Drs. Julie Capiola and Jon Sarnoff of Premier Pediatrics answer eight essential questions you will want answered before discharge!

It can be a daunting feeling to leave the hospital with a newborn. The doctors at Premier  Pediatrics understand this and have put together answers to the eight most common questions we receive from parents at discharge. If you have any additional questions after you finish reading, please feel free to reach out to info@premierpediatricsny.com, and we would be happy to help you out. Congratulations and we are confident that you are going to do great!

When do I need to follow-up with my pediatrician?

You should follow-up with your pediatrician two to three days after your hospital discharge. Under the following circumstances, the hospital pediatrician will likely ask you to see your pediatrician sooner:

  • significant weight loss (typically greater than 10%)
  • difficulty feeding
  • a concerning level of jaundice
  • your little one was in the Neonatal Intensive Care Unit

No matter what, communicate with us once you know when you are leaving the hospital, and we will ALWAYS make sure your first visit is scheduled at the right time for your baby.

What are the reasons I need to call my pediatrician before the first visit?

  • If your baby has a fever of 100.4℉ or 38℃ taken rectally. We only suggest taking your baby’s temperature if you have a reason. This could be that your baby seems hot after removing a wrap/swaddle or your baby seems inconsolable or lethargic.
  • If your baby is inconsolable or lethargic even without a fever. People often ask what defines inconsolable and lethargic. We define inconsolability as the inability to calm your baby after you have tried everything twice (diaper change, feed, etc). We define lethargy as the inability to arouse and suck/eat normally.
  • If your baby vomits up a green color (think pea soup), if your baby has a yellow color to the skin that extends below the diaper line, or if your baby has blue color to the lips.
  • If your baby is not making urine at least three times in a 24 hour period, or no stool for 24 hours.
  • Certainly if something concerns you and you are not sure, reach out to us!

How often should I feed my baby?

You might get conflicting advice on this, but we strongly believe that you should feed your baby when there are signs of hunger. This is consistent with the national guidelines established by the American Academy of Pediatrics (AAP). This can happen as early as 1 hour from the start of the prior feed or as late as 3 hours from the prior feed. Early hunger cues include being quiet and alert. Babies usually then get more active by starting to lip smack and suck on fingers. A later hunger cue is crying. We recommend trying to read and respond to your baby’s cues, rather than following a strict schedule. In each 24 hour period, you will feed between 8 and 12 times during these early days. We suggest that you visit Lactation Essentials for more information on early breastfeeding.

When should I bathe my baby?

Babies don’t need to be bathed often. Generally, twice weekly bathing is more than adequate. Prior to umbilical cord separation, we recommend only sponge baths. This is also the case if your little one was just circumcised, until the penis has healed (about 1 week). After this, you can bathe your baby partially immersed in the bath water. We recommend just water for the face and then you can use a nice gentle soap for the rest.

Where should my baby sleep?

The AAP has a very helpful set of guidance for safe sleep for babies1. The baby should sleep on a firm, flat, non-inclined surface. Generally a good rule of thumb is that if the words sleep, crib, or bassinet are not used in the product description, then it should not be used for sleep. Sitting devices, such as car seats, strollers, swings, loungers, infant carriers, and infant slings, are not recommended for routine sleep, particularly for infants younger than 4 months. The AAP also recommends that parents sleep in the same room – but not in the same bed as a baby, preferably for at least the first six months.

How warm should the room be?

The recommended temperature range for where the baby sleeps is about 68℉ to 72℉. There is data that a room which is too warm increases the risk of SIDS. To complicate matters, it can be very difficult to tightly control the temperature in a room, particularly in NYC! Generally if you feel comfortable, then your baby will as well. In addition, there is data that running a fan in the room with your baby further reduces the SIDS risk. It also will act as safe but effective white noise for your baby, which is wonderful, particularly in the early months of your baby’s life.

Can I go out and can folks visit?

It is wonderful to head outside and take a walk with your baby. Other than at the extremes of temperature, when no one should be outside for prolonged periods of time, it is safe and even beneficial for all of you to spend time outdoors. We often recommend a daily twenty minute walk as long as the delivering parent is also physically up for it!

Discussing when family and friends can visit is a little more of a personal decision. Babies under two months of age are vulnerable to serious infections. If your baby has a fever in these first two months, s/he needs to be evaluated in the hospital, and may require some invasive testing like bloodwork, urinary catheterization, and sometimes more. They often need to be admitted for IV antibiotics and monitoring as well. While it is certainly important for grandparents and other very close family members to meet your baby, we want this to be as safe as possible. We encourage you to remind visitors that if they are even a little under the weather (a scratchy throat, etc), then they should stay home. During flu season, risk can be reduced if visitors are vaccinated against influenza. Regular caregivers should be up to date on their Tdap vaccine, which helps protect from whooping cough, a potentially very serious or even deadly infection for a young infant. Never hesitate to talk with us about other strategies or advice if you have unique circumstances and need guidance. We are always here for you!

What about vitamin D? and tummy time?

All babies who are breastfed need to be supplemented with 400 IU of vitamin D3 daily. Babies will not be able to make their own vitamin D3 through sun exposure, and they would be at risk for vitamin d deficiency as a result and it is critical for healthy bone development. Only babies who are EXCLUSIVELY formula fed will receive their daily requirement of vitamin D3 through the formula. Feel free to ask us for some advice about options for vitamin D3 supplementation!

Supervised, awake tummy time is recommended to facilitate infant development and to minimize development of positional plagiocephaly. Parents are encouraged to place the infant in tummy time while awake and supervised for short periods of time beginning soon after hospital discharge, increasing incrementally to at least 15 to 30 minutes total daily by 7 weeks of age 1.

If You’ve Just Given Birth

Use the support in the hospital to help your body recover from the delivery or the c section. When you leave the hospital, remember that you are still recovering. Let your partner or another caregiver help with the baby and then try to get the rest you need. In the long run, it will make you a better caregiver as well.

Note to All New Parents

Always be on the lookout for signs of anxiety and/or depression during your pregnancy and the early days of parenthood. If you feel like you would like to find support, there are wonderful free resources and a help line at www.postpartum.net.