertussis (Whooping Cough): The first symptoms of whooping cough are similar to those of a "common cold," with a runny nose, dry cough and mild fever. After about 1 to 2 weeks, coughing begins to occur in spells that may last for over a minute. Between coughing spells, the child may gasp for air with a characteristic "whooping" sound - although infants may not "whoop" as do older children. Severe coughing spells can cause a child to turn blue in the face or vomit. Infants may actually stop breathing for a few seconds. Although the severe spells usually improve in about a week, coughing can continue for several weeks.

Whooping cough is a highly contagious bacterial infection. Whooping cough bacteria spread from person to person through the air - as when a susceptible person inhales airborne droplets from an infected person's sneeze or cough.

Whooping cough is treated with antibiotics, usually for 2 weeks. Antibiotics are mostly important in stopping the spread of whooping cough infection. Cough medicines often do not relieve whooping cough coughing spells.

Tetanus: is the result of an infection that affects the muscles and nerves. It is usually due to a contaminated wound. Tetanus often begins with muscle spasms in the jaw (also called trismus or lockjaw), together with difficulty in swallowing, and stiffness or pain in muscles of the neck, shoulder, or back. Spasms soon spread to muscles of the abdomen, upper arms, and thighs.

Tetanus patients are treated in a hospital, usually in an intensive care unit. They receive antibiotics to kill tetanus bacteria and antitoxin to neutralize the toxin. They also receive medicines to control muscle spasms and medicines to stop the abnormal nerve activity that would otherwise cause disturbances in heartbeat, blood pressure, and body temperature.

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Chosing your pediatrician

It is very important that you find a pediatrician who you feel completely comfortable with. As a new parent you should be able to ask them anything, no matter how trivial in may seem.

A good pediatrician has more than just the core competencies of disease treatment, which are reactive measures. Your pediatrician should also be knowledgeable in proactive qualities such as disease prevention, and child development. Your pediatrician should also be warm, compassionate, and open minded to your thoughts and feelings, and shares similar views.

Before you interview a pediatrician you can check with the Federation Of State Medical Boards (FSMB) to see if there have been any serious disciplinary actions, or professional peer reviews against the pediatrician. The FSMB Website has links to your state, or you can call them at
1-817-868-4000 to get the number for your state board.

Question to ask before you chose:

Is there a separate waiting area for "sick" and "well" kids?
Are the doctor and office staff friendly and accommodating?
What type of continuing education does this doctor use?
Does the doctor do home visits?
Does this doctor use rectal thermometers?
What technique will this doctor use to draw blood from your infant?
Does this doctor agree with your preferred vaccination practices?
Is this doctor willing to work with you or can his attitude be summed up with "do what I say or find someone else"?
How does this doctor feel about breastfeeding?
How many of his patients had to be weaned before they were 6 months?
How does the pediatrician feel about mothers calling in after hours over "little things"?
Is there a specific time during the day that the doctor will take phone calls?
Are there any weekend, early morning or late evening office hours for working parents?
How long in advance must you book appointments?
What kind of relationship does this doctor's office have with labs in the area? How long will your usual waight be for various test results?
Is the doctor available in after hours? Over the weekend?
How does the office deal with after hours emergencies?
Is there a 24 hour answering services that can connect you to a doctor?
Who covers for the doctor when they are on vacation?

You may wish to seek an alternative pediatrician if:

Pediatrician comes in, brusquely looks your kid over, quietly makes some notes and walks out without really talking to you
The office staff is unhelpful, cold and unfriendly
Pediatrician over treats your child for simple ailments, running a battery of tests that rack up your bills
Pediatrician gets upset when you seek a second opinion
Pediatrician makes you feel uncomfortable or stupid when you ask for additional details
Office staff makes you feel uncomfortable when you call with concerns or emergencies
You or your child feel uncomfortable with the pediatrician's bedside manner
Pediatrician seems unwilling to listen to your concerns

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Baby massage

Massage has been found to help bonding and interaction between baby and parent. It stimulates and helps develop the baby's circulation, digestion and immune systems and may also relieve colic and constipation.

Be sure that your fingernails are short and smooth.
Be sure that the room temperature is warm (78 degrees Fahrenheit). Undress the baby completely, if the weather is cold or humid cover the areas of the baby's body that are not being massaged.
A good time for a massage is after a bath and before or 30 min. after feeding. If your baby cries or falls asleep then leave them and massage later.
Avoid distractions such as bright light and loud noise.
Put the baby on a soft surface. You may want to use old towels underneath your child, because it may be difficult to get the oil out of your linens.
Use vegetable oil in case your baby later sucks on her fingers.
Rub your hands together to make the oil warm.
If the baby wants to change position let them do so. Do not force your baby to keep a position, you can go back to these areas later on.
With soft and gentle touches work on the head, face, shoulders, arms, chest, stomach and legs.

Back:
Begin with large and slow movements that include head, neck, back and legs, always in one direction. Give soft strokes on shoulders and back, massaging with your fingertips with circular movements. Do not massage the spinal cord, only put your hands over it and let the baby feel the warm sensation. Make small circular movements on your baby's back. Put your hands at the top of the legs and begin gently massageing while working your way down towards the foot.

Bottom of foot:
Holding the foot in both of your hands, firmly stroke the bottom of the foot with your thumbs, one after the other.
Toes: Squeeze each toe with your fingertips.
Stretch: Pull back at the balls of the foot, gently stretching the top of the foot. Pressure points: Press in with the thumb all over the bottom of the foot. This stimulates nerve endings that connect with other areas of the body. Reflexologists say that foot massages help to correct imbalances that block the flow of energy through the body. If you find an area that is very sensitive to your baby, massage these very gently. You are not wanting to cause pain. If your baby has been hospitalized and had a lot of heel sticks to draw blood, massage the heel firmly. This will break up any left-over scar tissue. This will help to release any fear of having his heels touched.

Top of foot:
Stroke the top of the foot, toes to ankle.
Circles: With your thumb and forefinger make circles around the ankle.
Rolling: Roll the leg between your hands from knee to ankle with a warming, soothing friction between the skin.

Legs:
Massage each leg with your whole hand, press gently on the thighs. Slightly flex the legs and knees pressing the thighs gently against the body.

Stomach:
Massage the stomach, moving your hands clockwise beginning below the ribs.

Shoulders and arms:
Form a ring with your fingers and thumb around your child's arm. Begin to massage around the armpit and then go down along the arm. Be very careful when you arrive at the elbow, it is a very sensitive region. In the wrist you use gentle turning motions.

Jaws:
Gently touch the frontal part of the neck. Make small strokes and massage the posterior part of the neck with slow movements down to the shoulders. Softly put both hands on baby's shoulders. Gently massage from the neck to the shoulders in the direction of the chest.

The head:
Touch the forehead, temples and the base of the cranium Eyebrows and eyelids, Nose, Cheeks, The area around the mouth, Ears and surrounding area

The eyes:
Massage the inner corner of the eye. Place your finger on the side of your baby’s nose, just above the eye. With firm pressure, run your finger down the entire length of the nose. It is very important that the pressure you apply is to the bony part of the nose, not the eye. Repeat for 10-15 strokes.

If your baby's tear ducts are blocked, try to do eye massage with each feeding or diaper change. You might also try putting a few drops of breastmilk in the eye at every feeding. About 90 percent of obstructed tear ducts will correct within the first year of life.

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Parenting

Once your baby is born you really understand that you are completely responsible for the well-being of another person. The baby is so small, so helpless. It may be love at first sight or you may fall for your baby gradually, over time. Do not let yourself fall into the "baby or me" trap. The baby has no maliciousness, it only gives you the signals it's supposed to give, and expects you to respond.

Your baby is born already used to your constant company. It exects to continue being close to you, hearing the sounds of your voice, your breathing and heartbeat, and feeling the warmth of your body. To the baby, who depends on you for everything, your absence means death. Don't blame her for her natural fear of being without you - keep her with you at all times, and enjoy this immediate need for your presence. Soon enough your baby will be running and playing with other children, and you'll be left missing having her sleeping in your lap.

Co-sleeping or family bed: having your baby/child sleep in your room (in your bed or in the crib next to your bed). This goes with the theory about how babies need to hear others breathe in order to learn to breathe properly themselves - as well as the fact that babies get more attention (and therefore cry less) at night, if they are right next to those taking care of them.

Another idea behind this is that some children don't take well to the night time separation from their parents, and that forcing that separation will teach the child "that their need for warmth and reassurance is a character flaw [..] that fear and loneliness are the expected currency of existence [..] that important figures in one's emotional world cannot be trusted to understand and respond with a caring attitude."
David Servan-Schreiber, M.D., Ph.D

Ferberizing: Dr. Richard Ferber's technique for teaching infants 5 months or older to sleep through the night on their own (described in his book, Solve Your Child's Sleep Problems). Despite the technique's success, many parents and health-care professionals are uncomfortable with allowing a baby to cry for a substantial amount of time. They say that Ferberizing doesn’t teach babies to put themselves to sleep by comforting themselves; it teaches them that their parents have abandoned them. Some even worry about the possible long-term psychological impact.

Attachment parenting: A style of parenting that includes trying to be in tune with the baby's emotions; keeping separation between baby and parent(s) down to a minimum; breastfeeding; co-sleeping; "wearing" the baby (in a sling or in your arms); assuming that the baby's wants are the baby's needs and not ignoring the crying baby just because you think you have met all of her basic needs.

Attachment is an emotional connection that is born when you are in constant physical contact with your baby. When you see a mother weeling her infant through the mall in a stroller, or talking to the cashier at the supermarket while the baby cries in the shopping cart infant seat, you know this mother is not Attached to her baby.

The Continuum Concept is the idea that in order to achieve optimal physical, mental and emotional development, human beings — especially babies — require the kind of experience to which our species adapted during the long process of our evolution (based on the book The Continuum Concept by Jean Liedloff). For an infant, these include such experiences as...

constant physical contact with his mother (or another familiar caregiver as needed) from birth;
sleeping in his parents' bed, in constant physical contact, until he leaves of his own volition (often about two years);
breastfeeding "on cue" — nursing in response to his own body's signals;
being constantly carried in arms or otherwise in contact with someone, usually his mother, and allowed to observe (or nurse, or sleep) while the person carrying him goes about his or her business — until the infant begins creeping, then crawling on his own impulse, usually at six to eight months;
having caregivers immediately respond to his signals (squirming, crying, etc.), without judgment, displeasure, or invalidation of his needs, yet showing no undue concern nor making him the constant center of attention;
sensing (and fulfilling) his elders' expectations that he is innately social and cooperative and has strong self-preservation instincts, and that he is welcome and worthy.

Unschooling: the idea that institutionalized education "fills the mind with artificial associations that must be got rid of, before the child can develop independent ideas out of actual experience." (Anne Sullivan)
The children spend less time sitting in a room and being told about the world - and more time going places and experiencing the world for themselves, and drawing their own conclusions.

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Books


*The Baby Book* by William Sears, M.D.	How to Raise a Healthy Child... by Robert S. Mendelsohn, M.D.	The Womanly Art of Breastfeeding by Gwen Gotsch, Judy Torgus	The Aware Baby by Aletha J. Solter, Ph.D.	Naturally Healthy Babies & Children: A Commonsense Guide to Herbal Remedies by Aviva Jill Romm	Medications and Mothers’ Milk 2000 by Thomas W. Hale, Ph.D